WJV  Vol.4 No.2 , May 2014
Increased Susceptibility to Pneumococcal Disease in Sjögren Syndrome Patients
Abstract: Susceptibility to pneumococcal infections in Sj?gren syndrome (SS)―an autoimmune inflammatory disease―patients is not well known, although these patients frequently develop respiratory diseases. The relative risk of developing pneumococcal disease in SS patients versus diabetes mellitus type 2 (DM-2) patients, matched by age, gender, and length of enrolment was studied. From January 1998 to September 2013 the records of Donostia University Hospital were analyzed, which among other patient’s data includes: number and type of hospital admissions and number and type of laboratory determinations. Streptococcus pneumoniae isolates of the same serotype causing recurrent infections were characterized by PFGE. The study comprised 127 patients in the SS group (69 primary and 58 secondary) and 127 in the DM-2 group as control. In 12 SS patients, (9.4%) 22 pneumococcal disease episodes were detected. Two patients (1.6%) with a single episode each one were observed among DM-2 patients, p = 0.01, RR for SS patients 6 (95% CI 1.4 to 26.3). No differences could be demonstrated between the two groups of patients in infections caused by Staphylococcus aureus or Streptococcus agalactiae. Most pneumococcal serotypes in SS patients belonged to the 13-valent (50%) and 23-valent (75%) anti-pneumococcal vaccine. SS patients are associated with and increased risk of suffering from pneumococcal disease. Vaccination should be considered in this group of patients.
Cite this paper: Ercibengoa, M. , Alonso, M. , Marimón, J. , Sáenz-Domínguez, J. and Pérez-Trallero, E. (2014) Increased Susceptibility to Pneumococcal Disease in Sjögren Syndrome Patients. World Journal of Vaccines, 4, 45-49. doi: 10.4236/wjv.2014.42007.

[1]   Ogutcen-Toller, M., Gedik, R., Gedik, S. and Goze, F. (2012) Sjögren’s Syndrome: A Case Report and Review of the Literature. West Indian Medical Journal, 61, 305-308.

[2]   Ramos-Casals, M., Solans, R., Rosas, J., Camps, M.T., Gil, A., Del-Pino, J., et al. (2008) Primary Sjögren Syndrome in Spain: Clinical and Immunological Expression in 1010 Patients. Medicine, 87, 210-219.

[3]   Amital, H., Govoni, M., Maya, R., et al. (2008) Role of Infectious Agents in Systemic Rheumatic Diseases. Clinical and Experimental Rheumatology, 26, S27-S32.

[4]   Igoe, A. and Scofield, R.H. (2013) Autoimmunity and Infection in Sjögren’s Syndrome. Current Opinion in Rheumatology, 25, 480-487.

[5]   Ross, S.C. and Densen, P. (1984) Complement Deficiency States and Infection: Epidemiology, Pathogenesis and Consequences of Neisserial and Other Infections in an Immune Deficiency. Medicine (Baltimore), 63, 243-273.

[6]   Chang, Y.S., Liu, C.J., Ou, S.M., Hu, Y.W., Chen, T.J., Lee, H.T., et al. (2013) Tuberculosis Infection in Primary Sjögren’s Syndrome: A Nationwide Population-Based Study. Clinical Rheumatology, 33, 377-383.

[7]   Joshi, N., Caputo, G.M., Weitekamp, M.R. and Karchmer, A.W. (1999) Infections in Patients with Diabetes Mellitus. The New England Journal of Medicine, 341, 1906-1912.

[8]   Davis, T.M., Weerarathne, T., Foong, Y., Mason, C. and Davis, W.A. (2005) Community-Acquired Infections in Type 2 Diabetic Patients and Their Nondiabetic Partners. The Fremantle Diabetes Study. Journal of Diabetes and Its Complications, 19, 259-263.

[9]   Thomsen, R.W., Hundborg, H.H., Lervang, H.H., Johnsen, S.P., Schonheyder, H.C. and Sorensen, H.T. (2004) Risk of Community-Acquired Pneumococcal Bacteraemia in Patients with Diabetes: a Population 180 Based Case-Control Study. Diabetes Care, 27, 1143-1147.

[10]   Kornum, J.B., Thomsen, R.W., Riis, A., Lervang, H.H., Schonheyder, H.C. and Sorensen, H.T. (2008) Diabetes, Glycaemic Control, and Risk of Hospitalization with Pneumonia: A Population-Based Case-Control Study. Diabetes Care, 31, 1541-1545.

[11]   Martinez, P.J., Mathews, C., Actor, J.K., Hwang, S.A., Brown, E.L., De Santiago, H.K., et al. (2014) Impaired 185 CD4+ and T-Helper 17 Cell Memory Response to Streptococcus pneumoniae Is Associated with Elevated Glucose and Percent Glycated Hemoglobin A1c in Mexican Americans with Type 2 Diabetes Mellitus. Translational Research, 163, 53-63.

[12]   Vitali, C., Bombardieri, S., Jonsson, R., Moutsopoulos, H.M., Alexander, E.L., Carsons, S.E., et al. (2002) Classification Criteria for Sjögren’s Syndrome: A Revised Version of the European Criteria Proposed by the American-European Consensus Group. Annals of the Rheumatic Diseases, 61, 554-558.

[13]   Theander, E., Manthorpe, R. and Jacobsson, L.T.H. (2004) Mortality and Causes of Death in Primary Sjögren’s Syndrome: A Prospective Cohort Study. Arthritis & Rheumatology, 50, 1262-1269.

[14]   Urowitz, M.B., Gladman, D.D., Abu-Shakra, M. and Farewell, V.T. (1997) Mortality Studies in Systemic Lupus Erythematosus: Results from a Single Center. III. Improved Survival over 24 Years. The Journal of Rheumatology, 24, 1061-1065.

[15]   Centers for Disease Control and Prevention (2013) Vaccines and Preventable Diseases: Pneumococcal Vaccination.

[16]   Public Health England (2013) Pneumococcal: The Green Book, Chapter 25.

[17]   Anonymous (1981) Pneumococcal Vaccination for Patients with Sjögren’s Syndrome. JAMA, 245, 2288.

[18]   Wotton, C.J. and Goldacre, M.J. (2012) Risk of Invasive Pneumococcal Disease in People Admitted to Hospital with Selected Immune-Mediated Diseases: Record Linkage Cohort Analyses. Journal of Epidemiology & Community Health, 66, 1177-1181.