Львівський клінічний вісник (Dec 2017)
Herpesviruses in Patients With Systemic Lupus Erythematosus (Literature Review and Clinical Cases Description)
Abstract
Introduction. Systemic lupus erythematosus is one of the autoimmune diseases prevailing in women of reproductive age and is, quite often, the cause of their disability. In recent years, the attention of researchers has been focused on clarifying the role of herpesviruses in origin, pathogenesis, the ability to influence the clinical and laboratory signs, course and prognosis of the disease. The aim of our study was to make an overview of the modern literature on the role of herpesviruses in patients with systemic lupus erythematosus and describe two clinical cases from our own practice. Materials and methods. The content analysis, method of the system and comparative analysis, the bibliosemantic method of study of the actual scientific researchers concerning the role of herpesviruses in the patients with systemic lupus erythematosus were used. Results. The analysis of the modern literature shows the important role of herpesviruses in the initiation, pathogenetic mechanisms, exacerbation and the course of systemic lupus erythematosus. The herpesviruses that are pathogenic to humans are the herpes simplex virus type 1 and type 2, the chicken pox virus, cytomegalovirus, the herpesvirus type 6, the herpesvirus type 7, M. I. Epstein-I. Barr virus and herpesvirus type 8. Viral infections cause the significant immunological disorders that contribute to the occurrence of various, often nonspecific clinical signs, which in turn are of the complex diagnostic problems for the clinicians, since they can be considered as symptoms of exacerbation of systemic lupus erythematosus or clinical manifestations of infections. Herpesviruses infections in such patients in many cases cause the deterioration of the course of the disease, lead to the increase of the frequency of the disease exacerbation and the increase of the doses of the immunosuppressive drugs. Additional laboratory and instrumental investigations of the presence of herpesviruses in patients with systemic lupus erythematosus are not often used in practice, and the prescribing of the immunosuppressive treatment often worsens the prognosis of such patients. For the examination of the patients with systemic lupus erythematosus with suspected infections and fever, it is necessary to detect not only the general bacterial infections (usually urinary and respiratory tract infections) but also the opportunistic viral infections, especially in those receiving immunosuppressive treatment; to carry out a survey of persons suspected of having systemic lupus erythematosus, to detect, in the first place, the most common viral infections described in the patients with the presence of the disease or in the persons with confirmed systemic lupus erythematosus, which are manifested by a fever without any clear indication of its exacerbation; to conduct a complex clinical and laboratory, and, if necessary, an instrumental examination in order to exclude the infection. The appropriate use of antiviral drugs, interferons and immunoglobulins are recommended for the complex treatment of patients with systemic lupus erythematosus with herpesviruses. In both our clinical cases, we have not previously detected viral infections that negatively affected the course of the disease, and our optimization of the complex treatment with the inclusion of antiviral drugs has had a positive effect. Conclusions. An overview of the modern literature and clinical presentations from our own practice suggest that herpesviruses, in particular, cytomegalovirus and the M. E. Epstein-I. Barr virus may be as risk factors for the systemic lupus erythematosus, its causes, triggers, one of the pathogenetic mechanisms, especially in those who are genetically predisposed. The similarity of clinical manifestations of polysyndromic disease, with a lesion of various organs in a patient with systemic lupus erythematosus, and herpesviruses infections significantly complicates the determination whether there is only an infection that is primary or chronic in the phase of exacerbation and clinically similar to systemic lupus erythematosus, or clinical symptoms in the patients with already diagnosed systemic lupus erythematosus are caused by the acute infection, exacerbation of chronic infection, or exacerbation of the systemic lupus erythematosus, which requires us to deepen our knowledge about the role of herpesviruses in patients with systemic lupus erythematosus, especially in the occurrence of comorbidities, isolating from them syntropic lesions of internal organs.
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