Evolution of patients with systemic lupus erythematosus diagnosed with dengue in the 2020 epidemic

Abstract

Introduction: Dengue is an endemic virus in Paraguay, in recent years its probable role in the pathophysiology of autoimmune diseases has been reported, being able to trigger or exacerbate them. Objectives: To evaluate the evolution of patients with Systemic Lupus Erythematosus (SLE) diagnosed with dengue in the period of time between January 2020 and March 2020. Materials and Methods: Observational, analytical longitudinal study, the sample size was 19 patients with SLE, diagnosed with dengue fever in the period from January to March 2020. Data was collected through an electronic record with specific data of the clinical characteristics before dengue and the evolutionary characteristics of dengue in patients with SLE. The determination of the NS1 antigen was carried out through rapid immunochro- matographic tests and, prior to the rRT-PCR reaction, the extraction of the viral RNA was carried out. The index of IgG and IgM anti-DENV studies will be completed. Results: The mean age was 32.10 ± 13.83 years, 84% were female and 98% came from the central department. 42% (8/19) of the referred patients had previously suffered from den- gue. Of the total number of patients, 15 patients presented laboratory confirmation either by detection of the NS1 antigen, PCR, or serology, as shown in Graph 1; the rest were included in this cohort due to an epidemiological link. DENV-4 was the most frequent serotype in 64% (9). The mean value of dengue evolution time was 3.84 ± 1.259 and the predominant symptoms were fever in 74% (14/19) and myalgia in 63% (12/19). In relation to the evolution of the patients, 42% (8/19) were hospitalized, 5.2% (1/19) were admitted to the ICU and no patients appeared deceased. The mean of SLEDAI at the beginning of the Dengue infection was 2.5 points and at three months it was 3 points. No statistically significant difference was found between the score values before and after dengue. (p=0.451). Conclusion: The evolution of dengue in patients with SLE was favorable in the patients included in this study. PCR was the diagnostic method that most frequently was able to detect a positive result in the febrile stage of dengue in patients with SLE. Although hospital admissions were even obtained in the ICU, they did not develop due to dengue in patients with SLE.