ENFERMEDADES INFECCIOSAS EN PACIENTES CON LUPUS ERITEMATOSO SISTÉMICO EN EL HOSPITAL CALDERÓN GUARDIA: CARACTERIZACIÓN, INCIDENCIA, PROFILAXIS Y FACTORES ASOCIADOS.

Abstract

Background Infectious diseases are very im-portant in Systemic Lupus Erythematous (SLE)because they represent the first cause of morbidi-ty and mortality in this group. Scientific evidenceis scarce, but suggests that endogenous bacterialflora is the first cause of infection. Also, opportunistic infections due to effective immunosuppresant therapy and local microbiologic variationmust be considered. The purpose of this study isto determine etiology, site of infection, mortalityand factors related to infections in SLE patientsattended in Hospital Calderón Guardia, CostaRica. Methods An observational and retrospectivestudy based on 242 medical files of SLE patientsfrom Hospital Calderón Guardia, between October 1997 and October 2007, was made. Caseswere divided into two groups: patients withoutprevious SLErelated infectious and with previous SLE-related infections who needed medicalattention. Results Sixty percent of patients had at leastone infection. Over 60% of infected patientsreported hospital stays longer than 12 days, compared with 35% of SLE non-infected patients.Fortyone percent of patients were diagnosed with SLE between ages 20 and 29. Only 1.7%had used prophylactic antibiotics. Most of infected SLE-patients used prednisone in doses over7.5mg per day and 50% of non-infected patientsused hydroxicloroquine compared with 34% ofinfected patients. Most common organisms iso-lated were Candida spp, Escherichia coli,Staphylococcus aureus, Toxoplasma gondii and human papilloma virus. In 52.4% of infectedpatients, there was no identified agent. Mostcommon site of infection was skin and mucousmembranes, followed by urinary tract and lung.Among clinical variables, only fever had a positive correlation with infections; and of laboratoryparameters, only acute phase reactants. Discussion A high incidence of infections wasfound. The time of first infection was, in average, seven years after diagnosis was made. In allgroups with comorbidities, infection rate washigher, particularly in patients with renal transplant. Predisone doses higher than 7.5mg per daywas associated with infectious events. It is suggested that hydrochloroquine use has a protectiveeffect on infection development, probably because of its immunomodulatory and antibioticproperties. Etiologic agents correlated withinfections reported on literature, but a high incidence of toxoplasmosis and HPV infection asnoted. A nymphal pentastomiasis case was reported.