系统性红斑狼疮与感染PPT课件下载推荐.pptx
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系统性红斑狼疮与感染PPT课件下载推荐.pptx
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Q3HowcantheriskofinfectiouscomplicationsinSLEbereduced?
Q1.WhatarethemostfrequentinfectionsinpatientswithSLE?
Infectionisresponsibleforapproximately25%ofalldeathsinpatientswithsystemiclupuserythematosus(SLE)ThemainreasonofhospitalizationAppearstobehighestwithinthefirst5yearsofdiseaseonsetInfectioninSLEClinRheumatol,2014.33
(1):
57-63.CharacteristicsofmajorinfectionsinSLERespiratorytractsUrinarytractsSkinandsofttissuesThetypesofinfectionsthatSLEpatientsdevelopedwerethesameasinthegeneralpopulationThemostfrequentinfectionsinclude:
Pneumonia,herpeszostervirus,andurinarytractinfectionArthritisCareRes(Hoboken),2015.67(8):
1078-85.CharacteristicsofmajorinfectionsinSLERelativerisksofhospitalizationsLupuscomparedwithgeneralpopulationArthritisCareRes(Hoboken),2015.67(8):
1078-85.PathogenofinfectioninSLEGram-negativebacilli,gram-positivecocci,fungalandotherbacterialinfectionsaccountedfor39.85%,31.58%,18.80%and9.77%,respectivelyofnosocomialinfections.ClinicalmanifestationsofinfectionsAtypical!
MycobacteriumtuberculosisTheprevalenceofTBinfectioninSLE:
5-30%Characteristicshigherincidenceratemorefrequentextra-pulmonaryinvolvementmoreextensivepulmonaryinvolvementHighrelapserateeveniftreatedwithprophylacticizoniazidmorecommoninSLErenaltransplantpatientsZandman-Goddard,G.,InfectionsandSLE.Autoimmunity,2009.38(7):
473-485.MycobacteriumtuberculosisTBmaypresentasamimickerofvasculitisTBmaypresentwithskindiseaseposingadiagnosticchallengeAhighindexofsuspicionwillallowprompttreatment.TB.spotDatainChinaViralinfectionsAcuteviralinfectionsinSLECMV(50%)parvovirusB19herpessimplexEBVvaricellazostervirushepatitisAamongotherlessfrequentlyreportedvirusesHZVTheannualage-adjustedincidenceofherpeszostervirusinSLEpatientsof12/1000person-yearsMostfrequentlyalate(5yrs)complicationsofSLEOftenoccurringduringinactivityormildSLEactivity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-HuntsyndromeCytomegalovirus(CMV)CMVinfectionandSLEexacerbationmaybedifficulttodistinguishDevelopmentofSLEmaybetriggeredbyaCMVinfection.ExistingSLEmayundergoanexacerbationfollowingaCMVinfectionCMVseropositiveVSovertclinicaldiseaseOver90%SLEptsareseropositiveAntigenemia18-44%Overtclinicaldisease:
uncommonPneumocystisPneumoniaPneumocystisPneumoniaAcutoffforPCPprophylaxisinanyparticulardisease:
3.5%?
6%?
however,thefrequencyofPCPvariesgreatlyfromdiseasetodisease.GPASLEIIMRA?
()RiskfactorsLowCD4+countsLymphocyte=20mg/dfor4weeksCurrentuseof=2DMARDsAbsolutelymphocytecount=350cell/mm3UnderlyingILDTMP-SMZ:
85%reductioninPCPinfectionRealworldsurvey,50%SLEptsonCYCusingprophylaxia15.88/1WptsreportsPCPinfection;
higherAEsratesNotsufficientevidencetosupportuniversaluseofprophylaxiaQ2WhicharetheclinicalfactorsinvolvedinthedevelopmentofinfectionsinSLE?
RiskfactorsforinfectionUseofsteroidseverUseofCYC,MMF,CD20mAbOrgandamageresultingfromseverelupusSeverelupusflaresinvolvingthekidneyorcentralnervoussystemHighSLEdiseaseactivityindex(SLEDAI)Danza,A.andRuiz-Irastorza,G.,Infectionriskinsystemiclupuserythematosuspatients:
susceptibilityfactorsandpreventivestrategies.Lupus,2013.22(12):
1286-94.Prednisoneusetobeassociatedwithinfectionrisk,witheach10mgperdayincreaseofprednisoneincreasingtheriskofseriousinfection11-fold.Ruiz-Irastorza,G.,Predictorsofmajorinfectionsinsystemiclupuserythematosus.ArthritisResTher,2009.11(4):
R109.LN:
感染高危因素ArthritisRheumatol,2015.67(6):
1577-85.SLE感染高危因素ArthritisRheumatol,2015.67(6):
1577-85.Q3HowcantheriskofinfectiouscomplicationsinSLEbereduced?
ForRheumatistEULARrecommendationsCarefultitrationofcorticosteroidsandotherimmuno-suppressiveagentsagainstdiseaseactivityPromptevaluationforinfectionsProphylacticuseofantibioticsforptsathighriskofcertaininfectionsImmunizationsGCsinSLE具体预防措施
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