title: Frequency of seropositivity against infectious agents amongst pemphigus vulgaris patients: a case-control study on Strongyloides stercoralis, Helicobacter pylori, Toxoplasma gondii, Leishmania major, and Epstein-Barr virus.
abstract: BACKGROUND
  Environmental and genetic factors may contribute to the pathogenesis of pemphigus vulgaris (PV) as an autoimmune disease. We aimed to determine rates of seropositivity for immunoglobulin G (IgG) antibodies against a number of infectious agents in untreated and treated PV patients and in healthy individuals.
  
  
  METHODS
  Eighty-two newly diagnosed untreated PV patients (34 men and 48 women; mean ± standard deviation [SD] age: 44.18 ± 14.43 years) and 36 previously diagnosed patients under immunosuppressive therapy (16 men and 20 women; mean ± SD age: 38.53 ± 9.96 years) were enrolled in the study. The clinical diagnosis of PV was confirmed by histopathology and direct immunofluorescence findings. As a control group, 131 healthy individuals (68 men and 63 women; mean ± SD age: 42.56 ± 19.69 years) were recruited. In all patients and controls, serum IgG antibodies against Strongyloides stercoralis, Helicobacter pylori, Epstein-Barr virus (EBV) capsid antigen, and Leishmania major were measured using enzyme-linked immunosorbent assays. The indirect immunofluorescence test was used to detect IgG antibodies against Toxoplasma gondii.
  
  
  RESULTS
  Newly-diagnosed untreated PV patients had significantly higher rates of seropositivity of IgG antibodies against S. stercoralis and H. pylori compared with the control group (69.5% vs. 16.0% [P < 0.001] and 79.3% vs. 59.5% [P = 0.004], respectively). For the other agents, namely T. gondii, L. major, and EBV capsid antigen, the differences between groups in seropositivity for IgG antibodies were not statistically significant.
  
  
  CONCLUSIONS
  Significant associations between S. stercoralis and H. pylori seropositivity rates and untreated disease led to the hypothesis that these pathogenic agents may contribute to the pathogenesis of PV.
authors.affiliation: Autoimmune Bullous Diseases Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.|Department of Dermatology, Razi Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Mortazavi
authors.affiliation: Department of Dermatology, Razi Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Pardis
authors.identifier: http://orcid.org/0000-0002-0577-8378
authors.initials: P
authors.lastname: Hejazi
authors.affiliation: Center for Research and Training in Skin Diseases and Leprosy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Khamesipour
authors.affiliation: Department of Medical Parasitology and Mycology, School of Public Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.|Center for Research of Endemic Parasites of Iran (CREPI), School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mohebali
authors.affiliation: Department of Dermatology, Razi Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Amir Hooshang
authors.initials: AH
authors.lastname: Ehsani
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Younes
authors.initials: Y
authors.lastname: Mohammadi
authors.affiliation: Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, 27695, USA.
authors.forename: Iman Vasheghani
authors.identifier: http://orcid.org/0000-0003-2273-303X
authors.initials: IV
authors.lastname: Farahani
authors.affiliation: Molecular Immunology Research Center, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.|Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali Akbar
authors.initials: AA
authors.lastname: Amirzargar
mesh_terms: D000328:Adult; D000818:Animals; D000956:Antigens, Viral / Q000097:blood* / Q000276:immunology; D036022:Capsid Proteins / Q000097:blood* / Q000276:immunology; D016022:Case-Control Studies; D005260:Female; D016480:Helicobacter pylori / Q000276:immunology*; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007492:Iran / Q000453:epidemiology; D018320:Leishmania major / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D010392:Pemphigus / Q000097:blood* / Q000188:drug therapy / Q000453:epidemiology*; D016036:Seroepidemiologic Studies; D017171:Strongyloides stercoralis / Q000276:immunology*; D014122:Toxoplasma / Q000276:immunology*
chemical_list: D000956:Antigens, Viral; D036022:Capsid Proteins; C041788:Epstein-Barr viral capsid antigen; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents