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Parasites often cause reactive arthritis. When our joints start to hurt, we usually do not associate it with a recent viral or bacterial infection or the appearance of parasites. However, they can cause the infection of the digestive system to have its consequences in the form of inflammation of the joints, resulting in difficulties with walking or bending the ankle.

Reactive arthritisis an inflammation that can be caused by: bacteria, viruses or parasites, but not strictly in the middle of the joint, but elsewhere in the body while giving joint symptoms. Infection with microorganisms may concern, for example, the digestive system, but the consequence of this infection will be joint disease.

What is reactive arthritis?

What is characteristic of this type of disease is the absence of IgM rheumatoid factor in the serum, typical for other rheumatological diseases. Moreover, it does not include two symmetrical joints, e.g. two knees, only one knee, for example, or - if it concerns several joints, e.g. the left knee and the right ankle joint.

The most common symptoms of reactive arthritis are:

  • puffiness,
  • restrictions on the mobility of the joint,
  • as well as his pain.

They usually appear up to a month after infection. So it may happen that we got "intestinal flu", and after 2 weeks our joints started to hurt.

Inflammation usually affects the joints of the lower extremities, i.e. the knee and ankle joints, to a lesser extent it affects the foot, sacroiliac or spine joints, and least often affects the joints of the upper limbs - interphalangeal or wrist joints.

Causes of reactive arthritis - parasites and other pathogens

Reactive arthritis is closely related to the past infection, e.g. of the respiratory, genitourinary or digestive systems, and the etiological factor of this disease are all kinds of pathogens.

In the case of bacteria, these are most often:

  • Yersinia enterocolitica,
  • Chlamydophila pneumoniae,
  • Shigella sp.,
  • Salmonella sp.,
  • Borrelia burgdorferi,
  • Mycoplasma pneumoniae,
  • Mycobacteriumtuberculosis.

In turn, the viruses that most often contribute to the occurrence of this disease are:

  • HBV,
  • HSV,
  • EBV
  • and Parovirus B19.

In addition, we also have fungi of the genus Candida, or protozoa such as:

  • Toxoplasma gondii

and parasites such as:

  • Toxocara canis,
  • Giardia lamblia,
  • or Cryptosporidium parvum.

They are responsible for the occurrence of infection resulting in reactive arthritis.

How to recognize a parasite infection?

Cryptosporidium parvum infection

Cryptosporidium is a genus of protozoa that can be hosted by reptiles, birds and mammals. A person becomes infected with them through contact with infected animals, eating contaminated food, drinking water poisoned with oocysts, by inhalation or by fecal-oral route.

Most oocysts (zygotes of Cryptosporidium surrounded by a shell) are found in the soil, as they are excreted there by infected animals. They give off a lot of them - an example are calves infected with C. parvum, which can excrete several billion oocysts a day, where only 10 are enough to infect a human.

Considering that soil contamination entails contamination of nearby waters, vegetables growing nearby, it infects many people quite quickly. Due to the fact that water treatment methods do not destroy oocysts, infection can also occur while swimming in a swimming pool, as chlorine does not destroy Cryptosporidium.

An infected human with Cryptosporidium produces two types of oocysts: thin-walled oocysts that locate in the human intestine and thick-walled oocysts that are excreted outside.

The former can grow massively, leading to an internal invasion in the body, the latter - are another source of infection (they infect for the next few months). The first symptoms of the disease appear between 2 and 10 days after infection (usually 7 days) and last for about 2 weeks.

The most common symptoms are:

  • diarrhea with mucus,
  • weight loss,
  • severe dehydration,
  • worse absorption of nutrients,
  • cramp-like abdominal pain,

as well as:

  • nausea,
  • vomiting
  • and fever.

However, they do not always have to appear. Sometimes protozoa can attack the human respiratory system and then a cough, a feeling of shortness of breath or breathing problems will appear.

In people withreduced immunity may also lead to morphological changes in the small intestine, gallbladder or bile ducts.

Giardia lamblia infection

Giardia lamblia is a protozoan that causes infection in 2-5% of the population. The infection occurs through the transmission of cysts, for example, from an infected animal to humans, and the gate through which they enter the body is the oral cavity. Later, the cysts move to the digestive tract.

The source of infection may be, in addition to animals, contaminated drinking water, bathing water, food and drinks.

Giardiasis is called the disease of dirty hands and it is an accurate observation, because most often we get infected without maintaining proper hygiene, e.g. by not washing our hands after stroking a dog or eating unwashed fruit. Protozoa of the genus Giardia are most readily located in the bile ducts of humans, duodenum and bile ducts.

The first symptoms of the disease appear 1-2 weeks after incubation. The most common symptoms of giardiasis are:

  • diarrhea,
  • stomach pains,
  • nausea,
  • vomiting,
  • headaches,
  • lack of appetite,
  • fever.

Sometimes, when the disease becomes chronic, there may be problems with the absorption of fats, with maintaining the proper level of vitamin B12, folic acid or minerals.

Toxocara infection

Toxocara are nematodes that develop either in the digestive tract of cats (Toxocara cati) or dogs (Toxocara canis) and then passed on to humans. The infection occurs through contact with an infected animal, contact with soil where animals have settled, and its contact with the oral cavity (if we do not wash our hands after being outside, where we have touched the ground and it was contaminated with nematodes and touch the mouth, then there is a high risk of developing toxocarosis) or consumption of contaminated food.

Due to the lack of implemented hygiene habits, frequent visits to public sandboxes, children become infected much more often than adults. They primarily infect second-stage nematode larvae that enter the intestines, and from there are distributed through the bloodstream to various organs.

Depending on where the larvae end up and what symptoms they give, we can talk about:

  • Classical, visceral toxocarosis (when it attacks e.g. the liver),
  • Ocular wandering larvae syndrome (as it locates in the eyes),
  • Latent toxicosis (gives little characteristic symptoms),
  • Toxicosis without symptoms,
  • Neurotoxicosis (infects the systemnervous).

In visceral toxocarosis, the symptoms may be:

  • anemia,
  • weight loss,
  • hepatomegaly,
  • hypergammaglobulinemia,
  • increased body temperature,
  • high levels of anti-A and anti-B isohemagglutinins,
  • cough,
  • bronchial asthma attacks.

With ocular toxocariasis, the vitreous body becomes cloudy, the lens is swollen, and the visual acuity is permanently deteriorated, and inflammatory changes in the anterior chamber. When the nematodes enter the gray or white matter of the brain, meninges, thalamus or spinal cord, it is called neurotoxicarosis.

Its symptoms can be very different:

  • cognitive functions may be impaired,
  • visual impairment,
  • inflammation of the spinal cord and roots,
  • inflammation of the meninges and the brain,
  • epilepsy.

Latent toxocarosis gives little specific symptoms, they can be:

  • cough,
  • stomach ache,
  • headache,
  • insomnia.

Parasite diagnostics

The basis for the correct diagnosis of parasites are stool tests and blood tests. In the case of Giardia lamblia, the faeces are checked for cysts and G. lamblia trophozoites. However, trapping them in feces is often a coincidence, as they are excreted periodically.

For this purpose, samples taken for 3 consecutive days are provided for the test, and the test is repeated in the following months to be sure.

Another method to detect G. lamblia is the detection of IgM and IgG antibodies by immunofluorescence.

The presence of IgM antibodies indicates the ongoing infection with G. lamblia, while IgG (without IgM) indicates that our body has had contact with the parasite in the past or that the infection has become chronic.

When we want to detect Toxocara nematodes, it will be useful to test the morphology, as elevated leukocytes, eosinophils and anemia indicators may suggest that we are dealing with a parasite infection. In addition, serological tests are performed to detect specific antibodies.

Cryptosporidium is detected during stool examination - oocysts are looked for there, or specific antigens are detected that indicate the presence of this parasite in the human digestive tract. In addition, duodenal content can be downloaded for examination.

Treatment of reactive parasite arthritis

The most effective treatment for reactive arthritis is to cure the main source of infection, e.g. to get rid of parasites and thenimplementation of drugs to help reduce inflammation in the joints.

In the treatment of Giardia lamblia there are 6 groups of drugs that have different mechanisms of action. Thus, for example, metronidazole, tinidazole, albendazole, furazolidone, paromomycin, nitazoxanide, quinacrin are used. In the case of Cryptosporidium infection, nitazoxanide, paromomycin as well as azithromycin are used.

In causal treatment the following are also used:

  • latromycin,
  • spiramycin
  • and atowakwon.

In the case of toxocara nematodes, the following is prescribed:

  • diethylcarbamazine,
  • thiabendazole and albendazole,
  • mebendazole,
  • fenbendazole.

In addition to antiparasitic drugs, NSAIDs - non-steroidal anti-inflammatory drugs are used in hypersensitivity arthritis, and when their effect is insufficient, glucocorticosteroids are activated.

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Category:

Anatomy