Infection and its Impact on Neuropsychiatric Manifestation in Patients with Systemic Lupus Erythematosus

Background: Systemic Lupus Erythematosus (SLE) is a multi-system autoimmune disease. Infections can act as environmental triggers inducing or promoting SLE. Aim of the Work: To investigate the prevalence of bacterial, viral and fungal agents in a cohort of NPSLE patients and to determine the relationship between type of infection and clinical manifestations and disease activity. Patients and Methods: Medical records of 116 Egyptian NPSLE patients were reviewed retrospectively for the clinical manifestation, laboratory features and SLE Disease Activity Index (SLEDAI). Results: Infection was found in 79 (68.1%) patients, with bacterial infection being the commonest in in 65 patients (82.2%) followed by fungal infection in 19 (24%) and viral infection in 14 (12%) patients. Combined infection with more than one causative organism was found in 22 patients (27.2%) while single pathogen infection was found in 57 patients (72.1%). The commonest site of infection was the skin (37%) followed by the urinary tract (31%) and chest (19%). SLE patients with infection there was a significant increase in the frequency of neuropsychiatric manifestations than those without infection (p 0.001). The SLEDAI was significantly higher (26.02±8.23) in those with infection compared to without (15.57±6.43) (p 0.001). Conclusion: Bacterial infection is the most common infectious organism in SLE patients and high disease activity is an important predictor for infection. There is no relationship between type of infectious organism and NPSLE clinical manifestations.