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PubMed1998

[Herd immunity and the role of Chlamydia pneumoniae in the etiology of respiratory diseases in the Czech Republic].

The objective of the investigation was to assess the seroprevalence of IgG in the population of the Czech Republic and to assess the etiological role of Chlamydia pneumoniae in respiratory diseases. The sera were examined by specific tests-genus by ELISA and species by the microimmunofluorescent test. The examination of sera from 1974-1975 for the serological survey was selected to make the results comparable with the results of examinations planned for 1996. Chlamydia IgG were detected already in the age group from 1-4 years with a marked rise in youth, and in adult age the seroprevalence was between 72.0 and 86.2% (mean 80.1%). In the seropositivity of Chlamydia IgG participated mainly immunoglobulin C. pneumoniae, which was present already in child and school age (seroprevalence 7.7-88.2%), culminating in adult age (92.0-100%). IgG C. trachomatis were detected practically only in adult age, IgG C. psittaci were found only rarely in serum. In 16 subjects (of 216 examined) serological tests revealed acute (in 27 suspect), in 6 subjects recent (in 17 suspect) infection with C. pneumoniae and 53 to 63 subjects had the infection in the past.

Adolescent↗
PubMed1997

[Tricuspid endocarditis caused by Chlamydia pneumoniae. Apropos of a case].

The authors report a case of tricuspid blood culture-negative endocarditis where serologic investigations showed high titers of antibodies against. Chlamydia pneumoniae, thus suggesting its possible role as the causal agent. The treatment consisted of polymicrobial therapy using ciprofloxacine and doxycycline with favorable response thus avoiding surgical intervention. In all cases of culture-negative endocarditis not responding to classic empiric antibiotics, Chlamydia infection should be suspected. Although rare cases of endocarditis due to Chlamydia pneumoniae have been reported in the literature, to our knowledge, this is the first case of isolated tricuspid valve endocarditis due to this agent to be reported.

Anti-Bacterial Agents↗
PubMed1998

[Chlamydia pneumoniae chronic infection in the development of arteriosclerosis].

On the basis of several epidemiological investigations performed simultaneously in the eighties and then in early nineties, a presumption has been put forward that is a relationship between the incidence of arteriosclerosis, especially of the coronary arteries and the presence of antibodies against antigens of Chlamydia pneumoniae in the blood serum. These investigations revealed that an infections by Chlamydia pneumoniae is an independent risk factor in the development of arteriosclerosis as well as hypertension, cigarette smoking and increased level of lipids in the blood serum. The present work is a survey of the current literature on the subject of presumable role of these bacteria in the process of arteriosclerosis. Clinical and epidemiological reports have been presented and two investigations on the animal models using rabbits and mice have been discussed. On the basis of the presented studies, it can be observed that Chlamydia pneumoniae has a specific tendency to accumulate not only in the respiratory system, but also in the arteries affected by arteriosclerosis. However, studies of the relationship between an infections by these bacteria and development of arteriosclerosis are far from final explanation of this problem.

Animals↗
PubMed1988

Urogenital Chlamydia trachomatis in Gabon: an unrecognised epidemic.

Samples from 218 men with urethritis, 517 women with pelvic pain or pelvic pain and vaginal discharge, 218 women consulting for infertility, and 598 postpartal women were screened for Chlamydia trachomatis by culture and direct immunofluorescence. Chlamydiae were detected in 18% (39/218) of the men, 18% (45/252) of women with vaginal discharge, 14% (38/265) of those with pelvic pain, 10% (21/218) of infertile, and 10% (59/598) of postpartal women. A chlamydial prevalence of 18% (41) was observed in 229 postpartal women aged under 21, whereas only 5% (10) of 360 postpartal women over 21 had C trachomatis. In the other clinical groups, an age related decrease in prevalence was noted in women over 25. The direct immunofluorescence test correlated well with culture. The small difference in isolation between symptomatic and postpartal women indicates that women in this population do not seek medical attention for chlamydial infections and expose themselves to chlamydial salpingitis and infertility.

Chlamydia Infections↗
PubMed1989

Current knowledge on Chlamydia pneumoniae, strain TWAR, an important cause of pneumonia and other acute respiratory diseases.

This article reviews current knowledge of Chlamydia pneumoniae strain TWAR, a newly recognized Chlamydia organism that causes acute respiratory infection, especially atypical pneumonia. Information is included on the microbiology, classification and laboratory diagnosis of the organism. Details of a series of studies of both endemic and epidemic respiratory infections are reviewed to present information on both the clinical and epidemiological characteristics of infection with strain TWAR. Laboratory studies of antibiotic sensitivity and recommendations for treatment are presented.

Adult↗
PubMed1988

Screening for Chlamydia trachomatis infection in a pregnancy counseling clinic.

Five hundred twenty asymptomatic women attending a pregnancy counseling clinic were interviewed and screened for cervical Chlamydia trachomatis infection before therapeutic abortion. Overall, 56 (10.8%) women were culture positive for C. trachomatis. Restricting testing to women with risk factors for infection or who had cervical leukocytosis on Gram staining of cervical mucus, or who were seropositive for C. trachomatis antibodies proved impractical because of insensitivity or nonspecificity. We evaluated three chlamydia diagnostic tests to determine which test had the best performance characteristics. In comparison with culture, the direct fluorescent antigen test had a sensitivity of 89% and a positive predictive value of 78%, whereas the enzyme immunoassay had 96% and 69%, respectively. When analysis was redone with any two positive laboratory tests to define true infection status, the performance parameters of enzyme immunoassay were sensitivity 98%, specificity 98%, and positive predictive value 87%. We conclude that all women undergoing therapeutic abortion require testing for C. trachomatis infection and that enzyme immunoassay is the most effective and practical test in this group of women.

Abortion Applicants↗
PubMed2004

Cell death, BAX activation, and HMGB1 release during infection with Chlamydia.

Infection by a number of Chlamydia species leads to resistance of the host cell to apoptosis, followed by induction of host-cell death. In a population of infected cells that displays protection against staurosporine-induced apoptosis among the adherent cells, we find that cells that had been recovered from the supernatant share characteristics of both apoptosis and necrosis, as assayed by the propidium iodide (PI)-annexin V double-labeling technique. Cell death was observed in both an epithelial cell line and primary fibroblasts, although the primary cells had a higher propensity to die through apoptosis than the immortalized cell line. Staurosporine-mediated activation of the pro-apoptotic BCL-2 family member, BAX, was inhibited in the epithelial cell line infected for 32 h with the lymphogranuloma venereum (LGV/L2) but not the murine pneumonitis (MoPn) strain of C. trachomatis, but inhibition of staurosporine-mediated BAX activation disappeared after 48 h of infection with the LGV/L2 strain. Conversely, infection with MoPn (C. muridarum) but not LGV/L2 led to BAX activation after 72 h, as previously reported for shorter (48 h) infection with the guinea pig inclusion conjunctivitis (GPIC) serovar of C. psittaci (C. caviae). These results suggest that the ability to inhibit staurosporine-mediated BAX activation or to activate BAX due to the infection itself may vary as a function of the chlamydial strain. Interestingly, both the epithelial cells and the fibroblasts also released high mobility group box 1 protein (HMGB1) during infection, although much less HMGB1 was released from fibroblasts, consistent with the higher level of apoptosis observed in the primary cells. HMGB1 is released preferentially by necrotic or permeabilized viable cells, but not apoptotic cells. In the extracellular space, HMGB1 promotes inflammation through interaction with specific cell-surface receptors. Higher levels of HMGB1 were also measured in the genital-tract secretions of mice infected vaginally with C. trachomatis, compared to uninfected controls. These results suggest that cells infected with Chlamydia release intracellular factors that may contribute to the inflammatory response observed in vivo.

Animals↗
PubMed1997

Chlamydia trachomatis and febrile complications of postpartum tubal ligation.

OBJECTIVE: Our goal was to determine whether chlamydia-infected women have a higher rate of febrile complications after postpartum tubal ligation. STUDY DESIGN: Cross-sectional analysis of 1447 women tested for chlamydial infection within 2 weeks of delivery and who underwent postpartum tubal ligation was performed. Subjects were identified with the Regenstrief Institute for Health Care database. Infected subjects were compared with uninfected subjects for incidence of fever not explained by nongynecologic sources. RESULTS: Women infected with Chlamydia trachomatis at delivery were more likely to experience febrile postoperative complications after tubal ligation (p < 0.0001, relative risk 9.5, 95% confidence interval 4.5 to 20.1). CONCLUSION: Women undergoing postpartum tuba ligation may benefit from prompt diagnosis and preoperative treatment of chlamydial infection.

Adult↗
PubMed1987

The effects of contraceptive hormones on the replication of Chlamydia trachomatis in human endometrial cells.

Several recent reports have documented a lower incidence of pelvic inflammatory disease (PID) among oral contraceptive users. The interpretation of this observation is difficult because the action of the contraceptive hormones may be directly by action on a specific host cell-parasite relationship, or indirectly via their action on other systems. In the present study we investigated the susceptibility of cultured human epithelial cells of the endometrium to infection by chlamydia and the influence of contraceptive steroids (ethinyl estradiol, mestranol and medroxyprogesterone acetate) upon replication of chlamydia in these cells. Forty-eight hours post-infection, elementary and reticulate bodies were observed in vacuoles of the infected endometrial cells by electron microscopy. Treatment of chlamydial-infected cells with contraceptive steroids in three different concentrations (10(-5)M, 10(-6)M and 10(-7)M) resulted in no effect on chlamydial replication, as examined by one-step growth curve. These results indicate that contraceptive hormones do not prevent chlamydial infection by direct effect on the replication of the agent.

Chlamydia Infections↗
PubMed1999

How useful is the Chlamydia micro-immunofluorescence (MIF) test for the gynaecologist?

Three patients with a chlamydial respiratory tract infection showed significant titre rises for the three chlamydial micro-immunofluorescence tests, performed with Chlamydia pneumoniae, C. psittaci and C. trachomatis. Such cross-reactions procure an inaccurate discrimination between the various Chlamydia species which remains speculative anyhow when only a positive serological profile against one chlamydial subspecies is performed. We consider that using the serologic assay as proof for past sexually transmitted C. trachomatis infection falls outside the limits of prudent interpretation of laboratory tests.

Aged↗
PubMed1997

Genital Chlamydia infections in sexually active female adolescents: do we really need to screen everyone?

PURPOSE: To evaluate current Chlamydia trachomatis screening guidelines, which recommend that all sexually active female adolescents undergoing a pelvic examination be tested for chlamydial infection, and determine if instead providers should target particular subpopulations of these adolescents. METHODS: Data were collected from 148,650 sexually active females, ages 15-19 years, tested by direct immunofluorescent antibody in 160 family planning clinics from 1988-92. Trends in chlamydia prevalence by demographic, behavioral, and clinical risk factors were analyzed. Logistic regression modeling was used to identify selective screening criteria. Predictive models were developed for all years combined, as well as for the years when prevalence was highest and lowest. RESULTS: The prevalence of C. trachomatis in this population was 10%, with a 42% decrease (13.2-7.6%) over the 5-year period. Logistic regression identified nine demographic, behavioral, and clinical predictors (p < 0.0001) associated with chlamydial infections. Predictor models from the highest and lowest prevalence years varied little from the combined model. Individual year predictor models showed poor sensitivity and were similar for these 2 years. The screening criteria could not identify a group of adolescents with a prevalence less than 6%. CONCLUSIONS: Several individual risk factors were strongly associated with C. trachomatis, but no single risk factor or combination of risk factors used for selective screening could identify more than 42% of infections in our population. These findings support earlier national recommendations and the need for universal screening of sexually active female adolescents.

Adolescent↗
PubMed2002

Chlamydia infection and subfertility.

In the majority of women chlamydia infections remain asymptomatic but they may increase the risk for tubal factor subfertility. Pelvic inflammatory disease (PID) and its chronic sequelae are associated with chlamydial IgG antibody formation in serum, and a correlation between the height of antibody titres and the presence of tubal factor subfertility has been established. The predictive value of chlamydia antibody testing (CAT) is limited however. Several factors affecting sensitivity and specificity of CAT have been identified. Because it is assumed that the presence of chlamydial heat shock proteins (HSPs) may be indicative of chronic inflammation, chlamydial HSP60 antibody testing has been evaluated in its prediction of tubal factor subfertility.

Antibodies, Bacterial↗
PubMedDate not supplied

Comparison of polymerase chain reaction, monoclonal antibody based enzyme immunoassay, and cell culture for detection of Chlamydia trachomatis in genital specimens.

An enzyme immunoassay (EIA; AntigEnz Chlamydia; Northumbria Biologicals, Northumberland, United Kingdom) and a polymerase chain reaction (PCR) assay (Genemed Biotechnologies, San Francisco, CA) were evaluated for the detection of Chlamydia trachomatis in urogenital specimens. Of 324 specimens, 23 were positive by cycloheximide-treated McCoy's cell culture method. Of 23 culture-positive specimens, 20 and 22 were found to be positive by EIA and PCR, respectively. Among 301 culture-negative samples, 4 were found to be positive by both PCR and EIA, 2 were PCR-positive and EIA-negative, and 3 PCR-negative and culture-negative specimens were found to be positive by EIA. In comparing nonculture methods with cell culture technique, combined sensitivities of 87.0% (90.9% in men and 83.3% in women) and 95.6% (90.9% in men and 100% in women), and specificities of 97.7% (99.4% in men and 95.7% in women) and 98.0% (99.4% in men and 96.5% in women) are achieved by EIA and PCR, respectively. The PCR proved to be the more sensitive of these two nonculture methods, and it can be used for the rapid diagnosis of C. trachomatis urogenital infection.

Antibodies, Monoclonal↗
PubMed1991

The role of Chlamydia trachomatis and Neisseria gonorrhoeae in the aetiology of ectopic pregnancy in Gabon.

OBJECTIVE: To study the association between ectopic pregnancy and Chlamydia trachomatis and Neisseria gonorrhoeae. DESIGN: A prospective observational study with two comparison groups. SETTING: A general hospital in Franceville, Gabon. SUBJECTS: Forty-five women with ectopic pregnancies and two comparison groups each of 45 women, one at 5 to 12 and the other at 32 to 41 weeks gestation. MAIN OUTCOME MEASURES: Serum levels of IgG and IgA antibodies to C. trachomatis (L1 and rMOMP) and N. gonorrhoeae (pili) in all the women. In the women with ectopic pregnancy peritoneal adhesions were scored and in 40 women samples of tube were cultured for organisms being studied. RESULTS: IgG and IgA antibodies to C. trachomatis (L1) were detected in 84% of the ectopic group and 53 and 39% of the comparison groups (P less than 0.0001). IgG and IgA antibodies to N. gonorrhoeae occurred in 49, 28 and 18% and 49, 28 and 26% of the groups but the differences were not statistically significant. Adhesions were positively associated with the antibodies. C. trachomatis was cultured from the tubes of 71% of the women with ectopic pregnancy. CONCLUSIONS: Infection with chlamydia, and probably with N. gonorrhoeae, is an important factor in the causation of ectopic pregnancy in Gabon.

Antibodies, Bacterial↗
PubMed1989

Enzyme immunoassay to determine exposure to Chlamydia pneumoniae (strain TWAR).

Recent studies suggest that a group of Chlamydia strains known as TWAR, which are now proposed to be a new species called Chlamydia pneumoniae, may be a frequent cause of respiratory disease in the United States and many other countries. Current serotesting methods do not allow rapid screening of large numbers of samples to distinguish C. trachomatis exposure from C. pneumoniae exposure. We developed an enzyme immunoassay to decrease cross-reactivity between immunoglobulin G antibodies reactive with C. trachomatis and C. pneumoniae. Elementary bodies of C. trachomatis or C. pneumoniae were treated with a detergent-chelating solution to decrease the reactivity of the common lipopolysaccharide antigens. Sera from four groups of patients, totaling 143 persons, were tested by this assay. The prevalences of titers of greater than or equal to 128 to C. trachomatis and C. pneumoniae, respectively, were as follows: (i) for 23 women seropositive for C. trachomatis by the microimmunofluorescence test, 21 (91%) and 18 (78%); (ii) for 50 adult blood donors, 13 (26%) and 39 (78%); (iii) for 40 sexually transmitted disease clinic patients, 20 (50%) and 32 (80%); (iv) for 30 healthy children 5 to 7 years old, 0 (0%) and 8 (27%). Western blots (immunoblots) of each antigen corroborated the differential reactivity of C. trachomatis-positive, C. pneumoniae-negative and C. trachomatis-negative, C. pneumoniae-positive serum samples. Western blots of serum samples from rabbits immunized with either C. trachomatis or C. pneumoniae elementary bodies revealed at least two protein bands (30 and 80 kilodaltons) which appeared to represent unique C. pneumoniae antigens.

Adult↗
PubMed1990

Lower genital tract infection with Neisseria gonorrhoeae and Chlamydia trachomatis in women requesting induced abortion and in their sexual partners.

The prevalence and patterns of gonococcal and chlamydial infection were investigated in a prospective microbiological study on 3,395 women requesting abortion and the sexual partners of culture positive women (organism identified). Neisseria gonorrhoeae was found in only 1.8% of 3,395 women during the whole study period of 7 years, but Chlamydia trachomatis in 13.5% of 1,635 women in the last 3 years. Women with positive cultures were significantly younger (p less than 0.001), and more frequently single (p less than 0.001) than those with negative cultures. Single women had more partners (mean 1.5) than those in an established relationship (mean 1.1). Almost all women with gonorrhea were single. Of the males, 62.7% were examined, of whom 47.3% had positive cultures. Twenty per cent of culture positive males had gonorrhea. A high prevalence of positive cultures in the males was only found where chlamydial cultures had been positive in the female. All women and men with positive culture results received antibiotic treatment before or after the abortion procedure. The incidence of laparoscopically verified post-abortion salpingitis was low, at 0.57%, while a clinical diagnosis of endometritis was made in 3.3%. Routine pre-operative microbial screening for Chlamydiae trachomatis should be considered for all women requesting abortion. Tracing and screening for chlamydial and gonorrheal infection of sexual partners of culture-positive women is necessary as a preventive measure.

Abortion Applicants↗
PubMed1991

Screening for Chlamydia trachomatis infection in women and aspects of the laboratory diagnostics.

Nine hundred and thirty-three women who attended consecutively a gynecological clinic for various symptoms, for abortion, or for contraceptives, were screened for genital Chlamydia trachomatis infection. A total of 95 (10.2%) women were found infected. Of women below 25 years of age, 13.4% were infected, as compared with 4.9% over 25. Women with symptoms of genital infection were not over-represented in the infected population. Enzyme immunoassays (EIA) verified with a direct fluorescence antigen test were evaluated and compared with culture controls. Reactive samples detected using EIA were regarded as true positive if they were also positive according to the verification test. The sensitivity of the verified EIA test was 91%, the specificity 100%, the positive predictive value 100% and the negative predictive value was 99%. The sensitivity of the culture was 90%. Low age is the most predictable risk factor for genital Chlamydia trachomatis infection. Compared with cultures, EIA verified with a direct fluorescence antigen test is a rapid and effective method for clinical use.

Adolescent↗
PubMed1994

Seroepidemiologic study of Chlamydia pneumoniae and other chlamydial species in a hyperendemic area for trachoma in the Sudan.

Sera of inhabitants of Angola village in central Sudan were investigated for the prevalence of antibodies to Chlamydia trachomatis, C. pneumoniae, and C. psittaci by the microimmunofluorescence (MIF) test. Clinical examination of 616 persons showed that the village is hyperendemic for trachoma. Of the 448 children examined, 334 (75%) had signs of active trachoma. The corresponding prevalence in the 168 adults was 25%. Using MIF, antibodies to C. trachomatis were found in the sera of 27 (81%) children and of 37 (88%) adults with trachoma. Antibodies to C. pneumoniae occurred in 13% and 24% of the preschool and school trachomatous children, respectively, and in 64% of the adults, which reflects earlier exposure to C. pneumonia in the Sudan than generally reported from temperate zones. Antibodies to C. psittaci were found in 6% of the children less than 16 years old and in 17% of the adults. Of the patients with trachoma, 16% had antibodies to both C. trachomatis and C. pneumoniae. The prevalence of multiple antibodies to Chlamydia increased with age. Antibodies to all three species occurred in 3% of the patients. The study does not support the existence of protective immunity between C. pneumoniae, C. trachomatis, and C. psittaci, as shown by the high prevalence of chlamydial antibodies in the hyperendemic trachoma community studied.

Adolescent↗