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Vol. 14. Issue 6.
Pages 843-855 (November - December 2008)
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Vol. 14. Issue 6.
Pages 843-855 (November - December 2008)
Artigo de Revisão/Review Article
Open Access
Associação entre lúpus eritematoso sistémico e tuberculose – Revisão crítica*
Systemic lupus erythematosus association with tuberculosis – Critical review
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João Cláudio Barroso Pereira1
1 Médico Tisiologista do Serviço de Atendimento Especializado da SMS-Belford Roxo, Médico do CRA-DIP do Hospital Municipal Nelson de SÁ Earp e do Programa de Controle da Tuberculose da SMS-Petrópolis – Rio de Janeiro, Brasil
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Resumo

Uma análise crítica sobre a associação lúpus eritematoso sistémico e tuberculose é proposta. É feita uma breve revisão sobre lúpus e sobre prováveis factores que desencadeiam a tuberculose nestes doentes, incluindo tópico sobre proteínas de choque térmico da família HSP 70KDa e HSP65KDa do Mycobacterium tuberculosis e receptores Toll TLR2, TLR4 e TLR9 que podem estar envolvidos na interacção entre antigénio do bacilo e tecido do hospedeiro causando indução autoimune no lúpus. Uma revisão de séries clínicas sobre o assunto é mostrada e ressalta as formas extrapulmonares como as mais comuns nestes casos. O autor conclui que diagnóstico precoce e tratamento apropriado são mandatórios em situações nas quais o LES está associado a TB, principalmente em áreas endémicas para esta doença.

Rev Port Pneumol 2008; XIV (6): 843-855

Palavras-chave:
Associação LES-TB
revisão de séries clínicas
formas extrapulmonares e diagnóstico precoce
Abstract

The author provides a critical analysis of systemic lupus erythematosus associated with tuberculosis. A brief review of the lupus-tuberculosis association is also given, and stresses that extra-pulmonary TB is the most usual form of TB in these cases. Other issues considered are the heat shock proteins of Mycobacterium tuberculosis HSP70KDa and HSP65KDa families and TLR2, TLR4, TLR9 that can be involved in interaction between bacilli antigen and host tissue causing autoimmune induction by lupus. The author concludes that early diagnosis and appropriate management are mandatory in SLE associated with TB, in areas where TB is endemic.

Rev Port Pneumol 2008; XIV (6): 843-855

Key-words:
SLE-TB association
clinical series review
extrapulmonary forms
early diagnosis
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Bibliografia
[1.]
R.F. Loeser.
Connective tissue structure and function.
Cecil Medicine, 1975 (2008), pp. 81
[2.]
D. Ferreira, S. Neves, A. Lira, I. Bastos, J. Almeida.
Manifestações pulmonares de patologias auto-imunes.
Rev Port Pneumol, XIII (2007), pp. 83-100
[3.]
I. Terao, T. Hagiwara, S. Lijima, T. Hayama, T. Horie.
Analysis of factors for the development of pulmonary tuberculosis in persons with collagenosis.
Kekkaku- Tuberculosis, 69 (1994), pp. 65-69
[4.]
J. Rovensky, M. Kovalancik, P. KristufeK, J. Lukac, S. Kopecky, D. Zitnan, F. Malis.
Contribution to the problem of occurence of tuberculosis in patients with systemic lupus erythematosus.
Zeitschrift fur Rheumatologie, 55 (1996), pp. 180-187
[5.]
J.E. Yun, S.W. Lee, T.H. Kim, J.B. Jun, S. Jung, S.C. Bae, T.Y. Kim, D.H. Yoo.
The incidence and clinical characteristics of Mycobacterium tuberculosis infection among systemic lupus erythematosus and rheumatoid arthritis patients in Korea.
Clinical and experimental rheumatology, 20 (2002), pp. 127-132
[6.]
L.S. Tam, E.K. Li, S.M. Wong, C.C. Szeto.
Risk factors and clinical features for tuberculosis among patients with systemic lupus erythematosus in Hong Kong.
Scand J Rheumatol, 31 (2002), pp. 296-300
[7.]
P.H. Feng, T.H. Tan.
Tuberculosis in patients with systemic lupus erythematosus.
Annals of the Rheumatic Diseases, 41 (1982), pp. 11-14
[8.]
C. Balakrishnan, G. Mangat, G. Mittal, V.R. Joshi.
Tuberculosis in patients with systemic lupus erythematosus.
Journal of the Association of Physians of India, 46 (1998), pp. 682-683
[9.]
M.K. Crow.
Systemic Lupus Erythematosus.
Cecil Medicine, 2022 (2008), pp. 31
[10.]
H.A. Kim, C.D. Yoo, H.J. Baek, E.B. Lee, C. Ahn, J.S. Han, S. Kim, J.S. Lee, K.W. Choe, Y.W. Song.
Mycobacterium tuberculosis infection in a corticosteroid-treated rheumatic disease patient population.
Clinical and Experimental Rheumatology, 16 (1998), pp. 9-13
[11.]
J. Keane, S. Gershon, R.P. Wise, E. Mirabile-Levens, J. Kasznica, W.D. Schwiertman, et al.
Tuberculosis associated with inflixmab, a tumor necrosis factor alpha-neutralizing agent.
N Engl J Med, 345 (2001), pp. 1098-1104
[12.]
L. Mayordomo, J.L. Marenco, J. Gomez-Mateos, E. Rejon.
Pulmonary miliary tuberculosis in a patient with anti-TNF-alpha treatment.
Scand J Rheumatol, 31 (2002), pp. 44-45
[13.]
M. Petri.
Infection in systemic lupus erythematosus.
Rheum Dis Clin North Am, 24 (1998), pp. 423-456
[14.]
E. Haddad.
Lupus érythémateux disséminé: nouvelle approuches physiopathologiques, noveaux traitments?.
Archives de pédiatrie, 11 (2004), pp. 512-514
[15.]
G.M. Kammer.
Impaired T cell capping and receptor regeneration in active systemic lupus erythematosus. Evidence for a disorder intrinsic to the T lymphocyte.
J Clin Invest, 72 (1983), pp. 1686-1697
[16.]
Y. Donati, D. Sloman, B. Polla.
Oxidative injury and heat shock response.
Biochem. Pharmacol, 40 (1990), pp. 2571-2577
[17.]
Y. Shoenfeld, D.A. Isemberg.
Mycobacteria and autoimmunity.
Immunol. Today, 9 (1989), pp. 178-181
[18.]
S. Lindquist, E.A. Craig.
The heat shock proteins.
Ann Genet, 22 (1988), pp. 631-677
[19.]
C. Karopoulos, M.J. Rowey, C.J. Handley, R.A. Strugnell.
Antibody reactivity to Mycobacterial 65kDa heat shock protein: relevance to autoimmunity.
J Autoimmun, 8 (1995), pp. 235-248
[20.]
M. Tischler, Y. Scohnfeld.
Tuberculose et auto-immunité: où sommes-nous?.
Annales de L`Institut Pasteur, 7 (1996), pp. 133-136
[21.]
B. Granel, L. Swiader, J. Serratrice, P. Disdier, P.J. Weiller.
Les heat shock proteins ou les<proteínes de stress>.
Rev Méd Interne, 21 (2000), pp. 421-427
[22.]
I. Kindas-Mugge, G. Steiner, J.S. Smolen.
Similar frequency of autoantibodies against 70kDa class heat shock proteins in heathy subjects and systemic lupus erythematosus patients.
Clin Exp Immunol, 92 (1993), pp. 46-50
[23.]
A.G. Pockley, J. Shephard, J.M. Corton.
Detection of heat shock protein 70 (Hsp-70. and anti Hsp 70 antibodies in the serum of normal individual.
Immunol Invest, 27 (1988), pp. 367-377
[24.]
V.B. Dhillon, S. McCallum, P.M. Norton, B.M. Twomey, F. Erkeller-Yuksel, P. Lydyard, D.A. Isenberg, D.S. Latchman.
Differential heat shock protein over expression and its clinical relevance in systemic lupus erythematosus.
Ann Rheum Dis, 52 (1993), pp. 436-440
[25.]
V.B. Dhillon, S. McCallun, D.S. Latchman, D.A. Isenberg.
Elevation of the 90kDa heat shock protein in specific subsets of systemic lupus erythematosus.
Quart J Méd, 87 (1994), pp. 215-222
[26.]
V.B. Dhillon, D.S. Latchman, D.A. Isenberg.
The expression of heat shock proteins in systemic lupus erythematosus.
Fundamental and Experimental Aspects of Autoimmunnity, pp. 99-129
[27.]
S. Tasneem, N. Islam, R. Ali.
Crossreactivity of SLE Autoantibodies with 70kDa Heat Shock Proteins of Mycobacterium tuberculosis.
Microbiol Immunol, 45 (2001), pp. 841-846
[28.]
D.E. Simcock, D. Mukherjee, N.S.T. Gendi.
Poncet`disease a novel cause of non compliance with anti-tuberculous drugs-case report.
Respiratory Medicine, 98 (2004), pp. 795-797
[29.]
J.J. Goronzy, C.M. Weyand.
The Innate and Adaptative Immune System.
Cecil Medicine, 249 (2008), pp. 59
[30.]
G.S. Firestein.
Mechanisms of Inflamation and Tissue Repair.
Cecil Medicine, 271 (2008), pp. 77
[31.]
R. Medzhitov, C.A. Janeway Jr..
Advances in Immunology: Innate Immunity.
[32.]
R. Medzhitov, C.A. Janeway Jr..
Innate Immunity: impact on adaptative immune response.
Curr Opin Immunol, 9 (1997), pp. 4-9
[33.]
K. Takeda, S. Akira.
Toll-like receptors in innate immunity.
International Immunology, 17 (2005), pp. 1-14
[34.]
A. Krieg, J. Vollmer.
Toll-like receptors 7, 8 and 9: linking innate immunity to autoimmunity.
Immunological Reviews, 220 (2007), pp. 251-269
[35.]
P.A. Hopkins, S. Sriskandan.
Mammalian Toll-like receptors: to immunity and beyond.
Clinical and Experimental Immunology, 140 (2005), pp. 395-407
[36.]
L.C. Parker, M.K.B. Whyte, et al.
The expression and roles of Toll-like receptors in the biology of the human neutrophil.
Journal of Leukocyte Biology, 77 (2005), pp. 886-892
[37.]
E.D. Papadimitraki, C. Choulaki, et al.
Expansion of Toll like Receptor 9 –Expressing B Cells in Active Systemic Lupus Erythematosus.
Arthritis & Rheumatism, 54 (2006), pp. 3601-3611
[38.]
T.K. Means, E. Latz, et al.
Human lupus antibody-DNA complexes activate DCs through cooperation of CD32 and TLR9.
J Clin Investigation, 115 (2005), pp. 407-417
[39.]
P.S. Kumar, B. Sanchita, et al.
Mycobacterium tuberculosis lipoarabinomannam- mediated IRAK-M induction negatively regulates Toll-like receptor dependent interleukin-12 p40 production in macrophages.
Journal of Biology Chemistry, 280 (2005), pp. 742-794
[40.]
N.D. Pecora, A.J. Gehring, et al.
Mycobacterium tuberculosis LprA is a lipoprotein agonist of TLR2 that regulates innate immunity and APC function.
Journal of Immunology, 177 (2006), pp. 422-429
[41.]
S.-B. Jung, C.-S. Yang, et al.
The mycobacterial 38-kilodalton glycoprotein antigen activates the mitogen-activated protein kinase pathway and release of proinflammatory cytokines through Toll-like receptors 2 and 4 in human monocytes.
Infection and Immunity, 74 (2006), pp. 2686-2696
[42.]
A. Tjarnlund, E. Guirado, et al.
Determinant role of Toll-like receptor signalling in acute mycobacterial infection in the respiratory tract.
Microbes and infection. Institut Pasteur, 8 (2006), pp. 1790-1800
[43.]
T.K. Means, A.D. Luster.
Toll-Like Receptor Activation in the Pathogenesis of Systemic Lupus Erythematosus.
Source Annals of the New York Academy of Sciences, 1062 (2005), pp. 242-251
[44.]
B. Hernández- Cruz, J. Sifuentes-Osornio, S. Ponce-de-León Rosales, A. Ponce-de-León Garduño, E. Díaz-Jouanen.
Mycobacterium tuberculosis infection with systemic rheumatic diseases. A case-series.
Clinical and Experimental Rheumatology, 17 (1999), pp. 289-296
[45.]
M.M. Yin, L. Yi, C.T. Mao, W.W. Sing, L.C. Sing.
Tuberculosis in systemic lupus erythematosus in an endemic area and the role of isoniazid prophylaxis during corticosteroid therapy.
Journal of Rheumatology, 32 (2005), pp. 609-615
[46.]
D. Nursen, P. Yavuz, S. Birkan, Y. Canan, E. Selim, D. Murat.
Localization of extrapulmonary tuberculosis in the synovial membrane, skin and meninges in a patient with systemic lupus erythematosus and IgG deficiency.
Rheumatology International, 22 (2002), pp. 41-44
[47.]
S.T. Victorio-Navarra, E.E. Dy, C.G. Arroyo, T.P. Torralba.
Tuberculosis among Filipino patients with systemc lupus erythematosus.
Seminars in Arthritis and Rheumatism, 26 (1996), pp. 628-634
[48.]
Subcommittee for Scleroderma Criteria of ARA Diagnostic and Therapeutic Criteria Committee: Preliminary criteria for the classification of systemic sclerosis (scleroderma).
Arthritis Rheum, 23 (1980), pp. 581-590
[49.]
A. Bohan, J.B. Peter.
Polymyositis and dermatomyositis.
New England Journal of Medicine, 292 (1975), pp. 437-447
[50.]
D. Alarcón- Segovia, M. Villarreal.
Classification and diagnostic criteria for mixed connective tissue disease.
Mixed Connective Tissue Disease, pp. 33-40
[51.]
H.Y. Kim, J.G. Im, J.M. Goo, J.K. Lee, J.W. Song, S.K. Kim.
Pulmonary tuberculosis in patients with systemic lupus erythematosus.
American Journal of Roentgenology, 173 (1999), pp. 1639-1642
[52.]
Centro de Referência Prof. Hélio Fraga. Sociedade Brasileira de Pneumologia e Tisiologia. Controle da Tuberculose-Uma Proposta de Integração Ensino-Serviço, Quinta ed, (2002),
[53.]
A.L. Kritisk, M.B. Conde, G.R.M. Souza.
Tuberculose: Do ambulatório à enfermaria, Terceira ed, (2005), pp. 107-143

Tema apresentado sob forma de caso clínico, através de poster, durante o XXII Congresso de Pneumologia e IV Congresso Luso-Brasileiro de Pneumologia, em Dezembro de 2006.

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