Association of the infectious triggers with childhood Henoch-Schonlein purpura in Anhui province, China

Jing Jing Wang; Yao Xu; Fei Fei Liu; Yue Wu; Sama Samadli; Yang Fang Wu; Huang Huang Luo; Dong Dong Zhang; Peng Hu

doi:10.1016/j.jiph.2019.07.004

Association of the infectious triggers with childhood Henoch-Schonlein purpura in Anhui province, China

J Infect Public Health. 2020 Jan;13(1):110-117. doi: 10.1016/j.jiph.2019.07.004. Epub 2019 Jul 20.

Authors

Jing Jing Wang¹, Yao Xu¹, Fei Fei Liu¹, Yue Wu¹, Sama Samadli¹, Yang Fang Wu¹, Huang Huang Luo¹, Dong Dong Zhang¹, Peng Hu²

Affiliations

¹ Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
² Department of Pediatrics, The First Affiliated Hospital of Anhui Medical University, Hefei, China. Electronic address: hupeng28@aliyun.com.

PMID: 31337540
DOI: 10.1016/j.jiph.2019.07.004

Abstract

Background: Although the specific etiology of Henoch-Schonlein purpura (HSP) is still unknown, several kinds of infectious triggers have been proved to participate in its pathogenesis. The objectives of present study were to analyze the association of the infectious triggers with childhood HSP in Anhui province, China.

Methods: 1200 HSP children were recruited from January 2015 to December 2017. Serum antistreptolysin O titer, TORCH, Epstein-Barr virus, helicobacter pylori (HP), Mycoplasma antibodies (MP-Ab), tubercle bacillus antibody (TB-Ab), respiratory pathogens (legionella pneumophila, chlamydia pneumoniae, adenovirus, respiratory syncytial virus, influenza A virus, influenza B virus, rickettsia, parainfluenza virus) were determined. Patients' histories were obtained by interviews and questionnaires.

Results: The annual incidence of HSP was 8.13-9.17 per 100,000. HSP occurred more commonly in spring and winter than in summer with an obvious west-to-east gradient. On admission, several potential infections were identified in 611 cases (50.92%). The infectious agents including streptococcus, HP, MP, parainfluenza, respiratory syncytial virus, TB and toxoplasma gondii were identified in 205 cases (17.08%), 71 cases (5.92%), 58 cases (4.83%), 6 cases (0.5%), 1 case (0.08%), 1 case (0.08%) and 1 case (0.08%) respectively. 123 cases (10.25%) relapsed or recurred more than one time; the mean number was 2.92, and the mean interval was 11.4 weeks. The infection was the most frequent trigger regardless of clinical phenotypes and relapse/recurrence. Symptomatic treatment plus adjunctive anti-infectious agents could significantly improve the remission rate of purpura in the infectious cases (x²=24.60, p<0.01).

Conclusions: Streptococcus is the most frequent infectious agent in HSP children regardless of clinical phenotype or relapse/recurrence. The complete elimination of infectious triggers may help relieve cutaneous purpura.

Keywords: Children; Henoch–Schonlein; Infection; Prednisone; Purpura; Streptococcus.

MeSH terms

Adolescent
Bacterial Infections / complications
Bacterial Infections / epidemiology*
Child
China / epidemiology
Female
Humans
IgA Vasculitis / epidemiology*
IgA Vasculitis / etiology*
Incidence
Male
Recurrence
Surveys and Questionnaires
Virus Diseases / complications
Virus Diseases / epidemiology*