Acquiring diarrhoeagenic Escherichia coli (E coli; DEC) increases the risk of developing reactive arthritis and musculoskeletal symptoms among individuals who travel internationally, according to study findings published in Annals of the Rheumatic Diseases.

Of a total of 526 study participants, data were analyzed from the 224 who provided pretravel and posttravel stool samples and completed pretravel, posttravel, and 3-week follow-up questionnaires. Stool samples were analyzed using a multiplex quantitative polymerase chain reaction assay to detect 9 bacterial pathogens, including DEC strains (enteroaggregative E coli, enteropathogenic E coli, enterotoxigenic E coli, enterohemorrhagic E coli, and enteroinvasive E coli), Salmonella, Shigella, Campylobacter, Yersinia, and Vibrio cholerae). Study findings were classified into 4 categories: no pathogens, only DEC pathogens, only non-DEC pathogens, and DEC plus non-DEC pathogens. Participants reported any new posttravel musculoskeletal symptoms through comprehensive phone interviews, which were clinically confirmed by a rheumatologist, if needed. Multivariate analysis was used to identify factors associated with musculoskeletal symptoms such as age, sex, pathogen category, severity of diarrhea, and antibiotic use.

In the posttravel stool findings, DEC-only pathogens were identified in 151 participants (67.4%), non-DEC pathogens in 5 participants (2.2%), DEC plus non-DEC pathogens in 17 participants (7.6%), and no pathogens in 51 participants (22.8%). Of the 224 participants, 38 (17.0%) reported musculoskeletal symptoms in the follow-up questionnaire, of whom 31 (20.5%) were classified with only DEC. In multivariate analysis, DEC-only acquisition was associated with reactive musculoskeletal symptoms (adjusted odds ratio, 3.9; 95% CI, 1.2-13.3); however, no association was observed for age, sex, antibiotic use, or severity of travelers’ diarrhea. Nine participants in the DEC-only group who reported reactive musculoskeletal symptoms met the criteria for reactive arthritis (n=4), reactive tendinitis (n=2), and reactive arthralgia (n=3); most cases were mild. No association was found between the development of reactive musculoskeletal symptoms and antibiotics used to treat travelers’ diarrhea.

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Study limitations included the fact that stool samples could not be collected while the study participants were abroad as a result of which some cases of the primary travelers’ diarrhea pathogen may have disappeared before sampling; the data may have overestimated the incidence of musculoskeletal symptoms; and the period between pathogen acquisition and clinical examination was relatively long so if symptoms appeared later than 3 weeks posttravel, it is possible that some cases of reactive arthritis may have been missed.


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According to the researchers, acquisition of DEC was associated with an increased risk of developing reactive musculoskeletal symptoms; however, the incidence of travel-related reactive arthritis remained low and was mostly mild.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference      

Tuompo R, Lääveri T, Hannu T, et al. Reactive arthritis and other musculoskeletal symptoms associated with acquisition of diarrhoeagenic Escherichia coli (DEC) [published online March 16, 2020]. Ann Rheum Dis. doi:10.1136/annrheumdis-2019-216736

This article originally appeared on Rheumatology Advisor