Infections and Immunizations
When you have lupus, you are at increased risk for all kinds of infections. There are two main reasons for this higher risk. First, lupus itself can make infections occur more often: the way lupus affects the immune system can sometimes limit the body’s ability to fight off foreign invaders, such as bacteria and viruses. Second, people with lupus often take immunosuppressive medicines to control their overactive immune system. These drugs limit the ability of the body’s immune system to respond, and can leave a person more open to infectious agents.
The most common infections seen with lupus involve the respiratory system (lungs and heart), the skin, and the urinary tract. You are also at an unusually high risk for developing Candida (yeast) infections and shingles (the same viral infection as chicken pox).
These types of infections tend to last longer and so require a longer period of treatment with antibiotics. Sulfa antibiotics, a class of drugs commonly used to treat infections, should be used very carefully to treat infections in anyone with lupus because these drugs can increase sensitivity to light and skin rashes, and can lower white blood cell counts.
You should do your best to avoid anyone who has a cold or other contagious condition. During cold and flu season, wash your hands often to cut down transmission of infectious germs. Also, talk to your dentist and surgeon about preventive antibiotics before you have dental work or other surgery.
Sometimes what appears to be an infection -- with fever and inflammation -- may not be an infection, but a lupus flare. Therefore it is very important to check with your doctor if any sign of an infection appears.
If you have a fever of 100 degrees Fahrenheit (F) or higher, you should contact your doctor promptly, as a fever can be a warning sign of a lupus flare or an underlying infection. A high fever can be especially serious if you are taking steroids or chemotherapy drugs.
Vaccines and Immunizations
Most people with lupus are able to be vaccinated against a variety of diseases with no problems. However, because your immune system may be weakened, you should always talk with your doctor before receiving any vaccine.
If you cannot receive vaccines for common illnesses you can still protect your health in many ways.
- Avoid crowds or wear a mask to prevent respiratory infection.
- Wash your hands well and often.
- Avoid touching your mouth or eyes.
- Consider asking close contacts, such as family members or caregivers, to be vaccinated for influenza, measles-mumps-rubella, and chicken pox if they aren’t already immunized.
- Wear a medical alert bracelet or carry a wallet card that explains that you have a suppressed immune system.
Frequently Asked Question
Are people with lupus more prone to infections even if they are not taking immunosuppressive drugs?
There is some evidence that people with lupus are more likely to get infections than completely healthy people, even when they are not taking corticosteroids (prednisone and similar medications). The most common infections are in the respiratory tract (colds, sore throats, sinusitis, bronchitis, and pneumonia), the urinary tract (bladder or kidney infections), and the skin (boils, cellulitis, and infected cuts).
If a person with lupus is taking corticosteroids every day, particularly more than 10 mg a day, the risk of infection goes up considerably. However, if a person can take corticosteroid doses once in the morning every other day -- instead of every day -- there is not much, if any, increase in the risk for infections. Of course, every-other-day treatment does not control active lupus as well as every day.
Other medications used for moderate to severe forms of lupus, such as azathioprine (Imuran), mycophenolate mofetil (CellCept), and cyclophosphamide (Cytoxan), increase infections even more than having the disease does. Herpes zoster outbreaks (shingles) -- with painful blisters along the course of a nerve -- are particularly increased by the immunosuppressive medications. In general, the more severe the lupus is, the higher the risk for infection, partly because of being sick and partly because of the treatments. In contrast, the anti-malarials (hydroxychloroquine, Plaquenil, is the most commonly prescribed) do not increase infections.
There are excellent strategies to reduce your risk for infection. You should have your vaccinations up to date, including Pneumovax to prevent pneumococcal pneumonia. You should take a flu shot every year. Most women can tell accurately that a bladder infection is present, and you should ask your doctor to give a prescription promptly when symptoms begin. If you are taking high doses of immunosuppressive drugs and/or prednisone, ask your doctor about taking medications to prevent pneumocystis pneumonia.
If you have frequent urinary tract infections, there are antibiotics taken once at bedtime and agents that change the acid in the urine that are effective at reducing urinary tract infection rates. If you suffer from outbreaks of herpes virus lesions/ulcers in your mouth, on your lips, or in genital areas, discuss preventive anti-viral treatment with your doctor. If you have been exposed to tuberculosis, you should have a PPD skin test (tuberculin) and consider taking six months of anti-tuberculosis antibiotics if the test is strongly positive. Finally, if it is possible to avoid people with bad colds or other communicable infections, you should do so. Of course, you cannot protect yourself from participating in life, so use your common sense.
2009 CDC revised immunization guidelines that include several clarifications and additions (PDF)
The Value of Vaccines
Summer 2009 Issue of Lupus Now magazine