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Is there any association between Sarcoidosis and infectious agents?: a systematic review and meta-analysis
Tiago Esteves1, Gloria Aparicio2, Vicente Garcia-Patos3,2
1Department of Medicine, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain. tcesteves990@sapo.pt.
Background:
During the last few years, investigators have debated the role that infectious agents may have in sarcoidosis pathogenesis. With the emergence of new molecular biology techniques, several studies have been conducted; therefore, we performed a meta-analysis in order to better explain this possible association.
Methods:
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement from the Cochrane collaboration guidelines. Four different databases (Medline, Scopus, Web of Science, and Cochrane Collaboration) were searched for all original articles published from 1980 to 2015. The present meta-analysis included case-control studies that reported the presence of microorganisms in samples of patients with sarcoidosis using culture methods or molecular biology techniques. We used a random effects or a fixed-effect model to calculate the odds ratio (OR) and 95% confidence intervals (CI). Sensitivity and subgroup analyses were performed in order to explore the heterogeneity among studies.
Results:
Fifty-eight studies qualified for the purpose of this analysis. The present meta-analysis, the first, to our knowledge, in evaluation of all infectious agents proposed to be associated with sarcoidosis and involving more than 6000 patients in several countries, suggests an etiological link between Propionibacterium acnes and sarcoidosis, with an OR of 18.80 (95% CI 12.62, 28.01). We also found a significant association between sarcoidosis and mycobacteria, with an OR of 6.8 (95% CI 3.73, 12.39). Borrelia (OR 4.82; 95% CI 0.98, 23.81), HHV-8 (OR 1.47; 95% CI 0.02, 110.06) as well as Rickettsia helvetica, Chlamydia pneumoniae, Epstein-barr virus and Retrovirus, although suggested by previous investigations, were not associated with sarcoidosis.
Conclusion:
This meta-analysis suggests that some infectious agents can be associated with sarcoidosis. What seems clear is that more than one infectious agent might be implicated in the pathogenesis of sarcoidosis; probably the patient's geographical location might dictate which microorganisms are more involved. Future investigations and more clinical trials are need to bring these evidences to a more global level.
Insights
This meta-analysis suggests infectious agents like Propionibacterium acnes and mycobacteria are linked to sarcoidosis. Further research is needed to confirm the role of specific microorganisms in sarcoidosis pathogenesis globally.
Area of Science:
- Immunology
- Microbiology
- Pulmonary Medicine
Background:
- Debate exists regarding the role of infectious agents in sarcoidosis pathogenesis.
- Advancements in molecular biology have prompted new investigations into potential microbial triggers.
- This meta-analysis aims to clarify the association between infectious agents and sarcoidosis.
Purpose of the Study:
- To systematically evaluate the evidence linking various infectious agents to sarcoidosis.
- To quantify the association between specific microorganisms and sarcoidosis using meta-analysis.
- To identify potential etiological factors in sarcoidosis based on existing research.
Main Methods:
- A comprehensive literature search was conducted across four major databases (Medline, Scopus, Web of Science, Cochrane Collaboration) for articles published between 1980 and 2015.
- Included case-control studies utilized culture or molecular techniques to detect microorganisms in sarcoidosis patients.
- Meta-analysis employed random or fixed-effect models to calculate odds ratios (OR) and 95% confidence intervals (CI), with sensitivity and subgroup analyses performed.
Main Results:
- The analysis included 58 studies involving over 6000 patients.
- A strong etiological link was found between Propionibacterium acnes and sarcoidosis (OR = 18.80; 95% CI: 12.62–28.01).
- A significant association was also observed between sarcoidosis and mycobacteria (OR = 6.8; 95% CI: 3.73–12.39).
- No significant association was found for Borrelia, HHV-8, Rickettsia helvetica, Chlamydia pneumoniae, Epstein-Barr virus, or Retrovirus.
Conclusions:
- The findings suggest that certain infectious agents are associated with sarcoidosis.
- Multiple infectious agents may contribute to sarcoidosis pathogenesis, potentially influenced by geographical factors.
- Further clinical trials and investigations are recommended to validate these findings globally.
