A cohort study: The Association Between Autoimmune Disorders and Leptospirosis

Abstract

& cheng-Yoong pang 6,7,8* there are limited studies on the association between systemic autoimmune rheumatic diseases (SARDs) and leptospirosis. Therefore, this study aims to identify the effects of leptospirosis on the risks of developing SARDs with a nationwide retrospective cohort study. Patients with leptospirosis who did not have a diagnosis of SARDs before the index date were enrolled from the Taiwan National Health Insurance Research Database between 2000 and 2010, as the leptospirosis cohort. For each patient with leptospirosis, one control without a history of leptospirosis and SARDs was randomly selected (non-leptospirosis cohort). Cox proportional hazards regression models were used to analyze the risk of SARDs according to sex, age, and comorbidities. Among the 23 million people in the cohort, 3,393 patients with leptospirosis (68.91% men, mean age 52.65 years) and 33,930 controls were followed for 18,778 and 232,999 person-years, respectively. The incidence of SARDs was higher in the leptospirosis cohort than in the non-leptospirosis cohort (1.38 vs 0.33 per 1000 person-years), with a hazard ratio (HR) of 4.42 (95% confidence interval [CI] = 2.82-6.92). The risk of developing SARDs was highest for leptospirosis patients aged ≥65 years (HR = 2.81% CI = 1.07-7.36) compared with patients aged ≤39 years. Patients with leptospirosis have a 4.42-fold higher risk of SARDs than that in the general population. Further research is warranted to investigate the mechanism underlying this association. Leptospirosis is a zoonotic disease caused by pathogenic spirochetes, genus Leptospira. Leptospirosis can be found globally, with a higher incidence in tropical and subtropical regions 1. The pathogen can enter the host through wounds in the skin, the conjunctiva, and mucous membranes. By direct contact with the body fluids from the infected domestic and sylvatic animals, humans may also be infected. Once infected, patients can either be asymptomatic or manifested as an acute febrile illness, with fever, chills, arthralgia, headache, and severe myalgia. Occasionally, it can cause severe disease leading to multiorgan dysfunction and even death 2. The nonspecific initial presentation and lack of a reliable point-of-care screening test make this disease a diagnostic challenge 3,4. Autoimmune diseases are conditions that are triggered by the immune system initiating an attack on self-molecules due to the worsening of immunologic tolerance to auto-reactive immune cells 5. Both environmental and genetic are significant contributors to the pathogenesis of autoimmune diseases 6. Autoimmune diseases can either be systemic, organ-specific or localized to specific tissue or region depending on the clinicopathology of each condition. Systemic autoimmune rheumatic diseases (SARDs) are a collective term for more than 80 systemic autoimmune diseases, including systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and systemic sclerosis (SS), Sjogren's syndrome, polymyositis, dermatomyositis. Female are inordinately affecte...

Identification of Microbiota Biomarkers With Orthologous Gene Annotation for Type 2 Diabetes

“…Given that ATP-binding proteins are essential for Leptospira and H. hepaticus, the identification of such protein from these species indicates the potential significant role of such species for T2D pathogenesis. In 2020, a systematic analysis confirmed the potential association between autoimmune disorders (including T2D) and Leptospira infection (Teh et al, 2020). Another independent research also validated that the infection of Leptospira is associated with diabetic chronic kidney disease (Carrillo-Larco et al, 2019).…”

Association Between Severity of Leptospirosis and Subsequent Major Autoimmune Diseases: A Nationwide Observational Cohort Study

“…However, these reports were either of small case numbers or outbreak series. An earlier study argued that onset of many autoimmune diseases would develop after Leptospira infection (23). They found that patients with prior leptospirosis were at increased risk of subsequently developing many autoimmune diseases (up to 18 autoimmune diseases).…”