Streptococcal infection in childhood Henoch-Schönlein purpura: a 5-year retrospective study from a single tertiary medical center in China, 2015–2019

Abstract

Background The present study focuses on the associations of streptococcal infection with the clinical phenotypes, relapse/recurrence and renal involvement in Henoch-Schönlein purpura (HSP) children. Methods Two thousand seventy-four Chinese children with HSP were recruited from January 2015 to December 2019. Patients’ histories associated with HSP onset were obtained by interviews and questionnaires. Laboratory data of urine tests, blood sample and infectious agents were collected. Renal biopsy was performed by the percutaneous technique. Results (1) Streptococcal infection was identified in 393 (18.9%) HSP patients, and served as the most frequent infectious trigger. (2) Among the 393 cases with streptococcal infection, 43.0% of them had arthritis/arthralgia, 32.1% had abdominal pain and 29.3% had renal involvement. (3) 26.1% of HSP patients relapsed or recurred more than 1 time within a 5-year observational period, and the relapse/recurrence rate in streptococcal infectious group was subjected to a 0.4-fold decrease as compared with the non-infectious group. (4) No significant differences in renal pathological damage were identified among the streptococcal infectious group, the other infectious group and the non-infectious group. Conclusions Streptococcal infection is the most frequent trigger for childhood HSP and does not aggravate renal pathological damage; the possible elimination of streptococcal infection helps relieve the relapse/recurrence of HSP.

Common Seasonal Pathogens and Epidemiology of Henoch-Schönlein Purpura Among Children

“…In this context, an epidemiologic study found a temporal correlation between HSP and hospital admissions for invasive group A streptococcus infections . Third, although the role of β-hemolytic streptococci in triggering HSP was suggested by previous studies, to our knowledge, there are currently no data on pneumococcal involvement in the disease. The main difficulty in establishing the association between HSP and S pneumoniae is that noninvasive pneumococcal diseases, which represent the highest burden of pneumococcal infections—the tip of the iceberg—are undocumented .…”

“…Second, the term potentially attributable fraction is an epidemiologic term reflecting a temporal association between the incidence of HSP and the population-level circulation of studied pathogens, which is not synonymous with a causal relationship. Third, in this study, we focused on frequent infectious agents with seasonal patterns and selected those most likely to trigger HSP on the basis of published data . We cannot exclude that other infectious agents may also be associated with HSP epidemiology.…”

“…Third, in this study, we focused on frequent infectious agents with seasonal patterns and selected those most likely to trigger HSP on the basis of published data. 2 , 3 , 20 , 24 , 28 , 29 , 34 We cannot exclude that other infectious agents may also be associated with HSP epidemiology. Fourth, our study methods allowed us to establish a correlation between HSP and pathogens with a precision limited to 1 month.…”

Causal relationships between circulating inflammatory factors and IgA vasculitis: a bidirectional Mendelian randomization study

“…The findings of our study suggest that inflammatory cytokines play critical roles in the pathogenesis of IgAV, which may serve as potential targets for IgAV prevention and treatment, and the underlying mechanisms might be involved in complex interactions or synergies with environmental or infectious factors related to IgAV. For instance, streptococcal infection, the most common infectious trigger for childhood IgAV, may induce or enhance the production of CRP and IL-8 by activating the immune system and endothelial cells, thereby leading to complement system activation and inflammation ( 64 – 66 ). Conversely, eliminating streptococcal infection may reduce the relapse/recurrence of IgAV by decreasing CRP and IL-8 levels ( 64 ).…”

“…For instance, streptococcal infection, the most common infectious trigger for childhood IgAV, may induce or enhance the production of CRP and IL-8 by activating the immune system and endothelial cells, thereby leading to complement system activation and inflammation ( 64 – 66 ). Conversely, eliminating streptococcal infection may reduce the relapse/recurrence of IgAV by decreasing CRP and IL-8 levels ( 64 ). Another factor is HSPs, which protect other proteins under stress and have antiviral effects by interacting with immune pathways ( 67 ).…”