M Lao1,2, X Wang3, M Ding2, Z Yang4, H Chen5, L Liang1, Z Zhan1, D Chen1. 1. 1 Department of Rheumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 2. 2 Department of Geriatrics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 3. 3 Department of Ultrasound, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China. 4. 4 Department of Pathology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, China. 5. 5 Department of Respirology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Abstract
OBJECTIVE: To investigate the characteristics and associated factors of invasive fungal disease in patients with systemic lupus erythematosus from Southern China. METHODS: A retrospective study was performed. Demographic and clinical characteristics, laboratory data, and radiographic manifestations were recorded. RESULTS: A total of 45 lupus patients with invasive fungal disease (incidence 1.1%) were included. Twenty-three cases (51.1%) were infected with mold and 22 cases (48.9%) with yeast. Aspergillus spp. (44.4%) and Cryptococcus spp. (33.3%) were common. Aspergillosis mainly occurred in the lung. Cryptococcosis developed in the lung (40.0%), meninges (46.7%) and bloodstream (13.3%). Compared with yeast infection, mold infection tended to develop in patients with active lupus nephritis (65.2% vs. 31.8%, P = 0.03) and the mortality rate was higher (20.0% vs. 0%, P = 0.001). Co-infection with bacteria, virus or superficial fungi occurred in 12 patients (26.7%). Multivariate logistic regression analysis indicated that lymphopenia (odds ratio 2.65, 95% confidential interval 1.14-6.20, P = 0.02) and an accumulated dose of glucocorticoid (odds ratio 1.58, 95% confidence interval 1.10-2.25, P = 0.01) was associated with invasive fungal disease in lupus patients. CONCLUSION: Mold infection tended to develop in patients with active lupus disease with high mortality. Co-infection is not rare. Lymphopenia and an accumulated dose of glucocorticoid are associated with invasive fungal disease in lupus patients.
OBJECTIVE: To investigate the characteristics and associated factors of invasive fungal disease in patients with systemic lupus erythematosus from Southern China. METHODS: A retrospective study was performed. Demographic and clinical characteristics, laboratory data, and radiographic manifestations were recorded. RESULTS: A total of 45 lupuspatients with invasive fungal disease (incidence 1.1%) were included. Twenty-three cases (51.1%) were infected with mold and 22 cases (48.9%) with yeast. Aspergillus spp. (44.4%) and Cryptococcus spp. (33.3%) were common. Aspergillosis mainly occurred in the lung. Cryptococcosis developed in the lung (40.0%), meninges (46.7%) and bloodstream (13.3%). Compared with yeastinfection, mold infection tended to develop in patients with active lupus nephritis (65.2% vs. 31.8%, P = 0.03) and the mortality rate was higher (20.0% vs. 0%, P = 0.001). Co-infection with bacteria, virus or superficial fungi occurred in 12 patients (26.7%). Multivariate logistic regression analysis indicated that lymphopenia (odds ratio 2.65, 95% confidential interval 1.14-6.20, P = 0.02) and an accumulated dose of glucocorticoid (odds ratio 1.58, 95% confidence interval 1.10-2.25, P = 0.01) was associated with invasive fungal disease in lupuspatients. CONCLUSION: Mold infection tended to develop in patients with active lupus disease with high mortality. Co-infection is not rare. Lymphopenia and an accumulated dose of glucocorticoid are associated with invasive fungal disease in lupuspatients.