To the differential diagnosis of arthritides of pseudotuberculous and chlamydial etiology

Ol'ga Aleksandrovna Burgasova; Бургасова Ольга Александровна; Nikolay Dmitrievich Yushchuk; Ющук Николай Дмитриевич; Lidiya Vasil'evna Pogorel'skaya; Погорельская Лидия Васильевна; Galina Yakovlevna Tseneva; Ценева Галина Яковлевна; Lidiya Borisovna Kulyashova; Куляшова Лидия Борисовна; Ekaterina Aleksandrovna Voskresenskaya; Воскресенская Екатерина Александровна; Ivan Pavlovich Fedunyak; Федуняк Иван Павлович; O A Burgasova; Burgasova O A; N D Yushchuk; Yushchuk N D; L V Pogorelskaya; Pogorelskaya L V; G Ya Tseneva; Tseneva G Ya; L B Kulyashova; Kulyashova L B; Ye A Voskresenskaya; Voskresenskaya Ye A; I P Fedunyak; Fedunyak I P

To the differential diagnosis of arthritides of pseudotuberculous and chlamydial etiology

Authors: Burgasova O.A.¹, Yushchuk N.D.¹, Pogorel'skaya L.V.², Tseneva G.Y.³, Kulyashova L.B.³, Voskresenskaya E.A.³, Fedunyak I.P.⁴, Burgasova OA⁵, Yushchuk ND⁵, Pogorelskaya LV⁶, Tseneva GY.⁷, Kulyashova LB⁷, Voskresenskaya Y.A⁷, Fedunyak IP⁸
Affiliations:
1. Московский государственный медико-стоматологический университет
2. РМАПО Росздрава
3. ФГУН НИИЭМ им. Л. Пастера Роспотребнадзора
4. Клиническая инфекционная больница № 30 им. С. П. Боткина
5. Moscow State University of Medicine and Dentistry, Russian Agency for Health Care
6. Russian Medical Academy of Postgraduate Education
7. Pasteur Saint Petersburg Research Institute of Epidemiology and Microbiology, Russian Inspectorate for the Protection of Consumer Rights and Human Welfare
8. S. P. Botkin Clinical Infectious Diseases Hospital
Issue: Vol 82, No 11 (2010)
Pages: 53-57
Section: Editorial
URL: https://journal-vniispk.ru/0040-3660/article/view/30747
ID: 30747

Cite item

Abstract

Aim: to define main differential diagnostic criteria for arthritides of chlamydial and pseudotuberculous etiology and to improve patient examination tactics.
Subjects and methods. Forty-six patients with pseudotuberculosis and 41 patients with chronic urogenital chlamydial infection with articular involvement were examined. A bacteriological method of polymerase chain reaction (PCR), agglutination test, enzyme immunoassay (EIA) (IgA, IgG, IgM), indirect hemagglutination (IHA) test were used to diagnose pseudotuberculosis. Diagnostic techniques for chlamydiasis involved cultural, direct immunofluorescence (DIF), real-time PCR, and EIA (IgM, IgG, IgA).
Results. Patients with pseudotuberculosis developed polyarthritis and oligoarthritis in 56 and 39%, respectively. The development of arthritides was accompanied by fever in 89%, exanthema in 57%, gastrointestinal lesion in 56%, hepatomegalia in 78%. The pseudotuberculous etiology of the disease was confirmed by the agglutination test in 71% of the patients and by IHA in 7%. EIA revealed IgG in 78% of the patients, IgA in 11%, and IgM in 29%. PCR of synovial fluid (SF), synovial shell, and other biological substrates revealed Yersinia pseudotuberculosis DNA in 43%. Chlamydiasis and polyarthritis developed in 71 and 19%, respectively. The diagnosis of chlamydiasis was verified by EIA detection of IgG and IgA in 76 and 27% of cases, respectively. DIF, PCR, and culture studies of urethral scrapes found Chlamydia in 9, 32, and 29% of cases, respectively. Examination of SF and synovial shells revealed Chlamydia trachomatis in 24% of the patients and culture studies detected the pathogen in 21%.
Conclusion. Asymmetrical polyarthritides mainly involving the knee joints are the most common arthritides of pseudotuberculous etiology. EIA detection of serum IgG and IgA and PCR study of SF are optimal diagnostic tools. Artritides of chlamydial etiology are asymmetrical oligoarthritides predominantly involving the knee and ankle joints. Examination of urethral and cervical canal scrapes, SF by culture and PCR studies and that of serum IgA and IgG by EIA are optimal diagnostic tests.

Keywords

differential diagnosis, arthritides of pseudotuberculous etiology, arthritides of chlamydial etiology

References

Богомолов Б. П. Поражение опорно-двигательного аппарата при некоторых инфекционных и паразитарных заболеваниях. В кн.: Дифференциальная диагностика инфекционных болезней. М.: Дизайн-Пресс; 2000. 176-186.
Toivanen P. Managing reactive arthritis. Rheumatology. 2000; 39: 117-121.
Van der Linden S., van der Heijde D. Clinical aspects, outcomeassessment, and management of ankylosing spondylitis and postenteric reactive arthritis. Curr. Opin. Rheumatol. 2000; 12: 263-268.
Малов И. В. и др. Некоторые эпидемиологические аспекты и клинико-патогенетическая характеристика псевдотуберкулеза в Восточной Сибири. В кн.: Патогенетические основы лечения острых инфекционных заболеваний. М.; 1999. 380-386.
Taccetti G., Trapani S., Ermini M., Falcini F. Reactive arthritistriggered by Yersinia enterocolitica: A review of 18 pediatric cases. Clin. Exp. Rheumatol. 1994; 12: 681-684.
Шубин С. В. Артриты, связанные с хламидийной инфекцией. Нов. мед. журн. 1996; 12: 20-23.
Bas S., Cunningham T., Kvvien T. K. et al. The value of isotype determination of serumantibodies against chlamydia reactive arthritis. Br. J. Rheumatol. 1996; 35(6): 542-548.
Gerloni V., Fantini L. Arthritis, diagnosis and treatment: a review. Acta Orthop. Scand. 1996; 67(2): 196-201.
Wollenhaupt J., Zeidler H. Chlamydia - induced arthritis. EULAR Bull. 1990; 3(2): 72-77.

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To the differential diagnosis of arthritides of pseudotuberculous and chlamydial etiology

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