Invasive fungal infection in systemic lupus erythematosus: an analysis of 15 cases and a literature review

Background:Infectious disease is one of the leading causes of mortality in systemic lupus erythematosus (SLE). Among these infections, invasive fungal infection (IFI) carries high mortality rate (25-70%), but the literature of IFI in SLE is limited.Objectives:To investigate the epidemiology and risk factors of invasive fungal infection and its subtypes, including candidiasis, aspergillosis, and cryptococcosis, in SLE patients.Methods:All patients with newly diagnosed SLE between 1997-2012 were enrolled from Taiwan National Health Insurance Research Database, with an age- and sex-matched non-SLE control group in a ratio of 1:10. IFI was identified by ICD9 codes1from discharge record and validated by use of systemic anti-fungal agents. The incidence rate (IR), incidence rate ratio (IRR), cause mortality rate of IFI and its subtypes were compared. A Cox multivariate model with time-dependent covariates was applied to analyse the independent risk factors of IFI.Results:A total of 269 951 subjects (24 541 SLE and 245 410 control) were included. There were 445 episodes of IFI in SLE group. Candida was the most common pathogen (52.8%), followed by cryptococcus and aspergillus. The IR of IFI in SLE was 20.83 per 10,000 person-years with an IRR of 11.1 (95% CI 9.8-12.6) compared to the control (figure 1). Kaplan-Meier curve also disclosed a lower IFI-free survival in SLE (figure 2). The all-cause mortality rate was similar between SLE and the control (26.7 vs 25.7%). In SLE, treatment with mycophenolate mofetil (HR=2.24, 95% CI 1.48-3.37), cyclosporin (HR=1.65, 95% CI 1.10-1.75), cyclophosphamide (HR=1.37, 95% CI 1.07-1.75), oral daily dose of steroid>5 mg prednisolone (HR=1.26, 95% CI 1.01-1.58), and intravenous steroid therapy (HR=29.11, 95% CI 23.30-36.37) were identified as independent risk factors of IFI. Similar analyses were performed for subtypes of IFI. Distinctive risk factors were found between different subtypes of IFI (table 1).Conclusion:SLE patients have a higher risk of IFI. Intravenous steroid therapy is the most important risk factor of IFI. This study provides crucial information for risk stratification of IFI in SLE.References:[1] Winthrop KL, Novosad SA, Baddley JW, et al. Opportunistic infections and biologic therapies in immune-mediated inflammatory diseases: consensus recommendations for infection reporting during clinical trials and postmarketing surveillance. Ann Rheum Dis. 2015 Dec; 74(12):2107-2116.Disclosure of Interests:None declared

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Invasive fungal infection in patients with systemic lupus erythematosus: Experience from a single institute of Northern China

Gene ◽

10.1016/j.gene.2012.06.059 ◽

2012 ◽

Vol 506 (1) ◽

pp. 184-187 ◽

Cited By ~ 9

Author(s):

Yu-Chen Fan ◽

Wen-Gang Li ◽

Ming-Hua Zheng ◽

Wei Gao ◽

Yuan-Yuan Zhang ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Fungal Infection ◽

Invasive Fungal Infection ◽

Lupus Erythematosus ◽

Northern China ◽

Systemic Lupus

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Invasive fungal infection in Chinese patients with systemic lupus erythematosus

Clinical Rheumatology ◽

10.1007/s10067-012-1980-x ◽

2012 ◽

Vol 31 (7) ◽

pp. 1087-1091 ◽

Cited By ~ 17

Author(s):

Guang-liang Chen ◽

Yi Chen ◽

Chang-qing Zhu ◽

Cheng-de Yang ◽

Shuang Ye

Keyword(s):

Systemic Lupus Erythematosus ◽

Fungal Infection ◽

Invasive Fungal Infection ◽

Lupus Erythematosus ◽

Chinese Patients ◽

Systemic Lupus

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Invasive fungal infections in Colombian patients with systemic lupus erythematosus

Lupus ◽

10.1177/0961203318763743 ◽

2018 ◽

Vol 27 (7) ◽

pp. 1116-1122 ◽

Cited By ~ 15

Author(s):

Y Santamaría-Alza ◽

J Sánchez-Bautista ◽

J F Fajardo-Rivero ◽

C L Figueroa

Keyword(s):

Systemic Lupus Erythematosus ◽

Fungal Infection ◽

Disease Activity ◽

Invasive Fungal Infection ◽

Lupus Erythematosus ◽

Fungal Infections ◽

Invasive Fungal Infections ◽

Bivariate Analysis ◽

Systemic Lupus ◽

Pericardial Disease

Introduction Systemic lupus erythematosus is an autoimmune disease with multi-organ involvement. Complications, such as invasive fungal infections usually occur in patients with a greater severity of the disease. Objective The objective of this study was to determine the prevalence and risk variables associated with invasive fungal infections in a Colombian systemic lupus erythematosus population. Materials and methods A cross-sectional, retrospective study that evaluated patients with systemic lupus erythematosus for six years. The primary outcome was invasive fungal infection. Descriptive, group comparison and bivariate analysis was performed using Stata 12.0 software. Results Two hundred patients were included in this study; 84.5% of the patients were women and the median age was 36 years; 68% of the subjects had haematological complications; 53.3% had nephropathy; 45% had pneumopathy and 28% had pericardial impairment; 7.5% of patients had invasive fungal infections and the most frequently isolated fungus was Candida albicans. Pericardial disease, cyclophosphamide use, high disease activity, elevated ESR, C3 hypocomplementemia, anaemia and lymphopenia had a significant association with invasive fungal infection ( P < 0.05). Conclusions We describe for the first time the prevalence of invasive fungal infection in a Colombian population with systemic lupus erythematosus, which was higher than that reported in other latitudes. In this population the increase in disease activity, the presence of pericardial impairment and laboratory alterations (anaemia, lymphopenia, increased ESR and C3 hypocomplementemia) are associated with a greater possibility of invasive fungal infections. Regarding the use of drugs, unlike other studies, in the Colombian population an association was found only with the previous administration of cyclophosphamide. In addition, patients with invasive fungal infections and systemic lupus erythematosus had a higher prevalence of mortality and hospital readmission compared with patients with systemic lupus erythematosus without invasive fungal infection.

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