Is there any association between Sarcoidosis and infectious agents?: a systematic review and meta-analysis

Abstract

BackgroundDuring the last few years, investigators have debated the role that infectious agents may have in sarcoidosis pathogenesis. With the emergence of new molecular biology techniques, several studies have been conducted; therefore, we performed a meta-analysis in order to better explain this possible association.MethodsThis review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement from the Cochrane collaboration guidelines. Four different databases (Medline, Scopus, Web of Science, and Cochrane Collaboration) were searched for all original articles published from 1980 to 2015. The present meta-analysis included case–control studies that reported the presence of microorganisms in samples of patients with sarcoidosis using culture methods or molecular biology techniques. We used a random effects or a fixed-effect model to calculate the odds ratio (OR) and 95% confidence intervals (CI). Sensitivity and subgroup analyses were performed in order to explore the heterogeneity among studies.ResultsFifty-eight studies qualified for the purpose of this analysis. The present meta-analysis, the first, to our knowledge, in evaluation of all infectious agents proposed to be associated with sarcoidosis and involving more than 6000 patients in several countries, suggests an etiological link between Propionibacterium acnes and sarcoidosis, with an OR of 18.80 (95% CI 12.62, 28.01). We also found a significant association between sarcoidosis and mycobacteria, with an OR of 6.8 (95% CI 3.73, 12.39). Borrelia (OR 4.82; 95% CI 0.98, 23.81), HHV-8 (OR 1.47; 95% CI 0.02, 110.06) as well as Rickettsia helvetica, Chlamydia pneumoniae, Epstein-barr virus and Retrovirus, although suggested by previous investigations, were not associated with sarcoidosis.ConclusionThis meta-analysis suggests that some infectious agents can be associated with sarcoidosis. What seems clear is that more than one infectious agent might be implicated in the pathogenesis of sarcoidosis; probably the patient’s geographical location might dictate which microorganisms are more involved. Future investigations and more clinical trials are need to bring these evidences to a more global level.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-016-0332-z) contains supplementary material, which is available to authorized users.

The Role of Infection in Interstitial Lung Diseases

“…A systematic review of 58 studies (> 6,000 patients) found a link between sarcoidosis and both P acnes, and mycobacteria. 63 Herpesvirus has also been implicated, although viruses have not been known to trigger granulomatous reactions. 64 Various other pathogens studied, including Borrelia, Rickettsia helvetica, Chlamydia pneumoniae, EBV, and retroviruses, were not associated with sarcoidosis.…”

Identification of Mycobacterium tuberculosis and non‐tuberculous mycobacteria from cutaneous sarcoidosis lesions by reverse blot hybridization assay

“…This is the first study to identify mycobacteria from cutaneous sarcoidosis specimens using REBA. The molecular techniques used in previous reports to identify mycobacterial DNA from sarcoidosis lesions were primarily nested or real‐time PCR . However, REBA hybridizes the PCR products of the DNA extracted from specimens on to a fixed mycobacterial DNA template and thus exhibits increased sensitivity as it amplifies the PCR results .…”

“…Sarcoidosis is a differential diagnosis of tuberculosis (TB), and the two diseases are similar in clinical and histopathological presentation . Owing to their similarities, it has long been proposed that Mycobacterium tuberculosis (MTB) is one of the causative antigens of the inflammatory cascade that results in sarcoidosis . Furthermore, some researchers have suggested that sarcoidosis and TB are diseases caused by MTB; however, they lie at opposite ends of the same disease spectrum .…”

Nicht‐infektiöse granulomatöse Dermatosen

“…Es werden Veränderungen der Interleukin 23/Th17‐Signalwege vermutet, welche gleichzeitig ein mögliches Therapieziel darstellen . Außerdem wird der Effekt verschiedener exogener Faktoren und insbesondere mikrobieller Antigene unter anderem von Myko‐ sowie Propionibakterien diskutiert . Eine kutane Sarkoidose ist die häufigste extrathorakale Manifestation und tritt bei 20–40 % der Sarkoidose‐ Patienten auf.…”