Impact of dengue infection on patients with autoimmune disease. Case review

Abstract

Introduction: Dengue is endemic in Paraguay. Several studies have reported immunological phenomena responsible for triggering immune mediated events due to circulating immune complexes, complement activation and cytocine release. Patients with autoimmune disease could be more vulnerable to complications. The aim of this review is to determine the effect of the infection on autoimmune disease and to determine the severity of Dengue infection in these patients. Methods: This is a retrospective, longitudinal observational study done with patients from the Rheumatology Deparment who had autoimmune disease and Dengue infection from february 2007 to february 2012. Baseline autoimmune disease, autoimmune disease activity , treatment ,clinical classification of Dengue severity and patient outcome were considered variables, and these were analized during actue phase of infection, 15-30 days post infection and 3 months after infection. Results: 22 patients were included with the following diagnoses: Lupus, Rheumatoid arthritis,Scleroderma, Spondyloarthropathy, vasuclitis and anti synthetase syndrome. Baseline autoimmune disease activity was categorized as : no activity (8), low (11), and moderate (3). Sixteen patients were taking immunesuppresants and 16 corticosteroids,3 of them at low doses. Denge was classified as: without alarm symptoms (10) and with alarm symptoms (11). One patient had severe Dengue. Eighteen patients (81%) had complete resolution of infection without worsening of baseline autoimmune disease, one had disease reactivation and one had new organ involvement, which was a CV A in a Rhuematoid arthritis patient. Complications related to Dengue included: thrombocytopenia with mucosal bleeding in a SLE patient with favorable outcome and a CN S hemorrage in a rheumatoid patient who died. Evaluation of autoimmune disease 15-30 days post infection revelaed no activity in 9 patients, baseline activity in 9 patients and exacerbation in 1patient. Sixteen patients had follow up at 3 months of which 7 had no activity, 7 had baseline activity and 2 had SLE exacerbation: one hematologic and one cutaneous. Conclusion: This case review established that despite having one death, acute dengue infection in patients with autuoimmune disease had a low rate of complications. Follow up revealed that most patients did not have baseline autoimmune disease worsening or reactivation. There was only one case of new organ involvement. Even though this is a small case series, we can conclude that immunesuppresant therapy used for autoimmune disease did not predispose these patients to more severe forms of the infection.