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Chlamydia pneumoniae infection is not an independent risk factor for arterial disease.

Appreciation of atherosclerosis as an infectious disease has fostered interest in the role that Chlamydia pneumoniae may play in atheroma development. Although data from seroepidemiological and experimental studies have established an association between the pathogen and atherosclerosis, little is known about how the organism contributes to lesion development. Atherosclerosis is a complex disease process and the role of any pathogen must be considered in the context of other risk factors. Here we focus on the relationship between Chlamydia pneumoniae and conventional risk factors for atherosclerosis. There is evidence for a strong association between chronic infection with Chlamydia pneumoniae and smoking as well as high serum cholesterol. It is concluded from the present data that chronic infection with the pathogen is not an independent risk factor for atherosclerosis.

Animals↗

Inhibition of Chlamydia trachomatis growth in endometrial cells by copper: possible relevance for the use of the copper IUD.

There is agreement that the relative risk of developing pelvic inflammatory disease (PID) increases among women who use the intrauterine contraceptive device (IUD). The role of Chlamydia in causing PID among IUD users is not clear. The present study demonstrates that Chlamydia trachomatis growth can be inhibited in cultured human endometrial cells by copper ions at concentrations known to be released by the copper IUDs. More than 98% inhibition was produced with 10(-5) and 10(-6) M of copper. Both C. trachomatis serovar E and a lymphogranuloma venereum Chlamydia serovar L2 (LGV) were inhibited by the copper ions. Although the mechanism of the inhibition is not known, the continuous presence of the copper ions during and after adherence appeared to be necessary for maximal effect. If such inhibition occurs in vivo, it is possible that copper ions released from the copper-containing IUD may partially protect against chlamydial infection.

Cells, Cultured↗

Maternal genital Chlamydia trachomatis infection and the risk of preterm labor.

OBJECTIVE: To determine the association between maternal genital Chlamydia trachomatis infection in pregnancy and the risk of preterm labor. The hypothesis tested was that a greater proportion of women experiencing preterm labor would have Chlamydia trachomatis than controls who were not experiencing preterm labor. METHODS: A case-control study in Yaoundé (Cameroon), involving 126 women of gestational age between 28 and 34 weeks, using serology and cervical swab cultures. Data analysis involved simple comparative descriptive statistics as well as univariate and multivariate analysis. RESULTS: The odds of experiencing preterm labor and having genital chlamydial infection were 72.59 (exact 95% C.I. 0.99-7.14); O.R.MH (Mantel-Haenszel) 2.80 (approximate 95% C.I. 1.13-6.97) using serological tests. The proportion of women with positive cervical swab cultures was statistically significantly different between cases and controls (Fisher's exact test, P = 0.02). CONCLUSION: Routine screening and treatment of pregnant women with Chlamydia trachomatis (along with their partners) may be beneficial in reducing the incidence of preterm labor and delivery and hence the perinatal mortality rate.

Case-Control Studies↗

Direct detection of Chlamydia trachomatis in clinical specimens by a dot-immunobinding technique using monoclonal antibody.

A dot-immunobinding technique (DIBT) has been developed to permit detection of Chlamydia trachomatis organisms or antigen in clinical specimens. This method was evaluated for the rapid diagnosis of chlamydia infections using monoclonal antibody. The membrane antigen extracted from reticulate bodies was used for the production of species-specific monoclonal antibodies by an in vitro immunization procedure. The DIBT involved spotting clinical specimen directly onto a nitrocellulose membrane followed by reaction with monoclonal antibody and a biotin-avidin-peroxidase indicator system. Specimens were tested for the presence of chlamydia by the cell culture method. Of these, 361 positives and 317 negatives were selected for detection of antigen using the DIBT method. Of 678 clinical specimens that were evaluated by DIBT, 654 (96.7%) gave identical results to the cell culture method, whereas 24 (3.5%) were positive by the DIBT but culture negative. The overall sensitivity was 100% with a specificity of 92.4%. The test could detect as little as 75 pg of chlamydial antigen.

Animals↗

A novel approach to the laboratory diagnosis of Chlamydia trachomatis infections using monoclonal anti-idiotypic antibodies.

We have developed a novel enzyme immunoassay (EIA) for the specific detection of Chlamydia trachomatis utilizing a monoclonal anti-idiotypic antibody to an antibody directed against a chlamydia specific epitope on 60 kDa heat-shock protein (HSP60). The basis of the assay is the inhibition of the binding of idiotype to anti-idiotype by antigen present in test samples. Two configurations of the assay were developed: a blocking EIA and a competition EIA. Greater sensitivity was observed using the competition EIA, with the assay detecting purified recombinant HSP60 and purified chlamydia in a concentration-dependent manner from 0.01 to 10 micrograms protein and from 0.5 to 12 micrograms total protein, respectively. The assay is highly specific and offers several potential advantages over currently available EIAs for the detection of this pathogen.

Animals↗

Chlamydia infection in a nurse-midwifery caseload.

The purpose of this study was to determine whether antepartum treatment of chlamydia infection resulted in a change in incidence of maternal infection in the intrapartum and postpartum periods as indicated by the incidence of maternal febrile morbidity or antibiotic therapy. In June of 1986, an inner-city tertiary-care center nurse-midwifery service began including diagnosis and treatment of chlamydia infection in routine antepartum care. In this retrospective chart review, the incidence of intrapartum and postpartum infection among women who delivered in this caseload between May 1985 and May 1986 (the last year prior to the routine chlamydia diagnosis and treatment) was compared with that of women who delivered between July 1986 and July 1987 (the first year after initiation of the testing). No significant differences were found. Implications for the development of research projects within nurse-midwifery clinical services are discussed, along with methodologic problems that may ensue when attempting to study changes in outcome in ones' own service.

Chlamydia Infections↗

Detection of Chlamydia trachomatis. A study of the direct immunofluorescence technique and a review diagnostic limitations.

Because of the high prevalence of Chlamydia trachomatis in adolescent females and the high cost of chlamydia cultures, we evaluated the use of the direct fluorescein conjugated monoclonal antibody test (DFA) in diagnosing C. trachomatis in adolescent females. Chlamydia trachomatis was found in 37 (20.1%) of 184 cultures. The sensitivity of the direct smear as compared with the culture was 89% and the specificity was 99%. The results of recent studies of the DFA and chlamydiazyme tests are reviewed as well as the problems in comparing techniques.

Adolescent↗

Altering TestPack Chlamydia sampling swab decreases testing time.

TestPack Chlamydia protocol time was reduced from 25 min to 15 min by altering the swab used to collect endocervical specimens for direct immunoassay detection of Chlamydia trachomatis. The clinical performance of the two TestPack Chlamydia protocols was statistically equivalent when evaluated with 607 paired endocervical specimens.

Antigens, Bacterial↗

Diagnostic value of rapid detection of Chlamydia trachomatis by using amplified enzyme immunoassay in infants with respiratory infections.

The diagnostic value of amplified enzyme immunoassay (IDEIA Chlamydia test) was compared with that of standard tissue culture in specimens obtained from pediatric patients. Of 286 clinical specimens, chlamydial antigen was detected in 34 by IDEIA Chlamydia. Chlamydia trachomatis was isolated from 30 specimens and C. pneumoniae from one specimen. IDEIA had excellent sensitivity and specificity relative to cell culture.

Antigens, Bacterial↗

A polymerase chain reaction (PCR) protocol for the specific detection of Chlamydia spp.

The polymerase chain reaction is an in vitro procedure for primer-directed enzymatic amplification of specific template nucleic acid sequences. This technique was used to detect and differentiate Chlamydia trachomatis and Chlamydia psittaci in laboratory samples of infected McCoy cells. The polymerase chain reaction was shown to be both sensitive, detecting in the order of one chlamydial DNA molecule in 10(5) cells, and specific. No cross reaction (amplified product) was detected when a variety of mammalian cell and bacterial DNAs were used as template with the Chlamydia-specific oligonucleotide primers.

Base Sequence↗

Distinguishing Chlamydia species by restriction analysis of the major outer membrane protein gene.

Clinical isolates of Chlamydia pneumoniae from diverse geographic locations and strains of other Chlamydia species were typed by polymerase chain reaction (PCR) amplification of the major outer membrane protein (MOMP) gene followed by restriction fragment length polymorphism analysis of the product. Use of synthetic primers corresponding to highly conserved regions of the MOMP gene resulted in amplification of a 1070 bp product in laboratory strains and clinical isolates of C. pneumoniae, C. trachomatis and C. psittaci. PCR products were digested with restriction enzymes Alu I and Mbo I and separated by polyacrylamide gel electrophoresis. Restriction fragment patterns varied in length from 8-12 bands of 30-400 bp in size in Alu I digests, and 6-7 bands of 50-400 bp in size in Mbo I digests. Strains representing different chlamydia species were easily distinguishable by this method, as were different serovars of C. trachomatis. Strains of C. pneumoniae tested include laboratory strain TW-183 and recent clinical isolates from Atlanta, Brooklyn, Wisconsin and Norway. One combination of primers reacted with C. psittaci strains and C. pneumoniae strain TW-183, but not with other strains of C. pneumoniae tested regardless of the concentration of DNA in the sample. With use of a pan-reactive primer combination, however, restriction patterns were similar in all strains of C. pneumoniae tested. This gene typing technique can be valuable for distinguishing the three chlamydial species and potentially strains of C. pneumoniae in clinical and epidemiologic studies.

Bacterial Outer Membrane Proteins↗

Follicular fluid antibodies to Chlamydia trachomatis and human heat shock protein-60 kDa and infertility in women.

BACKGROUND: The objective of this study was to establish the relationship between presence of anti-Chlamydia trachomatis and anti-HSP60 antibodies in serum and follicular fluid of infertile women. METHODS: Serum IgG and follicular fluid IgA to Chlamydia trachomatis and human heat shock protein 60 (HSP60) were determined in 41 women undergoing in vitro fertilization (IVF). RESULTS: A significant association was found between presence of bacterial antibodies in serum and IgA anti-HSP60 in follicular fluid. CONCLUSIONS: Chlamydia trachomatis infection might be triggering an autoimmune process that could negatively affect the success of IVF.

Adult↗

Cell death and inflammation during infection with the obligate intracellular pathogen, Chlamydia.

Infections by Chlamydia are followed by a strong inflammatory response, which is necessary to eliminate the infection, but at the same time is responsible for the pathology of infection. Resistance of infected cells against apoptosis induced by external ligands, together with the effects of IFNgamma secreted during infection, would be expected to contribute to persistence of infection. Secretion of TNFalpha plays an important role during clearance of the chlamydiae, but also triggers apoptosis of uninfected cells in infected tissues. Apoptosis of infected host-cells towards the end of the infection cycle is thought to participate in the release of chlamydiae from infected cells and propagation of the infection. Dysregulation of the apoptotic program during infection leads to a less efficient infection, but paradoxically, results in a higher inflammatory response and more severe pathology.

Apoptosis↗

Relationship quality, coital frequency, and condom use as predictors of incident genital Chlamydia trachomatis infection among adolescent women.

PURPOSE: To explore associations of relationship quality, coital frequency, unprotected coitus, and chlamydia infection over time. METHODS: Data came from 142 adolescent females with sexually transmitted infections attending three primary care adolescent clinics and one county STD clinic. Interview data were collected at 3 time points: enrollment, 1 month, and 3 months after enrollment. Predictor variables included relationship quality, coital frequency, unprotected coitus, and partner change. The outcome variable was infection with C. trachomatis at 3 months. Analyses were conducted using structural equation modeling. RESULTS: Chlamydia infection at 3 months was directly influenced by unprotected coitus during the previous 2 months (Beta = .25; p < or = .05) and partner change during the enrollment/1-month interval. Unprotected coitus was directly associated with coital frequency, both cross-sectionally and longitudinally. Increased relationship quality was associated with increased coital frequency but did not have direct effects on unprotected coitus. CONCLUSIONS: The data showed a protective effect of condom use for chlamydia infections. Prevention efforts should attend to the interpersonal factors behind decisions to use or not use condoms.

Adolescent↗

Scrotal mass with fever and generalized lymphadenopathy in a young man secondary to Chlamydia trachomatis infection.

A young man presented with systemic upset and generalised lymphadenopathy. Later, it transpired that he was under investigation for a scrotal mass. Investigations were carried out to ascertain the cause of his symptoms including lymph node biopsy. Because of the presence of a scrotal mass in a sexually active male, a urinary Chlamydia ligase chain reaction (LCR) test was carried out. The result was positive and he was treated with doxycycline for 2 weeks. His symptoms settled and further, the urinary LCR was negative. We propose that Chlamydia trachomatis infection caused his illness and that urine PCR or LCR tests for Chlamydia is a convenient and useful investigation in sexually active males with generalised lymphadenopathy and fever of unknown origin.

Adult↗

Chlamydia and programmed cell death.

Discordant views regarding host cell death induction by Chlamydia are likely owing to the different methods used for evaluation of apoptosis. Apoptotic and non-apoptotic death owing to both caspase-dependent and -independent activation of the Bax protein occur late in the productive growth cycle. Evidence also suggests that Chlamydia inhibits apoptosis during productive growth as part of its intracellular survival strategy. This is in part owing to proteolytic degradation of the BH3-only family of pro-apoptotic proteins in the mitochondrial pathway. Chlamydia also inhibits apoptosis during persistent growth or in phagocytes, but induces apoptosis in T cells, which suggests that apoptosis has an immunomodulatory role in chlamydial infections. The contribution of apoptosis in disease pathogenesis remains a focus for future research.

Apoptosis↗

Protection against Chlamydia trachomatis infection in vitro and modulation of inflammatory response in vivo by membrane-bound glycosaminoglycans.

Glycosaminoglycans (GAG) efficiently inhibit adherence of several strains of Chlamydia trachomatis to cell lines in vitro, but none of the GAG have been able to inhibit infections in vivo. One possible cause for failure of GAG inhibition in vivo is the inability to deliver a sustained concentration of GAG at the mucosal surface. We tested the possibility of enhancing cell protection by increasing the cell-surface concentration of GAG using membrane-anchored GAG (MAG), composed of phosphatidylethanolamine (PE)-linked GAG. These lipid conjugates were originally designed as extracellular phospholipase A2 (PLA2) inhibitors and exhibit a dual effect: the lipid moiety incorporates into the cell membrane, interfering with the action of PLA2 on cell membranes, and the anchored GAG protects the cell membrane from exogenous inflammatory mediators. We tested the ability of MAG to block chlamydia infection in vitro and in vivo. The MAG blocked infection of epithelial cells in vitro when added to the cells at the same time or before infection, but not if added after the bacteria had already invaded the host cells. One of the MAG led to the production of aberrant Chlamydia vacuoles, suggesting it may inhibit intracellular PLA2 associated with development of the vacuole. Although the MAG did not inhibit vaginal infection of mice, they decreased significantly the level of secretion of the inflammatory cytokines TNF-alpha and IFN-gamma but had no effect on secretion of the neutrophil chemokine, macrophage inflammatory protein-2 (MIP-2). Acute and chronic inflammatory cell infiltrates were not altered by MAG treatment. These findings suggest that lipid conjugation of GAG could be used as a novel approach for increasing cell-surface concentrations of GAG. The inconclusive in vivo results might be due to the physical properties of the tested MAG or an insufficient application protocol, and their improvement might provide the desired inhibitory effects.

Animals↗

Differential expression of three Chlamydia trachomatis hsp60-encoding genes in active vs. persistent infections.

Real time RT-PCR was used to assess expression of the three Chlamydia trachomatis hsp60-encoding genes (Ct110, Ct604, Ct755) over time in in vitro systems of active vs. persistent infection, and in synovial samples from patients with Chlamydia-induced arthritis. In HEp-2 cells actively infected with C. trachomatis (serovar K), mRNA from Ct110 (groEL) was apparent by 8 h post-infection (p.i.) and increased more than 10-fold through 48 h p.i.; mRNA from Ct604 followed a similar pattern. Transcripts from Ct755 were abundant at 8 h p.i. and remained 2-3-fold higher than those from Ct110 at all times. In persistently infected human monocytes in culture, expression of Ct110 and Ct755 was low from 1 to 7d p.i., while mRNA from Ct604 was abundant at 1d p.i. and increased more than 3-fold from 1 to 3d p.i., as the organism transited to the persistent state. Those mRNA levels remained high through 7d p.i. Real time analyses of RNA/cDNA from synovial tissue of patients with Chlamydia-associated arthritis showed high Ct604 mRNA levels, consistent with results from the in vitro monocyte system of persistence. These data demonstrate that each chlamydial hsp60-encoding gene is expressed independently, and that the three genes are expressed differentially in active vs. persistent infection. The results further suggest that the Ct604 gene product may function importantly during chlamydial persistence.

Adult↗