Lupus and Infections

Lupus infections remain one of the most serious complications for people living with the condition. Chapter 22 of The Lupus Encyclopedia, titled “Infections”, explains how lupus itself—and the treatments used to manage it—can weaken the immune system, increasing vulnerability to a wide range of infections. For many patients, distinguishing between a lupus flare and a true infection can be difficult, yet the difference is critical. Some infections can escalate quickly and become life-threatening if not treated promptly. Understanding the relationship between lupus and infections helps patients take proactive steps to protect their health, recognise early warning signs, and work closely with their healthcare team to manage risks.

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Infections are among the top three ­causes of death in SLE patients, and most are preventable. Vaccines, antibiotics, and doing every­thing you can to control lupus through
mea­sures that do not require immune system suppression can significantly reduce infection deaths.

The Lupus Encyclopedia (2nd ed.), p. 431

Understanding Lupus and Infections

Lupus and infections are closely linked, and understanding this connection is essential for staying healthy. Infections remain a major concern for people living with lupus. In fact, “infections are among the top three causes of death in SLE patients, and most are preventable.”

Therefore, we must take infection prevention seriously as part of our overall lupus care. When we understand the risks, we can act early and reduce complications.

Why Lupus Increases Infection Risk

Lupus affects how our immune system works. Normally, the immune system protects us from harmful germs. However, in lupus, that system does not function as it should.

As the Lupus Encyclopedia explains, “the lupus immune system may not be able to fight off infections normally.”

Moreover, lupus can damage protective barriers like the skin and lungs. These barriers usually keep harmful organisms out. When they weaken, infections become more likely.

The Role of Immunosuppressive Medications

Many lupus treatments suppress the immune system to control inflammation. While these drugs help manage disease activity, they also increase infection risk.

For example, “immunosuppressant drugs… can also lower the immune system’s ability to fight off infection.”

Steroids pose a particularly high risk. Higher doses increase the chance of infection even further. Therefore, doctors often try to reduce steroid use when possible.

However, not all lupus medications increase infection risk. Antimalarials like hydroxychloroquine actually help protect against infections. They can reduce infection risk by up to 60 percent.

Distinguishing Infection from Flare

It can be difficult to tell the difference between a lupus flare and an infection. Both can cause fever, fatigue, and pain.

The Lupus Encyclopedia notes that “fevers and chills in someone with lupus could signal an infection.”

However, lupus itself can also cause fever. Therefore, we should never assume the cause. Because treatments differ, doctors may sometimes treat both conditions at the same time.

You can learn more about flares here.

Common Lupus Infections

People with lupus can develop many types of infections. Some are mild, while others can become severe.

Bacterial Infections

Bacterial infections include pneumonia, urinary tract infections, and skin infections. These infections can spread quickly if untreated.

In severe cases, bacteria can enter the bloodstream. This condition, called bacteremia, can be life-threatening.

Viral Infections

Viral infections are also common. These include colds, flu, and viruses like herpes.

For example, people with lupus are more likely to develop herpes outbreaks. These can become more frequent and severe when taking immunosuppressants.

COVID-19 has also affected lupus patients more severely. Studies show higher rates of hospitalization and complications.

Fungal Infections

Fungal infections such as thrush can occur more often in lupus patients. These infections often affect the mouth or skin.

They typically develop when the immune system is weakened.

Opportunistic Infections

Opportunistic infections occur mainly in people with weakened immune systems. These infections rarely affect healthy individuals.

The Lupus Encyclopedia explains that these infections “usually occur in people with bad immune systems.”

Examples include tuberculosis, Candida, and Pneumocystis infections.

High-Risk Situations and Populations

Some people with lupus face higher infection risks than others.

Lupus Nephritis and Infection Susceptibility

People with lupus nephritis often require stronger medications. These treatments increase infection risk.

Additionally, kidney disease itself can weaken the body’s defenses.

Infection Risk in the Hospital

Hospital stays increase exposure to infections. Patients may come into contact with resistant bacteria.

Therefore, we should take extra precautions during hospital visits.

Special Considerations for the Elderly and Children

Older adults and children face unique risks. For example, people over 65 have a higher chance of severe infections.

Similarly, children may have developing immune systems that respond differently to infections.

Warning Signs: When to Suspect an Infection

Recognizing symptoms early can prevent serious complications.

Symptoms That May Indicate Infection

Common infection symptoms include:

• fever
• chills
• fatigue
• swollen glands

Other symptoms depend on the infection site. For example, cough may suggest a lung infection, while pain during urination may indicate a urinary infection.

Red Flags That Require Immediate Attention

Some symptoms require urgent care. These include confusion, difficulty breathing, and severe pain.

Sepsis is a serious condition that can occur if an infection spreads. It can cause low blood pressure and organ failure.

If we notice these signs, we should seek medical help immediately.

Diagnostic Tools and Monitoring

Doctors use several tools to diagnose infections in lupus patients.

Blood Work and Cultures

Blood tests help detect infection and inflammation. Cultures identify the specific organism causing the infection.

However, lupus can sometimes cause false-positive test results.

Therefore, doctors must interpret results carefully.

Monitoring While on Immunosuppressants

Patients taking immunosuppressants require close monitoring. Regular checkups help detect infections early.

Prevention Strategies

Preventing infections is one of the most important parts of lupus care.

Vaccinations and Immunizations

Vaccines play a key role in prevention. The Lupus Encyclopedia recommends flu, pneumonia, and other vaccines for most patients.

Whenever possible, we should receive vaccines before starting immunosuppressants.

Safe Food and Water Practices

Food safety reduces infection risk. We should avoid undercooked foods and contaminated water.

Simple habits like washing hands also make a big difference.

Travel Safety and Hygiene

Travel can expose us to new infections. Therefore, we should plan ahead and take precautions.

For example, we should check vaccine requirements and avoid high-risk areas when possible.

Treatment Approaches

Early treatment improves outcomes and reduces complications.

Antibiotics, Antivirals, and Antifungals

Doctors treat infections based on the cause. Bacterial infections require antibiotics, while viral infections may need antivirals.

However, not all infections need medication. Some mild viral infections improve with rest and supportive care.

Adjusting Lupus Medications During Infections

Managing lupus medications during infection can be complex. In some cases, doctors may pause certain drugs.

However, steroids often continue because stopping them suddenly can be dangerous. Therefore, we should always consult our healthcare team before making changes.

Lupus and infections require constant attention, but we can reduce risks with the right strategies. By staying informed, following treatment plans, and acting early, we can protect our health and improve our outcomes.

 

For more in-depth information on Lupus and Infections:

Read more in The Lupus Encyclopedia, edition 2

Look up your symptoms, conditions, and medications in the Index of The Lupus Encyclopedia

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