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The risk of infection before diagnosis with primary immune thrombocytopenia - a Swedish case-referent study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Marie Linder, Charlotta Ekstrand, Shahram Bahmanyar)
2016 (English)Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

Background: Infections are a global burden and may trigger autoimmune diseases. Some infections are more common before diagnosis of chronic immune thrombocytopenia (ITP), an autoimmune disease characterized by the autoantibody destruction of platelets. However, association between infection and newly diagnosed (disease duration less than 3 months) and persistent ITP (disease duration 3-12 months) is unknown. Aim: To investigate risk of infections before the diagnosis of newly diagnosed or persistent ITP (NP-ITP), and to estimate incidence of NP-ITP in Sweden.Method: We identified 1,945 adults with primary NP-ITP during years 2006-2013 using the Swedish Patient Register. The register also provided data on infections not already associated to secondary ITP. The Standardized Incidence Ratios (SIR), using age, sex and calendar year specific rates from the general population, and 95% confidence intervals (CI), were estimated as a measure of relative risk. Results: Overall risk of serious infections during five-years prior to diagnosis of primary NP-ITP, was increased (SIR=7.8, 95% CI 7.0-8.6). Higher magnitude SIRs were found for specific infections; sexually transmitted infections (SIR=156.7, 95% CI 87.6-258.4), candidiasis (SIR=78.4, 95% CI 56.9-105.2), chronic rhinitis, nasopharyngitis and phraryngits (SIR=613.4, 95% CI 293.7-1128.2) and nonsuppurative middle ear infections (SIR=292,5 95% CI 163.6-482.4). The incidence of primary NP-ITP in Sweden was 3.3 per 100 000 person-years between years 2006-2013. Conclusion: Pattern of infections before NP-ITP diagnosis is similar to that in chronic ITP. The findings suggest that for all subtypes of immune thrombocytopenia, infection is related to both immunomodulation treatment as well as the disease itself.

Place, publisher, year, edition, pages
National Category
Other Medical Sciences
URN: urn:nbn:se:uu:diva-302556OAI: oai:DiVA.org:uu-302556DiVA: diva2:958145
External cooperation
Karolinska Institutet
Subject / course
Public Health
Educational program
Master Programme in International Health
2016-05-30, 13:30 (English)
Available from: 2016-09-07 Created: 2016-09-06 Last updated: 2016-09-07Bibliographically approved

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