Simkania negevensis and newly diagnosed asthma: a case-control study in 1- to 6-year-old children

BACKGROUND: Simkania negevensis is an intracellular bacterium, sharing many characteristics with Chlamydophila and Chlamydia species. S. negevensis infection has been associated with bronchiolitis in infants and with pneumonia and exacerbations of COPD in adults. OBJECTIVE: The aim of the present study was to evaluate, in a case-control setting, whether S. negevensis serology had any association with the onset of asthma in children. METHODS: S. negevensis-specific IgM, IgA and IgG antibodies were measured by microimmunofluorescence in 104 children below school-age with newly diagnosed asthma, and in 122 control children. RESULTS: S. negevensis-specific IgM was detected in two (2%) cases and in nine (8%) of the controls. IgG was detected in 12 (12%) cases and 12 (10%) of the controls. IgA antibodies were absent in all children. The age distribution of the 35 children with S. negevensis-specific antibodies was even, the positivity rate being 11% in the 12- to 23-month-old group and 20-23% in the children aged between 2 and 5 years. CONCLUSION: Although S. negevensis appears to cause infections in the Finnish preschool-aged population, there was no association with asthma.     

脑卒中与肺炎衣原体感染的相关性

目的探索肺炎衣原体(Cpn)慢性感染与脑卒中之间的关系。方法2002年3月-2006年1月来复旦大学附属金山医院就诊的25岁至72岁脑卒中患者60例为病例组,选择60名性别、年龄和种族等与病例组相匹配的无脑卒中者为对照组,用微量免疫荧光法检测血清中Cpn抗体(IgA、IgG),并比较血清总胆固醇(TC),甘油三酯(TG)水平的差异。结果在脑卒中组和对照组血清中,Cpn IgA的阳性检出率分别为75.0%(45/60)和38.3%(23/60),P<0.001;Cpn IgG的阳性检出率分别为58.3%(35/60)和43.3%(26/60),P>0.05。脑卒中组TC(5.75±0.74 mmol/L)高于对照组(4.62±0.76mmol/L),具有统计学意义(P<0.05),TG水平差别无统计学意义。结论肺炎衣原体慢性感染的血清学证据与脑卒中危险有关,IgA滴度比IgG可能是更好的危险标记物。这一发现表明,脑卒中与Cpn之间有着临床的紧密关联,有关病因学的关系,有待进一步研究。     

Pneumonia due to Chlamydia pneumoniae in children: epidemiology, diagnosis, and treatment

The term "atypical" pneumonia has been used to differentiate infections caused by Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella, and other related organisms from pneumonia caused by classic bacteria, the prototype being Streptococcus pneumoniae. However, recent studies demonstrated that the clinical presentation of pneumonia due to atypical pathogens cannot readily be differentiated from those caused by "typical" bacteria. This is further complicated by the observation that coinfections with atypical pathogens and other bacteria are frequent. Nonetheless, the term "atypical" can be useful, as these organisms share a number of characteristics that separate them from "typical" bacteria. They are either obligate or facultative intracellular parasites that cannot be isolated using routine microbiologic methods. The most commonly used method of diagnosis of these infections is serology, which has significant limitations. Although C. pneumoniae is now recognized worldwide as a common cause of respiratory infections in adults and children, major gaps remain in our knowledge of the biology of this organism and how it causes disease, in major part due to the lack of readily available, standardized diagnostic methods.     

Role of viruses and atypical bacteria in exacerbations of asthma in hospitalized children: a prospective study in the Nord-Pas de Calais region (France)

We studied the role of viruses and atypical bacteria in children hospitalized with exacerbated asthma by a prospective study of children with acute asthma admitted to the Department of Pediatrics in Lille, and to 15 hospitals in the Nord-Pas de Calais region, from October 1, 1998-June 30, 1999. We included children aged 2-16 years with active asthma, defined as three or more recurrent episodes of reversible wheezing. The severity of asthma and of asthmatic exacerbations was recorded. Immunofluorescence assays (IFA) on nasopharyngeal secretions (NPS), serological tests, or both, were used for detection of influenza virus, respiratory syncytial virus (RSV), adenovirus, parainfluenza virus, and coronavirus. Polymerase chain reaction (PCR) assays on NPS were used for rhinovirus and enterovirus. Serological tests for Chlamydia pneumoniae and Mycoplasma pneumoniae were performed. A control group of asymptomatic asthmatic outpatients was examined for respiratory viruses (using IFA and PCR). Eighty-two symptomatic children (mean age, 7.9 years) were examined. Viruses were detected in 38% (enterovirus, 15.8%; rhinovirus, 12%; RSV, 7.3%). Serological tests for atypical bacteria were positive in 10% of patients (C. pneumoniae, 5%; M. pneumoniae, 5%). Among the 27 control subjects (mean age, 7.9 years), one PCR was positive for enterovirus. There was no correlation between severity of chronic asthma or asthmatic exacerbations and the diagnosis of infection. Atypical bacterial pathogen infections were linked with prolonged asthmatic symptoms. In conclusion, we confirmed the high incidence of viral infection in acute exacerbations of asthma, especially enteroviruses or rhinoviruses. Persistent clinical features were more frequently associated with atypical bacterial infections, suggesting that these infections should be investigated and treated in cases of persistent asthmatic symptoms.     

肺炎支原体感染诱发的小儿哮喘临床分析

目的探讨肺炎支原体（Mycoplasma Pneumoniae,MP）感染诱发的小儿哮喘的临床特点。方法选取我科收住院的确诊为MP感染诱发的哮喘且资料完整的40例为观察组,观察发热情况、喘息发作情况、肺部情况、辅助检查结果、住院时间、肺外脏器受累情况、对支气管扩张剂的治疗反应,并进行临床分析。对照组为同期住院的非MP感染的哮喘38例。结果以MP感染诱发的哮喘与对照组比较,在喘息特点、热程、肺部X线摄片结果、肺外脏器受累情况、对支气管扩张剂的反应方面,差异显著,具有统计学意义（P〈0.05）。结论 MP感染诱发的哮喘具有自身的特点,大环类酯类抗生素联合支气管扩张剂和皮质激素吸入治疗有效。     

肺炎衣原体与不稳定性心绞痛相关性的临床研究

目的　探讨肺炎衣原体感染与不稳定性心绞痛 (UAP)发病的关系。方法　UAP、稳定性心绞痛 (SAP)各 30例及正常对照组 2 0名。检测肺炎衣原体特异性抗体IgG、IgM滴度 ,肿瘤坏死因子α(TNFα)、C反应蛋白 (CRP)水平 ,组织型纤溶酶原激活剂 (tPA )及其抑制物 1(PAI 1)活性。结果　 (1)UAP组TNFα、CRP和PAI 1较SAP组和对照组升高 ;(2 ) 3组肺炎衣原体 IgG阳性率分别为 83.3%、6 0 %和 35 %,UAP组高于SAP组和对照组。IgM阳性率组间比较差异无显著性意义 ;(3)IgG阳性组TNFα、CRP、PAI 1及TG、TC、LDL C均显著高于阴性组 ,tPA低于阴性组。IgM阳性组和阴性组各参数比较差异无显著性意义。结论　肺炎衣原体慢性感染与UAP发生有关 ,其参与UAP的机制可能是 :肺炎衣原体感染诱导TNFα和CRP产生 ,促进PAI 1活性表达、降低tPA活性 ,并干扰血浆脂质代谢 ,从而促进UAP发生。     

Respiratory symptoms,asthma, atopy and Chlamydia pneumoniae IgG antibodies in a general population sample of young adults

Background: This study was designed to test the association of Chlamydia pneumoniae infection with respiratory symptoms and atopy. Methods: A general population sample of 369 young adults (aged 20-44 years) completed a questionnaire on respiratory symptoms and underwent skin prick testing. C pneumoniae IgG and IgM serum titers were measured by micro-immunofluorescence. Prior infection was defined by titers of IgG ≥ 1:32, acute infection by titers of IgG ≥ :512 and/or IgM ≥ 1:16. Results: The prevalence of cough and phlegm was higher in subjects with (19.0%) than in those without (11.4%) prior C. pneumoniae infection (p = 0.01). A similar difference was found for wheezing (14.3% vs 8.0%; p = 0.05), whereas the percentage of asthmatics was equally distributed between seropositive and seronegative subjects. IgG titers ≥ 1:128 were found more frequently in atopic subjects (p = 0.04). After adjusting for any confounding factors, cough and phlegm (but not wheezing) were found significantly associated with C. pneumoniae positivity, both for 1 : 32 (OR 1.80; 95% CI: 1.01-3.36; p = 0.05) and for 1 : 128 titers (OR 2.31; 95% CI: 1.20-4.42; p = 0.01). A significant association was also found for atopy, for titers ≥ 1 : 128 (OR 1.73; 95% CI: 1.01-3.20, p = 0.05). Acute infection was not associated with respiratory symptoms or asthma. Conclusion: We conclude that C. pneumoniae infection is associated with cough and phlegm and may have a role in the pathogenesis of chronic respiratory diseases. Moreover, our results indicate a relationship between atopy and C. pneumoniae infection. Received: October 9, 2001 · Revision accepted: March 3, 2002     

成人和儿童过敏性紫癜肺炎支原体/衣原体感染率分析

目的：探讨儿童和成人过敏性紫癜（HSP）临床肺炎支原体/衣原体感染率差异。方法：对我院2002年1月～2007年7月共147例过敏性紫癜患者的上呼吸道感染病史、临床表现及血清肺炎支原体/衣原体IgG、IgM检测结果进行回顾性分析。比较儿童组和成人组HSP患者在病（诱）因方面的差异。结果：①儿童组HSP患者近期上呼吸道感染病史较成人组多;②进一步血清肺炎支原体/衣原体IgG、IgM检测结果表明儿童组肺炎支原体/衣原体IgG、IgM感染率明显高于成人组。结论：儿童和成人HSP在发病诱因上所不同。上呼吸道感染,尤其肺炎支原体/衣原体感染是儿童HSP的多见诱因,对儿童组HSP发病有重要影响。     

Chlamydia pneumoniae seropositivity and cardiovascular risk factors: The InCHIANTI Study

OBJECTIVES: To assess the prevalence of Chlamydia pneumoniae (CP) seropositivity and test the hypothesis that CP infection (CPI) is associated with cardiovascular (CV) risk factors and levels of inflammatory biomarkers. DESIGN: Cross-sectional survey. SETTING: Representative sample of the residents of Greve in Chianti and Bagno a Ripoli, two small towns located in the Chianti geographic area (Tuscany, Italy). PARTICIPANTS: A total of 1,304 (age-range: 20-103, 79% aged> or =65) participants of the InCHIANTI study. MEASUREMENTS: CP seropositivity was assessed using immunofluorescence. Previous CPI was defined as immunoglobulin (Ig) G > or =1/16 and <1/256, and recent CPI was defined as IgG > or =1/512 or IgM > or =1/16. Inflammatory markers included interleukin (IL)-6, soluble IL-6 receptor (sIL-6r), tumor necrosis factor-alpha (TNF-alpha), IL-1beta, IL-1 receptor antagonist (IL-1ra), iron, ferritin, and C-reactive protein (CRP). CV risk factors included smoking, body mass index (BMI), lipid profile, and hypertension. RESULTS: The prevalence of CP seropositivity was 75%, increased with age, and was higher in men than in women (P<.01). CPI was not associated with IL-1beta, IL-1ra, iron, ferritin, CRP, BMI, lipids, and smoking. After adjusting for age and sex, previous or recent CPI was associated with higher TNF-alpha (P<.01), IL-6 (P<.03), sIL-6R (P<.01), and hypertension (P<.02). In additional age and sex-adjusted models, the associations between CPI and TNF-alpha, IL-6, sIL-6r, and hypertension appeared to be mutually independent. CONCLUSION: CP seropositivity is highly prevalent in the older population and is a significant, independent correlate of hypertension and circulating levels of TNF-alpha, IL-6, and sIL-6r.     

肺炎衣原体肺炎小鼠模型的建立与实验研究

目的 通过复制小鼠肺炎衣原体感染模型,对肺炎衣原体肺炎的发病机制进行初步的探讨。方法 以肺炎衣原体鼻内或静脉接种Icr小鼠,通过不同时点（60d)处死动物,观察其肺部的病理改变。结果 鼻内接种肺炎衣原体后,Icr小鼠可以产生肺部感染,特征性道理改变为斑片状间质性肺炎,早期（7d内）病变较重,以嗜中性粒浸润为主,并伴有泡沫细胞堆积;后期（14d以后）病变开始减轻,以嗜中性粒细胞和淋巴细胞混合浸润为主,并逐渐转为以淋巴细胞浸润为主。静脉接种肺炎衣原体后的肺部改变与鼻内接种类似,但病变程度要轻得多,范围也要小得多,恢复正常的时间也较快,两者差异在发病早期更为明显。以聚合酶链反应（PCR）法在接种后的肺组织中间歇性检测到肺炎衣原体DNA。被接种的小鼠可以产生血清IgG抗体。结论 给Icr小鼠接种肺炎衣原体可以产生以间质性肺炎为特征的肺部感染,鼻内接种者更为明显。     

Seroprevalence of Chlamydia pneumoniae Antibodies in a Young Adult Population Sample Living in Verona

Summary The aim of the study was to evaluate the prevalence of antibodies to Chlamydia pneumoniae in a random population sample of 369 young adults (age 20–44 years), living in Verona, Italy. IgG and IgM titers were measured by micro-immunofluorescence. IgG antibodies, greater or equal to 16, were found in 104/177 (58.8%) men and 76/192 (39.6%) women (p < 0.001). No relationship was found between IgG seropositivity, age, social class, education and family size. Factors positively associated with IgG seropositivity including smoking ( p < 0.001), occupational status (employed vs unemployed: p = 0.02; students vs unemployed: p < 0.01) and living area (suburban [65.0%] vs urban area [45.3%]: p = 0.03). The geometric mean of IgG titers was higher in students (GM: 26.05) than in both employed (GM: 11.02) and unemployed persons (GM: 4.80) (p < 0.01 and p < 0.001, respectively). IgG titres ≥ 512 and/or IgM titers ≥ 16 (suggestive of a recent C. pneumoniae infection) were found in 39 subjects (10.6%). Recent infection was more frequent in spring (14.9%), with no significant variation in the other seasons (mean prevalence 6.7%) (p < 0.01). Recent infection was also associated with cigarette smoking. On the other hand, no significant association was found between respiratory symptoms and serologic evidence of recent infection. In conclusion: 1) the prevalence of antibodies to C. pneumoniae in young adults from Verona is similar to that found in European countries, and therefore, in Europe, it seems not related to latitude or climate; 2) male sex, tobacco smoking, employment status and living in a suburban area are independent risk factors of infection; 3) the infection is subclinical in most cases. Received: February 3, 1999 · Revision accepted: December 7, 1999     

Incidence of community-acquired pneumonia in children caused by Mycoplasma pneumoniae: serological results of a prospective, population-based study in primary health care

OBJECTIVE: The objective of the present study was to assess the incidence of community-acquired pneumonia (CAP) in children caused by Mycoplasma pneumoniae. METHODOLOGY: During 12 months in 1981-1982, all CAP cases in a defined child population were registered. M. pneumoniae aetiology, initially measured by complement fixation (CF) test, was in 1999 supplemented by measurement of IgG and IgM antibodies using enzyme immunoassays (EIA). RESULTS: M. pneumoniae was detected in 61 (30%) of 201 paediatric CAP cases, being the most common aetiological agent in those 5 years of age or over. At that age, M. pneumoniae was responsible for over 50% of cases, and over 90% of mycoplasmal cases were treated as outpatients. The EIA detected 17 new cases over and above the 44 detected by CF, while CF alone revealed 10 cases. The incidence of M. pneumoniae CAP increased with age, being over 10/1000 children at the age of 10 years or more. Co-infections with Streptococcus pneumoniae and Chlamydia pneumoniae were present in over 30% and 15%, respectively, of mycoplasmal CAP cases. CONCLUSION: M. pneumoniae is a common cause of paediatric CAP in primary health care, and co-infections with S. pneumoniae are common. Both S. pneumoniae and M. pneumoniae should be taken into account when starting antibiotics for children with CAP.     

Toxocariasis and childhood asthma: A case-control study

Objective: The objective of this study is to investigate the association between anti-Toxocara IgG seropositivity and asthma in children. Methods: This was a case-control study conducted in a university hospital in south Brazil between May 2012 and June 2013. Were recruited 208 children up to 12 years old of whom 156 had asthma (cases) and 52 did not have asthma (controls), with a case-control ratio of 3:1 matched by age. Children's parents or guardians were interviewed using a structured questionnaire with closed questions. Serology was performed using enzyme-linked immunosorbent assay (ELISA) with excretory-secretory antigen of Toxocara canis (TES). Results: The seroprevalence of IgG anti-T. canis antibodies was 12.8% in the cases and 7.7% in the controls. There was no significant association between seropositivity to T. canis and risk of asthma (adjusted odds ratio [OR]: 1.89, 95% CI: 0.52 to 6.89, p = 0.33). Household income < 2 minimum salaries, paternal school years < 9, allergic rhinitis in children, a positive family history of asthma and rhinitis and contact with cats were significantly associated with asthma, with adjusted ORs (95% CIs) of 3.05 (1.21 to 7.73), 2.83 (1.11 to 7.18), 10.5 (4.32 to 25.6), 2.65 (1.14 to 6.17), 2.49 (1.07 to 5.78) and 2.73 (1.03 to 7.27), respectively. Conclusions: This study did not find a statistically significant association between seropositivity to Toxocara sp. and risk of asthma in children. Low family income, low paternal education level, concomitant allergic rhinitis, family history of asthma and allergic rhinitis and contact with cats were independent factors associated with childhood asthma.     

Chlamydia pneumoniae IgA titres and coronary heart disease; prospective study and meta-analysis.

AIMS: To examine associations between Chlamydia pneumoniae IgA titres and incident coronary heart disease, and to compare them with associations previously reported between C. pneumoniae IgG titres and coronary heart disease. METHODS AND RESULTS: We measured serum concentrations of C. pneumoniae IgA antibodies in 502 coronary heart disease cases and in 1005 age- and town-matched controls 'nested' in a community-based prospective study of 5661 British men (mean follow-up in controls, 16 years), and conducted a meta-analysis of published prospective studies to place our findings in context. Two hundred and twenty-one (44%) of the cases were in the top third of C. pneumoniae IgA titres compared with 336 (33%) of the controls, yielding an odds ratio for coronary heart disease of 1.84 (95% confidence interval 1.40-2.43) which was largely unchanged after adjustment. In aggregate, the present study and nine previously reported prospective studies of C. pneumoniae IgA titres involved 2283 cases, yielding a combined odds ratio for coronary heart disease of 1.25 (1.03-1.53), with no significant heterogeneity among the ten studies (chi(2)9=7.8; P>0.1). This combined odds ratio is compatible with that previously reported for C. pneumoniae IgG titres and coronary heart disease (1.15, 0.97-1.36). CONCLUSION: Neither C. pneumoniae IgA titres nor IgG titres are strongly predictive of coronary heart disease in the general population.     

Cytokine secretion in children with acute Mycoplasma pneumoniae infection and wheeze

The aim of this study was to evaluate cytokine secretion in children with acute Mycoplasma pneumoniae infection and wheeze. We studied 25 patients aged 2-14 years with an acute episode of wheezing (15 with acute M. pneumoniae infection) and 16 healthy controls of similar gender and age (8 with laboratory evidence of asymptomatic acute M. pneumoniae infection). Serum interleukin (IL)-2, interferon (IFN)-gamma, IL-4, and IL-5 concentrations were measured in samples obtained at enrollment, using enzyme-linked immunosorbent assay kits.In the presence of wheezing, IL-5 concentrations were significantly higher in subjects with acute M. pneumoniae infection (33.415 +/- 22.138 pg/mL) than in those without such infection (2.320 +/- 1.846 pg/mL, P < 0.0001). The children with acute M. pneumoniae infection and wheeze had higher IL-5 concentrations (33.415+/-22.138 pg/mL) than those with asymptomatic acute infection and without wheeze (1.740 +/- 2.299 pg/mL, P < 0.0001). No significant between-group differences were observed in terms of IL-2, IFN-gamma, or IL-4 levels, or the prevalence of atopy.Our results show that children with wheezing and acute M. pneumoniae infection have a specific cytokine profile characterized by a significant increase in serum levels of IL-5. This immune response may be important for understanding the pathophysiological mechanisms by which this pathogen contributes to the development of wheeze-related symptoms, and for identifying new treatment strategies.     

Indoor environmental risk factors and childhood asthma: A case-control study in a subtropical area

This study examined the relation between indoor environmental factors and childhood asthma in a subtropical area. A hospital-based case-control study was performed in Kaohsiung, Taiwan, between July of 1995 and June of 1996. Eighty-six children seen in the out-patient clinic of our university hospital and who had a first-time diagnosis of asthma made by a pediatrician were the test group; 86 control subjects were selected from children attending the Childhood Orthopaedic Clinic in the same hospital and who had no previous diagnosis of asthma or asthma symptoms and no history of physician confirmed atopic diseases. The control subjects were matched with test case children on the basis of gender and age. Information was obtained from parents using a structured questionnaire. Of the many indoor environmental factors included in this study, only home dampness showed an association with asthma (adjusted odds ratio = 1.77; 95% confidence intervals, 1.24–2.53). We conclude that dampness in the home is a new public health risk factor related to asthma in subtropical areas. Pediatr Pulmonol. 1998; 26:120–124. © 1998 Wiley-Liss, Inc.     

新疆伊犁儿童肺炎衣原体、鹦鹉热衣原体及沙眼衣原体血清抗体调查

目的 调查新疆伊犁地区农村居住儿童肺炎衣原体、鹦鹉热衣原体及沙眼衣原体感染状况 。方法 采用WHO推荐的微量间接免疫荧光方法(mIFA)半定量分析儿童血清肺炎衣原体、鹦鹉热衣原体及沙眼衣原体IgG抗体,比较每种病原体在不同调查点及年龄组间阳性率差异。结果 肺炎衣原体、沙眼衣原体及鹦鹉热衣原体人群血清IgG抗体阳性率分别为39.5%、2.1% 及0。巩留县(40.8%)及昭苏县(44.4%)人群肺炎衣原体抗体阳性率明显高于伊宁市(32.4%)。性别、年龄及民族等差异无统计学意义。结论 新疆伊犁农村地区儿童存在较高的肺炎衣原体抗体阳性率,沙眼衣原体阳性率较低。本调查没有检测到鹦鹉热衣原体抗体。     

Spirometry in 3-5-year-old children with asthma

Spirometry with incentive games was applied to 207 2-5-year-old preschool children (PSC) with asthma in order to refine the quality-control criteria proposed by Aurora et al. (Am J Respir Crit Care Med 2004;169:1152-159). The data set in our study was much larger compared to that in Aurora et al. (Am J Respir Crit Care Med 2004;169:1152-159), where 42 children with cystic fibrosis and 37 healthy control were studied. At least two acceptable maneuvers were obtained in 178 (86%) children. Data were focused on 3-5-year-old children (n = 171). The proportion of children achieving a larger number of thresholds for each quality-control criterion (backward-extrapolated volume (Vbe), Vbe in percent of forced vital capacity (FVC, Vbe/FVC), time-to-peak expiratory flow (time-to-PEF), and difference (Delta) between the two FVCs (DeltaFVC), forced expiratory volume in 1 sec (DeltaFEV(1)), and forced expiratory volume in 0.5 sec (DeltaFEV(0.5)) from the two "best" curves) was calculated, and cumulative plots were obtained. The optimal threshold was determined for all ages by derivative function of rate of success-threshold curves, close to the inflexion point. The following thresholds were defined for acceptability: Vbe 相似文献   

Correlation of hyperhomocysteinaemia and Chlamydia pneumoniae IgG seropositivity with coronary artery disease in a general population

BACKGROUND: Both Chlamydia pneumoniae infection and hyperhomocysteinaemia have been assumed to increase the atherosclerotic risk independently of each other and independently of the classic risk factors. The correlation between hyperhomocysteinaemia, C. pneumoniae infection and coronary artery disease (CAD) have not been investigated in the general population. METHODS: In an ancillary study to the Persian Gulf Healthy Heart Study, a cohort study of men and women aged >or=25 years, a random sample of 1699 (48.9% males, 51.1% females) subjects were evaluated. Total homocysteine, high sensitivity C-reactive protein (CRP) and IgG antibodies to C. pneumoniae were determined by ELISA. Minnesota coding criteria of a 12-lead resting electrocardiogram was used for evaluation of CAD. RESULTS: A total of 12.4% of the subjects had electrocardiogram-defined (Minnesota-coding criteria) coronary artery disease. Hyperhomocysteinaemia (>14 micromol/l) and IgG seropositivity were found in 50.8% and 37.7%, respectively. Neither of hyperhomocysteinaemia nor C. pneumoniae IgG seropositivity showed a significant association with CAD after adjusting of sex and age. Concurrent elevated CRP level (>8.2mg/l) and C. pneumoniae seropositivity (chronic C. pneumoniae infection) had a significant association with CAD [OR=1.73, CI (1.09-2.75); p=0.01] after adjusting for age, sex, systolic and diastolic blood pressures, BMI, and serum levels of LDL-cholesterol, fasting blood sugar and triglyceride as covariates in a logistic regression model. This odds ratio increased to 2.11, CI (1.18-4.12; p=0.02) when concurrent hyperhomocysteinaemia and chronic C. pneumoniae infection, as a single covariate entity; was adjusted for multiple risk factors in another logistic regression model. CONCLUSION: Concurrent hyperhomocysteinaemia and chronic C. pneumoniae infection, as a single entity, was independently associated with coronary artery disease in the general population. This synergism may have important implications for risk-stratification and intervention trials.     

Chlamydia pneumoniae infection in HIV-positive patients: prevalence and relationship with lipid profile

OBJECTIVES: The aims of this study were to evaluate the prevalence and impact of Chlamydia pneumoniae infection in HIV-positive patients and to establish the relationship between C. pneumoniae infection and lipid profile. METHODS: Detection of C. pneumoniae was by polymerase chain reaction (PCR) on Peripheral Blood Mononuclear Cells (PBMCs) collected from 97 HIV-positive patients. Samples were collected after overnight fast in EDTA-treated tubes. On the same day, patients were also tested for routine chemistry, HIV viral load, CD3, CD8 and CD4 cell counts and lipid profile [cholesterol, high-density lipoproteins (HDLs), low-density lipoproteins (LDLs) and triglycerides]. RESULTS: The overall prevalence of C. pneumoniae was 39%. The prevalence of C. pneumoniae was inversely related to the CD4 lymphocyte count (P=0.03). In the naive group, C. pneumoniae-positive patients had both significantly higher HIV load (71 021+/-15 327 vs. 14 753+/-14 924 HIV-1 RNA copies/mL; P=0.03) and lower CD4 cell count (348.0+/-165.4 vs. 541.7+/-294.8; P=0.04) than C. pneumoniae-negative patients. Moreover, treatment-naive patients with C. pneumoniae infection had significantly higher mean levels of cholesterol (185.3+/-56.2 vs. 124.8+/-45.9 mg/dL; P=0.01), triglycerides (117.2+/-74.7 vs. 68+/-27.6 mg/dL; P=0.04) and LDL (122.4+/-60.1 vs. 55.6+/-58 mg/dL; P=0.05) than C. pneumoniae-negative patients. CONCLUSIONS: These data indicate that, in HIV-positive subjects, C. pneumoniae infection is relatively frequent and is associated with both low CD4 cell count and high HIV load. Furthermore, C. pneumoniae appears to be associated with hyperlipidaemia and might therefore represent a further risk factor for cardiovascolar disease in HIV-positive patients.