Meta-Analysis
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Meta-Anal. Jun 28, 2021; 9(3): 309-316
Published online Jun 28, 2021. doi: 10.13105/wjma.v9.i3.309
Impact of Streptococcus pyogenes infection in susceptibility to psoriasis: A systematic review and meta-analysis
Amir Yousefi, Mohsen Karbalaei, Masoud Keikha
Amir Yousefi, Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad 1313199137, Iran
Mohsen Karbalaei, Department of Microbiology and Virology, School of Medicine, Jiroft University of Medical Sciences, Jiroft 09861615881, Iran
Masoud Keikha, Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad 1313199137, Iran
Author contributions: Keikha M conceived the study; Keikha M provided critical analyses; Keikha M and Karbalaei M analyzed the data; Yousefi A and Karbalaei M wrote the draft; Keikha M revised the draft; All authors read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masoud Keikha, PhD, Doctor, Instructor, Teaching Assistant, Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Qoreishi Center, Daneshgah Street, Mashhad 1313199137, Iran. masoud.keykha90@gmail.com
Received: April 23, 2021
Peer-review started: April 23, 2021
First decision: May 19, 2021
Revised: May 24, 2021
Accepted: June 17, 2021
Article in press: June 17, 2021
Published online: June 28, 2021
Processing time: 79 Days and 15.5 Hours
Abstract
BACKGROUND

Psoriasis is one of the most common chronic systemic diseases, mainly appearing as lesions on the skin and joints, and is associated with a high mortality due to a lack of standard treatment. The exact mechanism of this disease is not fully understood, but the inflammatory response and dysregulation of the immune system are the most important molecular processes that trigger this disease. The skin microflora is one of the main factors involved in inducing, maturing, and dysregulating the immune system, which may underly the development of psoriasis.

AIM

To determine the impact of Streptococcus pyogenes (S. pyogenes) infection and susceptibility to psoriasis using available case-control studies.

METHODS

In this study, we conducted a comprehensive literature search using PubMed, Scopus, Web of science, and Google scholar databases to obtain all available relevant studies on the association between S. pyogenes and psoriasis. We pooled the data using Comprehensive Meta-analysis software to investigate the role of S. pyogenes infection in the development of psoriasis. The probable connection between S. pyogenes and susceptibility to psoriasis was assessed using the odds ratio (OR) with corresponding 95% confidence intervals (CIs).

RESULTS

Data from 781 cases were evaluated in this study. Our results showed that the rate of infection with S. pyogenes in psoriatic patients and healthy individuals was 33.4% (95%CI: 27.8-39.6) and 16.2% (95%CI: 9.7-25.9), respectively. S. pyogenes infection significantly increased the risk of psoriasis (OR: 6.58; 95%CI: 3.64-11.87; P = 0.001).

CONCLUSION

S. pyogenes infection can significantly increase the risk of psoriasis. Thus, infection with S. pyogenes is a risk factor for the initiation and development of psoriatic events.

Keywords: Meta-analysis; Psoriasis; Streptococcus pyogenes; Infection; Susceptibility

Core Tip: Currently, the causes of autoimmune diseases are being seriously considered. According to various studies, both genetic and epigenetic events are reasonable hypotheses for these diseases. Psoriasis is one of the most common autoimmune diseases, and studies conducted in recent decades have shown that infectious diseases caused by Streptococcus pyogenes (S. pyogenes) (e.g., pharyngitis) may be associated with psoriasis. Based on these studies, autoantibodies produced against streptococcal M12 protein potentially react with human keratin. Statistical analyses in this study showed that infection with S. pyogenes increased the risk of psoriasis. Thus, long-term treatment as well as strategies to prevent streptococcal infections will be effective in reducing the risk of psoriasis.