RESUMO
Stroke is the third leading cause of death and is an important cause of long term disability. Inflammatory processes have fundamental roles in stroke in both the etiology of ischemic cerebrovascular disease [CVD] and the pathophysiology of cerebral ischemia. Chronic infection with Chlamydia pneumoniae [C. pneumoniae], a common respiratory pathogen capable of infecting endothelium, arterial smooth muscle, and monocytes, is a recently proposed risk factor for atherosclerosis and first ischemic stroke. In the present study we tried to provide evidence for the presence of C. pneumoniae in peripheral blood mononuclear cells [PBMCs] by tissue culture confirmed immunofluroscence [IF], polymerase chain reaction [PCR] on PBMCs and enzyme linked immunosorbent assay [ELISA] for detection of immunoglobulin A [IgA] to C. pneumoniae in patients with first ischemic stroke. The study included 157 cases with first ischemic stroke and 50 aged and gender matched healthy controls. The mean of age +/- SD of all patients was 61.68 +/- 11 years old. The patients were divided into two groups according to the age of onset: early onset group with age < 65 years old and late onset group with age >/= 65 years old. Using the multiple logistic regression analysis between patients and control, there was significant association between smoking [odds ratio= 7.8 and 95% confidence interval [C.I.] = 2.5 - 23.9, P=0.0001] and diabetes mellitus [odds ratio= 3.29 and 95% C.I. = 1.2 - 8.3, P= 0.013] as risk factors for ischemic stroke. There was statistical significant difference between patients and control groups for the presence of C. pneumoniae by tissue culture, IF, PCR on PBMCs and ELISA for IgA to C. pneumoniae. A statistical significant differences was found between both patients groups and control group for C. pneumoniae by all used laboratory measures. But there was no significant statistical difference between both patients groups in the frequency of C. pneumoniae by all used laboratory measures. On the other hand, there was no significant statistical relation between risk factors and C. pneumoniae presence in patients with first ischemic stroke. Measuring the sensitivity and specificity of each laboratory technique for C. pneumonia, we found that tissue culture is more sensitive [97%] but less specific than IF, and PCR is the most specific [100%], but also less sensitive than IF, and ELISA is more sensitive [93%], less specific than IF. There was statistical significant positive correlation between ELISA IgA for C. pneumoniae and both IF and PCR. Conclusions it is concluded that C. pneumoniae could be one of the important sharing factors in fist ischemic stroke occurrence, it should be searched fore in those patients admitted with first ischemic stroke. Tissue culture confirmed by IF could be used as routine measure for diagnosis of C. pneumoniae, and if needed it could be confirmed by PCR on PBMCs. ELISA IgA for C. pneumoniae could be used for screening of these patients for C. pneumoniae because of the time consumed to carryover tissue culture or PCR. Treatment of patients with ischemic stroke with C. pneumoniae antimicrobial therapy is needed to eliminate the infectious risk factor that may contribute in this disease especially in young patients which may not have other risk factors