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Modification of disease outcome in Salmonella-infected patients by HLA-B27
P Ekman1, J Kirveskari, K Granfors
1National Public Health Institute, Turku, Finland.
Objective:
To study whether HLA-B27 modifies the outcome of Salmonella infection in vivo.
Methods:
The frequency of HLA-B27 was determined in 198 Salmonella-infected patients and 100 healthy controls by immunofluorescence and polymerase chain reaction. The excretion of Salmonella was monitored at monthly intervals. The symptoms of acute infection and possible joint involvement were evaluated using questionnaires.
Results:
Thirty-eight of 198 Salmonella-infected patients (19.2%) and 13 of 100 healthy controls (13.0%) were HLA-B27 positive. The excretion of Salmonella did not differ significantly between HLA-B27-positive and -negative patients, or for patients with versus those without joint symptoms. As many as 35 patients (17.7%) reported Salmonella-triggered joint symptoms. Three of 14 patients (21.4%) with arthralgia, 5 of 13 patients (38.5%) with probable reactive arthritis (ReA), and 6 of 8 patients (75%) with confirmed ReA were HLA-B27 positive. The duration and severity of joint symptoms directly correlated with HLA-B27 positivity. Women reported Salmonella-induced pain and swelling of joints more frequently than men (P = 0.07 and P = 0.03, respectively). Patients with Salmonella-triggered joint symptoms reported abdominal pain and headache more frequently than patients without joint symptoms (P = 0.05 and P = 0.004, respectively).
Conclusion:
HLA-B27 did not (at least, not strongly) confer susceptibility to Salmonella infection. Salmonella excretion correlated neither with HLA-B27 positivity nor with the occurrence of joint symptoms. Joint symptoms were surprisingly common during or after Salmonella infection. HLA-B27-positive patients had a significantly increased risk of developing joint and tendon symptoms. Moreover, HLA-B27 positivity correlated with the development of more severe and prolonged joint symptoms.
Insights
Human leukocyte antigen B27 (HLA-B27) does not increase susceptibility to Salmonella infection. However, HLA-B27 positivity significantly increases the risk and severity of joint symptoms following Salmonella infection.
Area of Science:
- Immunogenetics
- Infectious Diseases
- Rheumatology
Background:
- Human leukocyte antigen B27 (HLA-B27) is a gene linked to autoimmune diseases.
- Salmonella infections can trigger reactive arthritis in susceptible individuals.
Purpose of the Study:
- To investigate the role of HLA-B27 in Salmonella infection outcomes.
- To determine if HLA-B27 influences susceptibility, Salmonella shedding, or joint symptom development.
Main Methods:
- HLA-B27 frequency determined by immunofluorescence and PCR in 198 Salmonella-infected patients and 100 controls.
- Salmonella excretion monitored monthly.
- Infection and joint symptoms assessed via questionnaires.
Main Results:
- HLA-B27 prevalence was 19.2% in infected patients vs. 13% in controls.
- Salmonella excretion did not differ between HLA-B27 positive/negative patients.
- HLA-B27 positivity correlated with increased risk, severity, and duration of joint symptoms, including reactive arthritis.
Conclusions:
- HLA-B27 does not strongly influence susceptibility to Salmonella infection or pathogen shedding.
- Joint symptoms are common post-Salmonella infection.
- HLA-B27 significantly increases the risk and severity of Salmonella-induced joint and tendon symptoms.