Reiter's Syndrome (Reactive Arthritis) and Travelers’ Diarrhea

Yates, Johnnie; Stetz, Lori C.

doi:10.1111/j.1708-8305.2006.00009.x

Cited by 20 publications

(16 citation statements)

References 15 publications

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“…Although TD is a self-limited disease with few acute complications, it can result in significant transient discomfort, cause changes in travel plans, and produce temporary incapacitation (25). TD has also been associated with long-term complications, such as postinfectious reactive arthritis, (27) Guillain-Barré neuropathy (22), and postinfectious irritable bowel syndrome (17).…”

mentioning

confidence: 99%

Influence of Host Interleukin-10 Polymorphisms on Development of Traveler's Diarrhea Due to Heat-Labile Enterotoxin-ProducingEscherichia coliin Travelers from the United States Who Are Visiting Mexico

Flores

DuPont

Lee

et al. 2008

Clin Vaccine Immunol

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Up to 60% of U.S. visitors to Mexico develop traveler's diarrhea (TD), mostly due to enterotoxigenicEscherichia coli (ETEC) strains that produce heat-labile (LT) and/or heat-stable (ST) enterotoxins. Distinct single-nucleotide polymorphisms (SNPs) within the interleukin-10 (IL-10) promoter have been associated with high, intermediate, or low production of IL-10. We conducted a prospective study to investigate the association of SNPs in the IL-10 promoter and the occurrence of TD in ETEC LT-exposed travelers. Sera from U.S. travelers to Mexico collected on arrival and departure were studied for ETEC LT seroconversion by using cholera toxin as the antigen. Pyrosequencing was performed to genotype IL-10 SNPs. Stools from subjects who developed diarrhea were also studied for other enteropathogens. One hundred twenty-one of 569 (21.3%) travelers seroconverted to ETEC LT, and among them 75 (62%) developed diarrhea. Symptomatic seroconversion was more commonly seen in subjects who carried a genotype producing high levels of IL-10; it was seen in 83% of subjects with the GG genotype versus 54% of subjects with the AA genotype at IL-10 gene position ؊1082 (P, 0.02), in 71% of those with the CC genotype versus 33% of those with the TT genotype at position ؊819 (P, 0.005), and in 71% of those with the CC genotype versus 38% of those with the AA genotype at position ؊592 (P, 0.02). Travelers with the GCC haplotype were more likely to have symptomatic seroconversion than those with the ATA haplotype (71% versus 38%; P, 0.002). Travelers genetically predisposed to produce high levels of IL-10 were more likely to experience symptomatic ETEC TD.Traveler's diarrhea (TD) affects up to 60% of short-term U.S. visitors to developing countries (23). Although TD is a self-limited disease with few acute complications, it can result in significant transient discomfort, cause changes in travel plans, and produce temporary incapacitation (25). TD has also been associated with long-term complications, such as postinfectious reactive arthritis, (27) Guillain-Barré neuropathy (22), and postinfectious irritable bowel syndrome (17).Up to 85% of TD cases are bacterial in origin. In Mexico, enterotoxigenic Escherichia coli (ETEC) is the single mostcommonly identified agent in the stools of travelers with diarrhea, ranging from 19% to 40% of cases (3). ETEC isolates from travelers can produce heat-labile toxin (LT), heat-stable toxin (ST), or both toxins simultaneously (LT/ST). Approximately 43% to 68% of strains isolated from subjects with TD in Mexico produce LT alone or in combination with ST (1,11,13). Contact with ETEC LT, as a result of vaccination or after natural infection, is associated with the production of LTspecific antibodies (8, 15) and may serve as an indicator of ETEC LT exposure.Previous studies carried out in Bangladesh have demonstrated that after adjusting for confounding variables, such as age and prior exposure, ETEC LT can be identified with similar frequencies in the stools of children with diarrhea and healthy controls (...

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mentioning

confidence: 99%

Influence of Host Interleukin-10 Polymorphisms on Development of Traveler's Diarrhea Due to Heat-Labile Enterotoxin-ProducingEscherichia coliin Travelers from the United States Who Are Visiting Mexico

Flores

DuPont

Lee

et al. 2008

Clin Vaccine Immunol

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“…ReA typically occurs 1e4 weeks after the triggering infection. The oligoarthritis is asymmetric, and it predominantly involves the lower limbs or sacroiliac joint [31]. Enthesopathy, especially at the heel, is common.…”

Section: Reactive Arthritismentioning

confidence: 99%

“…The diagnosis of ReA is a clinical one, and there are no diagnostic laboratory tests. The mean duration of ReA symptoms is commonly up to 4e5 months; however, approximately 15e30% of patients will develop chronic disease, most having a positive family history for spondyloarthropathy or being positive for human leucocyte antigen (HLA)-B27 [31]. NSAIDs are the mainstay of treatment.…”

Section: Reactive Arthritismentioning

confidence: 99%

“…Treatment of the triggering infection is warranted if the patient has persistent gastrointestinal symptoms at the time of diagnosis or if genitourinary infection with Chlamydia trachomatis was the trigger [4,31]. Sulphasalazine, methotrexate and anti-tumour necrosis factor (TNF) biologic agents have been used in refractory cases [31].…”

Section: Reactive Arthritismentioning

confidence: 99%

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Travel- and immigration-related problems in rheumatology

Adizie

Adebajo

2014

Best Practice & Research Clinical Rheumatology

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“…Although PI-IBS is perhaps not as debilitating as less frequent sequelae of reactive arthritis [8], Guillain Barré syndrome [9], or inflammatory bowel disease [10], the attributable burden of PI-IBS is measurable. A quick calculation reveals that, among the 100 million travelers each year from industrialized countries who are at intermediate to high risk of diarrhea, ∼30 million will develop TD, and 3 million new cases of PI-IBS will arise [11].…”

Section: Prevention Of Traveler's Diarrhea: a Call To Reconvenementioning

confidence: 99%