Antibiotic Exposure, Infection, and the Development of Pediatric Psoriasis

Horton, Daniel B.; Scott, Frank I.; Haynes, Kevin; Putt, Mary; Rosé, Carlos D.; Lewis, James D.; Strom, Brian L.

doi:10.1001/jamadermatol.2015.3650

Cited by 32 publications

(16 citation statements)

References 47 publications

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“…Interestingly, childhood chronic diseases such as asthma [ 35 ] and inflammatory bowel disease [ 36 ] have also been linked to antibiotic exposure in infancy but it is not clear whether the antibiotics or the infections for which they have been prescribed play a causal role in their development. A recent report suggests – contrary to what has previously been thought - that infectious disease per se and not antibiotic use increases the risk of psoriasis in the pediatric population [ 37 ]. Similar causal patterns may also be involved in the development of obesity since aberrant immune activation and a low-grade inflammatory state are hallmarks of obesity and metabolic disease.…”

Section: Discussionmentioning

confidence: 99%

Antibiotics, obesity and the link to microbes - what are we doing to our children?

Turta

Rautava

2016

BMC Med

114

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BackgroundChildhood obesity and overweight are among the greatest health challenges in the pediatric population. Obese individuals exhibit marked differences in the composition of the intestinal microbial community as compared to lean subjects. These changes in the gut microbiota precede the clinical manifestation of overweight. Convincing experimental data suggest a causal role for intestinal microbes in the development of obesity and associated metabolic disorders.DiscussionExposure to antibiotics exerts a devastating impact on the intestinal microbial community. Epidemiological studies have provided evidence indicating that early or repeated childhood exposure to antibiotics is associated with increased risk of overweight later in childhood but the causal role of this exposure in obesity development is not clear. However, data from studies conducted using experimental animal models indicate that antibiotic-induced changes in the gut microbiota influence host metabolism and lead to fat accumulation. The intestinal microbiota perturbation caused by antibiotic exposure in the perinatal period appears to program the host to an obesity-prone metabolic phenotype, which persists after the antibiotics have been discontinued and the gut microbiota has recovered. These observations may have serious implications in the clinical setting, since a substantial number of human infants are subjected to antibiotic treatment through the mother during delivery or directly in the immediate neonatal period. The clinical significance of these exposures remains unknown.SummaryPrudent use of antibiotics is paramount not only to reduce the propagation of antibiotic-resistant organisms but also to minimize the potentially detrimental long-term metabolic consequences of early antibiotic exposure. Improved means of reliably detecting neonates with bacterial infection would reduce the need for empirical antibiotic exposure initiated based on nonspecific symptoms and signs or risk factors. Finally, means to support healthy microbial contact in neonates and infants requiring antibiotic treatment are needed.

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Section: Discussionmentioning

confidence: 99%

Antibiotics, obesity and the link to microbes - what are we doing to our children?

Turta

Rautava

2016

BMC Med

114

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“…During preclinical phases, autoantibodies (or, in the case of PsA, skin psoriasis) may be present years prior to arthritis (35)(36)(37)(38). Numerous infections have been hypothesized to serve as triggers for initiating clinical expression of RA or PsA (39)(40)(41)(42)(43)(44)(45). In addition to antigen-specific activation of lymphocytes, microbes can provide the secondary signal necessary for the induction of a pathogenic autoimmune response, referred to as the adjuvant effect of the infection (46).…”

Section: Discussionmentioning

confidence: 99%

Autoimmune Arthritides, Rheumatoid Arthritis, Psoriatic Arthritis, or Peripheral Spondyloarthritis Following Lyme Disease

Arvikar

Crowley

Sulka

et al. 2016

Arthritis & Rheumatology

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Objective To describe systemic autoimmune joint diseases following Lyme disease and to compare their clinical features with Lyme arthritis. Methods Records of all adult patients referred to our Lyme arthritis clinic over a 13-year period in whom we diagnosed a systemic autoimmune joint disease following Lyme disease were reviewed. For comparison, records of patients enrolled in our Lyme arthritis (LA) cohort over the most recent 2-year period were analyzed. IgG antibodies to Borrelia burgdorferi and to 3 Lyme disease-associated autoantigens were measured. Results We identified 30 patients who developed a new-onset systemic autoimmune joint disorder a median of 4 months after Lyme disease, usually erythema migrans (EM). Fifteen had rheumatoid arthritis (RA), 13 had psoriatic arthritis (PsA), and 2 had peripheral spondyloarthropathy (SpA). The 30 patients typically had polyarthritis; and those with PsA/SpA often had previous psoriasis, axial involvement, or enthesitis. In the comparison group of 43 LA patients, monoarticular knee arthritis, without prior EM, was the usual clinical picture. Most systemic autoimmune patients had positive tests for B. burgdorferi IgG antibodies by ELISA, but they had significantly lower titers and lower frequencies of Lyme-associated autoantibodies than LA patients. Prior to our evaluation, the patients often received additional antibiotics for presumed Lyme arthritis without benefit. We prescribed anti-inflammatory therapies, most commonly disease modifying anti-rheumatic drugs (DMARDs), resulting in improvement. Conclusion Systemic autoimmune joint diseases, RA, PsA/SpA, may follow Lyme disease. Development of polyarthritis after antibiotic-treated erythema migrans, previous psoriasis, or low-titer B. burgdorferi antibodies are clues to the correct diagnosis.

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“…[20] In humans, skin and non-skin infections are associated with the development of pediatric psoriasis. [21] These studies have prompted efforts to profile the microbiome in patients with psoriatic disease. While there is no consensus on the composition of the psoriatic microbiome, the first collection of studies in this burgeoning field provides promising insights into the pathogenesis of psoriasis and its comorbidities [Table 1, Table 2].…”

Section: Psoriatic Disease and The Microbiomementioning

confidence: 99%

The Role of the Skin and Gut Microbiome in Psoriatic Disease

et al. 2017

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Purpose To understand the changes in the microbiome in psoriatic disease, we conducted a systematic review of studies comparing the skin and gut microbiota in psoriatic individuals and healthy controls. Findings Our review of studies pertaining to the cutaneous microbiome showed a trend towards an increased relative abundance of Streptococcus and a decreased level of Propionibacterium in psoriasis patients compared to controls. In the gut microbiome, the ratio of Firmicutes and Bacteroidetes was perturbed in psoriatic individuals compared to healthy controls. Actinobacteria was also relatively underrepresented in psoriasis patients relative to healthy individuals. Summary Although the field of the psoriatic microbiome is relatively new, these first studies reveal interesting differences in microbiome composition that may be associated with the development of psoriatic comorbidities and serve as novel therapeutic targets.

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Antibiotic Exposure, Infection, and the Development of Pediatric Psoriasis

Cited by 32 publications

References 47 publications

Antibiotics, obesity and the link to microbes - what are we doing to our children?

Antibiotics, obesity and the link to microbes - what are we doing to our children?

Autoimmune Arthritides, Rheumatoid Arthritis, Psoriatic Arthritis, or Peripheral Spondyloarthritis Following Lyme Disease

The Role of the Skin and Gut Microbiome in Psoriatic Disease

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