Symptomatic acute reactive arthritis after an outbreak of salmonella.
OBJECTIVE
In 2005, 592 individuals in Ontario developed acute gastroenteritis, predominantly after consuming bean sprouts contaminated with Salmonella enteritidis. Salmonella is a known trigger of reactive arthritis (ReA). We describe the population affected by the Salmonella outbreak in terms of clinical presentation of self-reported arthritic symptoms and HLA-B27 genotyping.


METHODS
Subjects were mailed a questionnaire, which assessed symptoms consistent with ReA. Subsequently, subjects were asked to submit saliva samples, which were analyzed for HLA-B27. Simple descriptive statistics were performed for analysis of survey responses, and the genetic component was analyzed by chi-square or Fisher's exact tests.


RESULTS
Most respondents were female (71.3%), with a mean age of 46.0 years. The mean duration of diarrhea symptoms was 16.5 days. 62.5% of respondents reported extraintestinal symptoms that were consistent with ReA. The most commonly reported features were joint pain, swelling or stiffness (46.2%), stiffness > 30 min (35.6%), ocular symptoms (24.0%), and visibly swollen joints (19.2%). Subjects with Salmonella infection had a similar incidence of HLA-B27, regardless of whether they developed symptoms consistent with ReA or not. Notably, HLA-B27 was present more frequently in those who developed Salmonella infection than in healthy controls (OR 3.0).


CONCLUSIONS
The study, one of the largest for a dysenteric outbreak, revealed a high event rate of self-reported symptoms consistent with ReA in those infected with Salmonella. Our results showed that HLA-B27 may have rendered individuals more susceptible to Salmonella infection, but did not contribute to the development of symptoms consistent with ReA after infection. We note that the methods used in this study, including self-report, are not ideal for diagnosis of inflammatory arthritis. However, given the rarity of large outbreaks of Salmonella, the study adds valuable knowledge about the course of ReA.
Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.
Sherry
S
Rohekar
Florence W L
FW
Tsui
Hing Wo
HW
Tsui
Nancy
N
Xi
Reena
R
Riarh
Rose
R
Bilotta
Robert D
RD
Inman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016918:Arthritis, Reactive / Q000453:epidemiology* / Q000235:genetics / Q000382:microbiology; D018563:Disease Notification; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D015796:HLA-B27 Antigen; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D000091402:Prohibitins; D012478:Salmonella Food Poisoning / Q000150:complications* / Q000453:epidemiology / Q000235:genetics; D012477:Salmonella enteritidis
D015796:HLA-B27 Antigen; C000717331:PHB2 protein, human; D000091402:Prohibitins