Intestinal microsporidiosis: a hidden risk in rheumatic disease patients undergoing anti-tumor necrosis factor therapy combined with disease-modifying anti-rheumatic drugs?

Authors

  • Nadia Emi Aikawa Universidade de São Paulo; Faculdade de Medicina; Pediatric Reumatology Unit
  • Aline de Oliveira Twardowsky Universidade de São Paulo; Faculdade de Medicina; Pediatric Reumatology Unit
  • Jozélio Freire de Carvalho Universidade de São Paulo; Faculdade de Medicina; CEDMAC Unit; Division of Rheumatology
  • Clovis A. Silva Universidade de São Paulo; Faculdade de Medicina; Pediatric Reumatology Unit
  • Ivan Leonardo Avelino França e Silva Universidade de São Paulo; Faculdade de Medicina; Division of Infectology
  • Ana Cristina de Medeiros Ribeiro Universidade de São Paulo; Faculdade de Medicina; CEDMAC Unit; Division of Rheumatology
  • Carla Goncalves Schain Saad Universidade de São Paulo; Faculdade de Medicina; CEDMAC Unit; Division of Rheumatology
  • Julio César Bertacini Moraes Universidade de São Paulo; Faculdade de Medicina; CEDMAC Unit; Division of Rheumatology
  • Roberto Acayaba de Toledo Faculdade de Medicina de São Jose do Rio Preto; CEDMAC Unit; Division of Rheumatology
  • Eloísa Bonfá Universidade de São Paulo; Faculdade de Medicina; CEDMAC Unit; Division of Rheumatology

DOI:

https://doi.org/10.1590/S1807-59322011000700008

Keywords:

Microsporidia, Parasitosis, Anti-TNF, Rheumatoid arthritis, Ankylosing spondylitis

Abstract

OBJECTIVE: Immunosuppressed patients are at risk of microsporidiosis, and this parasitosis has an increased rate of dissemination in this population. Our objective was to evaluate the presence of microsporidiosis and other intestinal parasites in rheumatic disease patients undergoing anti-tumor necrosis factor/disease-modifying anti-rheumatic drug treatment. METHODS: Ninety-eight patients (47 with rheumatoid arthritis, 31 with ankylosing spondylitis and 11 with psoriatic arthritis) and 92 healthy control patients were enrolled in the study. Three stool samples and cultures were collected from each subject. RESULTS: The frequency of microsporidia was significantly higher in rheumatic disease patients than in control subjects (36 vs. 4%, respectively; p<0.0001), as well as in those with rheumatic diseases (32 vs. 4%, respectively; p<0.0001), ankylosing spondylitis (45 vs. 4%, respectively; p<0.0001) and psoriatic arthritis (40 vs. 4%, respectively; p<0.0001), despite a similar social-economic class distribution in both the patient and control groups (p = 0.1153). Of note, concomitant fecal leukocytes were observed in the majority of the microsporidia-positive patients (79.5%). Approximately 80% of the patients had gastrointestinal symptoms, such as diarrhea (26%), abdominal pain (31%) and weight loss (5%), although the frequencies of these symptoms were comparable in patients with and without this infection (p>0.05). Rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis disease activity parameters were comparable in both groups (p>0.05). The duration of anti-tumor necrosis factor/disease-modifying anti-rheumatic drugs and glucocorticoid use were also similar in both groups. CONCLUSION: We have documented that microsporidiosis with intestinal mucosa disruption is frequent in patients undergoing concomitant anti-tumor necrosis factor/disease-modifying anti-rheumatic drug therapy. Impaired host defenses due to the combination of the underlying disease and the immunosuppressive therapy is the most likely explanation for this finding, and this increased susceptibility reinforces the need for the investigation of microsporidia and implementation of treatment strategies in this population.

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Published

2011-01-01

Issue

Section

Clinical Sciences

How to Cite

Aikawa, N. E., Twardowsky, A. de O., Carvalho, J. F. de, Silva, C. A., Silva, I. L. A. F. e, Ribeiro, A. C. de M., Saad, C. G. S., Moraes, J. C. B., Toledo, R. A. de, & Bonfá, E. (2011). Intestinal microsporidiosis: a hidden risk in rheumatic disease patients undergoing anti-tumor necrosis factor therapy combined with disease-modifying anti-rheumatic drugs? . Clinics, 66(7), 1171-1175. https://doi.org/10.1590/S1807-59322011000700008