Clinical characteristics of Chlamydia psittaci pneumonia: an analysis of 13 cases / 中华全科医师杂志

Objective:To analyze the clinical characteristics of pneumonia caused by Chlamydia psittaci (C. psitttaci). Methods:A retrospective analysis was performed on the clinical data of 13 consecutive patients with C. psitttaci pneumonia admitted to the First Affiliated Hospital of Xiamen University from November 2018 to February 2021. Results:All 13 cases had symptoms of fatigue and 6 cases had headache. At consultation, the ΔSequential Organ Failure Assessment (SOFA) scores of all patients were ≥2 points. According to the Pneumonia Severity Index (PSI) score, 2 patients were grade Ⅱ and the other 11 patients were grade Ⅳ or Ⅴ. Laboratory tests showed that C-reactive protein (CRP) and procalcitonin (PCT) levels were elevated in all patients; CRP≥100 mg/L was found in 11 cases and PCT≥0.5 ng/ml was found in 9 cases.There were 12 cases with respiratory failure and 12 cases with elevated transaminase. Chest CT scans showed multiple patchy exudative shadow, focal consolidation and air bronchial sign; and the lesions were mainly in the lower lungs (8 cases). C. psitttaci infections were confirmed by metagenomics next-generation sequencing (mNGS) and the patients′ conditions improved rapidly after timely adjustment of doxycycline based drug treatment and active organ support. The lesions were completely absorbed without residual fibrous cord changes and the prognosis was good. Conclusions:Pneumonia caused by C. psitttaci usually presents sepsis, and the disease progresses rapidly. The mNGS is of value for the early diagnosis of C. psitttaci pneumonia. Timely adjustment of antibiotics treatment after etiological diagnosis can lead to a good prognosis.

Chlamydophila pneumoniae infection is not associated with primary biliary cholangitis / La infección por Chlamydophila pneumoniae no está asociada con colangitis biliar primaria

ANTECEDENTES: La colangitis biliar primaria (CBP) es una enfermedad hepática inflamatoria crónica colestásica de causa desconocida. Varios patógenos virales y bacterianos han sido propuestos como factores que podrían gatillar una respuesta inmune por mimetismo molecular, o directamente estar relacionados en la persistencia del daño biliar. Existen reportes controversiales respecto al rol de en la patogenia de CBP. OBJETIVOS: Investigar marcadores de infección de séricos y en hígado de pacientes con CBP. PACIENTES Y MÉTODOS: Veinte pacientes diagnosticados con CBP y 20 pacientes control con otras enfermedades hepáticas crónicas no colestásicas fueron estudiados. Se determinaron anticuerpos séricos anti- (IgG). Se realizó detección inmunohistoquímica de antígenos de en hígado. Se extrajo DNA de hígado para amplificación de la secuencia específica de rRNA 16S de por PCR. Fueron usados controles de amplificación de DNA bacteriano y humano. Los pacientes firmaron consentimiento informado. Se realizó un metaanálisis de la diferencia de riesgo de CBP en pacientes infectados por y en un grupo control. RESULTADOS: Los anticuerpos séricos fueron positivos en 30% de los pacientes con CBP y 50% de los controles (p = NS). Antígenos de no fueron detectados en tejido hepático de pacientes con CBP ni de controles. No se amplificó ADN bacteriano en ninguna de las muestras. El metaanálisis de la diferencia de riesgo mostró gran heterogeneidad de los estudios, por lo que no se realizó una estimación de diferencia de riesgo agrupada. DISCUSIÓN: No encontramos asociación entre infección por y CBP. En la evidencia actual, un estudio presenta resultados a favor de la asociación entre y CBP y tres estudios resultados en contra.,

Primary biliary cholangitis (PBC) is a chronic cholestatic inflammatory liver disease of unknown cause. Several viral and bacterial pathogens have been proposed as factors that could either trigger an immune response by molecular mimicry or directly be involved in the persistence of biliary damage. There are conflicting reports respecting the role of in the pathogenesis of PBC. To investigate markers of infection in serum and liver tissue from patients with PBC. Twenty patients with diagnosis of PBC and 20 control patients with other non-cholestatic chronic liver diseases were studied. Serum anti- antibodies (IgG) were determined. Liver tissue was available for immunohistochemistry detection of antigens. DNA was extracted from liver tissue and a specific sequence of 16S rRNA gene was amplified by CPR. Adequate controls of bacterial and human DNA amplification were used. Informed consent was obtained from patients. A meta-analysis of risk difference of PBC in Chlamydophila pneumoniae infected patients and in the control groupwas performed. Serum antibodies were positive in 30% of patients with PBC and 50% of controls (p = NS). antigens were not detected in liver tissue neither of patients with PBC nor controls. Bacterial DNA did not amplify in any of the samples, despite good amplification of internal and external controls. Risk difference meta-analysis showed high heterogeneity between studies. Therefore, we did not estimate a pooled risk difference. Our results do not support the association between infection and PBC. In the current literature only one study shows an association between and PBC, but other three studies do not support it.

Papel del factor neurotrófico de origen cerebral y de la neurotropina-3 en la relación de Chlamydophila pneumoniae con la esquizofrenia / The relationship of Chlamydophila pneumoniae with schizophrenia: The role of brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) in this relationship

Several pathogens have been suspected of playing a role in the pathogenesis of schizophrenia. Chronic inflammation has been proposed to occur as a result of persistent infection caused by Chlamydophila pneumoniae cells that reside in brain endothelial cells for many years. It was recently hypothesized that brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) may play prominent roles in the development of schizophrenia. NT-3 and BDNF levels have been suggested to change in response to various manifestations of infection. Therefore, we aimed to elucidate the roles of BDNF and NT3 in the schizophrenia-C. pneumoniae infection relationship. RT-PCR, immunofluorescence and ELISA methods were used. Fifty patients suffering from schizophrenia and 35 healthy individuals were included as the patient group (PG) and the healthy control group (HCG), respectively. We detected persistent infection in 14 of the 50 individuals in the PG and in 1 of the 35 individuals in the HCG. A significant difference was found between the two groups (p < 0.05). Twenty-two individuals in the PG and 13 in the HCG showed seropositivity for past C. pneumoniae infection, and no difference was observed between the groups (p > 0.05). C. pneumoniae DNA was not detected in any group. A significant difference in NT-3 levels was observed between the groups, with very low levels in the PG (p < 0.001). A significant difference in BDNF levels was also found, with lower levels in the PG (p < 0.05). The mean serum NT-3 level was higher in the PG cases with C. pneumoniae seropositivity than in seronegative cases; however, this difference was not statistically significant (p > 0.05). In conclusion, we suggest that NT-3 levels during persistent C. pneumoniae infection may play a role in this relationship.

Existe la sospecha de que algunos patógenos pueden desempeñar un papel en la patogénesis de la esquizofrenia; en ese contexto, se ha propuesto que la infección persistente causada por células de Chlamydophila pneumoniae presentes en las células endoteliales cerebrales durante muchos años lleva a la inflamación crónica. Recientemente se ha planteado la hipótesis de que el factor neurotrófico de origen cerebral (BDNF, por sus siglas en inglés) y la neurotropina-3 (NT-3) podrían estar implicados en el desarrollo de la esquizofrenia, y se ha sugerido que sus niveles se modifican en respuesta a diversas manifestaciones de la infección. En esta investigación intentamos esclarecer el papel que desempeñan el BDNF y la NT3 en la relación entre la esquizofrenia y la infección por C. pneumoniae. Se utilizaron métodos de RT-PCR, inmunofluorescencia y ELISA. Se incluyeron 50 pacientes con esquizofrenia y 35 individuos sanos como grupo de pacientes (GP) y grupo de controles sanos (GCS), respectivamente. Detectamos una infección persistente en 14 sujetos del GP y en 1 de los del GCS, lo que constituyó una diferencia significativa (p < 0,05). Veinte participantes del GP y 13 del GCS fueron seropositivos para una infección pasada por C. pneumoniae, diferencia no significativa (p > 0,05). No se detectó ADN de C. pneumoniae en ninguno de los dos grupos. Se observó una diferencia significativa entre los grupos en los niveles de NT-3, que fueron muy bajos en el GP (p < 0,001), y de BDNF, inferiores en el GP (p < 0,05). La concentración sérica media de NT-3 fue mayor en los individuos seropositivos para C. pneumoniae en comparación con los seronegativos, pero esta diferencia no alcanzó significación estadística (p > 0,05). Sugerimos que los niveles de NT-3 durante una infección persistente por C. pneumoniae pueden estar implicados en la relación de Chlamydophila pneumoniae con la esquizofrenia.

Acute Respiratory Infection by Chlamydophila pneumoniae and Mycoplasma pneumoniae in a Population of Older Adults in Colombia / Infección respiratoria aguda por Chlamydophila pneumoniae y Mycoplasma pneumoniae en una población de adultos mayores en Colombia

Introduction: Acute Respiratory Infection (ARI) is a heterogeneous group of viral and bacterial respiratory pathologies including Chlamydophila pneumoniae (CP) and Mycoplasma pneumoniae (MP) that are not routinely identified; these infections in the older adults have mortality rates 3 to 5 times higher than that recorded in other age groups. Methods: this study was conducted prospectively to determine the proportion of atypical bacterial pathogens in older adults with ARI in Bogotá. Microbiological diagnosis was determined by real-time PCR (qPCR) in samples of respiratory origin and serology for antibodies IgG, IgA and IgM to MP and CP. Results: A total of 71 patients were enrolled from 2012 to 2013. Upper respiratory infections were diagnosed in the 69% of patients and lower respiratory infections in 31%. MP was identified in 9.8% and CP in 8.5%. Conclusions: these findings indicated that CP and MP must be viewed as a significant etiological agent of ARI in older adults in Bogotá.

Introducción: La infección respiratoria aguda (IRA) es un grupo heterogéneo de patologías respiratorias de etiología viral y bacteriana que incluye Chlamydophila pneumoniae (CP) y Mycoplasma pneumoniae (MP), que no son identificados de manera rutinaria, y en el adulto mayor presentan tasas de mortalidad 3-5 veces mayores que las registradas en otros grupos etarios. Metodología: Estudio prospectivo para determinar la proporción de patógenos bacterianos atípicos en los adultos mayores con IRA, en Bogotá. El diagnóstico microbiológico se determinó mediante PCR en tiempo real (qPCR) en muestras de origen respiratorio y serología para anticuerpos IgG, IgA e IgM frente a MP y CP. Resultados: Un total de 71 pacientes fueron incluidos entre 2012 y 2013. Las infecciones respiratorias superiores fueron diagnosticadas en el 69 % de los pacientes y las infecciones del tracto respiratorio inferior en un 31 %. MP fue identificado en el 9,8 % y el 8,5 % en CP. Conclusiones: Estos resultados indican que CP y MP son agentes etiológicos importantes de infecciones respiratorias agudas en los adultos mayores en Bogotá.

Application of serology and nested polymerase chain reaction for identifying Chlamydophila pneumoniae in community‑acquired lower respiratory tract infections in children.

Context: Chlamydophila pneumoniae is a common cause of community‑acquired respiratory infections, including pneumonia, bronchitis, and upper respiratory tract infections. Since it is difficult to detect C. pneumoniae in clinical practice, specific etiological diagnosis is established only in a minority of cases. Aims: To investigate the role of C. pneumoniae in community‑acquired lower respiratory tract infections (LRTIs) in children, with the use of serological tests and nested polymerase chain reaction (PCR) analysis. Settings and Design: One hundred children, age of 2 months to 12 years, hospitalized for community‑acquired LRTIs were investigated for C. pneumoniae etiology. Materials and Methods: We investigated 100 children hospitalized for community‑acquired LRTIs, using enzyme‑linked immunosorbent assay for detecting anti‑C. pneumoniae immunoglobulin M, and immunoglobulin G antibodies and nasopharyngeal aspirates for analysis of C. pneumoniae PCR. The demographic, clinical, and radiological findings for C. pneumoniae antibody positive and C. pneumoniae antibody negative cases were compared. Statistical Analysis Used: Data analysis was performed by Chi‑square test and Fisher’s exact tests using Epi Info (2002). Results: Clinical and radiological findings in both the groups were comparable. A relatively higher rate of C. pneumoniae infection in children was observed below 5 years of age. Serological evidence of C. pneumoniae infection was observed in 12 (12%) patients and nested PCR was positive in 5 (5%) children. Thirteen (13%) patients were diagnosed with C. pneumoniae infection by serology and/or nested PCR. Conclusions: Our study confirms that C. pneumoniae plays a significant role in community‑acquired LRTIs in children of all ages, even in children aged <5 years.

Evidencia molecular de la infección por Chlamydophila pneumoniae en reptiles de Argentina / Molecular evidence of Chlamydophila pneumoniae infection in reptiles in Argentina

En la región central de Argentina, las características epidemiológicas y moleculares de las infecciones por Chlamydophila pneumoniae en reptiles son desconocidas. Para detectar C. pneumoniae, se usó la reacción en cadena de la polimerasa anidada que amplifica el gen rpoB en muestras de hisopado cloacal de 19 reptiles. Once (57,89 %) reptiles resultaron positivos. La secuenciación y el análisis filogenético corroboraron la presencia de esta bacteria. No se detectó ADN de C. pneumoniae en la faringe ni IgM anti-C. pneumoniae en el suero de los cuidadores; sin embargo, ellos presentaron títulos muy elevados de IgG anti-C. pneumoniae. La detección de ADN de C. pneumoniae en los reptiles demostró la circulación de este agente en el centro recreativo donde se realizó este estudio, lo que podría explicar la exacerbada respuesta inmunitaria en los cuidadores; este hallazgo sugiere la presencia de un potencial ciclo zoonótico. Se reporta aquí por primera vez la detección de C. pneumoniae en reptiles en Argentina

In the central area of Argentina, the epidemiological and molecular characteristics of Chlamydophila pneumoniae infections in reptiles are still unknown. A nested polymerase chain reaction of the rpoB gene was used to detect C. pneumoniae in cloacal swab samples from 19 reptiles at a recreational area. Eleven (57.89%) reptiles were positive; the sequencing and phylogenetic analysis confirmed the presence of this bacterium. Neither C. pneumoniae DNA in the caregivers'pharynges nor IgM antibodies anti-C. pneumoniae in their serum samples were detected; however, caregivers presented very high titers of IgG anti-C. pneumoniae. The detection of C. pneumoniae DNA in reptiles demonstrated the circulation of this agent in the recreational area and could be responsible for the exacerbated immune response of the personnel handling the reptiles, which suggests a potential zoonotic cycle. This is the first report of the detection of C. pneumoniae in reptiles in Argentina

Correlations between chlamydophila pneumoniae, cytomegalovirus infection and carotid atherosclerotic plaque and its stability / 国际脑血管病杂志

Objective To investigate the correlations between the occurrence of carotid artery atherosclerosis and chlamydia pneumoniae (Cpn) and cytomegalovirus (CMV).Methods Carotid color ultrasonography showed that the patients with intima-media thickness (IMT) ＞ 1.5 mm were enrolled and were used as a carotid atherosclerosis group,and the healthy subjects (IMT ＜ 1.0 mm) were used as a control group.Enzyme-linked immunosorbent assay (ELISA) was used to detect the antibody levels and positive rates of the serum anti-Cpn and anti-CMV IgG.The demography,vascular risk factors,anti-Cpn and anti-CMV IgG antibody positive rates of the carotid atherosclerosis group and the control group were compared.Results A total of 92 patients of the carotid atherosclerosis group were enrolled,including 30 patients with stable plaque and 62 with unstable plaque; a total of 49 healthy subjects of the control group were enrolled.There were no significant differences in the proportions of age,male,hypertension,diabetes,hyperlipidemia,and smoking patients between the carotid atherosclerosis group and the control group (all P ＞0.05).The anti-Cpn IgG (69.5％ vs.26.5％ ; x2 =23.887,P ＜ 0.001),anti-CMV IgG positive rate (75.0％ vs.30.6％ ; x2 =26.156,P ＜ 0.001),and anti-Cpn IgG + anti-CMV positive rate (51.2％ vs.10.2％ ;x2 =24.006,P ＜0.001) of the carotid atherosclerosis group were significantly higher than those of the control group.In the atherosclerosis group,there were no significant difference in the proportions of age,male,hypertension,diabetes,hyperlipidemia,and smoking patients between the unstable plaque subgroup and the stable plaque subgroup (all P＞ 0.05).The anti-Cpn IgG (80.6％ vs.46.7％; x2=11.025,P=0.001),anti-CMV IgG positive rate (83.9％ vs.56.7％;x2 =7.980,P=0.005) and anti-Cpn IgG + anti-CMV positive IgG rate (44.6％ vs.7.6％ ; x2 =10.210,P =0.006) of the unstable plaque subgroup were significantly higher than those of stable plaque subgroup.Conelusions The occurrence of carotid atherosclerosis and the stability of plaque are associated with the Cpn and CMV infection.The Cpn and CMV infection may be the important factors for the occurrence of carotid atherosclerosis plaques and unstable plaques.

Secretion of TNF-α induced by heat shock protein 10 of Chlamydophila pneumoniae were mediated by TLR2 and TLR4 in THP-1 / 中华微生物学和免疫学杂志

Objective To investigate the effect of heat shock protein 10 (HSP1O) of Chlamydophila pneumoniae in inducing TNF-α on THP-1 cells and the roles of TLR4 and TLR2 involved in it.Methods Purified native recombinant HSP10 from Cpn(CHSP10) were produced and inactivated the endotoxin contamination,then different concentration (0.5,1,5,10,20,30 μg/ml) of CHSP10 were used to stimulate THP-1 for different time (0,6,12,24,36,48,60 h).TNF-α were measured by using human TNF-α ELISA kit and compared among different groups.THP-1 were collected and analyzed for TLR2 and TLR4 mRNA levels and protein expression by RT-PCR and immunofluorescence.Peritoneal macrophages isolated from wide-type (C3 H/HeN) and TLR4-deficient mice (C3H/HeJ) were stimulated with endotoxin-free proteins respectively,and the TNF-α were measured.Furthermore,neutralizing anti-human TLR2/TLR4 McAb as a blocking Ab was preincubated with THP-1,after stimulation with CHSP10,ELISA was used to detect the concentration of TNF-α.Results TNF-α can be induced with CHSP10 in THP-1,while it significantly decreased with heated or deproteinized CHSP10.Both TLR2 and TLR4 mRNA and protein were detected in THP-1.Macrophages from C3H/HeN mice displayed higher TNF-α compared with it from C3H/HeJ mice after stimulation with CHSP10.The CHSP10-induced TNF-α would obviously decline when treated with antiTLR2/TLR4 McAb.Conclusion As a potential inflammation related protein,CHSP10 are involved in the pathogenesis of Cpn inducing inflammation cytokine TNF-α.TLR2 and TLR4 appear to be involved in CHSP10-mediated expression of TNF-α.

Study on relationship between chlamydia pneumonia infection and blood-lipoids,high sensitivity C-reactive protein in ischemic stroke / 中国医师进修杂志

ObjectiveTo explore the relationship between chlamydia pneumonia (CPn) infection and blood-lipoids,high sensitivity C-reactive protein (hs-CRP) in ischemic stroke (IS).Methods Ninetyfive patients with IS were selected as study group and 50 healthy people as control group.Serum CPn specific antibody IgG was measured in control group and study group by enzyme-linked immunosorbentassay (ELISA).The levels of serum hs-CRP and blood-lipoids were measured in two groups by automatic biochemical analyzer.The relationship of CPn infection and the levels of serum hs-CRP and blood-lipoids were analyzed.ResultsThe positive rate of CPn IgG and the levels of serum total cholesterol (TC),triglyeride (TG),low density lipoprotein-cholesterol (LDL-C) and hs-CRP in study group [ 58.95％(56/95 ),(5.61 ±0.78) mmol/L,(1.96 ±0.69) mmol/L,(4.19 ±0.58) mmol/L and(10.82 ±2.73) mg/L] were significantly higher than those in control group [ 16.00％ (8/50),(4.15 ± 0.75 ) mmol/L,( 1.10 ± 0.37)mmol/L,(2.26 ±0.46) mmol/L and(4.58 ± 1.06) mg/L] (P ＜0.05),and the level of serum highdensity lipoprotein-cholesterol ( HDL-C ) in study group was lower than that in control group [ ( 1.09 ± 0.34) mmol/L vs. ( 1.32 ± 0.36)mmol/L,P ＜ 0.05 ].In IS patients,the levels of serum TC,TG,LDL-C and hs-CRP in CPn IgG positive patients [ (6.49 ± 0.96),(2.59 ± 0.52),(5.16 ± 0.74) mmol/L and ( 19.25 ± 5.68) mg/L] were significantly higher than those in CPn IgG negative patients [ (4.95 ± 0.59),(1.63 ± 0.43),(3.19 ± 0.71 )mmol/L and(8.29 ± 2.63 ) mg/L] (P ＜ 0.05 ),the level of serum HDL-C in CPn IgG positive patients was significantly lower than that in CPn IgG negative patients [ (0.85 ± 0.21 ) mmol/L vs.( 1.27 ± 0.38) mmol/L,P ＜ 0.05 ].ConclusionsThere is significant correlation between CPn infection and IS.CPn infection may be involved in the pathogenesis of IS by increasing the expression of blood-lipoids and hs-CRP.

Clinical and imaging features of neonatal chlamydial pneumonia / 中华放射学杂志

Objective To study the clinical and imaging features of chlamydial pneumonia in newborns.Methods Medical records,chest X-Ray and CT findings of 17 neonates with chlamydia pneumonia were reviewed.The age was ranged from 9.0 to 28.0 days with mean of ( 16.8 ± 5.8 ) days.There were 11males and 6 females.Sixteen were full term infants and one was born post term.All babies were examined with chest X-ray film,and 13 patients also underwent chest CT scan.Serologic test using immunofluorescence method for Chlamydia IgG and IgM antibodies were performed in all patients.Results All newborns presented with cough but without fever.Positive results of the serologic tests were demonstrated.Chest films showed bilateral hyperventilation in 10 patients,diffuse reticular nodules in 10 patients including nodules mimicking military tuberculosis in 7 patients,and accompanying consolidation in 9 patients.CT features included interstitial reticular nodules in 13 patients with size,density,and distribution varied.Subpleurul nodules ( 11patients) and fusion of nodules ( 10 patients ) predominated.Bilateral hyperinflation was found in 10 patients,which combined with infiltration in 12 patients,thickening of bronchovascular bundles in 10 patients,and ground glass sign in 5 patients.No pleural effusion and lymphadenopathy was detected in any patient.Conclusions Bilateral hyperinflation and diffuse interstitial reticular nodules were the most common imaging features of neonatal chlamydial pneumonia.The main clinical characteristic of neonatal chlamydial pneumonia is respiratory symptoms without fever,which is helpful to its diagnosis.

Comparison of Sputum and Nasopharyngeal Swab Specimens for Molecular Diagnosis of Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila

BACKGROUND: Differentiation of atypical pathogens is important for community-acquired pneumonia (CAP). In this study, we compared sputum and nasopharyngeal swabs (NPS) for use in detection of Mycoplasma pneumoniae (MP), Chlamydophila pneumoniae (CP), and Legionella pneumophila (LP), using Seeplex PneumoBacter ACE Detection Assay (PneumoBacter; Seegene). METHODS: Sputum and NPS specimens were collected from patients in 15 hospitals. DNA was extracted from sputum using QIAamp DNA Stool Mini Kit (Qiagen) and from NPS using easyMAG (bioMerieux). Both types of specimens were evaluated by multiplex PCR using PneumoBacter. To determine the diagnostic performance of this assay, sputum samples were also tested using BD ProbeTec ET Atypical Pneumonia Assay (APA; Becton Dickinson). RESULTS: Among 217 sputum and NPS, 20 (9.2%), 2 (0.9%), and 0 sputum were positive for MP, LP, and CP, respectively, whereas 8 (3.7%) NPS were positive for MP. The sputum APA test yielded 186, 206, and 204 interpretable results for MP, LP, and CP, respectively. Of these, 21 (11.3%) were positive for MP, 2 (1.0%) were positive for LP, and 0 samples were positive for CP. Compared to APA, the sensitivity and specificity of the sputum assay for MP were 95.2% and 100.0%, respectively, whereas for the NPS assay, these were 38.1% and 93.9%. Sputum testing was more sensitive than NPS testing (P=0.002). For LP and CP diagnosis, PneumoBacter and APA tests agreed 100%. CONCLUSIONS: Specimen type is crucial and sputum is preferred over NPS for simultaneous detection of MP, LP, and CP using multiplex PCR in CAP.

Detection of IgM and IgG antibodies to Chlamydophila pneumoniae in pediatric community-acquired lower respiratory tract infections.

Context: Chlamydophila pneumoniae (C. pneumoniae) is an emerging infectious agent with a spectrum of clinical manifestations including lower and upper respiratory tract infections. Aims: To investigate the role of C. pneumoniae in community-acquired lower respiratory tract infections (LRTIs) in children using serological tests. Settings and Design: Two hundred children, age 2 months to 12 years, hospitalized for community-acquired LRTIs were investigated for C. pneumoniae etiology. Materials and Methods: We investigated 200 children hospitalized for community-acquired LRTIs, using ELISA for detecting anti-C. pneumoniae IgM and IgG antibodies. The demographic, clinical and radiological findings for C. pneumoniae antibody positive and C. pneumoniae antibody negative cases were compared. Statistical Analysis Used: Data analysis was performed by Chi-square test and Fisher's exact tests using Epi Info (2002). Results: Clinical and radiological findings in both the groups were comparable. Serological evidence of C. pneumoniae infection was observed in 12 (6%) patients; specific IgM antibodies were detected in 11 (91.67%; specific IgG antibodies in 1 (8.33%) patients, while 4-fold rise in C. pneumoniae IgG antibody titers were noted in none of the patients. Conclusions: C. pneumoniae has a role in community-acquired LRTIs, even in children aged < 5 years. Serological detection using ELISA would enable pediatricians in better management of C. pneumoniae infections.

Perfil clínico, epidemiológico e etiológico de pacientes com pneumonia adquirida na comunidade internados em um hospital geral da microrregião de Sumaré, SP / Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia at a general hospital in the Sumaré microregion of Brazil

OBJETIVO: Analisar aspectos clínicos, etiológicos e epidemiológicos das pneumonias adquiridas na comunidade (PAC) em indivíduos internados. MÉTODOS: Foram estudados prospectivamente 66 pacientes com PAC maiores de 14 anos no Hospital Estadual Sumaré, localizado na cidade de Sumaré (SP), entre outubro de 2005 e setembro de 2007. Coletamos dados sobre história clínica, exame clínico, escore pneumonia severity index (PSI) e exames laboratoriais (hemocultura, bacterioscopia/cultura de escarro, sorologias para Chlamydophila pneumoniae, Mycoplasma pneumoniae e Legionella pneumophila, além de antígenos urinários de Legionella sp. e Streptococcus pneumoniae). RESULTADOS: A idade média dos pacientes foi de 53 anos, a maioria tinha baixa escolaridade, e 55,7 por cento apresentavam pelo menos uma comorbidade no momento da internação. O percentual de idosos vacinados contra influenza entre os internados foi significativamente menor que os da comunidade dos municípios da microrregião de Sumaré (52,6 por cento vs. > 70 por cento). A febre foi menos frequente entre os idosos (p < 0,05). A evolução clínica se associou com o escore PSI, mas não com a idade. A etiologia foi confirmada em 31 (50,8 por cento) dos casos, sendo 21 (34,4 por cento) devido a S. pneumoniae, detectado principalmente pelo antígeno urinário; seguido de C. pneumoniae, em 5 (8,2 por cento). Receberam alta hospitalar por cura 80,3 por cento dos pacientes. A taxa de letalidade foi de 4,9 por cento. CONCLUSÕES: O conhecimento do perfil etiológico de PAC no âmbito regional favorece a escolha adequada da terapia empírica, que é particularmente relevante em pacientes idosos e naqueles com comorbidades. A falta da vacinação contra influenza em idosos é um fator de risco de internação por PAC.

OBJECTIVE: To analyze the clinical, etiological, and epidemiological aspects of community-acquired pneumonia (CAP) in hospitalized individuals. METHODS: We prospectively studied 66 patients (> 14 years of age) with CAP admitted to the Hospital Estadual Sumaré, located in the Sumaré microregion of Brazil, between October of 2005 and September of 2007. We collected data related to clinical history, physical examination, pneumonia severity index (PSI) scores, and laboratory tests (blood culture; sputum smear microscopy and culture; serology for Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila; and detection of Legionella sp. and Streptococcus pneumoniae antigens in urine). RESULTS: The mean age of patients was 53 years. Most had a low level of education, and 55.7 percent presented with at least one comorbidity at the time of hospitalization. The proportion of elderly people vaccinated against influenza was significantly lower among the inpatients than in the general population of the Sumaré microregion (52.6 percent vs. > 70 percent). Fever was less common among the elderly patients (p < 0.05). The clinical evolution was associated with the PSI scores but not with age. The etiology was confirmed in 31 cases (50.8 percent) and was attributed to S. pneumoniae, principally detected by the urinary antigen test, in 21 (34.4 percent), followed by C. pneumoniae, in 5 (8.2 percent). The mortality rate was 4.9 percent, and 80.3 percent of the patients were classified as cured at discharge. CONCLUSIONS: The knowledge of the etiologic profile of CAP at the regional level favors the appropriate choice of empirical treatment, which is particularly relevant in elderly patients and in those with comorbidities. The lack of influenza vaccination in elderly patients is a risk factor for hospitalization due to CAP.

Investigation of relationship between recent chlamydia pneumoniae infection and active ankylosing spondylitis / 中华风湿病学杂志

Objective To investigate the relationship between recent chlamydia pneumoniae (Cp)infection and active ankylosing spondylitis (AS). Methods Seventy nine AS outpatients and 73 normal controls (NC) were enrolled into this study. Serum anti-Cp antibodies (CpIg) were tested using the enzymelinked immunosorbent assay (ELISA). Clinical and experimental data were collected. Patients with positive CpIgM or CpIgA were considered as having a recent Cp infection. Wilcoxon test, Student's t test, χ2 test and multivariate logistic regression were used for statistical analysis. Results Both AS patients and normal controls had a high prevalence for sero-positive CpIgG, which was 89％(70/79) vs 92％(67/73) respectively,while AS patients had a higher frequency of CpIgA and CpIgM when compared with NC [52％(41/79) vs 32％(23/73), χ2=6.61, P=0.010 for CpIgA; 80％(63/79) vs 21％(15/73), χ2=44.031, P＜0.01 for CpIgM]. The presence of CpIgM or CpIgA favored AS, the OR was 17.1 (95％CI 7.4～39.5), or 3.1 (95％CI 1.3～7.2),respectively. In addition, CpIgM was associated with disease activity parameters including ESR (χ2=2.56, P=0.021), CRP (χ2=7.28, P=0.007) and BASDAI (χ2=6.79, P=0.009). Furthermore, consecutive positive CpIgM favored the persistent active or relapsed disease, while negative CpIgM favored a reduced disease activity.There was no correlation between CpIgM/CpIgA and peripheral joint disease and enthesitis. Conclusion Recent Cp infection is highly associated with AS and CpIgM antibody relates with active AS, which indicates that Cp infections may be a critical triggering factor for active AS.

Chlamydia pneumoniae e doença aterosclerótica / Chlamydia pneumoniae and atherosclerotic disease

Objetivo: revisar os aspectos etiopatogênicos da infecção por Chlamydia pneumoniae na doença aterosclerótica, analisando estudos em modelos animais e in vitro, assim como ensaios clínicos que avaliaram associação entre a presença do patógeno e doença aterosclerótica.Fonte de Dados: foram revisados artigos disponíveis nas bases de dados PubMed, SciELO e LILACS, publicados entre 1986 e 2009.Síntese dos Dados: a Chlamydia pneumoniae pode se replicar no endotélio, células musculares lisas e macrófagos, contribuindo para a aterogênese. Lipopolissacarídeos e proteínas de choque térmico oriundos do patógeno podem induzir à formação de células espumosas. In vitro, macrófagos humanos infectados por Chlamydia pneumoniae apresentam acúmulo intracelular de lipídios por desregulação na absorção de lipoproteínas de baixa densidade. Em modelos animais, o patógeno é encontrado no ateroma de animais hiperlipêmicos, e macrófagos murinos aderem melhor ao endotélio quando infectados por Chlamydia pneumoniae. Os estudos soroepidemiológicos são controversos em termos da frequência de anticorpos anti-Chlamydia pneumoniae em pacientes com aterosclerose. Em ensaios clínicos, não há evidência cabal de benefício da terapia antibiótica sobre o prognóstico da doença arterial coronária. A ocorrência de infecção por Chlamydia pneumoniae não é, até o momento, fator de risco definido para doença aterosclerótica. Conclusões: a infecção por Chlamydia pneumoniae pode constituir achado de importância etiopatogênica na ateromatose. Entretanto, a relevância clínica dessa associação, como mostram os estudos epidemiológicos e ensaios clínicos aqui revisados, ainda é incerta.

Aims: To study the etiopathogenic role of Chlamydia pneumoniae infection in the atherosclerotic disease, in vitro studies and animal models involving Chlamydia pneumonia and atheromatosis were reviewed, as well as clinical assays that analyzed the association between the pathogen and atherosclerotic disease.Source of Data: Articles found in Pubmed, SciELO and LILACS data bases, published between 1986 and 2009, were reviewed. Summary of Findings: Chlamydia pneumoniae can replicate in the endothelium, smooth muscle cells and macrophages, contributing to atherogenesis. Lipopolysacharides and heat-shock proteins originated from the pathogen can induce the formation of foam cells. In vitro, human macrophages infected by Chlamydia pneumoniae induce intracellular accumulation of lipids through a deregulation in the absorption of low-density lipoproteins. In animal models, the pathogen is found in atheroma of hyperlipemic animals, and murine macrophages adhere better to the endothelium when infected by Chlamydia pneumoniae. The sero-epidemiological studies are controversial in terms of the anti-Chlamydia pneumoniae antibody frequency in patients with atherosclerosis. In clinical studies, there is no unequivocal evidence of the benefit of antibiotics on the prognosis of the coronary arterial disease. The occurrence of the infection by Chlamydia pneumonia is not, up to date, a defined risk factor for atherosclerotic disease. Conclusions: Infection by Chlamydia pneumonia may constitute an important etiopathogenic finding in atheromatosis. However, the clinical relevance of this association, as shown in the epidemiologic and clinical studies herein reviewed, is yet uncertain.

Comparison of three different novel Chlamydophila pneumonia recombinant antigens for serodiagnosis / 中华检验医学杂志

Objective To evaluate three different Chlamydophila pneumoniae recombinant antigens for use in Chlamydophila pneumoniae serodiagnosis. Methods The recombinant plasmids pGEX6p-2/ Cpn0146,Cpn0147 and Cpn0308 were constructed and expressed as GST fusion proteins. The immunogenicity and the immunocompetence of these recombinant protein were analyzed by Western-blot and indirect ELISA. A total of 183 sera samples of patients with respiratory tract infection and 32 sera samples of patients with Chlamydia trachomatis infection were detected with indirect ELISA coated microwell plates with the purified recombinant proteins comparing with SeroCP-TM IgG ELISA kits. The positive recognition rate, sensitivity and specificity of each method were analyzed. Results GST-Cpn0146, Cpn0147 and Cpn0308 were obtained after expression and purification. The titers of the specific IgG antibodies against Cpn0146, Cpn0147 and Cpn0308 were higher than 1:6 400, 1:128 00 and 1:128 00, respectively. When the indirect ELISA was developed to detect the IgG antibody against Chlamydophila pneumoniae in 183 samples, the concordance rate between the indirect ELISA test and SeroCP-TM IgG ELISA kits were 92. 3% (Cpn0146) , 94.5% (Cpn0147) and 96.7% (Cpn0308), respectively. The recombinant Cpn0146, Cpn0147 and Cpn0308 were recognized by 71 (38.8% positive recognition rate), 75 (40.9%), and 82 (44.8%) samples, respectively. The recombinant antigen-based detection assays displayed > 97% of detection specificity and>87%of sensitivity.Condusion GST-Cpn0308 shows a better sensitivity and specificity,which suggests it could be used for developing serodiagnosis kits of Chlamydophila pneumoniae infection.

Chlamydial protease-like activity factor from Chlamydophila pneumoniae induced THP-1 cells produced proinflammtory cytokines and apoptosis / 中华微生物学和免疫学杂志

Objective To express and purify Chlamydial protease-like activity factor(CPAF)from Chlamydophila pneumoniae,for investigating the effect of its recombinant protein GST-CPAF in inducing human monocytic cells to secrete proinflammatory cytokines and cell apoptosis.Methods The recom-bination expression plasmid pGEX6p-2/CPAF from Chlamydophila pneumoniae was transformed into E.coli.The recombination GST-CPAF was expressed after induction by IPTG,and purified by a agarose gel FF.Human monocytic cells were stimulated by the GST-CPAF to test the production of tumor necrosis factor a(TNF-α)and interleukin-6(IL- 6)by ELISA.Inhibition of cells proliferation with GST-CPAF was assessed by MTT.The THP-1 cell apoptosis stimulated by GST-CPAF was detected by Hoechst33258 fluorescence staining,DNA fragmentation analysis and cell apeptosis was detested bv Annexin V-FITC-propidiuum iodide (PI)staining.Results The recombination protein GST-CPAF was successfully expressed with high level in E.coli,and stimulated human monocytic cells to produce proinflammatory cytokines including TNF-α and IL-6 in a dose-and time-dependent manner.Otherwise,the GST-CPAF inhibited the growth of human monocytic cell in a dose-dependent manner.Apoptosis with nuclear chromatin fragmentation as well as cell shrinkage was observed by fluorescent staining and microscopy,DNA ladders in apoptosis cells were detected after 24 h with the GST-CPAF.Conclusion The GST-CPAF from Chlamydophila pneumoniae can induce the secretion of proinflammatory cytokines TNF-α and IL-6 by human monocytic cells,and inhibited the proliferation of THP-1 cell and apoptosis in vitro.

Signal transduction mechanism of Chlamydia pneumoniae in down-regulating the expression of ABCA1 and ABCG1 from THP-1-derived macrophages / 中国病理生理杂志

AIM: To investigate the signal transduction mechanism of Chlamydia pneumoniae (Cpn) in down-regulating the expression of ATP binding cassette A1 (ABCA1) and ATP binding cassette G1 (ABCG1),the key molecules in cholesterol efflux and atherogenesis,from THP-1-derived macrophages. METHODS: Cpn was propagated in Hep-2 cells. THP-1 monocytes were induced into macrophages by 160 nmol/L phorbol myristate acetate (PMA) for 48 h,and were randomly allocated into 4 groups to incubate continually: control group,50 mg/L low density lipoprotein (LDL); Cpn infection group,Cpn (1×10~6 IFU) and 50 mg/L LDL; Cpn and SP600125 (a special JNK inhibiter) group,THP-1 macrophages were previously treated with different concentrations (1-20 μmol/L) of SP600125 for 1 h,and then infected with Cpn (1×10~6 IFU) and 50 mg/L LDL; SP600125 group,SP600125(20 μmol/L)and 50 mg/L LDL. The expressions of ABCA1/ABCG1 and peroxisome proliferator-activated receptor γ (PPARγ) from each group were detected then. The cholesterol efflux was detected by enzyme-fluorescence. The expressions of ABCA1/ABCG1 and PPARγ mRNA and protein were determined by RT-PCR and Western blotting,respectively. RESULTS: Cpn not only down-regulated the ABCA1/ABCG1 expression,but also down-regulated the expression of PPARγ,which regulated the ABCA1/ABCG1 genes transcriptions. However,the mentioned effects of Cpn infection were restrained by the special JNK inhibitor SP600125 in a dose-dependent manner. CONCLUSION: Chlamydia pneumoniae may down-regulate ABCA1/ABCG1 expression from THP-1-derived macrophages via JNK-PPARγ signal transduction pathway.

Imunidade inata na asma fatal / Innate immunity in fatal asthma

INTRODUÇÃO: A inflamação das vias aéreas na asma envolve respostas imunes inatas. Os receptores do tipo Toll (Toll-like receptors, TLRs) e a citocina linfopoetina do estroma tímico (thymic stromal lymphopoietin, TSLP) estão envolvidos na inflamação brônquica da asma, mas a expressão destas proteínas em vias aéreas grandes e pequenas de asmáticos ainda não foi investigada. Os objetivos deste estudo foram analisar a expressão protéica de TLR2, TLR3, TLR4 e TSLP em vias aéreas grandes e pequenas de asmáticos, comparar sua expressão entre asmáticos tabagistas e não tabagistas e investigar se a expressão dos TLRs está associada à infecção por Chlamydophila pneumoniae e Mycoplasma pneumoniae. MÉTODOS: Foram analisadas por método imuno-histoquímico e análise de imagens as expressões de TLR2, TLR3, TLR4 e TSLP em vias aéreas grandes e pequenas de 24 indivíduos falecidos por asma (13 não tabagistas e 11 tabagistas) e 9 controles não asmáticos. A análise das proteínas foi realizada em quatro regiões das vias aéreas: camadas epitelial, interna, muscular e externa. A presença de C. pneumoniae e M. pneumoniae no tecido pulmonar foi investigada por meio de reação em cadeia da polimerase em tempo real. RESULTADOS: Os indivíduos asmáticos apresentaram maior expressão de TLR2 nas camadas epitelial e externa de vias aéreas grandes e pequenas, e maior TLR2 na camada muscular de vias aéreas pequenas. Asmáticos tabagistas tiveram menor expressão de TLR2 nas camadas interna e externa de vias aéreas pequenas do que asmáticos não tabagistas. Indivíduos asmáticos tiveram maior expressão de TSLP na camada epitelial e externa de vias aéreas grandes, aumento de TLR3 na camada externa de vias aéreas grandes e aumento de TLR4 na camada externa de vias aéreas pequenas. O DNA de C. pneumoniae e M. pneumoniae não foi detectado em nenhum indivíduo asmático ou controle. CONCLUSÕES: Os receptores da imunidade inata TLR2, 3 e 4 e a citocina TSLP estão aumentados nas vias aéreas de pacientes...

INTRODUCTION: Airway inflammation in asthma involves innate immune responses. Toll-like receptors (TLRs) and the cytokine thymic stromal lymphopoietin (TSLP) are involved in bronchial inflammation in asthma, but the expression of these proteins in large and small airways of asthmatics has not been investigated. The aims of this study were to analyze the protein expression of TLR2, TLR3, TLR4 and TSLP in large and small airways of asthmatics, to compare their expression in smoking and nonsmoking asthmatics and to investigate if TLR expression in associated with infection by Chlamydophila pneumoniae and Mycoplasma pneumoniae. METHODS: Using immunohistochemistry and image analysis, we investigated the expression of TLR2, TLR3, TLR4 and TSLP in large and small airways of 24 fatal asthma patients (13 nonsmokers and 11 smokers) and 9 nonasthmatic controls. The protein expression was analyzed in four regions of the airways: epithelial, internal, airway smooth muscle and outer layers. C. pneumoniae and M. pneumoniae presence in lung tissue was analyzed by real-time polymerase chain reaction. RESULTS: Fatal asthma patients had increased expression of TLR2 in the epithelial and outer layers of large and small airways, and also higher TLR2 in the muscle layer of small airways. Smoking asthmatics had lower TLR2 in the inner and outer layers of small airways than nonsmoking asthmatics. TSLP was increased in the epithelial and outer layers of large airways. Asthmatics also had greater TLR3 in the outer layer of large airways and greater TLR4 in the outer layer of small airways. C. pneumoniae and M. pneumoniae DNA was not detected in asthmatics or controls. CONCLUSIONS: Innate immunity receptors TLR2, 3 and 4 and innate cytokine TSLP are increased in the airways of fatal asthma patients, and TLRs expression is not associated with the presence of Mycoplasma pneumoniae and Chlamydophila pneumoniae in the lungs. Smoking may reduce TLR2 expression in the small airways...