Infections and lupus

Lupus Foundation of America

Resource Content

Infections pose a greater risk for people living with lupus. In fact, infections are the second most common major cause of illness and death for people with the disease.

Both lupus itself and some of the medications used to treat it—especially immunosuppressants such as prednisone and Cytoxan®—can leave people vulnerable to the common cold and strains of influenza and to “opportunistic infections” that occur after bacterial contact, such as pneumonia, urinary tract infections, strep throat, and thrush. Infections that develop from minor cuts and sores are also more common when there is an underlying autoimmune disease like lupus.

Infection risk factors

People with higher lupus disease activity, lupus kidney disease, or other related health complications are especially susceptible to infections—and it often takes them a long time to recover from their infections. This is partly because lupus causes the hyperactivity of certain immune cells, creating antibodies that are destructive to the immune system itself, says Diane L. Kamen, MD, MS, an assistant professor of medicine in the Division of Rheumatology at the Medical University of South Carolina.

“Treatment can get complicated as a result because you may need to take immune-suppressing medications to control your lupus,” she says, yet drugs like prednisone, azathioprine, mycophenolate mofetil, and other common immunosuppressant prescriptions can leave you vulnerable to bacteria, viruses, and other foreign agents.

Sherrie Geisler, 52, an account manager from Antioch, IL, sees a connection between her recurrent infections and lupus. It was her inability to recover from health problems over the past decade, including burning foot pain, herpes-like sores, and upper-respiratory infections, that prompted her to seek out the specialist who diagnosed her lupus.

Geisler says she was baffled and in constant pain until her diagnosis two years ago. Now taking a combination of medication and herbal supplements, she says she still gets sick but is better able to manage the symptoms.

Opportunistic infections

Opportunistic bacterial infections pose a special danger for people with lupus. Even small wounds take longer to heal, as Kristina Hayes discovered after a car accident in November 2011 left her with an injured toe. “It was torn up pretty badly and still hasn’t healed yet,” says Hayes, 24, a recent college graduate from Clifton, NJ. “My doctor says it’s just the lupus interfering, since the only medication I’m on is a low dose of prednisone. Every time my toe is almost healed, I get another infection.”

Hayes, who was diagnosed with lupus in 2007, notes that not only do cuts and sores take longer to heal, but she gets bronchitis, the flu, and colds more often, and more aggressively.

Steps for staying healthy

To help prevent such problems, Kamen recommends immunization against viruses such as influenza. She suggests people with lupus opt for non-live vaccines and avoid live versions, which may cause complications for those with compromised immune systems. “We’re usually talking about people currently taking higher doses of prednisone or biologics,” she says, although the effect of live vaccines on people with lupus hasn’t been fully studied. “They might be safe, but we need more information.” 

A healthy lifestyle is also important. “The foundation of staying healthy is to eat a good diet, cut out junk food, get enough sleep, and focus on stress management as much as possible,” Kamen says. She recommends talking to your physician about taking a daily vitamin D supplement to help counteract limited sun exposure.

Natural remedies help Geisler ward off infection. She uses vinegar to treat fungal infections on her feet and a probiotic for irritable bowel syndrome, under the supervision of her doctor. She also uses paraben-free cosmetics and body products to help reduce allergens that trigger immune response.