Enteroparasitoses in Patients with Rheumatoid Arthritis

Abstract

Background: Patients with rheumatic diseases have profound alterations in the immune system as a result of underlying diseases and the treatments used, which increases the risk of occurrence and severity of infections, including enteroparasitosis. The current treatment for rheumatoid arthritis involves immunosuppressive therapies powerfully needed for screening infectious processes. The prevalence of parasitic infections in rheumatoid arthritis patients is not currently documented in literature. The objective of the current study was to determine the prevalence of parasitic diseases in a population with RA. Methods: We collected demographic and socioeconomic data from 67 patients at the Hospital Universitário de Brasília from July 2015 to April 2016. All patients underwent a parasitological examination of their stool and multiple variables were analyzed using Poisson regression method. Results: The mean age of patients was 53.9 years. They were predominantly in women (94%) and caucasian (47.8%). The mean disease duration was 9.2 years and most patients had the disease in remission or light activity. The prevalence of parasitic infections in these patients was 11.9%, all cases being that of protozoa of the following species: Endolimax nana, Entamoeba histolytica and Entamoeba coli. The final multivariate analysis indicated that the presence of disease had a significant statistical relationship between the presence of enteroparasitosis and rheumatoid arthritis with no fatigue by VAS (p = 0.0488) and best current health index by VAS (p = 0.0012). Conclusion: This study indicates that the prevalence of enteroparasitoses in a population with Rheumatoid Arthritis was 11.9% and all cases were found of protozoa.

The Infection, Coinfection, and Abundance of Intestinal Protozoa Increase the Serum Levels of IFABP2 and TNF-α in Patients With Rheumatoid Arthritis

“…histolytica , and Ent. coli has been related to poor health scales and fatigue ( 20 ), but not with the parameters of disease's clinical activity ( 18 ), similar to what was found in this study. Nevertheless, B. hominis has been particularly associated with reactive RA in four clinical cases ( 13 , 17 , 19 ).…”

“…The prevalence of infection by intestinal protozoa in subjects with rheumatic diseases has been previously reported to be particularly high (25–30%) ( 48 ), when compared to that reported in Mexican population ( 49 ) and asymptomatic ( 50 ). In the present study, we found that 50% (9/18) of the individuals with RA recruited were positive for intestinal protozoa, similarly reported in an Egyptian population with RA ( 51 ), and higher than the report of Jimenez-Balderas et al ( 48 ) for patients with RA in Mexico City [25%, (3/12)], and also the one reported for patients with RA in Brazil [11.9%, (8/67)] ( 20 ). These differences could be explained by sociodemographic factors that influence risk of parasitic infection, such as living in rural areas, lacking basic services (drinking water, for example), and the number of inhabitants per household ( 52 ), poor personal hygiene ( 50 ), and living with pets ( 48 , 53 ).…”

“…Parasite's infection by Microsporidio ( 18 ), Endo. nana ( 20 ), and Cryptosporidium ( 51 ) has been previously reported in patients with RA. Hussein et al ( 51 ) reported up to 46.72% (50/107) of positive cases of parasitic infection in the Egyptian population, identifying mainly the presence of Cryptosporidium (48%), Cyclospora cayetanensis (32%), Giardia lamblia (24%), Blastocystis hominis (20%), and Ent.…”

“…In patients with RA, several studies have reported that infections by protozoa ( 11 – 20 ) and by nematodes ( 16 , 21 , 22 ) are related to the development of inflammatory syndromes. The infection by enteric pathogens such as protozoa has an effect on the regulation of genes that are related to the stress response and cell proliferation, thus promoting the chemokines' synthesis and inflammation ( 23 ).…”