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Systemic Lupus Erythematosus

  • Gaafar Ragab
  • Carina Dehner
  • Hazem Hamza
  • Martin Kriegel
Chapter

Abstract

Systemic lupus erythematosus (SLE) is a debilitating and life-threatening autoimmune disease affecting major organ systems including the kidneys, brain, joints, and skin. The etiology is unknown but microorganisms, both pathogenic and commensal, are implicated in the pathogenesis of SLE. An overview of the microbiome in human lupus and animal models is given with a summary of the most recent human microbiome association studies. Next, infectious agents with a pathogenic or protective role in the pathogenesis of SLE are summarized. The majority of the chapter reviews the contribution of infectious agents to the morbidity and mortality of SLE patients with a systematic overview organized by organ system. Invasive fungal infections and other serious infections are covered separately. Biomarkers such as C-reactive protein and procalcitonin are discussed in the context of an infectious episode versus a lupus flare. The chapter closes with a brief overview of the prevention of infections in SLE patients. In summary, this chapter encompasses the role of the microbiota and infectious agents in the pathogenesis of SLE, the infectious complications in SLE patients, and its detection and differentiation from lupus flares.

Keywords

Systemic lupus erythematosus Microbiome Pathogenic microorganisms Pathogenesis Risk factors for infection Clinical manifestations of infection Morbidity and mortality Prevention of infection 

Abbreviations

AZA

Azathioprine

CCR6

Chemokine receptor 6

CMV

Cytomegalovirus

CRP

C-reactive protein

CSF

Cerebrospinal fluid

cSLE

Childhood systemic lupus erythematosus

CW

Cutaneous warts

ESRD

End stage renal disease

HAI

Hospital-acquired infection

HBV

Hepatitis B virus

HLA

Human leukocyte antigen

HPV

Human papillomavirus

HR

Hazard ratio

HZI

Herpes zoster infection

IBLs

Infected brain lesions

IFI

Invasive fungal infection

IFN

Interferon

JCV

John Cunningham virus

LMP1

Latent membrane protein

LN

Lupus nephritis

LPS

Lipopolysaccharides

MMF

Mycophenolate mofetil

NETs

Neutrophil extracellular traps

NKs

Natural killer cells

PCT

Procalcitonin

PDC

Plasmacytoid dendritic cells

PMNs

Polymorphonuclear cells

PRRs

Pattern recognition receptors

RA

Rheumatoid arthritis

ROS

Reactive oxygen species

SBE

Subacute bacterial endocarditis

SFB

Segmented filamentous bacteria

SLE

Systemic lupus erythematosus

SLEDAI

Systemic lupus erythematosus disease activity index

SMR

Standardized mortality ratio

SMRs

Standardized mortality ratios

TB

Tuberculosis

Tfh

Follicular helper T cells

TLR

Toll-like receptors

Tregs

Regulatory T cells

UTI

Urinary tract infections

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Gaafar Ragab
    • 1
  • Carina Dehner
    • 2
  • Hazem Hamza
    • 3
    • 4
  • Martin Kriegel
    • 5
  1. 1.Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Faculty of MedicineCairo UniversityCairoEgypt
  2. 2.Department of ImmunobiologyYale School of MedicineNew HavenUSA
  3. 3.Virology LaboratoryNational Research CentreCairoEgypt
  4. 4.Department of ImmunologyInterfaculty Institute of Cell Biology, Eberhard Karls University TübingenTübingenGermany
  5. 5.Department of ImmunobiologyYale School of MedicineNew HavenUSA

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