ABSTRACT
Reactive arthritis (ReA) is a spondyloarthropathic disorder characterized by inflammation of the joints and tissues occurring after gastrointestinal or genitourinary infections. Diagnostic criteria for ReA do not exist and, therefore, it is subject to clinical opinion resulting in cases with a wide range of symptoms and definitions. Using standardized diagnostic criteria, we conducted a systematic literature review to establish the global incidence of ReA for each of the three most commonly-associated enteric pathogens: Campylobacter, Salmonella, and Shigella. The weighted mean incidence of reactive arthritis was 9, 12, and 12 cases per 1,000 cases of Campylobacter, Salmonella and Shigella infections respectively. To our knowledge, this is the first systematic review of worldwide data that use well-defined criteria to characterize diarrhoea-associated ReA. This information will aid in determining the burden of disease and act as a planning tool for public-health programmes.
ABSTRACT
Background: Reactive arthritis (ReA)/Reiter’s syndrome (RS) may be caused as a sequel of infections caused by enteric bacterial pathogens, although the mechanisms through, which different pathogens cause similar disease are not clear. Aim: This study was done to look for the presence and role of any common bacterial antigen among the pathogens isolated from such patients. Materials and Methods: A total of 51 patients of ReA and 75 controls (three groups of 25 subjects each: Group 1: Patients who did not develop arthritic complications within 3 months after bacillary dysentery/diarrhea; Group 2: Patients with other arthritic diseases and Group 3: Normal healthy subjects) were included. The isolated enteric pathogens were tested to detect the immunodominant antigens. Results and Conclusions: A common 30 kDa antigen was found to be specifi cally present among seven arthritogenic enteric bacterial strains belonging to three genera, Salmonella, Shigella and Hafnia. Post-dysenteric ReA patients’ sera show higher levels of immunoglobulin G, immunoglobulin M and immunoglobulin A antibodies against this antigen as compared to the controls. Lymphocytes of ReA patients recognize this antigen, proliferate and produce interleukin-2 in response to this antigen more than the lymphocytes of controls. 30 kDa antigen may be a common arthritogenic factor associated with postdysenteric ReA/RS. The association of Hafnia alvei with post-dysenteric ReA is described for the fi rst time. Four cases of mycobacterial ReA had an association with this antigen, suggesting that the arthritogenic antigen of mycobacteria and enteric bacteria may be of a similar nature.
ABSTRACT
A diarréia é a principal manifestação clínica das infecções entéricas. O desequilíbrio entre os processos de absorção e secreção intestinal decorrentes de alterações no transporte de água e eletrólitos é determinante na patogênese dos processos diarréicos. Os mecanismos fisiopatológicos estão associados às características particulares de cada patógeno. Dessa forma, a interação específica entre os patógenos entéricos e o epitélio intestinal resulta em diferentes tipos de diarréias. Na produção de suínos, o conhecimento da fisiopatologia das infecções entéricas é fundamental no desenvolvimento de métodos de diagnóstico e, em um futuro próximo, na elaboração de estratégias de prevenção e controle dessas afecções. Com base nos processos fisiológicos característicos do trato gastrointestinal, esta revisão tem como objetivo descrever aspectos relevantes e atuais dos mecanismos fisiopatológicos das diarréias em suínos. Serão enfatizadas as alterações patológicas no transporte intestinal de íons e nutrientes decorrentes da ação de patógenos entéricos importantes na produção suinícola.
Diarrhea is the main clinical manifestation of enteric infections. Imbalance between absorption and intestinal secretion process due to changes in the water and electrolytes transport is critical in the diarrheal diseases pathogenesis. The pathophysiological mechanisms are associated to specific characteristics of each pathogen. Therefore, specific interaction between enteric pathogens and intestinal epithelium result in different types of diarrhea. In swine production, the knowledge about the enteric infections pathophysiology is important for the development of diagnostic methods and, in a near future improvement of prevention and control strategies. The aim of this review is to describe different relevant aspects of the swine diarrhea pathophysiology based on the physiological processes typical of gastrointestinal tract. Pathological changes in the intestinal transport of ions and nutrients due to infectious relevant for swine production will be emphasized.
ABSTRACT
The objective of this study was to evaluate clinical and bacteriological effect of short course fleroxacin in uncomplicated typhoid and paratyphoid fever patients. Four hundred mg of fleroxacin was given oraly once daily for a period of 3 to 5 days. The diagnosis of typhoid and paratyphoid fever was established by clinical picture as well as blood culture or Widal serology test. Thirty patients in whom the clinical picture was confirmed as a typhoid or paratyphoid infection were eligible for this investigation. They consisted of 15 males and 15 females ranging in age from 18-38 years average 27.5 years of whom 18 were diagnosed by blood culture consisting of 16 S.typhi positive cases and two S.paratyphi A, while 12 other cases were positively confirmed by serial Widal agglutination serology. These cases suffered from fever between 3-14 days with a minimum recorded body temperature elevation of 38.5 degrees Celsius. Clinical response with defervescence of fever was obtained in the positive blood culture group within 3 days (8 patients) including 2 cases positive for S.paratyphi A and within two additional days (5 days) in the remaining 10 cases. In the twelve cases with a positive serology for typhoid fever a clinical response was obtained for defervescence within 3 days (6 cases) with 4 of these cases were on 3 days of fleroxacin and 2 cases on 5 days of fleroxacin. In the remaining 6 serologic positive cases fever resolved after 4-6 days with an average of 5 days with one on 3 days of fleroxacin and the rest (5 cases) on 5 days of fleroxacin. All positive blood culture cases reverted to negative after the fleroxacin course. No relapse or carrier state was recorded in this serie. It may be concluded that a 3 to 5 days closely monitored course of fleroxacin has excellent clinical as well as bacteriological efficacy in noncomplicated typhoid and paratyphoid fever.