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  1. 1. Microbiologist-Member of young researcher club & iranian Society of Microbiology
  2. 2. Introduction Autoimmune diseases arise from an inappropriate immune response of the body against substances and tissues normally present in the body. In other words, the immune system mistakes some part of the body as a pathogen and attacks its own cells. This may be restricted to certain organs (e.g. kidney,lung,heart and etc..) or involve a particular tissue in different places .The treatment of autoimmune diseases is typically with immunosuppression—medication which decreases the immune response. Lupus is an autoimmune disease
  3. 3. What Is Lupus? Lupus is a lifelong disorder of the immune system. Immune cells attack the body's own healthy tissues, leading to inflammation and tissue damage. Symptoms may be limited to the skin, but more often lupus also causes internal problems such as joint pain. In severe cases, it can damage the heart, kidneys, and other vital organs. Although there's no cure, there are treatments that can minimize the damage.
  4. 4. Joint Pain Joint and muscle pain is often the first sign of lupus. This pain tends to occur on both sides of the body at the same time, particularly in the joints of the wrists, hands, fingers, and knees. The joints may look inflamed and feel warm to the touch. But unlike rheumatoid arthritis, lupus usually does not cause permanent joint damage
  5. 5. Butterfly Rash A tell-tale sign of lupus is a butterfly-shaped rash across the cheeks and bridge of the nose. Other common skin problems include sensitivity to the sun with flaky, red spots or a scaly, purple rash on various parts of the body, including the face, neck, and arms. Some people also develop mouth sores
  6. 6. Nail Changes Lupus can cause the nails to crack or fall off. They may be discolored with blue or reddish spots at the base. These spots are actually in the nail bed, the result of inflamed small blood vessels. Swelling may also make the skin around the base of the nail look red and puffy.
  7. 7. Fever and Fatigue Most people with lupus experience some degree of fatigue. In many cases, it is severe enough to interfere with exercise and other daily activities. Most patients also run a low-grade fever from time to time. This unexplained fever may be the only warning sign in some people
  8. 8. Light Sensitivity Many people with lupus are unusually sensitive to the sun and other forms of ultraviolet light (such as tanning beds.) A day at the beach may trigger a skin rash in areas exposed to sunlight and may worsen other lupus symptoms. Certain medications can make people with lupus even more sensitive to UV light.
  9. 9. Hair Loss The symptoms of lupus tend to come and go, and this includes hair loss. Patients may go through periods where their hair falls out in patches or becomes thinner all across the scalp. Once the flare-up is over, new hair is likely to grow in evenly
  10. 10. Raynaud's Some people with lupus develop a condition called Raynaud's phenomenon. Their fingers and toes become painful, numb, and tingly in response to cold temperatures or emotional stress. This happens when small blood vessels spasm and restrict blood flow to the area. During an attack, the fingers and toes may turn white or blue. People can also have Raynaud's without having lupus or any serious health complications
  11. 11. When lupus begins, it can look a lot like rheumatoid arthritis, which causes joint pain and swelling, or fibromyalgia, which causes fatigue and pain. One aspect that sets lupus apart is the combination of skin rashes with joint pain and fatigue. There are also lab tests that can help distinguish lupus from other diseases
  12. 12. Diagnosing lupus can be tricky. The disease can mimic other conditions, and it often takes a different course in different people. Many people have it for years before developing tell-tale symptoms. Although there is no one test for lupus, certain proteins usually show up in a patient's blood. A blood test for antinuclear antibodies (ANAs) can provide a critical clue. Other lab tests may check cell counts, kidney function, and clotting time. A tissue biopsy of an involved organ such as the skin or kidneys sometimes helps with diagnosis Diagnosing Lupus
  13. 13. Who Gets Lupus? Anyone can get lupus. But it affects women 10 times more often than men. Aside from being female, your odds of getting the disease are higher if you are: •African-American, Latino, or Asian •Between the ages of 20 and 40 •Related to someone with lupus
  14. 14. Types of Lupus When people say "lupus," they usually mean systemic lupus erythematosus (SLE), the most common and serious type. But there are other types. Cutaneous lupus erythematosus – also called discoid lupus -- is limited to the skin and doesn't cause the organ damage that sometimes occurs with SLE. The most common symptom is a circular rash. Drug- induced systemic lupus causes temporary lupus symptoms in people who take certain medications.
  15. 15. Medical Treatments for Lupus There are ways to control the symptoms of lupus. These include corticosteroid creams for rashes and nonsteroidal anti-inflammatory drugs (NSAIDs) for joint pain and fever. Antimalarial medications can help fight joint pain, ulcers, and rashes. Corticosteroids may also be given as pills. In severe cases, they can be given intravenously. People with severe lupus may benefit from drugs that suppress the immune system. Care for Lupus Making some changes to your routine can also help reduce lupus flare-ups: •Cover up when you're in the sun. •Don't smoke. •Exercise regularly. •Improve your stress management skills. Also be sure to get plenty of rest. Some people with lupus need up to 12 hours of sleep a night.
  16. 16. Lupus and Kidney Problems As lupus progresses, it can interfere with the body's organs. Up to three out of four people with lupus can develop kidney problems. These problems may not cause symptoms, though some people notice swelling in their legs or ankles. Most patients only learn about their kidney trouble when a urine test reveals blood or abnormal protein levels.
  17. 17. Lupus and Heart Problems The most common heart problem linked to lupus is an inflammation of the sac around the heart. This may cause severe pain in the left side of the chest. People with lupus are also more likely to develop plaques that narrow or clog the arteries. This can lead to coronary artery disease. Other complications include heart valve disease and inflammation of the heart muscle. Call 911 immediately for chest pain, rather than trying figure out the cause yourself
  18. 18. Lupus and Lung Problems The tissue surrounding the lungs becomes inflamed in about a third of people with lupus. This may lead to painful breathing, or chest pain, or it may not cause any symptoms at all. Sometimes lupus causes chest pain that is not related to the lungs or the heart. Instead, the pain comes from an inflamed chest muscle or rib joint. Any chest pain should be promptly evaluated by a doctor
  19. 19. Lupus and Digestive Problems Digestive problems are not common with lupus, but some people may experience belly pain, nausea, vomiting, difficulty swallowing, or inflammation of the liver or pancreas. This can be related to lupus itself or medications used to treat the disease. Some people tend to lose weight during lupus flare-ups.
  20. 20. Lupus and Anemia Lupus and the medications used to treat it can contribute to anemia in some patients. This means the body has too few red blood cells, because it is not making enough, or red blood cells are being destroyed more quickly than they can be replaced. Symptoms include fatigue and shortness of breath.
  21. 21. Lupus and the Nervous System Lupus can trigger a wide range of problems with the nervous system, most commonly headaches. Mild memory problems are a less common complaint that may come and go over time. Some people with lupus have a greater risk for a stroke, and in rare cases, the disease can lead to seizures.
  22. 22. Lupus and Mental Health Depression and anxiety are a risk for people with lupus. This may be the result of the condition's affect on the nervous system combined with the emotional strain of coping with a chronic illness. Be sure to discuss any concerns about your mood with your doctor or other health care provider. There are highly effective treatments for depression and anxiety
  23. 23. Lupus and Pregnancy Most women with lupus can get pregnant, though the condition increases the risk of complications during pregnancy. Because lupus symptoms come and go, the best time to get pregnant is when symptoms are at a minimum. Women who conceive when symptoms are in remission are less likely to have complications. Make sure your obstetrician knows you have lupus. Your medications may be modified and you may undergo extra monitoring to ensure a successful pregnancy.
  24. 24. Neonatal Lupus Most babies born to women with lupus are entirely healthy. But in rare cases, the newborn of a mom with lupus may have neonatal lupus. This condition can cause a skin rash, anemia, or liver problems. The symptoms usually go away after a few months and don't cause permanent damage. However, some babies with neonatal lupus can be born with a serious heart problem.
  25. 25. Why Do People With Lupus Get Infections So Easily? An individual with lupus is more susceptible to infection than most people for two reasons:
  26. 26. 1. Lupus directly affects a person's immune system and reduces his or her ability to prevent and fight infection. 2. Many of the drugs used to treat lupus suppress the function of the immune system and leave the body more prone to infection.
  27. 27. Effects Of Medications Used In The Treatment Of Lupus
  28. 28. Cortisone-like drugs (prednisone) and cytotoxic drugs such as azathioprine (Imuran) and cyclophosphamide (Cytoxan) increase a person's susceptibility to infections because they suppress both normal and abnormal immune system function. However, controlling lupus is usually more important than the danger posed by a possible infection due to the use of immunosuppressive medications
  29. 29. The risk of infection parallels the dose and the duration of treatment with steroids: a. a daily dose of 20 mg. of prednisone is enough to impose a significant risk of infection b. taking steroids every other day ("alternate day" treatment) decreases the risk and incidence of infections
  30. 30. Direct Effects of Lupus On The Immune System
  31. 31. People with lupus have abnormalities in their immune systems, so they are more likely to develop infections. They are more susceptible to infection even if they do not take corticosteroids. Lupus experts such as Dr. Marian Ropes sparingly used steroids in treating her patients in the 1940s and 1950s. Yet, the data she published showed that the majority of her patients developed serious infections, even on low-dose steroids.
  32. 32. Types Of Infection In SLE Infections in people with lupus fall into two categories.
  33. 33. a. The first category includes infections with organisms that can affect persons with lupus and the general population: - streptococcus (which causes strep throat) - staphylococcus (which causes staph infections). b. The second category consists of "opportunistic" infections, which are caused by organisms that bring about disease only when the immune system is weakened
  34. 34. Fortunately, only a few individuals will need aggressive hospital treatment for infections. The most common infections in people with lupus usually do not require hospitalization. These common infections usually involve: the respiratory tract the urinary tract
  35. 35. However, infections in people with lupus tend to last longer and require a longer course of treatment with antibiotics than infections in people who do not have lupus. In addition, people with lupus are at an unusually high risk for contracting: salmonella (a bacteria)herpes zoster (a virus)candida (yeast)
  36. 36. Fevers In Lupus Anyone with lupus who experiences a fever should be thoroughly evaluated, especially if they are also taking aspirin, non-steroidal medications (e.g., Advil, Naprosyn), or steroids, which lower body temperature. Fevers in lupus may be due to: an infection a drug reaction active lupus
  37. 37. Laboratory testing for infection White blood cell counts this test can help a physician distinguish an infection from a lupus flare - a low white blood cell count usually suggests active lupus (although certain viruses can also give a low white count) - a high white blood cell count suggests infection Culture of throat, urine, blood or stool Complete blood count (CBC) Chest X-ray
  38. 38. Treatment and Prevention of Infection The treatment of infections in a person with lupus is basically the same as for anyone else; even people taking high doses of immunosuppressive medications for their lupus may respond well to antibiotics. However, the use of sulfa antibiotics to treat infections in people with lupus should be avoided whenever possible. Thirty percent of people with lupus are allergic to sulfa antibiotics. In addition, these types of antibiotics can: increase photosensitivity increase skin rashes lower white blood cell counts.
  39. 39. Living with Lupus The fatigue and joint pain associated with lupus can make it more difficult to do your job or care for your children. You may have to cut back on activities or ask for help when symptoms flare up. But most people with lupus are able to continue with their usual activities.
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  44. 44. END