Fatal infection in children with lupus nephritis treated with intravenous cyclophosphamide
- PDF / 138,659 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 99 Downloads / 177 Views
ORIGINAL ARTICLE
Fatal infection in children with lupus nephritis treated with intravenous cyclophosphamide Kamolwish Laoprasopwattana & Pornsak Dissaneewate & Prayong Vachvanichsanong
Received: 25 November 2008 / Revised: 9 February 2009 / Accepted: 10 February 2009 / Published online: 12 March 2009 # IPNA 2009
Abstract A knowledge of the causes and risk factors of fatal infection in childhood lupus nephritis (LN) patients treated with intravenous cyclophosphamide (IVCY) is important to enable optimal treatment. During an 11-year period (1996–2007), severe infection cases occurred in 31/84 (36.9%) patients with 64 infection episodes in our central referral institution in southern Thailand. Fatal infections occurred in 13/31 (41.9%) patients, most (11/13, 84.6%) during the first infective episode. The major causative organisms of the fatal infections were fungus and Gramnegative bacilli. Fatal infections were more likely to occur in patients with a prior history of treatment with pulse methylprednisolone and in patients with more active LN, as evidenced by the higher proteinuria and serum creatinine levels and lower hemoglobin and lymphocyte counts in this group than in patients with non-fatal infections. Multivariate analysis indicated that factors associated with fatal infection were prior treatment with pulse methylprednisolone [odds ratio (OR) 11.2, 95% confidence interval (CI) 1.9–61.0], renal failure (OR 5.9, 95% CI 1.0–34.8), and fungal infection (OR 23.9, 95% CI 1.9–298.2). Cases of active LN treated with IVCY and pulse methylprednisolone who later develop severe infection that fails to respond to antibiotics should be carefully investigated for fungal infection.
K. Laoprasopwattana : P. Dissaneewate : P. Vachvanichsanong Department of Pediatrics, Prince of Songkla University, Songkhla, Thailand K. Laoprasopwattana (*) Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand e-mail: [email protected]
Keywords Infection . Intravenous cyclophosphamide . Systemic lupus erythematosus
Introduction Systemic lupus erythematosus (SLE) is an autoimmune disease involving multiple organ systems that has a varying course and prognosis. The prognosis of SLE has dramatically improved since intermittent intravenous cyclophosphamide (IVCY) and corticosteroids have become the gold standard treatment for major SLE organ involvement [1–3]. However, immunosuppressive therapies not only suppress autoimmune diseases but also suppress the immune responses against microorganisms. Previous studies have found that the major risk factors of acquiring infection in SLE patients are current use of IVCY and steroids, active lupus, degree of renal involvement, hypocomplementemia, leukopenia and lymphopenia [4–10]. The infection rate of SLE patients reported in various studies varies from 10 to 45%, with infection being reported to be the cause of death in 22–65% of cases [6–19]. This large variation is primarily due to differences in the age groups, disease activity and severity
Data Loading...
