Abstract
The present study aims to determine the spectrum of etiological agents and to screen HLA-B27 and, related inflammatory markers in patients presenting with symptoms of Spondyloarthritis(SpA) post diarrhea, which can aid in prompt diagnosis of reactive arthritis (ReA). A total of 903 stool samples of patients presenting with diarrhea were collected and screened with microscopic and culture techniques to identify the etiological agents. Blood samples of patients presenting with both diarrhea and arthritis were collected and subjected to C- reactive protein(CRP), Erythrocyte sedimentation rate(ESR) and Human Leukocyte Antigen B27(HLA-B27) detection tests.Among the total of 903 patients, 20 Salmonella species were isolated. Othergut microbes identified included Escherichia coli 572(63%), Klebsiella species 126(14%), Proteus vulgaris 43(5%), Proteus mirabilis 27(3%), Citrobacter species and Enterococcus species 8(1%), while some of these organisms(3.2%) caused inflammation resulting in ReA. Parasitic etiology was found in 99 patients, among which the most common parasites include Entamoeba histolytica and hookworm, identified through microscopy. Among the total, 29 patients were found to have symptoms of joint pain with articular and extra articular manifestations, and some associated with HLA-B27.
Highlights
Reactive arthritis(ReA), defined as sterile synovitis, develops after a distant infection and may or may not be HLA-B27 associated
The present study aims to determine the spectrum of etiological agents and to screen HLA-B27 and, related inflammatory markers in patients presenting with symptoms of Spondyloarthritis(SpA) post diarrhea, which can aid in prompt diagnosis of reactive arthritis (ReA)
Infections caused by Salmonella, Shigella, or Yersinia have been significantly associated with the risk of ReA, while itis uncommon in infections caused by Campylobacter or E. coli [Schiellerup P.3, Ekman P.5]
Summary
Reactive arthritis(ReA), defined as sterile synovitis, develops after a distant infection and may or may not be HLA-B27 associated. The detection of microbial components in the joints of patients with ReA, has led to the redefinition of ReA as an immune-mediated synovitis It can result from slow bacterial infections with the presence of immunologic bacterial antigens and/or viable nonculturable bacteria in the intra-articular spaces, produced by metabolically active bacteria residing in the body, usually in the gastrointestinal or urogenital tract [Mustafa Serdar SA1,Colmegna I.2]. Infections caused by Salmonella, Shigella, or Yersinia have been significantly associated with the risk of ReA, while itis uncommon in infections caused by Campylobacter or E. coli [Schiellerup P.3, Ekman P.5]. Other factors such as age, sex, bacterial load, as well as the presence or absence of HLA B27, may influence the susceptibility for ReA [Schiellerup P.3, Ekman P.5]
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