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Children with celiac disease are more likely to have attended hospital for prior respiratory syncytial virus infection
Department of Pediatrics, Kalmar County Hospital, Kalmar, Sweden.
Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.ORCID iD: 0000-0003-1024-5602
2014 (English)In: Digestive Diseases and Sciences, ISSN 0163-2116, E-ISSN 1573-2568, Vol. 59, no 7, p. 1502-1508Article in journal (Refereed) Published
Abstract [en]

Background and Aim: The purpose of this study was to examine the association between celiac disease (CD) and prior respiratory syncytial virus (RSV) infection or any viral bronchiolitis.

Methods: This was a retrospective case–control study. During 2006–2008 small intestinal biopsy data were collected from Sweden’s 28 pathology departments. We identified 3,835 children diagnosed with CD (villous atrophy, Marsh stage 3) before the age of 2 years in 1987 or later. Using conditional logistic regression we calculated odds ratios (ORs) for having a prior diagnosis of respiratory syncytial virus or other viral bronchiolitis compared to 19,102 age- and sex-matched controls.

Results: Of the 3,835 children with CD, 36 (0.9 %) had a prior diagnosis of RSV compared to 117/19,102 (0.6 %) matched controls. This corresponded to an OR of 1.46 (95 % CI 1.03–2.07). ORs were similar in girls and boys. The highest ORs were seen in children developing early CD (before 1 year of age (OR 1.82; 95 % CI 0.91–3.62). Prior record of any type of viral bronchiolitis was found in 3.4 % (132/3,835) of individuals with CD and in 2.0 % (390/19,102) of the matched controls corresponding to an OR of 1.60 (95 % CI 1.33–1.92).

Conclusions: Children with CD diagnosed\2 years of age were more likely to have attended hospital for a prior RSV infection or any viral bronchiolitis than other children.

Place, publisher, year, edition, pages
Dordrecht, Netherlands: Springer, 2014. Vol. 59, no 7, p. 1502-1508
Keywords [en]
Autoimmunity, bronchiolitis, child, coeliac, infant, inflammation, respiratory syncytial virus
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:oru:diva-44857DOI: 10.1007/s10620-014-3046-1ISI: 000338344500024PubMedID: 24510390Scopus ID: 2-s2.0-84903546143OAI: oai:DiVA.org:oru-44857DiVA, id: diva2:818437
Funder
Swedish Society of Medicine
Note

Funding Agencies:

Kalmar County Council

Swedish Research Council-Medicine  522-2A09-195

Swedish Celiac Society

Fulbright Commission

Available from: 2015-06-08 Created: 2015-06-08 Last updated: 2019-02-27Bibliographically approved
In thesis
1. Celiac disease and Infections
Open this publication in new window or tab >>Celiac disease and Infections
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Celiac disease (CD) is a chronic immune-mediated enteropathy affecting about 1% of the population worldwide. CD is triggered by ingestion of gluten in genetically predisposed individuals but additional factors (e.g. infections) are required for the disease to develop. CD also seems to be associated with infectious complications.

Aim: The main objective of this thesis was to increase the knowledge about the associations between CD and infections.

Methods: Epidemiological and laboratory approaches. Studies I-III used a data set consisting of small intestinal biopsy reports. The biopsies were taken in 1969-2008 and collected in 2006-2008. A total of 29,096 individuals with CD, 13,306 with inflammation and 3,719 with potential CD were identified. Each individual was matched with up to 5 controls from the general population (n= 228,632). Through linkage of the data to the Patient Register study I examined the risk of hospital visits due to respiratory syncytial virus (RSV) in children <2 years prior to onset of CD. Study II used the Patient Register and Cause of Death Register to assess whether CD affects the outcome in sepsis. Study III linked the data to microbiological data bases and the Public Health Agency to estimate risk of invasive pneumococcal disease (IPD) in CD. In study IV children with CD and controls were recruited from Kalmar County Hospital. Complement activation (C3a and sC5b-9) in plasma were analysed after incubation with pneumococci.

Results: Study I found that children with CD were more likely than controls to have attended hospital due to RSV infection prior to diagnosis (odds ratio 1.46; 95% confidence interval (CI)=1.02-2.07). CD did not seem to influence survival in sepsis (adjusted hazard ratio (HR) 1.10 95%CI=0.72-1.69) (study II). Study III indicated a 46% risk increase for individuals with CD to acquire IPD (HR 1.46; 95%CI=1.05-2.03) but study IV did not reveal any differences in complement response in regard to CD status (p=0.497and p=0.724), explaining this excess risk.

Conclusion: This thesis supports associations between CD and infections preceding and complicating diagnosis. However, CD does not seem to influence the outcome in a severe infection like sepsis and altered complement function is unlikely to be responsible for the excess IPD risk in CD.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 97
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 188
Keywords
Celiac disease, small intestinal, infection, respiratory syncytial virus, sepsis, streptococcus pneumoniae, complement, cohort, register
National Category
General Practice
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-71643 (URN)978-91-7529-278-6 (ISBN)
Public defence
2019-03-22, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 13:00 (English)
Opponent
Supervisors
Available from: 2019-01-22 Created: 2019-01-22 Last updated: 2019-04-10Bibliographically approved

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Röckert Tjernberg, AnnaLudvigsson, Jonas

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