Background Non-typhoid salmonellosis is a frequent infection complication in SLE. The extraintestinal manifestations and sepsis are more frequent in SLE than simple gastroenteritis. SLE was identified to be an important risk factor of salmonella generalisation together with glucocorticosteroids treatment or liver cirrhosis.
Objectives The objective of the study was to study the SLE patients with the history of non-typhoid salmonellosis and to determine the population in the highest risk.
Methods A retrospective study of the medical database of the Institute of Rheumatology over the years 1995-2015 was performed. All SLE patients who undergone non-typhoid salmonellosis were identified. The patients who did not fulfill the classification criteria of SLE or had non-typhoid salmonellosis in the past were not included into the study. In the patient, the demographic and clinical data were collated and the activity using SLEDAI and damage (SLICC) were evaluated.
Results We have identified 20 SLE patients, 3 males and 17 females in which the non-typhoid salmonellosis was confirmed. Mean age of the group was 35,9±12,2 years, mean duration of the disease 5,4±7,1years. Only 6 patients experienced gastroenteritis, 3 patients had urinary infection, 2 had septic gonitis, 6 had sepsis, 2 had infected skin defects and 1 had absces of a lower limb. The detailed clinical and laboratory data were available in 18 patients, in which the activity and damage were evaluated. The activity of the group was high (SLEDAI 10,9±6,6), but the SLICC was only 1,1±1,0. We have identified two different types of SLE patients. First was a group of patients with severe SLE disease (lupus nephritis, vasculitis), high activity and usually treated with high doses of glucocorticosteroids. In the other subgroup of patients (n=5) the salmonellosis induced the symptoms SLE which was later diagnosed, or in one case of patient with RA induced an overlap of RA and SLE.
Conclusions The non-typhoid salmonellosis is a relativelly common agent of infective complications of SLE. It may result from an immunodeficiency due to SLE or treatment with immunosupressive drugs including GC, but on the other hand, the salmonellosis may be also a triggering moment of induction or flare of lupus. Every patient with salmonella infection should be treated very carefully.
Acknowledgements This work was supported by the project (Ministry of Health, Czech Republic) for consensual development of research organization 023728.
Disclosure of Interest None declared