Infections in rheumatology practice: an experience from NIMS, Hyderabad

Abstract Objective Infections are not uncommon in rheumatology practice both because of the disease by itself and the medications used especially after the advent of biological therapy. Identifying and predicting infections is crucial in managing these patients as sometimes they are indistinguishable from the disease itself. The present retrospective study evaluates the clinical spectrum of infections in patients of rheumatology. Methods Medical records of patients from the January 2007 to June 2008 were retrieved. The data of patients with serious infections requiring hospitalization or infections diagnosed after hospitalization, concomitant medications, co-morbid conditions, previous infections, and any other predisposing factors were analyzed. Inclusion criteria All patients who were admitted at the rheumatology department and have had evidence of minor or major infections were included. Results There were a total of 1236 admissions, of which 225 patients had infections. Eighty-four were systemic lupus erythematosus (SLE) patients, 72 were rheumatoid arthritis (RA) patients, 69 patients fell in the others group, and there was one patient who had RA—SLE overlap. Fever was the presenting complaint in 69 (82.1%) patients with SLE and 43 (58.9%) patients with RA. Lower respiratory tract infection comprised 22.9% of SLE infections, 32.5% of RA infections. Bacterial infections (21.27%) are common infections and Escherichia coli is the most common organism identified in SLE. Conclusions Infections are the common cause for hospital admission in RA and SLE. The commonest site of infections is the respiratory tract in both RA and SLE. The occurrence of infections in SLE is not directly proportional to the level of immunosuppression.