Children with SLE at Higher Risk of Bacterial Infections, Especially Pneumonia, Study Finds

Children with systemic lupus erythematosus (SLE) may be prone to develop infections, especially bacterial pneumonia, according to a new study. Also, the risk of infection was higher among African American and Native American children, children with lupus nephritis and other health conditions, and those under corticosteroid treatment.

The findings were published in the journal Arthritis Care and Research, titled “Serious Infection Rates Among Children With Systemic Lupus Erythematosus Enrolled In Medicaid.”

SLE patients have a high risk of infections, either due to the disease itself or their treatment with immunosuppressives, as their immune system is under control of the medication and may not prevent the invasion of pathogen. Also, patients with lupus nephritis (kidney inflammation due to SLE) may be at higher risk of infection compared to SLE patients without this condition.

However, most studies with SLE children have been carried out with patients from single centers, and so the prevalence and incidence of infections among SLE patients across the U.S. were poorly known.

Researchers analyzed the medical data of 3,500 children and teens (ages 5 to 17) with SLE and lupus nephritis enrolled in Medicaid from 2000 to 2006 to study the prevalence and incidence of serious infections among these patients. Infections were classified as bacterial, fungal, or viral.

Results showed that 1,053 serious infections occurred over 10,108 person-years. The incidence of infection was 10.42 per 100 person-years among SLE patients, and 17.65 per 100 person-years among patients with lupus nephritis, showing that children with both diseases were more susceptible to infection. The mortality rate at one month after hospital discharge was 4.4 percent.

Among the three subtypes of infection, bacterial infections were the most common (87 percent), especially bacterial pneumonia (39 percent).

Children with African-American and Native American ethnicities were more prone to become infected than white children. Children with other medical conditions or under corticosteroid treatment (a type of immunosuppressant) were also at higher risk of infection than others. Also, boys had lower rates of serious infections compared to girls.

“We take from this study that a high burden of serious infections exists among children diagnosed with SLE and enrolled in Medicaid from 2000-2006,” researchers wrote. “There were significantly higher rates of serious infections among children of African and Native American race/ethnicity compared to white children, those with [lupus nephritis] compared to those without [lupus nephritis], those with higher comorbidity, and among those treated with corticosteroids.”

More studies are necessary to investigate how infection rates may be influenced by immunosuppressive treatments and prophylactic measures, such as vaccination and antibiotic use, as well as the reasons underlying ethnic differences in infection risk among SLE children.