Infectious etiology of vasculitis: Diagnosis and management

Abstract

Vasculitides are a heterogeneous group of syndromes characterized by inflammation of the vessel wall. Several microbial pathogens have been known or suspected to cause vasculitis, and the development of molecular biology has promoted the search and confirmation of infectious agents in idiopathic vasculitis. Though several agents present primarily as an infectious process with vasculitis as an occasional manifestation, vasculitis may be the major manifestation of disease. Less definitive, and more controversial, is the role of infection and inflammation of the vessel wall in the pathogenesis of atherosclerotic disease. Clinical features can be nonspecific, and a high index of suspicion is required in order to make a diagnosis of vasculitis. Infection should always be excluded based on appropriate cultures and serologic assays, and, if confirmed, early and aggressive treatment should be instituted. However, in many instances, especially if there is a delay in the diagnosis, surgical intervention becomes necessary to treat the associated anatomic and physiologic sequelae.

Cutaneous Vasculitis in Small Animals

“…Infectious causes of cutaneous or systemic vasculitis may develop owing to direct invasion of the vessel wall by a pathogen, as a result of immune complex deposition on the vascular endothelium, or via activation of B or T cells. 17 In human medicine, a distinction is often made between primary and secondary vasculitides, with primary vasculitis representing immunologic or autoimmune diseases with no identifiable infectious agent, and secondary vasculitis representing those vasculitic diseases that should be considered a symptom or clinical feature of an infectious disease by itself. 17 Before the development of advanced molecular diagnostic methods, idiopathic human vasculitides were considered common.…”

“…17 In human medicine, a distinction is often made between primary and secondary vasculitides, with primary vasculitis representing immunologic or autoimmune diseases with no identifiable infectious agent, and secondary vasculitis representing those vasculitic diseases that should be considered a symptom or clinical feature of an infectious disease by itself. 17 Before the development of advanced molecular diagnostic methods, idiopathic human vasculitides were considered common. However, with recent developments in diagnostic methods, an increasing body of evidence is mounting for the potential role of microbial agents and infections in the pathogenesis Refs.…”

“…However, new insight into this area may substantially increase our understanding of these diseases in the future. 17,19…”

Severe systemic vasculitis in a neonate

“…The severe eosinophilic vasculitis noted in our newborn did not recur after short-term steroid treatment. This fact strongly argues for a vasculitis secondary either to drugs or acute infections [2,6]. Both streptococci and staphylococci, the causative agents of the severe thoracic infection of our patient, have been known or suspected to cause vasculitides.…”

Infection-related vasculitis

“…Microorganism(s) directly and/or indirectly, through immune-mediated mechanisms are able to induce vasculitis leading to variable degrees of occlusion, tissue ischemia, and necrosis [1,2].…”