Children with Lupus Nephritis in Countries with Limited Resources Exhibit High Infection-Related Mortality Rates
In a new study, children with lupus nephritis (LN) and in under-resourced areas had significant infection-related mortality rates. Of the fatal infections observed, most (55%) were found in the lungs, many (44%) were caused by invasive fungal infections, and 18% were acquired in hospital.
The average age at infection was 13 years with female children (93.4%) more likely to exhibit infection. They also exhibited high levels of urine protein and steroids used to treat inflammation – methylprednisolone and prednisolone – which increased their risk for infection. Children with a neutrophil-to-lymphocyte ratio of more than 20 (indicative of inflammation) and on a high daily prednisolone dose (30 mg/day) were likely to develop a fatal infection.
In developing countries, 30-65% of all deaths in children with lupus are due to infections. To improve survival rates, invasive fungal infection prevention and minimizing daily prednisolone dosage is important in routine clinical care of children with LN in under-resourced areas. They require specific assessment, especially if they exhibit a high neutrophil-to-lymphocyte ratio.
Infections are a major medical problem in under-resourced areas. Suboptimal infrastructure including water supply, sewage systems and hospital hygiene enhances the transmission of pathogens. Several limitations, including poverty, malnutrition, low education and restricted access to healthcare, increase the severity of infections and the risk of death of children with lupus in developing countries. Learn about lupus and your risk of infections.