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A Pilot Study for Detection of Intra-articular Chromosomal and Extra-Chromosomal Genes of Chlamydia trachomatis among Genitourinary Reactive Arthritis Patients in India

Author Affiliations

  • 1Microbiology laboratory, National Institute of Pathology (ICMR), Safdarjung hospital campus, Post Box No. 4909, New Delhi-110 029, INDIA
  • 2 Central Institute of Orthopedics (CIO), Vardhaman Mahavir Medical College (VMMC) & Safdarjung hospital, New Delhi-110 029, INDIA

Int. Res. J. Medical Sci., Volume 1, Issue (4), Pages 16-20, May,28 (2013)

Abstract

Chlamydia trachomatis is reportedly the most frequent sexually transmitted pathogen associated with genitourinary Reactive Arthritis (gReA) in developed countries. However, there is a paucity of reliable data on the intra-articular presence of C. trachomatis in seronegative spondyloarthropathies such as reactive arthritis from developing countries like India. As genital infection with C. trachomatis is fairly common in our country, it is quite possible that C. trachomatis is either underdiagnosed or else, underestimated in gReA patients. The aim of the present study was to investigate C. trachomatis in joint fluid of gReA patients by targeting C. trachomatis-specific chromosomal and extra-chromosomal genes by Polymerase Chain Reaction (PCR) assay. A case control pilot study was designed and carried out in collaboration with a tertiary care large government hospital in New Delhi (India) to calculate the frequency of C. trachomatis in gReA while patients with Rheumatoid Arthritis (RA) served as controls. Joint fluid was aspirated during arthrocentesis in 57 arthritic (gReA/ RA) age-matched patients. DNA was isolated using a commercially available kit (QIA Amp DNA Blood mini kit; Qiagen, Germany). PCR was performed using primers for C. trachomatis 16s-rRNA (150 bp) and plasmid (201 bp) genes. 7/25 (28%) gReA patients were found positive for plasmid/ 16s-rRNA gene while 3.1% (1/32) RA patients were also found to be C. trachomatis-positive. The presence of intra-articular infection with C. trachomatis in patients with gReA is cause of concern in Indian set-up. We recommend screening of larger number of gReA patients for determining the exact magnitude of C. trachomatis infection and to evaluate the effect of treatment on the persistent state of chlamydial infection in the synovium.

References

  1. Gaydos C.A., Theodore M., Dalesio N., Wood B.J. and Quinn T.C., Comparison of three nucleic acid amplification tests for detection of Chlamydia trachomatis in urine specimens, J. Clin. Microbiol.,42, 3041-3045 (2004)
  2. Singh V., Rastogi S., Garg S., Kapur S., Kumar A., Salhan S. and Mittal A., Polymerase chain reaction for detection of endocervical Chlamydia trachomatis infection in Indian women attending gynecology outpatient department, Acta Cytol., 46, 540-544 (2002)
  3. Rastogi S., Das B. and Mittal A., Serum IgM to Chlamydia trachomatis in pregnancy: Its usefulness for screening, Br. J. Biomed. Sci59, 30-34 (2002)
  4. Vats V., Rastogi S., Kumar A., Ahmed M., Singh V., Mittal A., Jain R.K. and Singh J., Detection of Chlamydiatrachomatis by polymerase chain reaction in non-gonococcal urethritis male patients attending STD clinic, Sex. Transm. Infect.,80, 327-328 (2004)
  5. Kvien T.K., Glennas A., Melby K., Granfors K., Andrup O., Karstensen B. and Thoen J.E., Reactive arthritis: Incidence, triggering agents and clinical presentation, J. Rheumatol., 21, 115-122 (1994)
  6. Gerard H.C., Carter J.D. and Hudson A.P., Chlamydia trachomatis is present and metabolically active during the remitting phase in synovial tissues from patients with chronic Chlamydia-induced reactive arthritis, Am. J. Med. Sci., Sep. 20 (Epub ahead of print) (2012)
  7. Hannu T., Kauppi M., Tuomala M., Laaksonen I., Klemets P. and Kuusi M., Reactive arthritis following an outbreak of Campylobacter jejuni infection, J. Rheumatol.,31, 528-530 (2004)
  8. Guerrant R.L., Hughes J.M., Lima N.L. and Crane J., Diarrhoea in developed and developing countries: Magnitude, special setting and etiology, Rev. Infect. Dis.,12(1), 41–50 (1990)
  9. Chandrasekaran A.N., Infection and arthritis our experience a retrospective and prospective study, J. Ind. Rheumatol. Assoc.,1, 17-20 (1993)
  10. Sinha R., Aggarwal A., Prasad K. and Misra R., Sporadic enteric reactive arthritis and undifferentiated spondyloarthropathy: evidence for involvement of Salmonella typhimurium, J. Rheum.,30(1), 105-113 (2003)
  11. Aggarwal A., Misra R., Chandrasekhar S., Prasad K.N., Dayal R. and Ayyagari A., Is undifferentiated seronegative spondyloarthropathy a forme fruste of reactive arthritis, Rheumatology,36, 100-104 (1997)
  12. Chandrashekara S., Aggarwal A., Prasad K.N. and Misra R., Sporadic reactive arthritis in north India: Lack of IgA response, J Indian Rheumatol Assoc.,12, 134–138 (2004)
  13. Amor B., Dougados M., Listrat V., Menkes C.J., Roux H., Benhamou C., Blotman F., Pattin S., Paolaggi J.B., Duquesnoy B., et al, Are classification criteria for spondylarthropathy useful as diagnostic criteria, Rev. Rhum. Engl. Ed.,62, 10-15 (1995)
  14. Dougados M., van der Linden S., Juhlin R., Huitfeldt B., Amor B., Calin A., Cats A., Dijkmans B., Olivieri I., Pasero G., et al & European Spondylarthropathy Study Group, The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy, Arthritis Rheum., 34, 1218-1227 (1991)
  15. Arnett F.C., Edworthy S.M. and Bloch D.A., The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis, Arthritis Rheum., 31,315-324 (1988)
  16. Griffais R. and Thibon M. Detection of Chlamydia trachomatis by the polymerase chain reaction, Res. Microbiol.,140, 139–141 (1989)
  17. Wilkinson N.Z., Kingsley G.H., Sieper J., Braun J. and Ward M.E., Lack of correlation between the detection of Chlamydia trachomatis DNA in synovial fluid from patients with a range of rheumatic diseases and the presence of an anti-chlamydial immune response, Arthritis Rheum., 41, 845-854 (1998)
  18. Whittum-Hudson J.A., Gérard H.C., Schumacher H.R. and Hudson A.P., Pathogenesis of Chlamydia- associated arthritis, In: Bavoil P., Wyrick P. (eds.) Chlamydia– Pathogenesis and Treatments, Blackwell Publishing Inc., Boston, MA, USA, 475–504 (2006)
  19. Henry C.H., Hudson A.P., Gérard H.C., Franco P.F. and Wolford L.M., Identification of Chlamydia trachomatis in the human temporomandibular joint, J. Oral Maxillofac. Surg., 57(6), 683–688 (1999)
  20. Bas S., Griffais R., Kvien T.K., Glennas A., Melby K. and Visher T.L., Amplification of plasmid and chromosome Chlamydia DNA in synovial fluid of patients with reactive arthritis and undifferentiated seronegative oligoarthropathies, Arthritis Rheum.,38, 1005–1013 (1995)
  21. Schumacher H.R. Jr, Magge S., Cherian P.V., Sleckman J., Rothfuss S., Clayburne G. and Sieck M., Light and electron microscopic studies on the synovial membrane in Reiters syndrome: Immunocytochemical identification of chlamydial antigen in patients with early disease, Arthritis Rheum., 31, 937-946 (1988)
  22. Schnarr S., Putschky N., Jendro M.C., Zeidler H., Hammer M., Kuipers J.G. and Wollenhaupt J., Chlamydia- and Borrelia-DNA in synovial fluid of patients with undifferentiated oligoarthritis: Results of a prospective study, Arthritis Rheum.,44, 2679–2685 (2001)
  23. Sieper J., Rudwaleit M., Braun J. and van der Heijde D., Diagnosing reactive arthritis: Role of clinical setting in the value of serologic and microbiologic assays, Arthritis Rheum., 46, 319–327 (2002)
  24. Zeidler H., Kuipers J. and Kohler L., Chlamydia-induced arthritis, Curr. Opin. Rheumatol.,16, 380–392 (2004)
  25. 5.Rastogi S., Salhan S. and Mittal A., Detection of Chlamydia trachomatis antigen in spontaneous abortions. Is this organism a primary or secondary indicator of risk, Br. J. Biomed. Sci., 57, 126-129 (2000)
  26. Mittal A., Rastogi S., Reddy B.S., Varma S., Salhan S. and Gupta E., Enhanced immunocompetent cells in chlamydial cervicitis, J. Reprod. Med., 49, 671-677 (2004)
  27. Siala M., Gdoura R., Younes M., Fourati H., Cheour I., Meddeb N., Bargaoui N., Baklouti S., Sellami S., Rihl M., Hammami A., Detection and frequency of Chlamydia trachomatis DNA in synovial samples from Tunisian patients with reactive arthritis and undifferentiated oligoarthritis. FEMS Immunol. Med. Microbiol.,55(2), 178-186 (2009)
  28. Gerard H.C., Freise J., Rudy D., Roberts G., Rudy D., Krauss-Opatz B., Kohler L., Zeidler H., Schumacher H.R., Whittum-Hudson J.A. and Hudson A.P., Chlamydia trachomatis genes whose products are related to energy metabolism are expressed differentially in active vs. persistent infection, Microb Infect.,4, 13-22 (2002)
  29. Carter J.D. and Inman R.D., Chlamydia-induced reactive arthritis: Hidden in plain sight, Best Pract. Res. Clin. Rheumatol.,25, 359-374 (2011)
  30. Gupta R., Jha R., Salhan S., Eickhoff M., Krupp G. and Mittal A.,Existence of plasmid-less clinical isolate of Chlamydia trachomatis in India is a cause for concern and demands the use of real-time PCR assays, Inter. Jour. Microbiology,5, 1-8 (2008)