Abstract

Objective: To describe the epidemiology and clinical spectrum of ReA following culture-confirmed infection with bacterial enteric pathogens in a population-based study in the United States.

Methods: We conducted telephone interviews of persons age > 1 year with culture confirmed Campylobacter, E.coli O157, Salmonella, Shigella, and Yersinia infections reported to FoodNet in Minnesota and Oregon between 2002 and 2004. Subjects with new onset joint pain, joint swelling, back pain, heel pain, and morning stiffness lasting ≥ 3 days within 8 weeks of culture (possible ReA) were invited to complete a detailed questionnaire and physical examination.

Results: 6,379 culture-confirmed infections were reported; 70% completed screening interviews. Of these, 575 (13%) developed possible ReA; incidence was highest following Campylobacter (2.1/100,000) and Salmonella (1.4/100,000) infections. Risk was greater for females (RR 1.5, 95% CI, 1.3-1.7), adults (RR 2.5, 95% CI, 2.0-3.1), and subjects with severe acute illness (e.g. fever, chills, headache, persistent diarrhea). Risk was not associated with antibiotic use or HLA B-27. Fifty-four (66%) of 82 subjects examined had confirmed ReA. Enthesitis was the most frequent finding; arthritis was less common. The estimated incidence of ReA following culture-confirmed Campylobacter, E. coli O157, Salmonella, Shigella and Yersinia infections in Oregon was 0.6-3.1 cases/100,000.

Conclusions: This is the first population-based study of ReA following infections due to bacterial enteric pathogens in the United States. These data will help determine the burden of illness due to these pathogens and inform clinicians about potential sequelae of these infections.