Amplification of autoimmune disease by infection

Posnett, David N; Yarilin, Dmitry

doi:10.1186/ar1691

Arthritis Research & Therapy

Table 1 Disease associations

From: Amplification of autoimmune disease by infection

Disease	EBV	CMV	HHV6	HHV7	HHV8	Chlamydia trachomatis	Chlamydia pneumoniae	PV B19	References
SLE	+^a	+^b	+		+			+	[127-133]
RA	++	++			+	++	++	++	[64,95,130,134]
Sjoegren's disease	++		++						[135,136]
Myocarditis	+	+					+	++	[137-139]
MS	+	+	++				++		[91,140-142]
T1DM^c	+	+							[143]
IgA nephritis	++	++							[144,145]
Guillain–Barré syndrome	+	+							[146,147]
Uveitis		++				+			[148,149]
Reiter's syndrome	+	+				++			[64,89]
Polymyositis dermatomyositis		+			+				[130]
Aplastic anemia								++	[66]
ITP	+	+						+	[150,151]
Vasculitis	+	+			+			++	[130]
Behcet's disease					+				[130]
Giant cell arteritis							++?	+	[152,153]
Scleroderma		+						+	[154,155]
Glomerulonephritis	++							++	[144,145,156-158]
Autoimmune infertility						+			[159,160]
Psoriais		+							[161]
Pityriasis rosea			++	++					[162]
Atherosclerosis	+	+					++		[98]
Leprosy	+	+							[102,103,163]
After transplant	++^d	++^d	+	+	+	+	+		[123,124,164-173]

^aAssociations that include some form of documented presence (by culture, electron microscopy, immunohistochemistry, PCR or in situ hybridization) of the microbe in autoimmune target tissues are indicated by ++. Other associations are indicated by +. Note that the references are not comprehensive and omit most of the contradictory literature; the purpose was to look for evidence of microbial presence specifically in the autoimmune target tissues.
^bCMV in SLE is often a complication from immunosuppressive therapy causing colitis, ileitis, retinitis, pneumonitis or vasculitis, but infection can also occur before therapy. It is unclear whether infection occurs on top of a pre-existing autoimmune lesion in an autoimmune tissue (for example skin or kidney). In settings of viral reactivation due to immunosuppression, the virus may be expressed ubiquitously and we were therefore more interested in reports in which expression was limited to an autoimmune target tissue.
^cA recent review lists up to six viruses associated with type I diabetes mellitus (T1DM), but we focus here only on those mentioned repeatedly in association with a wide variety of autoimmune disorders.
^dPTLD (post-transfusion lymphoproliferative disease) represents a spectrum of disorders in which lymphocytes (predominantly B cells) infiltrate the allotransplant organ. PTLD can evolve from a condition that is reversible upon cessation of immunosuppression, to an irreversible monoclonal lymphoma. Productive herpesvirus infections, especially EBV and CMV, occur in situ in allotransplants. By contrast, EBV is not usually present in rejected transplant tissues. Chlamydiae can cause infectious complications in severely immunodeficient transplant patients but do not directly infiltrate the transplanted tissues.
CMV, cytomegalovirus; EBV, Epstein–Barr virus; HHV, human herpesvirus; ITP, immune thrombocytopenia; MS, multiple sclerosis; PV, parvovirus; RA, rheumatoid arthritis; SLE, systemic lupus erythematosus.

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