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Hu YC, Yang YH, Chiang BL. Immunoglobulin A vasculitis: The clinical features and pathophysiology. Kaohsiung J Med Sci 2024. [PMID: 38828518 DOI: 10.1002/kjm2.12852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 05/06/2024] [Accepted: 05/07/2024] [Indexed: 06/05/2024] Open
Abstract
Palpable purpura, gastrointestinal symptoms, joint involvement, and renal disease characterize immunoglobulin A vasculitis (IgAV). Renal involvement ranging from mild proteinuria to severe nephritic or nephrotic syndrome highlights the importance of monitoring kidney function in patients with IgAV. Recognizing these key features is crucial for early diagnosis and appropriate management to prevent long-term complications related to kidney disease. However, the pathogenesis of IgAV remains unclear. Disease mechanisms involve various factors, including the interplay of aberrantly glycosylated IgA, anti-endothelial cell antibodies, and neutrophils following infection triggers, which are the main pathogenic mechanisms of IgAV. Insights from cases of IgAV related to Coronavirus disease 2019 have offered additional understanding of the connection between infection and IgAV pathogenesis. This review provides a valuable resource for healthcare professionals and rheumatology researchers seeking a better understanding of the clinical features and pathophysiology of IgAV.
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Affiliation(s)
- Ya-Chiao Hu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yao-Hsu Yang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Bor-Luen Chiang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
- Genome and Systems Biology Degree Program, College of Life Science, National Taiwan University, Taipei, Taiwan
- Medical Research, National Taiwan University Hospital, Taipei, Taiwan
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2
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Liu C, Luo L, Fu M, Li Z, Liu J. Analysis of children with Henoch-Schonlein purpura secondary to infection. Clin Rheumatol 2022; 41:803-810. [PMID: 34993728 DOI: 10.1007/s10067-021-06007-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Henoch-Schonlein purpura (HSP) is the most common childhood vasculitis, infection is the most essential inducement. We hypothesized that infection could impact the blood routine characteristics and/or outcome of vasculitis. Thus, we aim to find the most common infectious agent in HSP patients and identify convenient indicators to predict renal involvement in HSP patients with infection. METHOD We conducted a retrospective study of 208 HSP children and 98 healthy children. Clinical parameters were compared in those cases. RESULTS A total of 68.75% of patients were infected with various pathogens. The mean platelet volume (MPV) (P < 0.02) was lower in HSP patients with infection than patients without infection. Mycoplasma pneumoniae (MP) infection accounted for the largest proportion (45.77%). MPV in HSP nephritis (HSPN) group was lower than in HSP patients (excluded renal involvement) in patients with MP infection. Logistic regression analysis found that age and MPV were risk factors for the occurrence of MP-infected HSPN. The receiver operating characteristic curve (ROC) analysis showed that the combination of MPV with the onset age at the optimal cut-off point had 81% sensitivity in predicting whether HSP patients with MP infection would develop into HSPN. CONCLUSIONS Our research revealed that MP was the most commonly infected pathogen of children's HSP. MPV was an essential predictor of nephritis in HSP patients with MP infection. This discovery can prompt clinical treatments as well as reduce costs. Key Points • Mycoplasma pneumoniae (MP) accounts for the largest proportion in HSP children with infection. • MPV can be used as a predictor for the development of MP-triggered HSP to HSPN.
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Affiliation(s)
- Can Liu
- Clinical Laboratory, Hunan Children's Hospital, Changsha, 410007, China.
| | - Lingli Luo
- Clinical Laboratory, Hunan Children's Hospital, Changsha, 410007, China
| | - Min Fu
- Clinical Laboratory, Hunan Children's Hospital, Changsha, 410007, China
| | - Zhengqiu Li
- Clinical Laboratory, Hunan Children's Hospital, Changsha, 410007, China
| | - Jianlong Liu
- Clinical Laboratory, Hunan Children's Hospital, Changsha, 410007, China
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3
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Kang SA, Khalaf SA, Nelson T. Immunoglobulin A vasculitis induced by atypical pneumonia infection with Chlamydophila pneumonia. IDCases 2022; 30:e01624. [PMID: 36193106 PMCID: PMC9526174 DOI: 10.1016/j.idcr.2022.e01624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/24/2022] [Indexed: 11/26/2022] Open
Abstract
Infections are a common trigger for IgA vasculitis. Among the bacteria that cause atypical pneumonia, Mycoplasma pneumoniae infection has strongly been associated with IgA vasculitis, with Chlamydophila pneumoniae reported with IgA vasculitis in only one case. Though IgA vasculitis is a self-limiting disease, patients with infection-related vasculitis have shown to benefit from early identification and treatment with antimicrobial therapy. Here, we report a case of IgA vasculitis due to C. pneumoniae infection in a 19-year-old male who presented with an acute onset of rash, that was later followed by symptoms of cough and fever.
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4
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Konstantinou GN, Sagonas I, Giannoula FC. Chronic Spontaneous and Inducible Urticaria Associated With Mycoplasma pneumoniae Infection. Cureus 2021; 13:e18746. [PMID: 34790492 PMCID: PMC8588722 DOI: 10.7759/cureus.18746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/05/2022] Open
Abstract
Acute childhood urticaria is a common disorder that has been associated with infections. In a few children, it may last for more than six weeks, thereafter it is characterized as chronic urticaria (CU). We report two cases, one suffering from chronic spontaneous urticaria and one chronic inducible urticarias (dermographism and cold urticaria). Both children had concomitant respiratory symptoms that were associated with Mycoplasma pneumoniae (MP) infection. Urticarias' symptoms and signs were refractory to regular antihistamines dose but showed marked improvement or complete resolution following clarithromycin administration. CU response to antibiotics pointed strongly to a potential causative role of MP in the pathogenesis of chronic spontaneous and chronic inducible urticarias. It is not clear if MP was the etiopathogenic cause or just the trigger. Nevertheless, refractory to antihistamines urticarias associated with MP infection may respond to antibiotics, which should be considered as an alternative therapeutic approach.
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Affiliation(s)
- George N Konstantinou
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, GRC
| | - Ioannis Sagonas
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, GRC
| | - Fani C Giannoula
- Department of Allergy and Clinical Immunology, 424 General Military Training Hospital, Thessaloniki, GRC
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5
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Liu J, Li Y. Thrombosis associated with mycoplasma pneumoniae infection (Review). Exp Ther Med 2021; 22:967. [PMID: 34335909 PMCID: PMC8290426 DOI: 10.3892/etm.2021.10399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/18/2021] [Indexed: 12/12/2022] Open
Abstract
Mycoplasma pneumoniae is a common pathogen causing respiratory infections in children and adults. In addition to respiratory diseases, Mycoplasma pneumoniae is also involved in numerous extrapulmonary diseases. Thrombosis is an extrapulmonary manifestation associated with Mycoplasma pneumoniae infection. In recent years, an increasing number of case reports have been published identifying thrombosis secondary to Mycoplasma pneumoniae infection. In the present study, the available relevant literature in English available on PubMed, Medline and Web of Science was consulted. The results of the present study demonstrated that in patients with thrombosis caused by Mycoplasma pneumoniae infection, some of the factors causing thrombosis are transient and some are due to hereditary thrombophilia. Following timely treatment, the majority of patients recovered completely but some patients had a poor prognosis. The present review focuses on the pathogenesis, clinical features, treatment and prognosis of this crucial issue, which contributes toward the understanding of the disease.
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Affiliation(s)
- Jingwei Liu
- Department of Pediatrics Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
| | - Yumei Li
- Department of Pediatrics Intensive Care Unit, The First Hospital of Jilin University, Changchun, Jilin 130021, P.R. China
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6
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Epidemiology and Clinical Characteristics of Henoch-Schönlein Purpura Associated with Mycoplasma pneumoniae Infection in 131 Children in Hubei Province, China. Mediterr J Hematol Infect Dis 2021; 13:e2021037. [PMID: 34007425 PMCID: PMC8114884 DOI: 10.4084/mjhid.2021.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022] Open
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7
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Gómez Rufo D, García Sánchez E, García Sánchez JE, García Moro M. [Clinical implications of the genus Mycoplasma]. REVISTA ESPANOLA DE QUIMIOTERAPIA 2021; 34:169-184. [PMID: 33735544 PMCID: PMC8179937 DOI: 10.37201/req/014.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dentro del género Mycoplasma, las especies que tradicionalmente se han relacionado con cuadros infecciosos han sido principalmente M. pneumoniae, M. genitalium, M. hominis o U. urealyticum. Sin embargo, existen otras muchas que están implicadas y, que muchas veces, son desconocidas para los profesionales sanitarios. El objetivo de esta revisión es identificar todas las especies del género Mycoplasma que se han aislado en el hombre y determinar su participación en la patología infecciosa humana.
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Affiliation(s)
| | - E García Sánchez
- Enrique García Sánchez, Departamento de Ciencias Biomédicas. Facultad de Medicina. Universidad de Salamanca. Spain.
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8
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Atypical Bacterial Pathogens and Small-Vessel Leukocytoclastic Vasculitis of the Skin in Children: Systematic Literature Review. Pathogens 2021; 10:pathogens10010031. [PMID: 33401725 PMCID: PMC7823485 DOI: 10.3390/pathogens10010031] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 12/27/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022] Open
Abstract
Leukocytoclastic small-vessel vasculitis of the skin (with or without systemic involvement) is often preceded by infections such as common cold, tonsillopharyngitis, or otitis media. Our purpose was to document pediatric (≤18 years) cases preceded by a symptomatic disease caused by an atypical bacterial pathogen. We performed a literature search following the Preferred Reporting of Systematic Reviews and Meta-Analyses guidelines. We retained 19 reports including 22 cases (13 females and 9 males, 1.0 to 17, median 6.3 years of age) associated with a Mycoplasma pneumoniae infection. We did not find any case linked to Chlamydophila pneumoniae, Chlamydophila psittaci, Coxiella burnetii, Francisella tularensis, or Legionella pneumophila. Patients with a systemic vasculitis (N = 14) and with a skin-limited (N = 8) vasculitis did not significantly differ with respect to gender and age. The time to recovery was ≤12 weeks in all patients with this information. In conclusion, a cutaneous small-vessel vasculitis with or without systemic involvement may occur in childhood after an infection caused by the atypical bacterial pathogen Mycoplasma pneumoniae. The clinical picture and the course of cases preceded by recognized triggers and by this atypical pathogen are indistinguishable.
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9
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Castan P, Maigne G, Boutemy J, Martin Silva N, De Boysson H, Aouba A, Audemard-Verger A. [IgA vasculitis secondary to Klebsiella pneumoniae infection]. Rev Mal Respir 2020; 37:417-421. [PMID: 32360054 DOI: 10.1016/j.rmr.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/03/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION IgA vasculitis is a leucocytoclastic vasculitis of small vessels with immune deposits of IgA. It tends to occur in a post-infectious context, though the pathogenic agent is rarely found. OBSERVATION We report, for the first time, the case of an 81-year old patient who presented with an acute IgA vasculitis with cutaneous and joint involvement during a Klebsiella pneumoniae respiratory infection. Remission of vasculitis was observed after antibiotic therapy alone. CONCLUSION This observation reminds us of the need to search carefully for any pathogenic agent that may be driving IgA vasculitis as this may be important both for understanding aetiology and for treatment.
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MESH Headings
- Aged, 80 and over
- Humans
- Immunoglobulin A/adverse effects
- Klebsiella Infections/complications
- Klebsiella Infections/immunology
- Klebsiella pneumoniae/immunology
- Klebsiella pneumoniae/physiology
- Lung Abscess/complications
- Lung Abscess/immunology
- Lung Abscess/microbiology
- Male
- Pneumonia, Bacterial/complications
- Pneumonia, Bacterial/immunology
- Pneumonia, Bacterial/microbiology
- Vasculitis/diagnosis
- Vasculitis/etiology
- Vasculitis, Leukocytoclastic, Cutaneous/diagnosis
- Vasculitis, Leukocytoclastic, Cutaneous/etiology
- Vasculitis, Leukocytoclastic, Cutaneous/immunology
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Affiliation(s)
- P Castan
- Service de médecine interne et immunologie clinique, CHU de Caen Côte de Nacre, 14000 Caen, France.
| | - G Maigne
- Service de médecine interne et immunologie clinique, CHU de Caen Côte de Nacre, 14000 Caen, France
| | - J Boutemy
- Service de médecine interne et immunologie clinique, CHU de Caen Côte de Nacre, 14000 Caen, France
| | - N Martin Silva
- Service de médecine interne et immunologie clinique, CHU de Caen Côte de Nacre, 14000 Caen, France
| | - H De Boysson
- Service de médecine interne et immunologie clinique, CHU de Caen Côte de Nacre, 14000 Caen, France
| | - A Aouba
- Service de médecine interne et immunologie clinique, CHU de Caen Côte de Nacre, 14000 Caen, France; Université de Caen-Normandie, UFR Médecine, 19, rue Claude-Bloch, Caen, France
| | - A Audemard-Verger
- Service de médecine interne et immunologie clinique, CHRU de Tours, Tours, France
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10
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Dapsone treatment is efficient against persistent cutaneous and gastrointestinal symptoms in children with Henoch-Schönlein purpura. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2018; 162:154-158. [DOI: 10.5507/bp.2017.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/06/2017] [Indexed: 11/23/2022] Open
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Abstract
Vasculitides are disorders characterized by inflammation of the vessel walls, often caused by autoimmunity, but sometimes as a result of microbial invasion. Almost all types of microbes including bacteria, viruses, protozoa and fungi have been incriminated in the pathogenesis of vasculitis. Accurate etiological diagnosis is important since immunosuppressive treatment may lead to further deterioration if infection is the cause of vasculitis. Clinical features sometimes provide clues to the etiology. Further evaluation requires a focused and cost-effective plan of laboratory investigation. The investigations aim at establishing the diagnosis of vasculitis and identify the causative organism. An accurate diagnosis of vasculitis optimally requires histological examination and imaging. For infection-associated vasculitis, the identification of the organism requires studies of stained specimens, cultures, and/or detection of antigens and antibodies. Ideally, the treatment involves administration of an appropriate antimicrobial. In non-self-limiting types of vasculitides, glucocorticoids are needed when the symptoms are progressive, with vital organs involvement, and sometimes, when there is no antimicrobial agent of proven efficacy against the incriminated agent. Additional immunosuppressive agents or interventions must be considered when the disease is severe and/or post-infective immune mechanisms are involved in the pathogenesis, e.g., severe HBV- or HCV-associated vasculitides. Available preventative vaccinations are also crucial. The incidence of HBV-associated vasculitides dramatically decreased following HBV vaccination campaigns, and other infection-associated vasculitides may as well in the future.
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Affiliation(s)
- Syed A Haq
- BSM Medical University, Dhaka, Bangladesh
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12
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Fukuda K, Matsuda K, Matsuda S, Kado S, Masu H, Dohi H, Nishida Y. Chemosynthetic homologues of Mycoplasma pneumoniae β-glycolipid antigens for the diagnosis of mycoplasma infectious diseases. Bioorg Med Chem 2017; 26:824-832. [PMID: 29373272 DOI: 10.1016/j.bmc.2017.12.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 12/25/2017] [Accepted: 12/28/2017] [Indexed: 11/26/2022]
Abstract
Mycoplasma pneumoniae expresses β-glycolipids (β-GGLs) in cytoplasmic membranes, which possess a unique β(1 → 6)-linked disaccharide epitope, which has high potential in biochemical and medicinal applications. In the present study, a series of β-GGLs homologues with different acyl chains (C12, C14, C16, and C18) were prepared from a common precursor. An ELISA assay using an anti-(β-GGLs) monoclonal antibody indicated that the synthetic homologues with long acyl chains had greater diagnostic potential in the order C18 > C16 > C14 > C12. Toward a simultaneous detection of natural glycolipids by mass spectrometry (MS), a deuterium-labeled C16 homologue (β-GGL-C16-d3) was prepared and applied as an internal standard for a high-resolution electrospray ionization MS (ESI-MS) analysis. The ESI-MS analysis was used to identify and quantify acyl homologues (C16/C16, C16/C18, and C18/C18) of β-GGL-C16 in cultured M. pneumoniae. A β-GGLs homologue with a 1,2-diacetyl group (C2) was also prepared as a "water soluble" glycolipid homologue and characterized by 1H NMR spectroscopy. We envisage that each of these chemosynthetic homologues will provide promising approaches to solve medical and biological problems associated with mycoplasma infectious diseases (MIDs).
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Affiliation(s)
- Kazuo Fukuda
- Molecular Chirality Research Center, Graduate School of Advanced Integration Science, Chiba University, 648 Matsudo, Matsudo, Chiba 271-8510, Japan; Center for Analytical Instrumentation, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan
| | - Kazuhiro Matsuda
- M. Bio Technology Inc., 2-1-3-1103, Fukasawa, Setagaya-ku, Tokyo 158-0081, Japan
| | - Sachie Matsuda
- M. Bio Technology Inc., 2-1-3-1103, Fukasawa, Setagaya-ku, Tokyo 158-0081, Japan
| | - Sayaka Kado
- Center for Analytical Instrumentation, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan
| | - Hyuma Masu
- Center for Analytical Instrumentation, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba 263-8522, Japan
| | - Hirofumi Dohi
- Molecular Chirality Research Center, Graduate School of Advanced Integration Science, Chiba University, 648 Matsudo, Matsudo, Chiba 271-8510, Japan
| | - Yoshihiro Nishida
- Molecular Chirality Research Center, Graduate School of Advanced Integration Science, Chiba University, 648 Matsudo, Matsudo, Chiba 271-8510, Japan.
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14
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Lucchese A. Streptococcus mutans antigen I/II and autoimmunity in cardiovascular diseases. Autoimmun Rev 2017; 16:456-460. [PMID: 28286107 DOI: 10.1016/j.autrev.2017.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 02/05/2017] [Indexed: 12/12/2022]
Abstract
Infectious pathogens from the oral cavity cause oral diseases such as caries, gingivitis, periodontitis, endodontic infections, and alveolar osteitis, and often are also concomitant to systemic diseases, including cardiovascular disorders, stroke, preterm birth, diabetes, and pneumonia, among others. The relationship(s) between oral infections and systemic diseases are still unclear. Using the bacterial cell surface antigen I/II from S. mutans and cardiovascular diseases as a model, this study analyzes peptide commonalities that might underlie autoimmune crossreactions between the bacterial antigen and human proteins associated with cardiovascular disorders. The study outlines a vast peptide sharing that calls attention on autoimmune crossreactivity as a possible mechanism by which S. mutans infection might contribute to induce cardiovascular diseases, and, more in general, offers a new approach to investigate the still elusive molecular links between focal oral infections and human systemic diseases.
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Affiliation(s)
- Alberta Lucchese
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania 'Luigi Vanvitelli', Via de Crecchio 6, 80138 Naples, Italy.
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Tang C, Scaramangas-Plumley D, Nast CC, Mosenifar Z, Edelstein MA, Weisman M. A Case of Henoch-Schonlein Purpura Associated with Rotavirus Infection in an Elderly Asian Male and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:136-142. [PMID: 28174414 PMCID: PMC5310226 DOI: 10.12659/ajcr.901978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Patient: Male, 73 Final Diagnosis: Henoch-Schönlein purpura (HSP) Symptoms: Abdominal pain • bloating • blood in stool • nausea • vomiting Medication: — Clinical Procedure: EGD • colonoscopy • kidney biopsy • skin biopsy • arthrocentesis Specialty: Rheumatology
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Affiliation(s)
- Chen Tang
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Cynthia C Nast
- Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zab Mosenifar
- Department of Nephrology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Marc A Edelstein
- Department of Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael Weisman
- Department of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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