Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 10, Number 11—November 2004
THEME ISSUE
ICEID & ICWID 2004
ICWID Session Summaries

Infectious Etiologies of Chronic Diseases: Focus on Women

Author affiliations: *Centers for Disease Control and Prevention, Atlanta, Georgia, USA; †Johns Hopkins University, Baltimore, Maryland, USA; ‡Emory University School of Medicine, Atlanta, Georgia, USA

Cite This Article

Infections can directly or indirectly cause chronic conditions through progressive pathology (e.g., chronic infection, inflammation, immunity, malignant transformation), sudden permanent insults (e.g., West Nile virus poliomyelitis paralysis), or by predisposing people to noninfectious sequelae (e.g., neurologic consequences of preterm birth). Bacteria, parasites, prions, viruses, and fungi may be the single or one of several factors contributing to chronic disease; one organism can cause more than one syndrome, and diverse pathogens produce similar syndromes as pathways to disease converge (1). Certain potential outcomes disproportionately affect women (e.g., autoimmune diseases), and in some settings, detection, prevention, or treatment efforts (e.g., ocular trachoma, underdiagnosed genital infections) may marginalize women. Women’s activities can also increase exposures to chronic disease pathogens (e.g., schistosomiasis attributable to chores or agriculture), and gender can affect transmission (e.g., increased male-to-female transmission of human T-cell leukemia virus–1). Preventing maternal infections may further minimize chronic disease and neurodevelopmental disorders in offspring.

Are Women’s Autoimmune Diseases Really Autoimmune?

Systemic and organ-specific autoimmune diseases, such as rheumatoid arthritis and myocarditis, are the leading cause of death in women <65 years of age (2). They affect 14–22 million people (5%–8% of the population) in the United States (3) and millions more worldwide. In autoimmunity, the immune system may attack or damage self-tissues with autoantibodies and autoreactive T and B cells. However, the indolent nature of most autoimmune diseases makes determining infectious triggers difficult. Animal models help to understand such links. For example, transfer of disease by autoantibodies and immune cells from affected animals indicates the immune-mediated nature of these syndromes (46). Toll-like receptors and the innate immune system, critical components of the normal human response to infection, are essential to naturally and experimentally induced autoimmunity. Genetic and other factors affect susceptibility to both infection and autoimmune disease. For example, coxsackievirus B3 induces viral myocarditis in susceptible mice. Certain cytokines (interleukin [IL]-1β and tumor necrosis factor [TNF]-α), but not viral replication, correlate with cardiac inflammation and can overcome resistance to chronic myocarditis (79). These findings suggest that, while infection may trigger autoimmunity, evidence suggests that immune processes drive disease progression. Estrogen amplifies the immune response to coxsackievirus B3 in susceptible mice, increasing TNF- α and IL-4 levels (unpub. data), which is perhaps consistent with women’s predisposition to autoimmune disease. Identifying triggers, including infection, and early markers of autoimmunity are important goals for preventing onset of or disrupting progression to autoimmune disease.

Infection Connection in Neurodevelopmental Disorders

Intrauterine infections are known causes of congenital defects worldwide. Infections during the time of fetal brain development might also contribute to neuropsychiatric disorders, including schizophrenia. Studies linking various gestational insults (including infections) and subtle premorbid behavioral alterations to adult schizophrenia implicate a neurodevelopmental origin. However, the long latency between putative infection or insult and the emergence of psychotic symptoms complicates establishing direct links. While most reports have been ecologic studies without confirmed maternal infection, Brown et al. (10) found that 20.4% of persons with a documented in utero exposure to rubella developed an adult schizophrenia spectrum disorder. Experimentally, lymphocytic choriomeningitis virus infection in a neonatal rat model produces some latent changes similar to those of schizophrenia, e.g., hippocampal atrophy and impaired inhibitory GABA neurotransmission (11); blocking IL-1 partially attenuates the hippocampal cell loss. Inflammatory cytokine responses, perhaps amplified by immunogenetic abnormalities, may be a common thread linking intrapartum infections and noninfectious gestational and obstetric complications to neurodevelopmental disorders (12).

Keys to the Future

A continuum from acute infection to chronic disease exists, and each stage is an opportunity to prevent or minimize an avoidable fraction of chronic disease: that resulting from infectious disease. Crucial steps include identifying infectious etiologies and cofactors, determining persons (including women) at risk for infection or outcome, and implementing measures that minimize chronic sequelae. Research incorporating longitudinal studies that precede clinical disease must support evidenced-based conclusions and actions. The benefits to women could be substantial.

Top

References

  1. Knobler  SL, O’Connor  S, Lemon  SM, Najafi  M, eds. The infectious etiology of chronic diseases: defining the relationship, enhancing the research, and mitigating the effects—workshop summary. Forum on emerging infections, Institute of Medicine. Washington: The National Academies Press; 2004.
  2. Walsh  SJ, Rau  LM. Autoimmune diseases: a leading cause of death among young and middle-aged women in the United States. Am J Public Health. 2000;90:14636. DOIPubMedGoogle Scholar
  3. National Institutes of Health. Autoimmune diseases research plan [monograph on the Internet]. 2003 Jul [cited 2003 Mar 21]. Available from http://www.niaid.nih.gov/dait/pdf/ADCC_Report.pdf
  4. Fairweather  D, Lawson  CM, Chapman  AJ, Brown  CM, Booth  TW, Papdimitriou  DM, Wild isolates of murine cytomegalovirus induce myocarditis and antibodies that cross-react with virus and cardiac myosin. Immunology. 1998;94:26370. DOIPubMedGoogle Scholar
  5. Fairweather  D, Rose  NR. Type 1 diabetes: virus infection or autoimmune disease? Nat Immunol. 2002;3:33840. DOIPubMedGoogle Scholar
  6. Fairweather  D, Kaya  Z, Shellam  GR, Lawson  CM, Rose  NR. From infection to autoimmunity. J Autoimmun. 2001;16:17586. DOIPubMedGoogle Scholar
  7. Fairweather  D, Yusung  S, Frisancho  S, Barrett  M, Gatewood  S, Steele  R, IL-12 receptor beta 1 and Toll-like receptor 4 increase IL-1 beta- and IL-18-associated myocarditis and coxsackievirus replication. J Immunol. 2003;170:47317.PubMedGoogle Scholar
  8. Lenzo  JC, Fairweather  D, Cull  V, Shellam  GR, James Lawson  CM. Characterization of murine cytomegalovirus myocarditis: cellular infiltration of the heart and virus persistence. J Mol Cell Cardiol. 2002;34:62940. DOIPubMedGoogle Scholar
  9. Lenzo  JC, Fairweather  D, Shellam  GR, Lawson  CM. Immunomodulation of murine cytomegalovirus-induced myocarditis in mice treated with lipopolysaccharide and tumor necrosis factor. Cell Immunol. 2001;213:5261. DOIPubMedGoogle Scholar
  10. Brown  AS, Cohen  P, Harkavy-Friedman  J, Babulas  V, Malaspina  D, Gorman  JM, Prenatal rubella, premorbid abnormalities, and adult schizophrenia. Biol Psychiatry. 2001;49:47386. DOIPubMedGoogle Scholar
  11. Pearce  BD. Modeling the role of infections in the etiology of mental illness. Clin Neurosci Res. 2003;3:27182. DOIGoogle Scholar
  12. Gilmore  JH, Jarskog  LF. Exposure to infection and brain development: cytokines in the pathogenesis of schizophrenia. Schizophr Res. 1997;24:3657. DOIPubMedGoogle Scholar

Top

Cite This Article

DOI: 10.3201/eid1011.040623_07

Table of Contents – Volume 10, Number 11—November 2004

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Siobhán O’Connor, Centers for Disease Control and Prevention, 1600 Clifton Rd, Mailstop C12, Atlanta, GA 30333, USA; fax: 404-639-3039

Send To

10000 character(s) remaining.

Top

Page created: May 04, 2011
Page updated: May 04, 2011
Page reviewed: May 04, 2011
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external