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PubMed2006

Antigen-specific CD8+ T cells respond to Chlamydia trachomatis in the genital mucosa.

Following sexual transmission, Chlamydia trachomatis specifically targets genital tract epithelial cells. Because epithelial cells are readily recognized by CD8+ T cells, the response of CD8+ T cells to Chlamydia infection has been explored in a number of studies. It has been shown that CD8+ T cells are present in the genital tracts of mice following C. trachomatis infection, but the specificity of these T cells has remained undefined. To determine whether Chlamydia-specific CD8+ T cells migrate to the genital tract in response to Chlamydia infection, we generated retrogenic mice that express a TCR specific for a Chlamydia-specific T cell Ag CrpA. T cells from the retrogenic mice were transferred into naive recipient animals to increase the frequency of Chlamydia-specific T cells to a level at which they could be tracked during primary infection. We observed that the Chlamydia-specific retrogenic T cells proliferated in lymph nodes draining the genital tract in response to genital infection with C. trachomatis. Furthermore, we found that these cells acquired the ability to produce IFN-gamma and migrated into the genital mucosa of the infected mice.

Adoptive Transfer↗
PubMed2006

Chlamydia trachomatis infection alters the development of memory CD8+ T cells.

The obligate intracellular bacterium Chlamydia trachomatis is the most common cause of bacterial sexually transmitted disease in the United States and the leading cause of preventable blindness worldwide. Prior exposure to C. trachomatis has been shown to provide incomplete protection against subsequent infection. One possible explanation for the limited immunity afforded by prior C. trachomatis infection is poor activation of Chlamydia-specific memory CD8+ T cells. In this study, we examined the development of CD8+ memory T cell responses specific for the Chlamydia Ag CrpA. The percentage of CrpA63-71-specific T cells expressing an effector memory T cell phenotype (IL-7R+ CD62low) was dramatically diminished in mice immunized with C. trachomatis, compared with mice immunized with vaccinia virus expressing the CrpA protein. These alterations in memory T cell development were correlated with a significant reduction in the capacity of convalescent mice to mount an enhanced recall response to Chlamydia Ags, compared with the primary response. CrpA-specific memory T cells primed during VacCrpA infection also failed to respond to a challenge with Chlamydia. We therefore investigated whether C. trachomatis infection might have a global inhibitory effect on CD8+ T cell activation by coinfecting mice with C. trachomatis and Listeria monocytogenes and we found that the activation of Listeria-specific naive and memory CD8+ T cells was reduced in the presence of C. trachomatis. Together, these results suggest that Chlamydia is able to alter the development of CD8+ T cell responses during both primary and secondary infection, perhaps accounting for the incomplete protection provided by prior Chlamydia infection.

Animals↗
PubMed1999

Study on vertical transmission of Chlamydia trachomatis using PCR and DNA sequencing.

OBJECTIVE: To investigate the vertical transmission rate of Chlamydia trachomatis (CT) in Chongqing, China. METHODS: Specimens taken from 278 women and from their 79 infants were examined by cell culture, polymerase chain reaction (PCR) and DNA sequence analysis. Chlamydia trachomatis was isolated in McCoy cell culture. CT DNA was extracted with a modified Nal method. After cloning, recombinant plasmids were used for sequence analysis with the dideoxy chain termination method. RESULTS: 10.8% (30/278) of the cervical cultures of pregnant women were positive for Chlamydia trachomatis, while the positive rate tested by PCR was 14.0% (39/278). The vertical transmission rate of Chlamydia trachomatis was 55.0% (11/20). The incidences of conjunctivitis and pneumonia in infants with Chlamydia trachomatis positive mothers were 27.3% and 18.2%, respectively. DNA sequences of Chlamydia trachomatis isolated from the cervix of a mother and the nasopharynx of her baby were identical. CONCLUSION: Chlamydia trachomatis infection is quite common in Chongqing, China. Our report is the first report of CT vertical transmission proved by DNA sequence analysis.

Adult↗
PubMed2001

Species specific chlamydiae antibodies in voluntary blood donors of Delhi.

BACKGROUND & OBJECTIVES: Different species of genus Chlamydia have been associated with ocular, genitourinary and respiratory infections, and coronary artery disease. Since the majority of these infections remain asymptomatic or subclinical, antibodies may be present in apparently healthy individuals, and the determination of species specific Chlamydia antibodies in a healthy population may reflect exposure. We therefore screened the sera of healthy blood donors for species specific Chlamydia antibodies by microimmunofluorescence assay. METHODS: Sera of 844 voluntary blood donors from Delhi were screened by microimmunofluorescence assay using specific antigens of C. trachomatis (18 serovars divided in 3 pools of serotypes A-C, D-K and L1-L3), C. psittaci and C. pneumoniae for Chlamydia antibodies. RESULTS: A total of 470 (55.69%) blood donors were found positive for Chlamydia antibodies. Of these, 361(42.77%) were positive for C. pneumoniae, 106 (12.5%) for C. trachomatis [of which 72 (8.5%) were against serotypes D-K and 34(4%) were against serotypes A-C]. There donors (0.3%) had antibodies to C. psittaci. INTERPRETATION & CONCLUSION: The results suggested that more than half of the study population (55.69%) is exposed to one or other species of chlamydiae. Majority of the donors (44.7%) had C. pneumoniae antibodies, suggesting the presence of widespread apparent or inapparent C. pneumoniae infection. The findings also suggest that Chlamydia antibody testing for the diagnosis of chlamydial infections may not be helpful due to the presence of antibodies in a large proportion of healthy individuals.

Antibodies, Bacterial↗
PubMed2004

[Expression of SOCS-1, 3 induced by Chlamydia trachomatis-infected Hela229].

OBJECTIVE: To explore the relationship between SOCS, immune suppression and chlamydial persistence of Chlamydia trachomatis-infected cells. METHODS: After being infected with Chlamydia trachomatis, RT-PCR was used to examine the expression of SOCS-1, 3 mRNA and Western blotting to examine the expression of SOCS-1,3 protein in Hela229 cells. Immunofluorescence was used to examine the effect of SOCS obstruction on the multiplication of Chlamydia trachomatis. RESULTS: Chlamydia trachomatis-infected Hela229 cells can induce the expression of SOCS-1,3 both on mRNA level and on protein level. The multiplicity of Chlamydia trchomatis can be suppressed after the expression of SOCS-1,3 was obstructed. CONCLUSION: Chlamydia trachomatis-infected Hela229 cells can induce the expression of SOCS-1,3, which is one of the mechanisms that Chlamydia trachomatis can suppress host immune and result in persistence.

Chlamydia Infections↗
PubMed2005

Prevalence and risk factors for Chlamydia trachomatis infection in female New Zealand university students.

AIMS: To measure the prevalence of urogenital Chlamydia trachomatis infection in a sample of sexually active female university students, to identify risk factors associated with infection, and to measure the uptake of screening. METHODS: Female students aged 18-25 years, presenting to a university student health service from March to October 2003, were invited to participate. Information on demographic details and sexual behaviour was collected with a self-completed questionnaire. The students were tested for Chlamydia infection using the Roche Amplicor CT/NG PCR test of first void urine specimens. RESULTS: Chlamydia prevalence was 2.7% (19/715). Infection was associated with previous sexually transmitted infection (STI), non-European ethnicity, and irregular use of condoms. Most participants were not using condoms regularly despite the risk of STI. Screening was technically straightforward and the participation rate was 59.9% (718/1199). CONCLUSIONS: New Zealand needs to develop and implement an adequately resourced and evidence-based Chlamydia control strategy. This strategy should contain national guidelines on screening in a range of settings, including universities, as well as strategies for primary prevention of Chlamydia and other STI. Clinicians treating university-aged students should consider opportunistic Chlamydia screening for all of those who are sexually active. Further research, preferably in conjunction with intervention studies, is essential to assess the prevalence of Chlamydia in other populations.

Adolescent↗
PubMed1991

[The value of symptoms and clinical findings in cervical Chlamydia trachomatis infection].

The frequency of symptoms in the case histories of 68 female patients with and of 313 without Chlamydia trachomatis infections was investigated. Dysuria, vaginal discharge and/or burning/itching in the genital region were reported by 50% (n = 34) of chlamydia-positive women and 53.7% (n = 168) of chlamydia-negative women. Clinical investigation of the chlamydia-positive patients revealed discharge in 83.8% (n = 57), contact bleeding in 38.3% (n = 26) and ectopia in 27.9% (n = 19). The corresponding investigations in chlamydia-negative women disclosed discharge in 72.8% (n = 228) women, contact bleeding in 19.8% (n = 62) and ectopia in 16.8% (n = 52). The results were significantly different as far as contact bleeding and ectopia were concerned. Only when yellow or whitish yellow discharge was distinguished from clear discharge was the difference between the two groups significant (66.7% vs 43.9%). Significant numbers of polymorphonuclear leucocytes (greater than 4 per high power field with oil immersion) were found in 52.9% of the chlamydia-positive women, as against 23% of the chlamydia-negative women. Overall, 48.7% of the women with a C. trachomatis infection were found to have notes of symptoms in the history and signs of cervicitis revealed by clinical investigation. Symptoms only were found in 1 woman, while in 36.8% of the patients signs only were found. Neither symptoms nor signs were mentioned by 13.3% of the women. These results indicate that microbiological detection of the infectious agent is obligatory for the diagnosis of C. trachomatis cervicitis.

Bacteriological Techniques↗
PubMedDate not supplied

[Chlamydia trachomatis in women].

The results of the prospective study of chlamydia trachomatis infection in women are presented. The study comprised 288 women aged from 19 to 67 years with the completed clinical and anamnestic data and the following tests have been performed: indirect immunofluorescence test for detection of Chlamydia trachomatis antigens in endocervical smears (using monoclonal antibodies), ELISA test for detection of IgG antibodies against Chlamydia trachomatis in the sera and complement binding reaction for detection of antibodies against grouped Chlamydia antigen. Chlamydia trachomatis infection was found in 29.51% of cases equally distributed in all age groups. The incidence of Chlamydia positive findings was analysed according to clinical diagnosis, parity, relevant data from gynecologic anamnesis and the results of vaginal secretion and Papanicolau's stain test. In order to establish a reliable diagnosis of Chlamydia trachomatis infection two methods should be regularly used: one direct-for detection of a causative agent in patients' materials, and the other-indirect, for detection of specific antibodies in the serum.

Adult↗
PubMed1982

Significance of cervical Chlamydia trachomatis infection in postabortal pelvic inflammatory disease.

The prevalence of Chlamydia trachomatis infection of the cervix uteri and its possible association with postabortal pelvic inflammatory disease (PID) were investigated in women subjected to first-trimester-induced abortion. None of the women had signs or symptoms of genital infection at the time of abortion. Chlamydia organisms were isolated from the cervix/urethra in 33 (10%) of 333 women. Women with a positive Chlamydia culture were comparable to women with a negative culture in regard to gestational age at the time of abortion. However, Chlamydia-positive women were significantly younger and had gonorrhea more often than Chlamydia-negative women. Two hundred seventy (81%) of the women were followed up 1 month after the abortion. Thirty-two of these developed postabortal PID. Eight (28%) of 29 women with a positive Chlamydia culture and 24 (10%) of 241 women with a negative culture developed postabortal PID. This difference is significant (P less than .025) and indicates that the presence of Chlamydia in the cervical canal at the time of abortion in asymptomatic women increases the risk of postabortal PID.

Abortion, Induced↗
PubMed1997

[Detection of Chlamydia trachomatis in children with acute lower respiratory infection].

BACKGROUND: Diagnosis of respiratory tract infections due to Chlamydia trachomatis in pediatric patients is very important because of its complications and sequelae. The aim of the present study was to evaluate the performance of rapid methods for reading this diagnosis in 111 children with lower acute respiratory disease. MATERIAL AND METHODS: Their nasopharyngeal aspirates were studied for detection of Chlamydia spp. antigens using enzyme immunoassay, indirect immunofluorescence and isolation in cell culture. The presence of respiratory viruses was also investigated for immunofluorescence. RESULTS: Chlamydia spp. were isolated from 16 samples (14.4%) using cell monolayer cultures. They were detected in 22 samples by immunofluorescence (19.8%) and in seven samples by enzyme immunoassay (6.5%). Respiratory viruses were detected in 77 samples (69.4%). Sixty two percent of cell culture positive samples for Chlamydia were also positive for respiratory syncytial virus and 6% were positive for adenovirus. Sensitivity and specificity of immunofluorescence were 37.5% and 83.1% respectively using Chlamydia cell culture as "golden standard". For enzyme immunoassay these percentages were 26 and 96.8% respectively. CONCLUSIONS: The values obtained are not acceptable for recommending these methods for detecting Chlamydia spp. from nasopharyngeal aspirates. It will be necessary to modify these techniques or to develop alternative methods in order to rapidly and easily obtain a diagnosis of respiratory tract infections due to Chlamydia spp.

Acute Disease↗
PubMed2003

Improving participation in Chlamydia screening programs: perspectives of high-risk youth.

BACKGROUND: Many young people at highest risk for chlamydial infection do not use chlamydia screening services. OBJECTIVES: To describe young people's beliefs and opinions about obstacles to and motivators for obtaining testing and to provide recommendations for how to improve youth participation in chlamydia screening programs. METHODS: Eight focus group interviews (4 male and 4 female groups) were conducted with young people using a semistructured interview guide. Thirty-two male and 23 female volunteers (mean age, 18.2 years; age range, 15-24 years) were recruited from Job Corps and Department of Youth Services sites. The main outcome measure was categorization of textual data using content analysis techniques. Data were coded by 2 investigators into categories of responses based on research questions and spontaneously offered comments. Satisfactory intercoder agreement was achieved. RESULTS: Participants described many obstacles to testing, including concern that someone will know they were tested or tested positive, fear about discovering they have a sexually transmitted disease, and fear of acquired immunodeficiency syndrome. Many participants were unsure what physical effects chlamydia produced or thought it was possible to die of a chlamydial infection. Participants recommended providing more information about the effects of chlamydia, availability of urine testing, and ease of treatment to motivate more young people to seek testing. They also emphasized the need to make sexually transmitted disease screening services more private and confidential. There was an overwhelming interest in using a home Chlamydia test (much like a home pregnancy test) if one were available. CONCLUSIONS: To increase youth participation in screening programs, it will be necessary to address their concerns, dispel misconceptions, and provide more information about chlamydia. A home Chlamydia test might be one way to increase screening.

Adolescent↗
PubMed2001

Identification of Chlamydia trachomatis antigens recognized by human CD4+ T lymphocytes by screening an expression library.

Identification of the immunogenic proteins that induce Chlamydia trachomatis (CT)-specific T cell responses is crucial to the development of protective vaccines and understanding the mechanisms of chlamydia-induced pathology. To characterize the targets of the human T cell response we have used chlamydia-reactive human T cell clones as cellular probes to screen a CT genomic library expressed in Escherichia coli using peripheral blood mononuclear cells to present antigens. The library was screened with three chlamydia-reactive T cell clones of unknown specificity and three novel stimulatory chlamydia antigens were identified. These E. coli recombinants were shown to express the chlamydia proteins, enolase, pmpD and CT579. Enolase and pmpD proteins were purified and shown to induce the proliferation of synovial fluid mononuclear cells isolated from the knee joints of patients suffering from chlamydia-associated reactive arthritis. We suggest that these stimulatory antigens are common targets of the T cell response in this group of patients. A greater understanding of T cell-mediated immunity in uncomplicated CT infection, and in patients with CT-induced chronic inflammatory disease (trachoma, salpingitis, arthritis) may identify the principal immune responses associated with immunopathology.

Antigen-Presenting Cells↗
PubMed2006

Lateral transfers of serine hydroxymethyltransferase (glyA) and UDP-N-acetylglucosamine enolpyruvyl transferase (murA) genes from free-living Actinobacteria to the parasitic chlamydiae.

The chlamydiae are important human and animal pathogens which form a phylogentically distinct lineage within the Bacteria. There is evidence that some genes in these obligate intracellular parasites have undergone lateral exchange with other free-living organisms. In the present work, we describe two interesting cases of lateral gene transfer between chlamydiae and actinobacteria, which have been identified based on the shared presence of conserved inserts in two important proteins. In the enzyme serine hydroxymethyltransferase (SHMT or GlyA protein), which links amino acid and nucleotide metabolisms by generating the key intermediate for one-carbon transfer reactions, two conserved inserts of 3 and 31 amino acids (aa) are uniquely present in various chlamydiae species as well as in a subset of Actinobacteria and in the Treponema species. Similarly, in the enzyme UDP-N-acetylglucosamine enolpyruvyl transferase (MurA), which is involved in the synthesis of cell wall peptidoglycan, a 16-aa conserved insert is specifically present in various sequenced chlamydiae and a subset of actinobacteria (i.e., Streptomyces, Actinomyces, Tropheryma, Bifidobacterium, Leifsonia, Arthrobacter, and Brevibacterium). To determine the phylogenetic depths of the GlyA and MurA inserts, the fragments of these genes from two chlamydiae-like species, Simkania negevensis and Waddlia chondrophila, were PCR amplified and sequenced. The presence of the corresponding inserts in both these species strongly indicates that these inserts are distinctive characteristics of the Chlamydiales order. In phylogenetic trees based on GlyA and MurA protein sequences, the chlamydiae species (and also the Treponema species in the case of GlyA) branched with a high affinity with various insert-containing actinobacteria within a clade of other actinobacteria. These results provide strong evidence that the shared presence of these indels in these bacteria is very likely a consequence of ancient lateral gene transfers from actinobacteria to chlamydiae. Pairwise sequence identity and the branching pattern of the GlyA homologues in the phylogenetic tree indicates that the glyA gene was initially transferred from an actinobacteria to an ancestor of the Treponema genus and from there it was acquired by the common ancestor of the Chlamydiales.

Actinobacteria↗
PubMed2002

Chlamydia pneumoniae infection among healthy children and children hospitalised with pneumonia in Greece.

Chlamydia pneumoniae has been recognized as a cause of respiratory tract infection in humans, and its prevalence has been shown to vary among different age groups and populations. The prevalence of Chlamydia pneumoniae antibody was determined by serological investigation in 343 healthy children and in 77 children consecutively hospitalised for pneumonia in southwestern Greece. Seventy-eight (22.7%) healthy children had IgG Chlamydia pneumoniae titers > or =1/8. The prevalence of Chlamydia pneumoniae antibody in the age groups 6 months-5 years, 6-9 years and 10-15 years was 7.9%, 11.4% and 36%, respectively. One child hospitalised for pneumonia had serological results consistent with acute Chlamydia pneumoniae infection. The results of the present study suggest a low prevalence of Chlamydia pneumoniae antibody among preschoolers in Greece, followed by a steep rise in children 10-15 years of age. Chlamydia pneumoniae is not a common etiologic agent of childhood pneumonia requiring hospitalisation.

Adolescent↗
PubMed1996

Increased prevalence of IgA-Chlamydia antibodies in NIDDM patients.

Chlamydia trachomatis oculogenital infection is a common disease in western societies. Despite the fact that diabetes is accompanied by increased risk for infections, no data on chlamydial infections in the non-insulin-dependent diabetic (NIDDM) patient exist. In our study Chlamydia antibodies were determined using an immunoperoxidase reaction in NIDDM patients (n = 79) and in a local nondiabetic control population (n = 125) which was randomly invited to a medical control visit without any preselection criteria. In total, 46% of diabetics and 55% of controls were IgG-Chlamydia antibody positive (ns). Using IgA-Chlamydia antibodies to define 'seroactive' chlamydial infection, 22% of NIDDM patients and 14% of controls were positive. Thus seroactive chlamydial infection of all patients with proven contact to Chlamydia (IgG-Chlamydia antibody positive) was 47% in diabetics versus 25% in controls, respectively (P < 0.05). Forming subgroups, significance was reached in females (52% vs. 32%, P < 0.05) only, but a similar trend was observed in males (36% vs. 21%, ns). Seroactivity was neither correlated with HbA1c nor with nephelometrically determined total serum immunoglobulins (IgG, IgA). Additionally we observed significantly elevated total IgM and IgA-levels in NIDDM patients whereas IgG-levels were comparable in both groups. In conclusion, seroactive chlamydial infections in subjects with proven contact to Chlamydia are more frequent in NIDDM patients than in nondiabetic controls. Additionally, higher IgM and IgA serum levels might indicate a higher susceptibility to active surface infections in NIDDM.

Adult↗
PubMed2006

Chlamydia screening in at-risk adolescent females: an evaluation of screening practices and modifiable screening correlates.

PURPOSE: To identify modifiable correlates of chlamydia screening that could offer intervention targets to enhance screening. METHODS: We surveyed a representative sample of primary care providers (n = 186) at an integrated healthcare delivery system to document their self-reported adherence to annual screening of sexually-active adolescents and to identify specific, modifiable constructs that were correlated with annual chlamydia screening. To cross-validate providers' self-report, we also used automated data to examine adolescent screening in an anonymous sample of primary care providers (n = 143). RESULTS: Forty-two percent of providers reported annual chlamydia screening of sexually-active adolescents. Univariate correlates of annual screening were: provider type (non-physician) (p = .01), female gender (p = .001), fewer years of clinical experience (p = .001), greater perceived knowledge about chlamydia (p = .001), greater confidence across a range of screening-related activities (p < or = .01), greater comfort recommending screening for sexually transmitted diseases (p = .001), and greater perceived patient comfort discussing sexual issues (p < .01). In multivariate analyses, providers' perceived knowledge, confidence, comfort, and perceived patient comfort continued to be significantly associated with annual chlamydia screening after controlling for other relevant provider characteristics. Self-reported screening practices were consistent with observed screening rates in the anonymous provider sample. CONCLUSIONS: Routine chlamydia screening among asymptomatic, at-risk adolescent females could be enhanced through additional intervention targeting specific provider attitudes and beliefs about chlamydia screening.

Adolescent↗
PubMed2004

Production of prostaglandin E2 in monocytes stimulated in vitro by Chlamydia trachomatis, Chlamydophila pneumoniae, and Mycoplasma fermentans.

Chlamydia trachomatis (CT) as well as Chlamydophila pneumoniae (CP) cause chronic inflammatory diseases in humans. Persistently infected monocytes are involved in the pathogenesis by inducing mediators of inflammation. An in vitro system of chlamydial persistence in human peripheral blood monocytes (HPBM) was used to investigate prostaglandin E(2) (PGE(2)) production and the expression of the key enzyme for prostaglandin production, cyclooxygenase-2 (COX-2). PGE(2) production was determined by PGE(2)-ELISA of HPBM-culture supernatants. Cox-2 mRNA expression was measured by real-time RT-PCR of total RNA isolated from HPBM. Both, CT and CP, stimulated PGE(2) production of HPBM in vitro. Equivalent numbers of CT per host cell induced a higher PGE(2)-response compared to CP. The amount of synthesized PGE(2) depended on the chlamydial multiplicity of infection (MOI). Even at an MOI of 10 the amount of CT- and CP-induced prostaglandin, respectively, was lower than the amount of prostaglandin induced by E. coli lipopolysaccharide (LPS) at a concentration of 10microg/ml. In contrast to stimulation with LPS, Chlamydia-induced PGE(2) production as well as cox-2 mRNA decreased after day 1 post infection (p.i.). These data indicate that Chlamydia stimulate PGE(2) production in human monocytes. Since Chlamydia are often contaminated by mycoplasma, the influence of mycoplasma on the prostaglandin production was investigated additionally. Mycoplasma fermentans (MF) also stimulated PGE(2) production. The co-infection of mycoplasma and Chlamydia resulted in an additive effect in the production of PGE(2). Thus it is important to use host cells and Chlamydia free of mycoplasma contamination for the analysis of Chlamydia-induced prostaglandin production.

Chlamydia trachomatis↗
PubMed1998

Chlamydia pneumoniae infection is frequent but not associated with coronary arteriosclerosis in cardiac transplant recipients.

We sought to explore the relation between Chlamydia pneumoniae, cytomegalovirus (CMV), and cardiac transplant-associated arteriosclerosis. Serologic evidence of past Chlamydia pneumoniae infection was investigated in 3 patient groups at the time of cardiac catheterization: cardiac transplant recipients (n=49), patients having coronary artery bypass grafting (CABG) (n=39), and a control group free of angiographic coronary artery disease (n=21). High Chlamydia pneumoniae immunoglobulin G titers (> or =1:160) were more frequently observed in cardiac transplant recipients (odds ratio[OR] 13.7; 95% confidence intervals [CI] 1.6 to 117.4, p <0.05) and CABG patients (OR 21.7; 95% CI 1.6 to 287.0, p <0.05) than in controls. However, high Chlamydia pneumoniae titers did not distinguish between cardiac transplant recipients with or without angiographic transplant-associated arteriosclerosis or CABG patients with or without bypass vein graft disease. Furthermore, there was no significant relation between elevated Chlamydia pneumoniae titers and the presence or progression of transplant-associated arteriosclerosis in the subgroup of patients who were also CMV positive. Yet, analysis of the same angiograms demonstrated an association between CMV infection and the recent progression of transplant-associated arteriosclerosis. Thus, patients with cardiac transplantation have evidence of past Chlamydia pneumoniae and CMV infection but Chlamydia pneumoniae does not appear to have an independent role or synergistic relation to CMV in the development of transplant-associated arteriosclerosis.

Adult↗