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Parasitic Rheumatism among Patients Infected with Intestinal Parasites by CLEW ..... Rheumatoid Arthritis

Date:   7/30/2020 2:25:03 AM ( 13 months ago ago)
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Eman M Hussein1*, Eman M El-Hamshary1, Aziza S Omar2, Amira B Mokhtar1
Departments of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
*Corresponding Author: Eman M Hussein, Departments of Parasitology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
Research Article
Received: June 24, 2019; Published: July 12, 2019
Keywords: Parasitic Rheumatism; Rheumatic Syndromes
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
importance of parasitic infection as an underlying cause of rheumatic syndromes especially in developing countries must be studied
in patients undergoing evaluation for rheumatic complaints.
[2], parasitic arthritis, parasitic rheumatism [4,7] where the causative pathogen is the parasite, followed after free interval with a
characteristic pattern of arthropathy as a reaction to the presence
of the parasite [8]. During that process, usually in 1 to 3 weeks,
antigens are transported to the synovial tissue. This may occur
intra-cellularly within mononuclear or other phagocytosing cells,
as immune complexes, or even in the form of free antigen [9-11].
The consequence is a CD4+ cell mediated reaction, manifested as
acute Arthritis [12], immune complex mediated cytotoxicity may
also participate [10]. For chronic antigen induced arthritis, a periodic or continuous supply of the antigen is required [13]. Arthritis
induced by parasitic infection is very polymorphic; symptoms are
monoarticular, oligoarticular, or polyarticular, involving small, medium, and/or large joints. They can mimic the clinical picture of different inflammatory rheumatic diseases [7]. Essential criteria for
diagnosis of parasitic rheumatism were inflammatory arthropathy,
residence in an area of endemic parasitosis, absence of radiological
changes, identification of a pathogenic parasite, inefficacy of antiDOI: 10.31080/ASGIS.2019.02.0059


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