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Systemic Lupus Erythematosus

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The Microbiome in Rheumatic Diseases and Infection

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Abstract

Systemic lupus erythematosus (SLE) is a debilitating and life-threatening autoimmune disease affecting major organ systems including the kidneys, brain, joints, and skin. The etiology is unknown but microorganisms, both pathogenic and commensal, are implicated in the pathogenesis of SLE. An overview of the microbiome in human lupus and animal models is given with a summary of the most recent human microbiome association studies. Next, infectious agents with a pathogenic or protective role in the pathogenesis of SLE are summarized. The majority of the chapter reviews the contribution of infectious agents to the morbidity and mortality of SLE patients with a systematic overview organized by organ system. Invasive fungal infections and other serious infections are covered separately. Biomarkers such as C-reactive protein and procalcitonin are discussed in the context of an infectious episode versus a lupus flare. The chapter closes with a brief overview of the prevention of infections in SLE patients. In summary, this chapter encompasses the role of the microbiota and infectious agents in the pathogenesis of SLE, the infectious complications in SLE patients, and its detection and differentiation from lupus flares.

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Abbreviations

AZA:

Azathioprine

CCR6:

Chemokine receptor 6

CMV:

Cytomegalovirus

CRP:

C-reactive protein

CSF:

Cerebrospinal fluid

cSLE:

Childhood systemic lupus erythematosus

CW:

Cutaneous warts

ESRD:

End stage renal disease

HAI:

Hospital-acquired infection

HBV:

Hepatitis B virus

HLA:

Human leukocyte antigen

HPV:

Human papillomavirus

HR:

Hazard ratio

HZI:

Herpes zoster infection

IBLs:

Infected brain lesions

IFI:

Invasive fungal infection

IFN:

Interferon

JCV:

John Cunningham virus

LMP1:

Latent membrane protein

LN:

Lupus nephritis

LPS:

Lipopolysaccharides

MMF:

Mycophenolate mofetil

NETs:

Neutrophil extracellular traps

NKs:

Natural killer cells

PCT:

Procalcitonin

PDC:

Plasmacytoid dendritic cells

PMNs:

Polymorphonuclear cells

PRRs:

Pattern recognition receptors

RA:

Rheumatoid arthritis

ROS:

Reactive oxygen species

SBE:

Subacute bacterial endocarditis

SFB:

Segmented filamentous bacteria

SLE:

Systemic lupus erythematosus

SLEDAI:

Systemic lupus erythematosus disease activity index

SMR:

Standardized mortality ratio

SMRs:

Standardized mortality ratios

TB:

Tuberculosis

Tfh:

Follicular helper T cells

TLR:

Toll-like receptors

Tregs:

Regulatory T cells

UTI:

Urinary tract infections

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Authors and Affiliations

  1. Rheumatology and Clinical Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt

    Gaafar Ragab

  2. Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA

    Carina Dehner

  3. Virology Laboratory, National Research Centre, Cairo, Egypt

    Hazem Hamza

  4. Department of Immunology, Interfaculty Institute of Cell Biology, Eberhard Karls University Tübingen, Tübingen, Germany

    Hazem Hamza

  5. Department of Immunobiology, Yale School of Medicine, New Haven, CT, USA

    Martin Kriegel

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  1. Gaafar Ragab
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  2. Carina Dehner
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Correspondence to Gaafar Ragab .

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  1. Faculty of Medicine, Cairo University, Cairo, Egypt

    Gaafar Ragab

  2. University of Alabama, Birmingham, Alabama, USA

    T. Prescott Atkinson

  3. University of Alabama, Birmingham, Alabama, USA

    Matthew L. Stoll

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Ragab, G., Dehner, C., Hamza, H., Kriegel, M. (2018). Systemic Lupus Erythematosus. In: Ragab, G., Atkinson, T., Stoll, M. (eds) The Microbiome in Rheumatic Diseases and Infection. Springer, Cham. https://doi.org/10.1007/978-3-319-79026-8_21

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