The other patient, whose SLE was not active (SLEDAI 4), had active infection with HHV-7, but also had active HCMV infection (identified as the 12th patient in Table 3). 8600 Rockville Pike https://doi.org/10.1128/CMR.00052-13. Consent of the patient or guardian authorizing the collection of the serum sample for the study; 3. Women in general are much more likely to have lupus than men, says Dr. Stojan. It was observed that in patients with active SLE (SLEDAI equal to or greater than 8), HHVs-DNA detection in the DNA extracted from the serum samples occurred more frequently, and this difference was statistically significant between the serum samples extracted from the DNA of patients without active SLE (SLEDAI <8), p<0.0001 (Table2). To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. and transmitted securely. herpes simplex virus; keratitis; meningoencephalitis; systemic lupus erythematosus. Certain gene mutations have also presented a link, such as TREX1, but theyre quite rare and not all patients have them, says Dr. Stojan. In other words, severe HSV infection was nearly four times more frequent in the lupus group than in healthy individuals. : There is no correlation. HZ, herpes zoster; SLE, systemic lupus erythematosus. Pope JE, Krizova A, Ouimet JM, Goodwin JL, Lankin M. Close association of herpes zoster reactivation and systemic lupus erythematosus (SLE) diagnosis: Case-control study of patients with SLE or noninflammatory nusculoskeletal disorders. Suite 700 Clinics. Serum samples were collected from 71 SLE patients and their DNAs were extracted and analyzed to detect HHV-DNA viruses using the nucleic acid amplification technique. Part of The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. Lupus is a disease that occurs when your body's immune system attacks your own tissues and organs (autoimmune disease). Chronic treatment with hydroxychloroquine and SARS-CoV-2 infection. The present study was supported by grants from the Guangdong Technology Project (grant nos. Fertility Medicine 31 years experience. Author(s) (or their employer(s)) 2019. Federal government websites often end in .gov or .mil. Infections with human herpesvirus 6 (HHV-6 A/B), and more rarely human herpesvirus 7 (HHV-7), result in exanthem subitum in infants, whereas primary infections with HHV-6A are generally asymptomatic [12]. They found that patients with an early but non-severe infection, those given intravenous steroid pulse therapy, and those receiving a daily oral dose of greater than 7.5mg of prednisolone were at a2.3-, 5.3-, and 1.59-times higher risk for developing a severe HSV infection, respectively. Unfortunately you will need to go to see your doctor. Terms and Conditions, sharing sensitive information, make sure youre on a federal You can technically predict it based on these changes in atmospheric factors 10 days prior to the time the patient shows up for their clinic visit, he says. The resulting DNA was eluted in 20L of TE-buffer. The active and non-active SLE data described in the study were collected from the patients medical records. Here, the possible causes of lupus that researchers are digging intoand what treatment looks like once someone is diagnosed. The site is secure. However, Dr. Stojan emphasizes that exposure to Epstein-Barr does not guarantee the development of lupus. Ayala Gutirrez MDM, Rubio-Rivas M, Romero Gmez C, Montero Sez A, Prez de Pedro I, Homs N, Ayuso Garca B, Cuenca Carvajal C, Arnalich Fernndez F, Beato Prez JL, Vargas Nez JA, Letona Gimnez L, Surez Fernndez C, Mndez Bailn M, Tun de Almeida C, Gonzlez Moraleja J, de Guzmn Garca-Monge M, Helguera Amezua C, Fidalgo Montero MDP, Giner Galva V, Gil Snchez R, Collado Senz J, Boixeda R, Ramos Rincn JM, Gmez Huelgas R, On Behalf Of The Semi-Covid-Network. Levin MJ, Smith JG, Kaufhold RM, Barber D, Hayward AR, Chan CY, Chan IS, Li DJ, Wang W, Keller PM, et al. PMC One or more painful, fluid-filled blisters may appear. Compared with patients without complications, patients with complications of HZ demonstrated a significantly higher percentage of lymphopenia (63.6 vs. 28.6%; P=0.04) and more abnormal hematologic findings (100 vs. 28.6%; P<0.001). Bone Marrow Transplant. There are no known concrete causes or cures. Risk of severe herpes simplex virus infection in systemic lupus Of note was the lower prevalence than that reported from other Asian regions. As presented in Table I, the majority of patients with HZ were female (95.7%) and mean age at the diagnosis of SLE was 35.014.0 years (range, 1875 years). 1; 126 (9):3165-75. doi: https://doi.org/10.1172/JCI84418. Lupus and Epstein-Barr. In total, 42 of the 46 patients (91.3%) were undergoing GC treatment at the time of HZ onset, at a mean equivalent dose of 34.838.4 mg (range, 5200 mg) prednisone. DNA virus detection in serum can be very useful for the clinical assessment of patients with SLE and for monitoring the diseases progression, which is important for clinical practice so as to avoid unnecessary immunosuppressive treatments and allow a better prognosis. Yalcin S, Karpuzoglu T, Suleymanlar G, Mutlu G, Mukai T, et al. Human herpes simplex virus infections: epidemiology, pathogenesis, symptomatology, diagnosis, and management. https://doi.org/10.1097/BOR.0b013e3283535801 Review. The present study demonstrated that lymphopenia led to a risk of HZ infection and serious complications concomitant with HZ in patients with SLE. The frequencies of other active viral infections were 22% for HSV-1, 16.7% for HHV-7, and 5.5% for HSV-2. Learn how we can help 4.9k views Reviewed >2 years ago Detection of Cytomegalovirus infection by PCR in renal transplant patients. This study detected the presence of HSV-1 and HHV-2-DNA in 5/71 patients (7%) in total, of whom 2/5 (40%) had active SLE disease. Can lupus cause testical pain? | HealthTap Online Doctor Mal Infect. In SLE reports, these HHV rates can achieve high levels, close to 90%. April 29, 2019. HHV-7 and HCMV coinfection and immune modulation are important factors for this virus pathogenic potential [48]. grace Helpful - 0 Comment sara176 Cohen EJ. FOIA the contents by NLM or the National Institutes of Health. Table3 presents the patients HHV test results and correspondent SLEDAI score and clinical symptoms in case of positive HHV-DNA. 2012;245(1):189208. The pulmonary manifestation of HCMV disease, SLEDAI 10, was responsible for the death of this patient, showing the importance of medical monitoring to avoid the aggravation of SLEDAI score. Herpes Zoster (HZ), which is a form of recurrent infection of varicella zoster virus (VZV), typically occurs decades after an instance of childhood VZV attack (1). Manzi S, Kuller LH, Kutzer J, Pazin GJ, Sinacore J, Medsger TA, Jr, Ramsey-Goldman R. Herpes zoster in systemic lupus erythematosus. All patients that the samples were included in this study have signed the written informed consent form at the beginning of the study allowing the usage of this material. Demographic data, clinical characteristics and administered treatments were compared between SLE patients with and without HZ (Table I). Genital herpes - Symptoms and causes - Mayo Clinic Demographic information, clinical and laboratory data, and medications used were collected and analyzed. Steininger C. Novel therapies for cytomegalovirus disease. Furthermore, compared with healthy individuals, patients with SLE and HZ have a greater tendency to develop cutaneous and visceral dissemination of lesions (7), which are significantly associated with a poor prognosis (7,8). Dr. Gerard Honore answered: "No: Gardasil does not cause herpes. varicella, herpes zoster (Zostavax) live attenuated influenza vaccine (LAIV) - however, a killed vaccine is available. HHS Vulnerability Disclosure, Help 2005;174(11):6599607. In addition, HZ was demonstrated to be an early complication of SLE, with the highest risk of HZ within 36 months following SLE diagnosis. The curiously suspicious: a role for Epstein-Barr virus in lupus. Mod Rheumatol. Nagasawa et al (22) suggested that the high incidence of HZ in patients with SLE was likely due to defects in CMI. Clin Microbiol Rev. 1. Data are presented as the mean standard deviation unless otherwise stated. lupus and genital herpes | Autoimmune Diseases discussions | Body Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. Gross AJ, Hochberg D, Rand WM, Thorley-Lawson DA. The committee on prognosis studies in SLE. How common are mouth ulcers in lupus? Ng WL, Chu CM, Wu AK, Cheng VC, Yuen KY. Lymphopenia at presentation is associated with increased risk of infections in patients with systemic lupus erythematosus. Clin Diagn Virol. Table 1 shows the characteristics of the 71 patients included in the study. Alex Domingos Reis, Cristiane Mudinutti and Murilo de Freitas Peigo contributed equally to this work. Herpes Zoster (HZ), which is a form of recurrent infection of varicella zoster virus (VZV), typically occurs decades after an instance of childhood VZV attack ().Furthermore, compared with healthy individuals, patients with SLE and HZ have a greater tendency to develop cutaneous and visceral dissemination of lesions (), which are significantly associated with a poor prognosis (7,8). In fact, Salmonella is the most common cause of septic arthritis in younger SLE patients [ 140 ]. Its probably a perfect storm that occurs and leads to the occurrence of the disease, says Dr. Stojan. Experts are. Another notable finding was the higher prevalence of complications of HZ among the present cohort than that based on general population. Patients with SLE are at higher risk of severe HSV infection, and related risk factors include being older than 18 years, having a history of HSV mucocutaneous infection, recent receipt of steroid pulse therapy and a daily oral dose of steroid over 7.5 mg prednisolone. Clipboard, Search History, and several other advanced features are temporarily unavailable. Lymphopaenia, anti-Ro/anti-RNP autoantibodies, renal involvement and cyclophosphamide use correlate with increased risk of herpes zoster in patients with systemic lupus erythematosus. 2006;52(5):3525. Human herpesvirus 6 and human herpesvirus 7 infections in renal transplant recipients and healthy adults in Turkey. Herpesvirus (HHV) infections in patients with systemic lupus erythematosus (SLE) are an important cause of morbidity and mortality [1,2,3,4,5,6]. J Clin Med. Herpes infection can cause sores or breaks in the skin or lining of the mouth, vagina, and rectum. Gershon AA, Gershon MD. Iqra Mumal, MSc Lupus blister, or herpes blistersI i have systemic lupus and CAS Problems with the . In the majority of patients (67.4%; 31/46), HZ was diagnosed within 36 months following SLE diagnosis, and rates reduced thereafter. Salmonella can cause disseminated infections in lupus patients leading to bacteremia, septic arthritis, pneumonia and soft-tissue infections [136,138,139]. However, few attempts to analyse the associated incidence and risk factors have been made. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Therefore, these factors may act as predictors for the occurrence of HZ in patients with SLE. 2023 BioMed Central Ltd unless otherwise stated. The dermatome occurred in trigeminal regions in 2 instances (2/48, 4.2%), 1 in the inner corner of the eyelids and 1 on the tip of the ear. Transplantation. This transversal study was undertaken to determine the frequency of HHV infections in patients with SLE using the Nested PCR (NPCR) technique, and to evaluate the laboratorial findings with disease activity. A total of 10 patients (21.7%) were ultimately treated with intravenous ganciclovir due to clinical resistance to acyclovir. However, the connection is strong and well-studied: People who are exposed to silica at work (say, in mining or glass production) have a two to five times higher risk of lupus. Google Scholar. White DW, Beard RS, Barton ES. Ospina FE, Echeverri A, Zambrano D, Suso JP, Martnez-Blanco J, Caas CA, Tobn GJ. 8 Possible Triggers of the Autoimmune Disease, Fiona Phillips Reveals Alzheimers Diagnosis, nearly 1.5 million Americans who live with some form of lupus, according to the Lupus Foundation of America, Lupus presents a wide variety of symptoms, 65 percent of lupus patients say chronic pain. In other words, these were all found to be independent risk factors for severe HSV infection. What causes lupus? Epub 2020 Sep 10. This provides a way for HIV to enter the body. It was hypothesized that a study of HZ in patients with SLE in Southern China may help increase the awareness of the extent and natural history of this disease in the region, assess therapeutic strategies on higher risk patients with HZ, and identify any subgroup(s) of patients who may benefit the most from the new zoster vaccine. Eilertsen G, Becker-Merok A, Nossent JC. PubMedGoogle Scholar. Its certainly possible but having these antibodies alone doesnt mean somebody will develop lupus in the future.. The monitorization of SLE patients avoiding deleterious manifestations of the disease by seeking for a balance of SLE manifestations and the immunological status of the patient associated to the immunosuppressors intake, may propitiate a reduction of the SLE manifestations and allows the immunological response reduce the HHV infection risks and, consequently, lower the risk of death and morbidities [37]. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Herpes would come years later, and with RA and Lupus, it almost killed me. CMV PCR monitoring in leukocytes of transplant patients. Furthermore, lymphopenia was considered as an independent risk factor for severe HZ in patients with SLE. Article Please enable it to take advantage of the complete set of features! Chang YS, Liu CJ, Chen WS, Lai CC, Wang SH, Chen TJ, Tzeng CH, Tsai CY, Wang SJ. Her research has ranged from across various disease areas including Alzheimers disease, myelodysplastic syndrome, bleeding disorders and rare pediatric brain tumors. Human herpesvirus-7 in Brazilian liver transplant recipients: a follow-up comparison between molecular and immunological assays. 2009;38(3):24952. Conclusions: Pan Afr Med J. Neutropenia was defined as a total neutrophil count <1.5109/l. In addition, those with lymphopenia may benefit most from vaccination for HZ. Second of all you are aware that HPV virus is easily spread but the most common way of getting it is usually unprotected sex. Period. government site. Yet for people with lupus, in some cases, vaccines can trigger a lupus flare. The degrees of immunosuppression were estimated according to the protocol of the University of Campinas Rheumatology Service: 0 No immunosuppression=prednisone concentrations lower than 5mgkg/day; 1 Low Immunosuppression=prednisone concentrations greater than or equal to 5mgkg/day and less than 30mgkg/day; 2 Moderate Immunosuppression=prednisone concentrations greater than or equal to 30mgkg/day and less than or equal to 59mgkg/day; 3 High Immunosuppression=prednisone dosage greater than or equal to 60mgkg/day and/or dosage of the following drugs: azathioprine, cyclophosphamide, methotrexate and methylprednisolone (pulse therapy) [26]. Received 2016 Jan 5; Accepted 2017 Sep 7. and transmitted securely. Systemic lupus erythematosus (SLE) patients are a higher risk for severe herpes simplex virus (HSV) infection, but younger age seems to be a protective factor, a study from Taiwan suggests. This type of antibiotic should be avoided wherever possible. Measures of disease activity and damage in SLE. Results indicated that more SLE patients develop severe HSV infection (0.5%) compared to controls (0.2%). Systemic lupus erythematosus (SLE) is an autoimmune disease, can cause various co-morbidities resulting in impaired quality of life. Clin Exp Rheumatol. These more severe forms spread quickly and are associated with poorer outcomes if not diagnosed and treated on time. Only 2 of these 7 patients with postherpetic neuralgia had a course longer than 12 months. These ulcers are almost always. There are two types of these lesions: those that do not correlate with active disease (more frequent) those associated with active disease Therefore, the direct involvement of the oral cavity by lesions of lupus in the mouth may indicate active disease. 1998;12(3):40513 Baillieres. Rheumatology. Laboratory analysis of the serum samples collected from the SLE patients for detection of the presence of HHVs-DNA. A handful of gene variations have been linked to the development of lupus, and most are thought to be involved in immune system function, according to the U.S. National Library of Medicine. They are in various parts of my body.two behind each knee, one on my arm. Active SLE was considered when the patients SLEDAI was greater than or equal to 8, as recommended by the American College of Rheumatology and internal protocols [16,17,18]. Of these positive HHV results, 26.6% had HSV-1-DNA; 1/15 (6.6%) had HSV-2-DNA; 6/15 (40%) had HCMV-DNA; and 20% had HHV-7-DNA. Nagasawa K, Yamauchi Y, Tada Y, Kusaba T, Niho Y, Yoshikawa H. High incidence of herpes zoster in patients with systemic lupus erythematosus: An immunological analysis. Researchers in Taiwan conducted a retrospective nationwide cohort study to investigate the incidence and risk factors of severe HSV infections in people with SLE. A likely molecular mimicry between EBV antigens and those targeted in SLE combined with increased seroconversion to EBV is also suggested, indicating higher viral reactivation in patients with SLE [38]. Cinque P, Brytting M, Vago L, Castagna A, Parravicini C, et al. To the best of our knowledge, the present study is the first from Southern China to focus on SLE patients with HZ infection. Cite this article, A Correction to this article was published on 11 September 2020. Razonable RR, Paya CV. National Library of Medicine all the acyclovir in the world won't help with non-herpes problems. PubMed Risk factors predisposing SLE patients to HZ infection are not well established. It is important to note that HHVs are ubiquitous viruses, HCMV being present in almost 100% of adults in developing countries (based on seroprevalence). These medications have been shown to prevent flares by 50 percent and ultimately help patients live longer, says Dr. Stojan. PubMed A total of 20 patients (43.5%) received high-dose GC therapy, and the remaining 22 patients received low-dose GC therapy. Another option is corticosteroids, which are typically administered to help patients work through a flare, since the drug works quickly. Yes. Horn J, Mullholand JB, Ashraf S, Shore D, Van de Louw A. Front Microbiol. Of the four patients with SLEDAI 8, two with HHV-7-DNA, one with HSV-1-DNA and one with HSV-2-DNA, none showed any HHVs symptoms (SLEDAI 8, 10, 12 and 9, respectively). Lupus and the digestive system - Lupus Foundation of America Laboratorial screening to detect HHV-DNA using NAAT can be a tool for obtaining a more accurate diagnosis and a better prognosis, which may lead to a more suitable use of antiviral therapy. Several studies reposted a possible modulation of the immune system by EBV, which would cause an increase in the autoimmune activity [40,41,42,43,44]. The clinical utility of CMV surveillance cultures and antigenemia following bone marrow transplantation. The aim of the present study was to investigate the clinical features, complications, and potential risk factors of HZ in patients with SLE from Southern China. From the initial diagnosis of SLE, patients were subsequently followed-up until the occurrence of HZ. Lupus tends to cluster in families. Created for people with ongoing healthcare needs but benefits everyone. . 2002;8(8):6518. The ultraviolet light can both induce mutations in certain genes that then become unrecognized by the immune system and become targets, leading to lupus rashes, he explains. They used data on 122,520 people including24,504 patients and 98,016 age- and sex-matched healthy controls from the National Health Insurance Research Database (NHIRD) in Taiwan. If you have a fever of 100 degrees Fahrenheit (F), or 37 degrees Celsius, or higher, you should contact your doctor right away. Seventy-one patients aged from 18 to 62years old, with SLE, who were treated in the Rheumatology Service of the University of Campinas Clinical Hospital between September 2007 and April 2009, in any stage of treatment, were included in this study. CAS Fatahzadeh M, Schwartz RA. Can herpes cause testical pain? Viral coinfection (two or more viruses detected in the same sample) occurred in three patients (16.7%). NAAT (nucleic acid amplification test) was chosen for detection of the herpesvirus in the DNA samples (active infection). All procedures performed in this study were in accordance with the ethical standards for research involving human beings of the institutional ethical committee of State University of Campinas and Brazilian national research committee, and with the 1964 Helsinki declaration and its later amendments. Advances in Rheumatology If signs (what you see) or symptoms (what you feel) occur, a person may experience: Tingling, itching, or burning. Variables associated with the onset of HZ complications, i.e., lymphopenia and SLEDAI scores, were included in the multivariate logistic regression model. What You Can Do Doctors don't know exactly what causes lupus. Tanaka Y, Seo R, Nagai Y, Mori M, Togami K, Fujita H, Kurata M, Matsushita A, Maeda A, Nagai K, Kotani H, Takahashi T. Systemic lupus erythematosus complicated by cytomegalovirus-induced hemophagocytic syndrome and pneumonia. The following variables were found to be risk factors for the development of HZ in patients with SLE in multiple analysis: Lymphopenia (OR=4.6; 95% CI=1.513.8; P=0.006) and high-dose GC therapy (OR=4.3; 95% CI=1.611.7; P=0.004). Inflammation caused by lupus can affect many different body systems including your joints, skin, kidneys, blood cells, brain, heart and lungs. Arch Virol. All data were collected from clinical reports stored in the medical clinical reports service of the Clinical Hospital of the State University of Campinas to evaluate their correlation with positive HHV-DNA, e.g., SLEDAI, hospitalization and symptoms, allowing the inference of a diagnostic status. The incorrect author name is: Alex Domingos dos Reis. ADR, CM, MFP and SHAB designed the experimental procedure and conducted the data analysis, having also drafted and proofread the manuscript; LTLC, CLR, SCBC and LLL reviewed the design of this study and proofread the manuscript; SHAB coordinated all phases of the research in the Laboratory of Virology/FCM/UNICAMP, conceptualized and designed the study, reviewed its design and proofread the manuscript. In fact, a person has a 20 times higher risk of developing lupus if they have a sibling with the disease. A Cox multivariate proportional hazards model was applied to analyse the risk factors of severe HSV infection in patients with SLE. Pensacola, FL 32502 How Telehealth Could Help Manage Type 2 Diabetes, Shannen Doherty Reveals Cancer Spread to Her Brain, 9 Best Supportive Insoles That Ease Foot Pain. Time distribution of occurrence of HZ in relation to the onset of SLE. The .gov means its official. Chan PK, Ho-Keung NG, Cheung JLK, Cheng AF. Understanding the HPV vaccine If you knew you were at increased risk of developing a particular form of cancer, and there was a vaccine that could help prevent it, wouldn't you want to receive it? Disclaimer. 2002;11:17580. Patients with complications of HZ exhibited significantly higher SLEDAI scores than patients without complications (13.08.5 vs. 7.96.8; P=0.04), which indicated that the disease was more active in patients with complications. Of the four patients with SLEDAI 8, three had HHV-1-DNA and one had HHV-7+HCMV coinfection. A fever can be a warning sign of a lupus flare or an underlying infection. by Active human herpesvirus infections in adults with systemic lupus But people with SLE are known to be more vulnerable to infections due to immune system abnormalitiees as well as treatments that involve immune system suppression (known as immunosuppressants). 2013;26(4):72843. Similar results were previously reported by Wu et al (14) and Manzi et al (25), who noted that steroid usage increased the risk of HZ in a dose-dependent manner. The SLE Disease Activity Index (SLEDAI) was used to evaluate SLE activity during HZ, and patients were defined as active SLE if the SLEDAI score was 6 (18). Patients who did not meet the criteria described above. Transpl Infect Dis. Biology, natural history, treatment, and prevention. Guthridge JM, Cogman A, Merrill JT, Macwana S, Bean KM, Powe T, Roberts V, James JA, Chakravarty EF. All cases had complete resolution of rash with no cutaneous scarring. The site is secure. Google Scholar. Our main objective was to determine the presence of the genome of herpesviruses in DNA extracted from serum samples of patients with SLE attested in institutional protocols and receiving immunosuppressive treatment. Furthermore, previous studies have rarely investigated the association between lymphopenia and HZ. 1993;342:398401. Finally, human herpesvirus 8 (HHV-8) is mainly associated with Kaposis sarcoma, one of the neoplasms that is most frequently encountered in HIV-infected patients [13]. Clin Infect Dis. While it is not known exactly why SLE develops, one of its commonly investigated triggers is infection by bacteria or virus. 81603435). This suggests that careful monitoring of HZ occurrence is warranted in patients with SLE taking high-dose GC, and that discontinuing ISA therapy may be unnecessary during instances of HZ in patients with SLE. Introduction. Alisa Hrustic is the deputy editor at Prevention, where she leads the brands digital editorial strategy. An amendment to this paper has been published and can be accessed via the original article. They added that early treatment should be applied to prevent severe complications in patients with SLE undergoing steroid therapy., 3 W Garden St Aberrant Epstein-Barr viral infection in systemic lupus erythematosus. Recent Pat Antiinfect Drug Discov. Clin Immunol. 8600 Rockville Pike Mouth ulcers may indicate a flare-up or be the first. 2008;41:5569. Inclusion in an NLM database does not imply endorsement of, or agreement with, One of these patients was a 31-year-old woman with severe HCMV disease, who showed a series of symptoms (Table 3), such as fever, oral ulcers and edema, but also tachypnea, which leads to respiratory insufficiency. Some prescription medications such as hydralazine and procainamide can cause lupus. Epub 2022 Jun 12. Rev Assoc Med Bras. The study, Risk of severe herpes simplex virus infection in systemic lupus erythematosus: analysis of epidemiology and risk factors analysis in Taiwan, was published in the journal Annals of Rheumatic Diseases. Herpes simplex: Signs and symptoms - American Academy of Dermatology 2013;42(2):11928. 2016 Jan;25(1):102-9. doi: 10.1177/0961203315603141. https://doi.org/10.1016/j.ijantimicag.2013.04.023.
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