Patients with lupus are more susceptible to infections because
they have altered immune systems, and also because many patients
are on treatment (steroids & cytotoxics) that suppresses immune
system function, leaving them more prone to infection.
Lupus patients who get infections frequently show worse clinical
signs, & require longer treatment than non-lupus patients.
The most common bacterial infections seen in lupus affect the respiratory
tract and the urinary tract. Septic arthritis, tuberculosis, salmonella,
cold viruses, & shingles are also more common. The most common
fungal infection seen in lupus is candida (thrush).
It is important to distinguish between a lupus flare and an infection.
Fever and decreased energy are symptoms that are associated with
both infections and lupus flares. Any lupus patient who exhibits
symptoms that could be an infection or flare should contact her
physician. Blood tests such as a white cell count can help to distinguish
a flare from an infection.
Patients at high risk of infection should probably take antibiotics
before surgical or dental procedures.
Lupus patients should try to minimise their exposure to people
who have colds, 'flu, and other infections, although this is easier
said than done!
Lupus patients should probably avoid the antibiotics penicillin
and septrin (sulfa), as they may exacerbate lupus, and many lupus
patients are allergic to them.
It has been previously thought that lupus patients should avoid
immunisations because they could exacerbate lupus. However, the
vaccine for influenza has now been shown to be safe and effective;
the pneumococcal vaccine is also safe, but resultant antibody levels
are somewhat lower in patients with SLE. It is not advisable for
patients receiving steroids or cytotoxic therapy to have live vaccines,
because these drugs cause immune suppression that may promote infection.
Some patients who receive allergy shots (immunotherapy) will have
a flare following this treatment. In 1989, the World Health Organisation
recommended that patients with autoimmune diseases should not receive
allergy shots. Lupus patients should always consult their rheumatologist
before receiving immunotherapy.