What are the risk factors for pneumonia in immunocompromised patients with autoimmune conditions?

Updated: Jan 07, 2019
  • Author: Julie B Zhao, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Answer

Answer

Infections in persons with autoimmune conditions can result from the effects of immunosuppressive therapies as well as their underlying condition.

In systemic lupus erythematosus (SLE), distinguishing infection from an autoimmune flare is important. Treatment with steroids in the setting of infection could be deleterious. 

Complement deficiencies and elevated Fc gamma III and granulocyte-macrophage colony-stimulating factor (GM-CSF) levels may contribute to increased susceptibility to infection in patients with SLE. [40]  

Low complement, the use of more than 20 mg prednisone daily, and the use of cyclophosphamide in patients with SLE were important risk factors in multivariate analyses. [41]

Consideration of initiating prophylaxis for Pneumocystic jiroveci in SLE patients exceeding 20 mg of prednisone a day or with usage of cyclophosphamide has been proposed. [42]

The large majority of infectious complications are due to bacterial pathogens. Viral infections (CMV, VZV) are also common.

In connective tissue diseases, the primary condition and the use of immunosuppressive medications place patients at increased risk. One meta-analysis showed that 29% of patients developed a serious infection, and 24% died from this infection—most reported as bacteremia or pneumonia. [43]


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