Absence of mycobacterial DNA in peripheral blood and artery specimens in patients with Takayasu arteritis.

The objective of this study was to demonstrate the presence of mycobacterial nucleic acid sequences in peripheral blood and arteries from patients with Takayasu arteritis (TA). Polymerase chain reaction was performed to detect mycobacterial DNA from three different nucleic acid sequences including the insertion sequence (IS) 6110, the 65-kDa heat shock protein gene (HSP65), and the 16S ribosomal RNA (rRNA) gene in peripheral blood from 32 TA patients and in arterial specimens from 10 TA patients. Twenty-eight HIV-negative patients with pulmonary tuberculosis prior to therapy were tested for IS6110 in peripheral blood as positive controls, and 24 blood donors were evaluated as healthy controls (HC). All TA patients were negative for the insertion sequence IS6110 and for HSP65 and 16S rRNA genes in blood samples and in arterial specimens. IS6110 sequence was found in peripheral blood from 22 (78.5 %) patients with pulmonary tuberculosis but not in HC. In conclusion, the strategy of mycobacterial-specific nucleic acid amplification in the peripheral blood and arterial specimens of TA patients was unable to lend support to the association between TA and tuberculosis long suggested in the literature.

Comparison of clinical characteristics in patients with Takayasu arteritis with and without concomitant tuberculosis.

Because of frequent tuberculosis in patients with Takayasu arteritis (TA), a possible relationship between TA and tuberculosis has been proposed. However, there are no studies to date that have examined clinical manifestations in patients diagnosed with TA with or without tuberculosis. Two hundred sixty-seven patients were diagnosed with TA according to the 1990 American College of Rheumatology criteria between September 1994 and April 2014. Patients with TA were classified into groups with or without tuberculosis. Among the 267 patients with TA studied, 47 patients (17.7 %) who had a history of previous treatment of tuberculosis (34 patients), concurrent diagnosis of tuberculosis with TA (10 patients), or diagnosis of tuberculosis during the follow-up period for TA (3 patients) were included in the group with tuberculosis. The group with tuberculosis comprised of 33 patients (70.2 %) with pulmonary tuberculosis, 12 patients (25.5 %) with tuberculous lymphadenitis, and 2 patients (4.3 %) with tuberculosis of the skin and colon, respectively. Comorbid disease and patients' signs and symptoms were not significantly different between TA patients with and without tuberculosis. Additionally, the site of disease involvement in angiographic findings and distribution of angiographic type were similar between the two groups. In conclusion, tuberculosis including tuberculous lymphadenitis was frequently observed in patients with TA. Clinical features and angiographic findings in TA were not different according to the presence or absence of concomitant tuberculosis.

Takayasu's or tuberculous arteritis?

Takayasu's arteritis (TA) is a large vessel vasculitis of unknown aetiology characterised by involvement of the aorta and its major branches. Tuberculous arteritis of the aorta is an uncommon condition usually secondary to the dissemination of Mycobacterium tuberculosis infection from the mediastinum and/or lung to the adjacent aorta; this may mimic TA. We report a case of a 23-year-old woman with cutaneous granulomatous vasculitis and saccular aneurysmal dilation of the aorta and large vessels, and highlight the findings shared by TA and tuberculous arteritis.

Computed tomography findings in a patient with fungal aortitis: acute aortic syndrome secondary to fusariosis.

Fusarium is a mould widely distributed in soil and water which causes various diseases in plants and occasionally in animals. The Fusarium species cause a broad spectrum of infections in humans, of which, the degree of severity is largely determined by the immune-status of the host, occurring in the most severe and invasive forms in immunocompromised individuals. Skin infections, sinusitis and pneumonia are the most common human manifestations of the disease. In patients with severe immunodeficiency, the disease can become invasive and disseminated causing fungemia. We report a case of an immunocompromised patient presenting with acute chest pain secondary to complicated Fusarium aortitis.

Detection of IS6110 and HupB gene sequences of Mycobacterium tuberculosis and bovis in the aortic tissue of patients with Takayasu's arteritis.

BACKGROUND: Takayasu's arteritis (TA) is a chronic inflammatory disease affecting the large arteries and their branches; its etiology is still unknown. In individuals suffering from TA, arterial inflammation progresses to stenosis and/or occlusion, leading to organ damage and affecting survival. Relation of TA with Mycobacterium tuberculosis has been known, but there have been only a few systematic studies focusing on this association. The IS6110 sequence identifies the Mycobacterium tuberculosis complex and the HupB establishes the differences between M. tuberculosis and M. bovis. Our objective was to search the presence of IS6110 and HupB genes in aorta of patients with TA. METHODS: We analyzed aorta tissues embedded in paraffin from 5760 autopsies obtained from our institution, we divided the selected samples as cases and controls; CASES: aortic tissues of individuals with Takayasu's arteritis. Control positive: aortic tissues (with tuberculosis disease confirmed) and control negative with other disease aortic (atherosclerosis). RESULTS: Of 181 selected aorta tissues, 119 fulfilled the corresponding criteria for TA, TB or atherosclerosis. Thus 33 corresponded to TA, 33 to tuberculosis (TB) and 53 to atherosclerosis. The mean age was 22 ± 13, 41 ± 19, and 57 ± 10, respectively. IS6110 and HupB sequences were detected in 70% of TA tissues, 82% in tuberculosis, and in 32% with atherosclerosis. Important statistical differences between groups with TA, tuberculosis versus atherosclerosis (p = 0.004 and 0.0001, respectively) were found. CONCLUSION: We identified a higher frequency of IS6110 and HupB genes in aortic tissues of TA patients. This data suggests that arterial damage could occur due to previous infection with M. tuberculosis.

Absence of Mycobacterium tuberculosis in arterial lesions from patients with Takayasu's arteritis.

OBJECTIVE: Previous studies have suggested that Mycobacterium tuberculosis (MT) could be involved in the pathogenesis of Takayasu's arteritis (TA). The search for MT in arterial lesions of TA has never been assessed directly by sensitive methods. Our aim was to assess the presence of MT in arterial samples obtained in patients with TA. METHODS: Fresh arterial samples were collected from 10 consecutive patients (9 women and 1 man, median age 42 yrs, range 19-67 yrs) with a diagnosis of TA according to the American College of Rheumatology criteria who underwent vascular surgical procedures for their disease. Three patients had recent onset of TA and 7 had longstanding disease. No patient had evidence of active tuberculosis. Arterial biopsies were collected during vascular surgical procedures, and were systematically studied by a pathologist specializing in vascular diseases. Presence of MT was assessed in the biopsies by acid-fast and auramine-fluorochrome stainings, mycobacterial cultures, and direct amplification test (DAT) for MT. RESULTS: Histological examination showed active (n = 5) and inactive (n = 5) arterial lesions. MT was not detected in arterial lesions of either active or inactive TA, by acid-fast and auramine-fluorochrome staining, mycobacterial cultures, or DAT. No DAT inhibitors were found. CONCLUSION: Our study does not support a direct role of MT in the pathogenesis of arterial lesions in either recent or longstanding TA, but does not exclude the possibility of a cross-reaction between mycobacterial and arterial antigens.

Animal models of infection-mediated vasculitis: implications for human disease.

The human vasculitides including Takayasu's arteritis are idiopathic syndromes for which both autoimmune and infectious etiologies have been proposed. Although proof of a correlation between infection and human vasculitis would aid in patient management, it is difficult to confirm causality. To study infection-mediated vascular disease, different animal models have been developed. Infections with the bacteria C. pneumoniae, an RNA virus, and herpesviruses all cause vascular pathology and will be reviewed here. Many aspects of the human diseases are recapitulated in these models, so further animal studies may help elucidate mechanisms of infection-mediated vasculitis. Such results may improve management, and potentially, prevention of these important human diseases. Importantly, the animal models provide an opportunity to define how the immune and inflammatory processes function in the great vessels and the molecular basis for the selectivity of certain viral infections for the great elastic arteries.

Takayasu's arteritis: role of Mycobacterium tuberculosis and its 65 kDa heat shock protein.

BACKGROUND: Mycobacterium tuberculosis has been implicated in the pathogenesis of Takayasu's arteritis (TA). Recently, its 65 kDa heat shock protein (HSP) has been implicated in the pathogenesis of other autoimmune diseases. We thus decided to study humoral immune response to Mycobacterium tuberculosis antigens in patients with TA. AIM: To study humoral immune response to Mycobacterium tuberculosis and its 65 kDa HSP, a putative autoantigen, in patients with TA. METHODS: Antibodies to sonicated Mycobacterium tuberculosis extract (MBA) and its recombinant 54 kDa protein were measured using ELISA in 36 patients with TA and 35 healthy controls. Levels exceeding mean +2 S.D. of the controls were taken as positive responses. RESULTS: Abnormally elevated levels of IgG, IgM and IgA antibodies against MBA were present in 6, 20 and 7 patients respectively whereas those against r65 kDa protein were present in 6, 7 and 33 patients, respectively. Though the levels of IgG antibodies were also elevated, those of IgM and IgA antibodies were elevated to a greater extent. CONCLUSIONS: Patients with TA have heightened immune response to Mycobacterium tuberculosis antigens, in particular to its 65 kDa HSP, suggesting that this organism may have a role in the immunopathogenesis of this disease.