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Risk of bacterial pneumonia and pneumococcal infection in youths with celiac disease - A population-based study

Cristina Canova1, Jonas Ludvigsson2, Vincenzo Baldo1

  • 1Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy.

Digestive and Liver Disease : Official Journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
|March 31, 2019
PubMed

Insights

Young individuals with celiac disease (CD) face a higher risk of bacterial pneumonia, particularly before diagnosis. Pneumococcal infection risk was not significantly increased. Anti-pneumococcal vaccination is recommended for children and youth with CD.

Area of Science:

  • Pediatric Gastroenterology
  • Infectious Diseases
  • Clinical Epidemiology

Background:

  • Celiac disease (CD) is an autoimmune disorder affecting the small intestine.
  • Individuals with CD may have altered immune responses, potentially increasing infection susceptibility.
  • The risk of bacterial pneumonia and pneumococcal infections in pediatric CD populations is not well-established.

Purpose of the Study:

  • To assess the risk of hospitalizations for bacterial pneumonia and pneumococcal infections in young individuals diagnosed with celiac disease.
  • To compare these risks against a matched cohort of individuals without CD.
  • To analyze infection risks in relation to the timing of CD diagnosis.

Main Methods:

  • A large cohort study of 213,635 individuals born between 1989-2012 in Italy.
  • Identification of 1294 CD patients and 6470 matched controls using pathology reports and hospital records.
  • Statistical analysis using Cox regression for post-diagnosis and conditional logistic regression for pre-diagnosis periods, focusing on first-time bacterial pneumonia and pneumococcal infections.

Main Results:

  • A 1.82-fold increased risk of bacterial pneumonia was observed in CD patients post-diagnosis (HR 1.82; 95%CI 0.98-3.35).
  • Significantly elevated risks of bacterial pneumonia were found before CD diagnosis, peaking in the year prior (OR 6.00; 95%CI 1.83-19.66).
  • No significant increase in the risk of pneumococcal infections was detected in CD patients.

Conclusions:

  • Children and adolescents with celiac disease exhibit an increased risk of bacterial pneumonia, especially around the time of diagnosis.
  • The findings highlight a critical period of vulnerability for bacterial pneumonia in young CD patients.
  • Routine anti-pneumococcal vaccination is strongly recommended for all pediatric and adolescent CD patients to mitigate this risk.
Abstract

Keywords:
Coeliac diseaseCohort studyPediatric populationPneumococcal infection

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