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Helpful Tips for those Living with Lupus

Lupus and Infections: Flare or Infection?

The threat of infection for people with lupus is very real and very dangerous. Lupus patients have abnormalities in their immune systems that predispose them to develop infections. It is harder to fight infections partly because the drugs that are normally prescribed, Cytotoxic (Imuran, Cytoxan) and corticosteroids (Prednisone) suppress both normal and abnormal immune functions. Interestingly enough, research shows that lupus patients are still susceptible to infections whether or not they are on these medications just by the sheer nature of the disease. Lupus reduces the ability to ward off and fight infections because cellular mechanisms are responsible for defective microbial killing.

Sometimes infections can cause auto-antibodies to be produced and this may be a causes of Lupus. When the immune system goes wrong, antibodies can be formed that bind to parts of the body (an auto-antibody). The antibodies circulate in the blood, but sometimes cell walls let these antibodies in. These can then attack the DNA in the cell’s nucleus. That’s why some organs are attacked during a flare while others aren’t.

To further complicate things, lupus flares and infections mimic each other. Both conditions show signs of fever, chills, pain, lack of energy and motivation. The only way to know for sure is to get a blood test that will measure your white blood count. Some physicians find a C-reactive protein (CRP) blood test to be helpful in differentiating active lupus from infection, but this is controversial.

The treatment of infections in lupus patients is basically the same as for other patients. Even those taking high doses of immunosuppressive medications for their lupus may respond well to antibiotics. The use of sulfa and penicillin drugs in the treatment of infections should be avoided whenever possible, because they can increase photosensitivity and they may aggravate the condition. Bacterial infections have a tendency to adapt genetically and resist antibiotics over time. You should urge your doctor to use caution when using antibiotics for fear of the drugs becoming less effective. Some bacteria build a tolerance to antibiotics, making it difficult to treat diseases such as meningitis and lyme disease. To prevent possible infections, patients at high risk of infection often benefit from taking antibiotics before dental treatment or surgical procedures. This is especially important if you have had joint replacements, as there is an increased risk of infection. In general, individuals with lupus should avoid exposure to people with colds or other infections.

There seems to be some controversy regarding immunization shots and lupus patients. It seems the medical society is at odds as to whether or not getting immunizations, including flu shots, is detrimental to lupus patients. Lupus patients make fewer antibodies that circulate for shorter periods of time and have more adverse reactions after receiving a flu shot but there seems to be some agreement that flu shots are safe. However it is not recommended for patients who are on steroids, i.e., prednisone or cytotoxic, i.e., (Cytoxan, Imuran) therapy to receive live vaccines because these drugs hamper the immune system thus running the risk of infection or a flare. It is important that lupus patients consult their rheumatologist before receiving any type of allergy shots (immunotherapy). In 1989, the World Health Organization recommended that patients with autoimmune diseases not take allergy shots (immunotherapy) because they will flare.

According to a report from the Lupus Foundation of America, infections that occur in people with lupus fall into two categories. The first category includes infections caused by organisms which can induce infection in anybody. This category includes organisms such as streptococcus (which causes strep throat) and staphylococcus (which causes staph infections).

The second category consists of “opportunistic” infections. Opportunistic infections are caused by organisms capable of inducing disease only when one’s immune system is weakened. Most of the opportunistic infections are fungal, parasitic or protozoan.

The most common infections that lupus patients contract involve the respiratory tract, skin and urinary tract and usually these are not serious and only a few lupus patients will need aggressive hospital treatment for infections. However, infections in lupus patients tend to last longer and require a longer course of treatment with antibiotics than infections in people who do not have lupus. It is also important to know that hydrocortisone medications increase the likelihood of fungal infections because it eliminates both good and bad bacteria making yeast and thrush infections hard to control. In someone with an impaired immune system, however, such infections, called dermatophytoses, can persist for long periods Fungi can also invade internal organs of the body, especially the lungs, where the infections resemble pneumonia or pulmonary tuberculosis.

Lupus patients are at an unusually high risk for contracting Salmonella, Herpes Zoster and Candida (yeast) infections. Oral infection and yeast infection are common among lupus patients and should be avoided at all cost. Bacterial infections are also common with urinary tract and respiratory tract infections being quite common especially if you have allergies.

The fight to be healthy is dependent on the support of physicians and knowing yourself. Anytime something is amiss it is important to step back an evaluate what is going on and seek medical attention.

Glossary

Antibodies-Proteins produced by white blood cells (B lymphocytes). Their normal function is to stick to bacteria and make them easy for the white blood cells to capture and destroy.

Autoimmune-The immune system treats the body as if was a foreign component and builds antibodies against it. The body is fighting itself.

Fungus Infections-Diseases caused by the growth of fungi in or on the body. In most healthy people fungal infections are mild, involving only the skin, hair, nails, or other superficial sites, and they clear up spontaneously. See Thrush.

Immune system-A group of cells, molecules and organs that act together to defend the body against foreign invaders that may cause disease. The health of the body is dependent on the immune system’s ability to recognize and repel invaders.
Infection-injurious contamination of the body or part of the body by pathogenic agents, such as fungi (see Fungus Infections), bacteria, protozoa, rickettsiae, or viruses, or by the toxins that these agents may produce.

Herpes Zoster-Also known as Shingles, is caused by the same virus that causes chicken pox. The rash of blisters, usually confined to one side of the body, erupts when dormant virus particles reproduce in the nerves supplying the skin. Because the virus damages nerves in particular, pain, sometimes severe, may persist for many months after the rash heals. Herpes zoster may occur at any age, but older and immunosuppressed patients are most frequently and seriously affected.

Hydrocortisone, also cortisol, common names for 17-hydroxy-corticosterone, the principal hormone secreted by the outer layer, or cortex, of the adrenal gland. Hydrocortisone affects the metabolism of carbohydrate, protein, and fat; the maturation of white blood cells; the retention of salt and water in the body; the activity of the nervous system; and the regulation of blood pressure. Secretion of hydrocortisone from the adrenal cortex is stimulated by the pituitary hormone ACTH.

Protozoan- The collective name for animal-like, single-celled organisms, some of which may form colonies. In the classification followed in this encyclopedia the protozoa are placed in the kingdom Protista with other single-celled organisms that have membrane-enclosed nuclei. Protozoa have little or no differentiation into tissue systems. Several phyla are commonly recognized. They include flagellated Zoomastigina, many species of which live as parasites in plants and animals; the amoeboid Sarcodina, which includes the Foraminifera and Radiolariaboth important components of the plankton; ciliated Ciliophora, many with specialized structures suggesting the mouth and anus of higher organisms; Cnidosporidia, parasites of invertebrates, fish, and a few reptiles and amphibians; and Sporozoa, many species of which are parasites of animals (including humans). More than 20,000 species are known, including such familiar forms as paramecium and amoeba.

Thrush-A fungal infection characterized by creamy-white, curd like patches on the tongue and other mucosal surfaces of the mouth. The disease is caused by an overgrowth of Candida albicans, a species of yeast that normally inhabits the mucous membranes as a benign saprophyte. Those most susceptible to thrush include adults whose immune systems have been weakened by antibiotics, steroids, or, most commonly, acquired immune deficiency syndrome (AIDS). Infants can become infected during birth if the mother has a vaginal yeast infection (see Gynecology).

When the curd like discharge is removed from patches of thrush, raw and bleeding areas are visible and can be especially painful. If left untreated, these superficial lesions may allow the yeast to spread to other areas of the body. In cases of severe immunosuppression or prolonged antibiotic therapy, the organism can invade the major organs, causing serious complications. Diagnosis requires microscopic identification of the pseudomycelial (branching-arms) forms. Generally, thrush is treated with a topical (surface) agent such as miconazole or clotrimazole.