Reactive arthritis in coinfection with Chlamydia trachomatis and Chlamydia pneumoniae

Abstract

The below case of the development of reactive arthritis against the background of coinfection of Chlamydia trachomatis and Chlamydia pneumoniae is interesting by the features of the clinical picture, the duration of the course, the complexity of diagnosis, laboratory observation, and a comprehensive approach to therapy.

Reactive arthritis belongs to the group of seronegative spondyloarthritis, has a variety of symptoms with damage to various organs and systems. All patients have pathology of peripheral joints and/or axial skeleton. The disease is immuno-inflammatory in nature, may follow an infection of the genitourinary or digestive tract. A special role in the development of urogenic reactive arthritis is assigned to Chlamydia trachomatis. Less often, reactive arthritis is caused by C. pneumoniae. In the case of persistent infection, non-simultaneous development or low expression of symptoms, the diagnosis of reactive arthritis is difficult, and in about one case out of five, the disease becomes chronic. Predisposition to severe course of reactive arthritis may cause the presence of HLA-B27 antigen in the patient. It can be assumed that coinfection of two varieties of chlamydia (C. pneumoniae and C. trachomatis) can act synergistically, increasing the risk of developing reactive arthritis.

The available data on the effectiveness of the complex of antibacterial anti-chlamydia drugs, own experience of the lymphotropic method of administration, has been successfully used in the complex treatment of the patient.

Keywords

reactive arthritis / urogenic reactive arthritis / infection / persistent chlamydia infection / lymphotropic antibiotic therapy / case report

References

[1] Carter JD, Hudson AP. Recent advances and future directions in understanding and treating Chlamydia-induced reactive arthritis. Expert Rev Clin Immunol. 2017;13(3):197–206. doi: 10.1080/1744666X.2017.1233816

[2] Carter J.D., Hudson A.P. Recent advances and future directions in understanding and treating Chlamydia-induced reactive arthritis // Expert Rev Clin Immunol. 2017. Vol. 13, N 3. Р. 197–206. doi: 10.1080/1744666X.2017.1233816

[3] Carter JD, Inman RD, Whittum-Hudson J, Hudson AP. Chlamydia and chronic arthritis. Ann Med. 2012;44(8):784–792. doi: 10.3109/07853890.2011.606830

[4] Carter J.D., Inman R.D., Whittum-Hudson J., Hudson A.P. Chlamydia and chronic arthritis // Ann Med. 2012. Vol. 44, N 8. Р. 784–792. doi: 10.3109/07853890.2011.606830

[5] Rizzo A, Domenico MD, Carratelli CR, Paolillo R. The role of Chlamydia and Chlamydophila infections in reactive arthritis. Intern Med. 2012;51(1):113–117. doi: 10.2169/internalmedicine.51.6228

[6] Rizzo A., Domenico M.D., Carratelli C.R., Paolillo R. The role of Chlamydia and Chlamydophila infections in reactive arthritis // Intern Med. 2012. Vol. 51, N 1. Р. 113–117. doi: 10.2169/internalmedicine.51.6228

[7] Hamdulay SS, Glynne SJ, Keat A. When is arthritis reactive? Postgrad Med J. 2006;82(969):446–453. doi: 10.1136/pgmj.2005.044057

[8] Hamdulay S.S., Glynne S.J., Keat A. When is arthritis reactive? // Postgrad Med J. 2006. Vol. 82, N 969. Р. 446–453. doi: 10.1136/pgmj.2005.044057

[9] Hannu T, Inman R, Granfors K, Leirisalo-Repo M. Reactive arthritis or post-infectious arthritis? Best Pract Res Clin Rheumatol. 2006;20(3):419–433. doi: 10.1016/j.berh.2006.02.003

[10] Hannu T., Inman R., Granfors K., Leirisalo-Repo M. Reactive arthritis or post-infectious arthritis? // Best Pract Res Clin Rheumatol. 2006. Vol. 20, N 3. Р. 419–433. doi: 10.1016/j.berh.2006.02.003

[11] Pope JE, Krizova A, Garg AX, et al. Campylobacter reactive arthritis: A systematic review. Semin Arthritis Rheum. 2007;37(1):48–55. doi: 10.1016/j.semarthrit.2006.12.006

[12] Pope J.E., Krizova A., Garg A.X., et al. Campylobacter reactive arthritis: A systematic review // Semin Arthritis Rheum. 2007. Vol. 37, N 1. Р. 48–55. doi: 10.1016/j.semarthrit.2006.12.006

[13] Morris D, Inman RD. Reactive arthritis: developments and challenges in diagnosis and treatment. Curr Rheumatol Rep. 2012;14(5):390–394. doi: 10.1007/s11926-012-0280-4

[14] Morris D., Inman R.D. Reactive arthritis: Developments and challenges in diagnosis and treatment // Curr Rheumatol Rep. 2012. Vol. 14, N 5. Р. 390–394. doi: 10.1007/s11926-012-0280-4

[15] Inman RD, Whittum-Hudson JA, Schumacher HR, Hudson AP. Chlamydia and associated arthritis. Curr Opin Rheumatol. 2000;12(4):254–262. doi: 10.1097/00002281-200007000-00004

[16] Inman R.D., Whittum-Hudson J.A., Schumacher H.R., Hudson A.P. Chlamydia and associated arthritis // Curr Opin Rheumatol. 2000. Vol. 12, N 4. Р. 254–262. doi: 10.1097/00002281-200007000-00004

[17] Owlia MB, Eley AR. Is the role of Chlamydia trachomatis underestimated in patients with suspected reactive arthritis? Int J Rheum Dis. 2010;13(1):27–38. doi: 10.1111/j.1756-185X.2009.01446.x

[18] Owlia M.B., Eley A.R. Is the role of Chlamydia trachomatis underestimated in patients with suspected reactive arthritis? // Int J Rheum Dis. 2010. Vol. 13, N 1. Р. 27–38. doi: 10.1111/j.1756-185X.2009.01446.x

[19] Selmi C, Gershwin ME. Diagnosis and classification of reactive arthritis. Autoimmun Rev. 2014;13(4-5):546–549. doi: 10.1016/j.autrev.2014.01.005

[20] Selmi C., Gershwin M.E. Diagnosis and classification of reactive arthritis // Autoimmun Rev. 2014. Vol. 13, N 4-5. Р. 546–549. doi: 10.1016/j.autrev.2014.01.005

[21] Carlin EM, Ziza JM, Keat A, Janier M. 2014 European Guideline on the management of sexually acquired reactive arthritis. Int J STD AIDS. 2014;25(13):901–912. doi: 10.1177/0956462414540617

[22] Carlin E.M., Ziza J.M., Keat A., Janier M. 2014 European Guideline on the management of sexually acquired reactive arthritis // Int J STD AIDS. 2014. Vol. 25, N 13. Р. 901–912. doi: 10.1177/0956462414540617

[23] Zeidler H, Kuipers J, Köhler L. Chlamydia-induced arthritis. Curr Opin Rheumatol. 2004;16(4):380–392. doi: 10.1097/01.bor.0000126150.04251.f9

[24] Zeidler H., Kuipers J., Köhler L. Chlamydia-induced arthritis // Curr Opin Rheumatol. 2004. Vol. 16, N 4. Р. 380–392. doi: 10.1097/01.bor.0000126150.04251.f9

[25] Carter JD, Gérard HC, Espinoza LR, et al. Chlamydiae as etiologic agents in chronic undifferentiated spondylarthritis. Arthritis Rheum. 2009;60(5):1311–1316. doi: 10.1002/art.24431

[26] Carter J.D., Gérard H.C., Espinoza L.R., et al. Chlamydiae as etiologic agents in chronic undifferentiated spondylarthritis // Arthritis Rheum. 2009. Vol. 60, N 5. Р. 1311–1316. doi: 10.1002/art.24431

[27] Carter JD, Espinoza LR, Inman RD, et al. Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: A double-blind, placebo-controlled, prospective trial. Arthritis Rheum. 2010;62(5):1298–1307. doi: 10.1002/art.27394

[28] Carter J.D., Espinoza L.R., Inman R.D., et al. Combination antibiotics as a treatment for chronic Chlamydia-induced reactive arthritis: A double-blind, placebo-controlled, prospective trial // Arthritis Rheum. 2010. Vol. 62, N 5. Р. 1298–1307. doi: 10.1002/art.27394

[29] Zeidler H, Hudson AP. New insights into Chlamydia and arthritis. Promise of a cure? Ann Rheum Dis. 2014;73(4):637–644. doi: 10.1136/annrheumdis-2013-204110

[30] Zeidler H., Hudson A.P. New insights into Chlamydia and arthritis. Promise of a cure? // Ann Rheum Dis. 2014. Vol. 73, N 4. Р. 637–644. doi: 10.1136/annrheumdis-2013-204110

[31] Schumacher HR, Gérard HC, Arayssi TK, et al. Lower prevalence of Chlamydia pneumoniae DNA compared with Chlamydia trachomatis DNA in synovial tissue of arthritis patients. Arthritis Rheum. 1999;42(9):1889–1893. doi: 10.1002/1529-0131(199909)42:9<1889::AID-ANR13>3.0.CO;2-W

[32] Schumacher H.R., Gérard H.C., Arayssi T.K., et al. Lower prevalence of Chlamydia pneumoniae DNA compared with Chlamydia trachomatis DNA in synovial tissue of arthritis patients // Arthritis Rheum. 1999. Vol. 42, N 9. Р. 1889–1893. doi: 10.1002/1529-0131(199909)42:9<1889::AID-ANR13>3.0.CO;2-W

[33] Villareal C, Whittum-Hudson JA, Hudson AP. Persistent Chlamydiae and chronic arthritis. Arthritis Res. 2002;4(1):5–9. doi: 10.1186/ar382

[34] Villareal C., Whittum-Hudson J.A., Hudson A.P. Persistent Chlamydiae and chronic arthritis // Arthritis Res. 2002. Vol. 4, N 1. Р. 5–9. doi: 10.1186/ar382

[35] Gérard HC, Wang Z, Wang GF, et al. Chromosomal DNA from a variety of bacterial species is present in synovial tissue from patients with various forms of arthritis. Arthritis Rheum. 2001;44(7):1689–1697. doi: 10.1002/1529-0131(200107)44:7<1689::AID-ART293>3.0.CO;2-K

[36] Gérard H.C., Wang Z., Wang G.F., Schumacher H.R. Chromosomal DNA from a variety of bacterial species is present in synovial tissue from patients with various forms of arthritis // Arthritis Rheum. 2001. Vol. 44, N 7. Р. 1689–1697. doi: 10.1002/1529-0131(200107)44:7<1689::AID-ART293>3.0.CO;2-K

[37] Telyatnikova N, Hill Gaston JS. Prior exposure to infection with Chlamydia pneumoniae can influence the T-cell-mediated response to Chlamydia trachomatis. FEMS Immunol Med Microbiol. 2006;47(2):190–198. doi: 10.1111/j.1574-695X.2006.00080.x

[38] Telyatnikova N., Hill Gaston J.S. Prior exposure to infection with Chlamydia pneumoniae can influence the T-cell-mediated response to Chlamydia trachomatis // FEMS Immunol Med Microbiol. 2006. Vol. 47, N 2. Р. 190–198. doi: 10.1111/j.1574-695X.2006.00080.x

[39] Peters BM, Jabra-Rizk MA, O’May GA, et al. Polymicrobial interactions: Impact on pathogenesis and human disease. Clin Microbiol Rev. 2012;25(1):193–213. doi: 10.1128/CMR.00013-11

[40] Peters B.M., Jabra-Rizk M.A., O’May G.A., et al. Polymicrobial interactions: Impact on pathogenesis and human disease // Clin Microbiol Rev. 2012. Vol. 25, N 1. Р. 193–213. doi: 10.1128/CMR.00013-11

[41] Pasman L. The complication of coinfection. Yale J Biol Med. 2012;85(1):127–132.

[42] Pasman L. The complication of coinfection // Yale J Biol Med. 2012. Vol. 85, N 1. Р. 127–132.

[43] Yokoi S, Maeda S, Kubota Y, et al. The role of Mycoplasma genitalium and Ureaplasma urealyticum biovar 2 in postgonococcal urethriti. Clin Infect Dis. 2007;45(7):866–871. doi: 10.1086/521266

[44] Yokoi S., Maeda S., Kubota Y., et al. The role of Mycoplasma genitalium and Ureaplasma urealyticum biovar 2 in postgonococcal urethritis // Clin Infect Dis. 2007. Vol. 45, N 7. Р. 866–871. doi: 10.1086/521266

[45] Maeda S, Deguchi T, Ishiko H, et al. Detection of Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in patients with non-gonococcal urethritis using polymerase chain reaction-microtiter plate hybridization. Int J Urol. 2004;11(9):750–754. doi: 10.1111/j.1442-2042.2004.00887.x

[46] Maeda S., Deguchi T., Ishiko H., et al. Detection of Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma parvum (biovar 1) and Ureaplasma urealyticum (biovar 2) in patients with non-gonococcal urethritis using polymerase chain reaction-microtiter plate hybridization // Int J Urol. 2004. Vol. 11, N 9. Р. 750–754. doi: 10.1111/j.1442-2042.2004.00887.x

[47] Brunner H, Weidner W, Schiefer HG. Quantitative studies on the role of Ureaplasma urealyticum in non-gonococcal urethritis and chronic prostatitis. Yale J Biol Med. 1983;56(5-6):545–550.

[48] Brunner H., Weidner W., Schiefer H.G. Quantitative studies on the role of Ureaplasma urealyticum in non-gonococcal urethritis and chronic prostatitis // Yale J Biol Med. 1983. Vol. 56, N 5-6. Р. 545–550.

[49] Carter JD, Valeriano J, Vasey FB. Doxycycline versus doxycycline and rifampin in undifferentiated spondyloarthropathy, with special reference to chlamydia-induced arthritis. A prospective, randomized 9-month comparison. J Rheumatol. 2004;31(10):1973–1980.

[50] Carter J.D., Valeriano J., Vasey F.B. Doxycycline versus doxycycline and rifampin in undifferentiated spondyloarthropathy, with special reference to chlamydia-induced arthritis. A prospective, randomized 9-month comparison // J Rheumatol. 2004. Vol. 31, N 10. Р. 1973–1980.

[51] Molochkov VA, Ilyin II. Chronic urethrogenic prostatitis. 2nd ed., revised and updated. Moscow: Meditsina; 2004. 286 p. (In Russ).

[52] Молочков В.А., Ильин И.И. Хронический уретрогенный простатит. Изд. 2-е, перераб. и доп. Москва: Медицина, 2004. 286 с.

RIGHTS & PERMISSIONS

Eco-Vector