Chlamydia trachomatis in the etiology of acute otitis media.
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Child↗
Biomedical subjects
M R Hammerschlag
Publications and source records attributed to M R Hammerschlag.
Chlamydia pneumoniae pneumonia with pleural effusion: diagnosis by culture.
A case of Chlamydia pneumoniae pneumonia with pleural effusion in an otherwise healthy 19-year-old man is described. Diagnosis was made by serologic means as well as by culture of both the nasopharynx and the pleural fluid.
Adolescent↗
Role of Chlamydia pneumoniae in acute chest syndrome of sickle cell disease.
Children with sickle cell disease and acute chest syndrome were investigated for infection with Chlamydia pneumoniae and Mycoplasma pneumoniae. Of 30 patients who had 32 episodes of acute chest syndrome, four (13%) had C. pneumoniae isolated from the nasopharynx; two of these also had serologic evidence of acute infection, and one had positive nasopharyngeal isolates on two subsequent occasions during the course of 1 year with stable, elevated titers of anti-C. pneumoniae IgG, suggesting chronic infection. Two patients with negative cultures had serologic evidence of infection with C. pneumoniae. None of 32 cultures for M. pneumoniae were positive, and although anti-M. pneumoniae IgM developed in two patients, one of these patients had evidence of C. pneumoniae infection (positive culture and seroconversion). We conclude that C. pneumoniae infection is prevalent in our sickle cell population with acute chest syndrome. Until further studies clarify the pathophysiologic significance of C. pneumoniae infection, we believe that early inclusion of erythromycin as antimicrobial therapy for acute chest syndrome seems reasonable.
Adolescent↗
Infection with Chlamydia pneumoniae in Brooklyn.
Of 91 children and adults with lower respiratory tract infection, 17 (18.7%) had evidence of infection with Chlamydia pneumoniae. Infection was more common in older adolescents and adults than in children. Only 3 of 8 culture-positive patients with paired sera had serologic evidence of acute infection. Two patients were culture positive over a 12-month period. Two other culture-positive patients had evidence of coinfection with other bacterial respiratory tract pathogens, which in these cases appeared to be responsible for the acute episode of pneumonia. Patterns of infection ranged from acute pneumonia to apparent chronic asymptomatic carriage, and there was no characteristic clinical presentation. Studies using cultures in other populations, including asymptomatic individuals, are needed for a better understanding of the epidemiology and clinical relevance of this organism.
Acute Disease↗
Office diagnosis of neonatal chlamydial conjunctivitis.
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Chlamydia trachomatis↗
Isolation of Chlamydia pneumoniae from the lungs of patients infected with the human immunodeficiency virus.
Chlamydia pneumoniae is being recognized as a common cause of respiratory tract infections. Bronchoalveolar lavage specimens from human immunodeficiency virus-infected patients were examined by culture for this pathogen. Of 50 specimens examined, 5 (10%) were positive for C. pneumoniae. Four of these (80%) were also positive for other pathogens frequently implicated as causes of respiratory disease in this patient population. C. pneumoniae may frequently inhabit the respiratory tracts of human immunodeficiency virus-infected individuals.
Adult↗
Asymptomatic respiratory tract infection with Chlamydia pneumoniae TWAR.
Chlamydia pneumoniae is a newly recognized organism associated with respiratory tract infections. Asymptomatic infection with C. pneumoniae, although it has been suggested to occur, has not been previously documented. We describe two asymptomatic individuals infected with this organism; these infections demonstrate that C. pneumoniae is able to establish a subclinical infection.
Antibodies, Bacterial↗
Chlamydicidal activity of human alveolar macrophages.
Pneumonia due to Chlamydia trachomatis is a disease limited mainly to infants under 6 months of age. Rare cases have been reported in immunocompromised adults. One possible reason for the propensity of the pneumonia to occur in the very young may be related to differences in the phagocytic and bactericidal capacity of alveolar macrophages (AMs) in young infants and adults. At birth a function of AMs is clearance of surfactant-related material from the alveolar surface. Studies in animals have suggested that engorgement of AMs with surfactant-related lipids may reduce the microbicidal capacity of these cells. In the present study we determined that AMs obtained from healthy, nonsmoking adults were capable of killing both human biovars of C. trachomatis, with complete killing observed by 48 h after inoculation. Preincubation of AMs from adults with surfactant did not reduce the capacity of the cells to kill C. trachomatis.
Adult↗
Comparison of Kodak Surecell Chlamydia Test Kit with culture for the diagnosis of chlamydial conjunctivitis in infants.
The accuracy of the Surecell Chlamydia Test Kit (Kodak Clinical Products, Rochester, N.Y.) in detecting neonatal conjunctival infection caused by Chlamydia trachomatis was determined by comparison of this enzyme immunoassay with the isolation of C. trachomatis in tissue culture. Kodak Surecell is a rapid monoclonal antibody-based membrane capture enzyme immunoassay which can be processed in the office of a physician. The sensitivity and specificity compared to culture in detecting C. trachomatis in conjunctival specimens from infants with conjunctivitis were 93 and 96%, respectively. The test does not require specialized equipment or trained personnel and would be ideal for physicians who see low numbers of infants with possible chlamydial conjunctivitis in their offices.
Antibodies, Monoclonal↗
Comparison of two enzyme immunoassays to culture for the diagnosis of chlamydial conjunctivitis and respiratory infections in infants.
Data are limited for the performance of enzyme immunoassays for the detection of Chlamydia trachomatis in conjunctival and nasopharyngeal specimens from infants. The only available data are for one assay, Chlamydiazyme (Abbott Diagnostics). The purpose of this study was to compare a new enzyme immunoassay, Pathfinder (Kallestad Diagnostics), with Chlamydiazyme and culture for the diagnosis of chlamydial conjunctivitis and pneumonia in infants. Pathfinder differs from Chlamydiazyme in that it uses a monoclonal antibody directed against the chlamydial lipopolysaccharide in addition to a polyclonal antichlamydial antibody. Triplicate conjunctival and nasopharyngeal specimens were obtained from 97 infants with conjunctivitis, and additional nasopharyngeal specimens were obtained from 14 infants with suspected chlamydial pneumonia (total, 111 nasopharyngeal specimens). Twenty-nine (30%) of the conjunctival specimens from infants with conjunctivitis and four (28.6%) of the nasopharyngeal specimens from the infants with pneumonia were positive for C. trachomatis by cell culture. The sensitivities, specificities, and positive and negative predictive values for Pathfinder for conjunctival specimens were 96.6, 98.5, 96.6, and 98.5%, respectively. The results for Chlamydiazyme were 96.6, 100, 100, and 98.6%, respectively. For nasopharyngeal specimens, the results for Pathfinder were 77.8, 94.6, 73.7, and 95.7%, respectively. The results for Chlamydiazyme were 66.7, 95.7, 75, and 93%, respectively. Pathfinder and Chlamydiazyme appeared to perform equivalently for the detection of C. trachomatis in both eye and nasopharyngeal specimens from infants with chlamydial conjunctivitis and pneumonia.
Antibodies, Monoclonal↗
Efficacy of neonatal ocular prophylaxis for the prevention of chlamydial and gonococcal conjunctivitis.
Opinions differ concerning the efficacy of prophylaxis against neonatal chlamydial and gonococcal conjunctivitis. From January 1986 through June 1988, we gave all infants born at Kings County Hospital Medical Center one of three prophylactic agents -- silver nitrate drops, erythromycin ophthalmic ointment, or tetracycline ophthalmic ointment. The treatments were rotated monthly. Gonococcal ophthalmia occurred in 8 of the 12,431 infants born during the study (0.06 percent), 1 in the silver nitrate group, 4 in the erythromycin group, and 3 in the tetracycline group (P not significant). Seven of these infants were born to women who had received no prenatal care. From September 1985 through December 1987, we screened 4357 pregnant women for cervical chlamydial infection, of whom 341 (8 percent) had positive cultures. Of their offspring, 230 were evaluated for neonatal chlamydial conjunctivitis; the incidence was 20 percent in the silver nitrate group, 14 percent in the erythromycin group, and 11 percent in the tetracycline group (P not significant). We conclude that neonatal ocular prophylaxis with either erythromycin or tetracycline ophthalmic ointment does not significantly reduce the incidence of chlamydial conjunctivitis in the offspring of mothers with chlamydial infection as compared with silver nitrate, and that better management of maternal chlamydial infection is therefore required. We also conclude that there is a small but appreciable incidence of neonatal gonococcal ophthalmia that could be prevented by better prenatal screening and treatment of maternal gonococcal infection.
Chlamydia Infections↗
Herpes zoster in an adult recipient of live attenuated varicella vaccine.
A healthy 30-y-old female physician who was immunized with two doses of live attenuated varicella vaccine developed a localized case of zoster involving the right T8-10 dermatomes 36 mo after vaccination. The virus isolated from her rash was an unusual wild-type of varicella-zoster virus. After immunization she developed detectable antibodies to varicella-zoster virus, but antibodies were no longer detectable after 20 mo. Six months before development of zoster, she was exposed to a patient with varicella; however, she did not develop a clinical illness although she again became seropositive. To date, this is the only reported case of zoster among 187 healthy adult vaccinees.
Adult↗
Lack of specificity of Chlamydiazyme for detection of vaginal chlamydial infection in prepubertal girls.
A 1-year prospective study was undertaken of 65 prepubertal girls referred for evaluation of sexual abuse or vulvovaginitis to compare Chlamydiazyme, an enzyme immunoassay (EIA), with culture for the detection of Chlamydia trachomatis i in vaginal specimens. Five (8%) of 65 patients were initially EIA-positive. On repeat sampling without intervening antibiotic treatment, 4 girls who were initially positive became negative and 1 remained persistently positive. Chlamydial cultures were negative in all patients. The patient with the persistently positive EIA also had Group A streptococcal vaginitis. We were able to demonstrate that some strains of Group A Streptococcus can cause a positive reaction with the EIA. Cross-reactions with other bacterial species are also known to occur. We therefore conclude that Chlamydiazyme is not specific for the detection of chlamydial infection in the vagina of prepubertal girls and, for medicolegal reasons, should not be used for evaluation of sexual abuse.
Antigens, Bacterial↗
Ceftriaxone treatment of penicillinase-producing Neisseria gonorrhoeae infections in children.
The incidence of penicillinase-producing Neisseria gonorrhoeae (PPNG) among adults with gonorrhea in Brooklyn now exceeds 24%. Because children usually acquire their infection from adults, it follows that we have had a concomitant rise in PPNG among sexually abused children. The Centers for Disease Control now recommends ceftriaxone for the first line treatment of gonorrhea but there are no data as to its use in children for this indication. From May, 1987, through March, 1989, 33 children, 4 days to 10 years of age, were admitted to Kings County Hospital for 34 episodes of gonorrhea. Nine (26.5%) were caused by PPNG. Twenty-three were female; 10 were male. There were 17 isolates from the vagina, 3 from the urethra, 9 from the pharynx, 9 from the rectum and 6 from the eye. Eight children (all girls) had infections at greater than or equal to 1 site; 2 were infected at 3 sites. Twenty-eight children were sexually abused and 5 were neonates with ophthalmia (1 PPNG). All isolates were susceptible to ceftriaxone by disc diffusion testing. Agar dilution was performed for 18 isolates; minimal inhibitory concentrations to ceftriaxone were less than or equal to 0.06 mg/liter. The 5 PPNG isolates tested had minimal inhibitory concentrations to penicillin of 2 to 16 mg/liter and 3 isolates were resistant to tetracycline with minimal inhibitory concentrations of 32 mg/liter. Twenty-eight children were treated with a single dose of ceftriaxone, including the 5 neonates with ophthalmia; the dose was 125 mg if less than 45 kg or 250 mg if greater than 45 kg.(ABSTRACT TRUNCATED AT 250 WORDS)
Ceftriaxone↗
In vitro susceptibilities of Chlamydia pneumoniae (Chlamydia sp. strain TWAR).
The in vitro susceptibilities of two clinical isolates of Chlamydia pneumoniae from Brooklyn, N.Y., were determined for tetracycline, erythromycin, sulfamethoxazole, ciprofloxacin, and three new macrolides--azithromycin, clarithromycin, and roxithromycin. Clarithromycin was the most active drug tested, followed by the other macrolides, tetracycline, and ciprofloxacin.
Anti-Bacterial Agents↗
Comparison of two rapid microscopic methods and culture for detection of Chlamydia trachomatis in ocular and nasopharyngeal specimens from infants.
The data available for the diagnosis of chlamydial infections in infants which compare direct fluorescent-monoclonal-antibody stains (DFAs) with culture are limited to one reagent, MicroTrak (Syva Inc., Palo Alto, Calif.). We therefore performed a comparison of Pathfinder (Kallestad Diagnostics, Chaska, Minn.) and MicroTrak with chlamydia culture. Paired conjunctival and nasopharyngeal specimens for DFAs and cultures were obtained from 56 infants less than 1 month of age with conjunctivitis. The sensitivities for detecting C. trachomatis in conjunctival specimens with MicroTrak and Pathfinder were 93.8 and 88.2%, respectively, and the specificities were 87.5 and 94.9%, respectively. The DFA tests on nasopharyngeal specimens from infants with conjunctivitis did not perform as well. The sensitivities for Pathfinder and MicroTrak were 33 and 50%, respectively. There were a total of six patients with culture-positive chlamydial conjunctivitis whose nasopharyngeal specimens were DFA positive and culture negative; four of the specimens were positive by both DFAs. These six discordant specimens were further evaluated by preparing pellets and smears of the original culture specimens. All six contained typical fluorescing elementary bodies when stained with the Syva DFA reagent.
Chlamydia Infections↗
Chlamydia trachomatis selectively stimulates myeloperoxidase release but not superoxide production by human neutrophils.
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Chlamydia trachomatis↗