Background In the last decades long time survival of patients with systemic diseases of connective tissue improved dramatically, not only due to new therapeutic methods but also thanks to prompt diagnostics of infections and their effective treatment.
In spite of this, infection complications constitute a considerable determinant of mortality in patients with systemic lupus erythematosus (SLE). In these patients, morbidity by bacterial, viral and fungal diseases is higher compared to patients suffering from other rheumatic diseases. There are many reasons why it is so, the most important include variability of infection agents virulence factors, immunopathogenic features of diseases (dysbalance of T-lymphocytes populations, cytokine dysbalance), activity of disease, factors related to it and also the therapy (corticosteroids and immunosuppressants).
Objectives Authors present detailed results of longitudinal retrospective analysis of morbidity and mortality caused by infections summarised from studies published up to now in the world literature as well as clinical analysis of infectious complications in a group of SLE patients treated in Research Institute of Rheumatic Diseases.
Methods A group of 135 patients with SLE diagnosed according ARA criteria was studied for infections induced by community acquired pathogens and opportune microorganisms. Clinical and laboratory predictors of infection development in these patients were assessed as well.
Results Actual morbidity for infection was 36,3% and mortality in connexion to the infection was 1,5%. From the community acquired pathogens the most frequent were infections caused by enterobacteria and Staphylococcus aureus. Fungal infections caused by Candida spp. were predominant in the group of opportune infections. Regarding anatomical site of infection the most frequent were infections of lower respiratory tract and urogenital system. Significant correlation between past infection, activity of the disease (evaluated by ECLAM and SLEDAI indices), proteinuria, leucopenia and high corticoids dosage were revealed. In multiple regression model only activity of the disease as a risk factor for development of infection in patients with SLE was designated.
Conclusion For effective control and prevention of infectious complications in systemic diseases of connective tissues, changing pathogenicity time trends and resistance to anti-infectious therapy (antibiotics, antifungal and antiviral agents) have to be considered.
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