Osteoarticular infectious complications in patients with primary immunodeficiencies

Abstract

Purpose of review-To describe the incidence and management of various infectious arthritides in selected primary immunodeficiency states.Recent findings-Joint complications have been a well recognized finding in patients with primary immunodeficiencies for many years. Many are clearly infectious in etiology, but other apparently noninfectious joint abnormalities similar to rheumatoid arthritis have been shown to be due to an underlying infectious trigger. In humoral immunodeficiencies such as common variable immunodeficiency and X-linked agammaglobulinemia, bacterial organisms are the most common causes of infectious arthritis, but mycoplasmas and ureaplasmas are also of particular importance. In nonhumoral immunodeficiencies, noninfectious inflammatory arthritides are more prevalent, although microbiologic organisms have been reported in some cases of arthritis. Lack of appropriate culturing techniques and documentation of infectious agents may underestimate the prevalence of low-virulence infections in these patients.Summary-Infectious arthritis is a significant comorbidity associated with primary immunodeficiencies and can be the presenting feature for some patients. Prompt examination for common as well as atypical organisms is not only important for the treatment but also crucial to the understanding of the exact etiology of arthritides as a whole in these disorders.

Bruton’s Disease Presenting With Arthritis; A Case Report

“…Since 1952, when Bruton's disease was first described, the prevalence of infections and frequency of hospital admissions have decreased, because of earlier diagnosis and proper management (3). Recurrent infections are the main manifestations of PIDs (3,5), especially sinopulmonary ones (6), but other infections such as meningitis, arthritis, osteomyelitis, cellulitis, and gastroenteritis may occasionally occur (6). In common variable immunodeficiency (CVID) and XLA, compared to the other congenital immunodeficiencies, bone and joint infections are observed more (6, 7).…”

“…In common variable immunodeficiency (CVID) and XLA, compared to the other congenital immunodeficiencies, bone and joint infections are observed more (6, 7). Nonpathogenic organisms in immunocompetent individuals, like mycoplasma and ureaplasma, are the most common agents causing arthritis in such immunocompromised patients (6), although Staphylococcus aureus and streptococcal infections are also commonly observed (3,6,7). Bone and joint abnormalities can occur in patients with PID, with arthritis being the most common joint manifestation.…”

Obična Varijabilna Imunodeficijencija (Cvid)

“…i Salmonella spp. su najčešće pronađeni uzroci infektivne dijareje (17,18). U velikim multicentričnim prospektivnim studijama hronična opstruktivna bolest pluća je identifikovana kod 34,2% pacijenta pri postavljanju dijagnoze CVID.…”

“…Preporučena minimalna doza je 400 mg/kg tjelesne mase mjesečno. Veće doze intravenskih imunoglobulina (IVIG) smanjuju još više broj bakterijskih infekcija, zato mnogi centri koriste veće doze (600-800 mg/kg TM) ili frekvencije (tri do četiri puta nedeljno) (18,19). Subkutana aplikacija imunoglobulina se sve više praktikuje (0,1 g/kg TM/sedmično).…”

A Returning Traveler With Fever

“…Mycobacterial and fungal arthritis are rare but can present as a monoarthritis where disease is endemic or if the patient is immunocompromised. [15][16][17][18] There are a variety of parasitic pathogens that can cause arthritis. Toxoplasma gondii , Entamoeba histolytica , Giardia lamblia , Strongyloides stercoralis , and Schistosoma mansoni are some that have been reported.…”