系统性红斑狼疮与感染.pptx

LUPUSVsINFECTION
Zhaojiuliang
DepartmentofRheumatology
PUMCH,Beijing
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Q1. What are the most frequent vasculitis
TB may present with skin disease posing a diagnostic challenge
A high index of suspicion will allow prompt treatment.

Data in China
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Viral infections
Acute viral infections in SLE
CMV(~50%)
parvovirus B19
herpes simplex
EBV
varicella zoster virus
hepatitis A
among other less frequently reported viruses
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HZV
The annual age-adjusted incidence of herpes zoster virus in SLE patients of 12/1000 person-years
Most frequently a late(>5yrs) complications of SLE
Often occurring during inactivity or mild SLE activity
往往皮疹重而神经系统表现轻
溃疡性角膜炎
耳带状疱疹， Ramsay-Hunt syndrome
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Cytomegalovirus （CMV）
CMV infection and SLE exacerbation may be difficult to distinguish
Development of SLE may be triggered by a CMV infection.
Existing SLE may undergo an exacerbation following a CMV infection
CMV seropositive VS overt clinical disease
Over 90% SLE pts are seropositive
Antigenemia 18-44%
Overt clinical disease: uncommon
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Pneumocystis Pneumonia
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Pneumocystis Pneumonia
A cut off for PCP prophylaxis in any particular disease: %? 6%？
however, the frequency of PCP varies greatly from disease to disease.
GPA>SLE>IIM>RA?()
Risk factors
Low CD4+ counts
Lymphocyte<350+GCs and cytotoxic therapy
GCs: mean daily dose, cumulative dose, and/or pulse dosing
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Pneumocystis Pneumonia
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Pneumocystis Pneumonia
Clinical Manifestations
High rate of co-infection with other OI, including CMV, Aspergillus, and Candida species.
High mortality: 32%(CTD-PCP), but only ~1/4 were solely attributable to PCP
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Pneumocystis Pneumonia
Proposed PCP prophylaxis in Pts with CTD
2 or more of the following
GCs>=20mg/d for >4weeks
Current use of >=2 DMARDs
Absolute lymphocyte count=<350 cell/mm3
Underlying ILD
TMP-SMZ：85% reduction in PCP infection
Real world su