Parasitic Rheumatism among Patients Infected with Intestinal Parasites

Abstract

Rheumatic syndromes, including inflammatory arthritis, inflammatory myositis, and vasculitis have been described among multiple different parasitic infections of all parasitic divisions including protozoa, nematode, and platy-helminthes [1,2]. Rheumatic pain is the main clinical manifestation of rheumatic syndromes and is defined as; pain involving articular (related to joints) and/or extraarticular structures (related to tendons and muscles) [3]. Evidence for underlying parasitic infection should be sought in patients presenting with unexplained or atypical rheumatic syndromes [4,5]. Diagnosis of parasitic rheumatism is based on the demonstration of infection with a pathogenic parasite, lack of response to antiinflammatory agents, especially non steroidal anti-inflammatory drugs (NSAD), and improvement following anti-parasitic therapy with eradication of the parasite [1]. Many terms were introduced to describe the condition, e.g. reactive arthritis [6], rheumatic syndromes associated with parasites Introduction: Many intestinal parasites can induce a variety of rheumatic syndromes as a result of direct infiltration of musculoskeletal structures or an immune mediated mechanism.Objectives: In this study, patients having unexplained rheumatic pain were examined to identifying the frequency of intestinal parasitic infection among them and which of them fulfilling parasitic rheumatism criteria.Methodology: Stool samples of 107 patients having un explained rheumatic pain were examined to explore patients with parasitic rheumatism and rheumatologic blood investigation beside plan X ray for the affected joints were done. Results:The results showed that 50 patients out of 107 had parasitic infection. Cryptosporidium infection was the commonest (48.0%) followed by C. cayetanensis (32%), G. lamblia (24%), B. hominis (20%) and E. histolytica (8%). Beside Microsporidia, S. mansoni, A. lumbricoides and S. stercoralis were 4% for each. Some patients had mixed and triple parasitic infection. Infected parasitic patients fulfilling parasitic rheumatism criteria were 16/50 (32%). Giardiasis patients having parasitic rheumatism constituted 8/16 (50%) and were the commonest. The other eight (50%) patients had Cryptosporidium, C. cayetanensis, E. histolytica/dispar and S. stercoralis. Two patients per each parasite. Giardiasis patients with parasitic rheumatism were females. Half of them (50%) were < 15 years, complained of mono-articular joint pain, while the other were adults, complained of poly-articular joint pain. Conclusion:Due to similarity of musculoskeletal presentations of parasitic diseases to many rheumatic diseases; consequently the

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

“…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.…”

Reactive Arthritis Update: Spotlight on New and Rare Infectious Agents Implicated as Pathogens

“…Thus, especially in endemic areas, it is important to consider organisms other than the classical ones as a trigger for ReA. A recent study of patients having unexplained rheumatic pain attending the rheumatology and rehabilitation outpatient clinic in Suez Canal University Hospital reported the frequency of intestinal parasitic infection fulfilling the criteria for parasitic rheumatism, which is often published under the term ReA [34]. The results of examination of stool samples showed that 50 of 107 patients with unexplained rheumatic pain had a parasitic infection.…”

Septic arthritis significance: A path toward awareness

“…Septic arthritis is mainly caused by bacterial and fungal infections 5,6 . Some publications include viruses also 7 , while others prefer to mention them as a differential diagnosis 5 , while parasitic arthritis is usually associated with reactive arthritis 8 . Whether or not a viral etiology is considered, it represents about 1% of cases, and severe consequences are rare 9 .…”