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Evidence for Chlamydia pneumoniae infection in
David L Hahn, MD*; Don Bukstein, MD*; Allan Luskin, MD*; and Howard Zeitz, MD†
Background: Chlamydia pneumoniae
is an obligate intracellular respiratory
strong association of C. pneumoniae
pathogen capable of persistent infection. Seroepidemiologic studies and the results
of open-label antimicrobial treatment of patients with non-steroid-dependent asthma
have suggested a potential role for C. pneumoniae
12.5 for titers of 1:128 or greater).8 C.
To evaluate the results of antimicrobial treatment in patients with
is a plausible candidate as
uncontrolled steroid-dependent asthma and serologic evidence suggesting C. pneu-
Three nonsmoking asthmatic patients (aged 13 to 65 years) whose
symptoms remained poorly controlled despite daily administration of inhaled and
oral steroid (10 to 40 mg/d). All met serologic criteria for current or recent C.
tion and inflammation.10–12 The culture
After prolonged treatment (6 to 16 weeks) with clarithromycin or
for C. pneumoniae
infection in the ini-
azithromycin all three patients were able to discontinue oral steroids. All three
patients have remained well controlled with inhaled antiasthma therapy only during
3 to 24 months of postantibiotic therapy observation.
In adolescent and adult asthmatic patients, Chlamydia pneumoniae
infection may contribute to symptoms of asthma that are poorly controlled by
linking C. pneumoniae
steroids. Serologic evidence for C. pneumoniae
infection should be sought in such
patients. A trial of appropriate antibiotic therapy may be helpful in those patients
with high titers of anti-C. pneumoniae
Ann Allergy Asthma Immunol 1998;80:45–9.
obtained from three patients who de-veloped
asthma following clinical respiratoryillnesses and who also had serologic
treated chronic Chlamydia trachomatis
met clinical and spirometric criteria for
, is a human pathogen recog-
stimuli. Spirometric criteria for revers-
*Dean Medical Center, Madison, Wisconsin.
†Rush-Presbyterian-St. Luke’s Medical Cen-
gestive of a role for C. pneumoniae
and Grayston,14 we measured C. pneu-
Received for publication March 3, 1997.
-specific IgM and IgG antibod-
Accepted for publication in revised form June
patients. C. pneumoniae
ter of IgG specific for C. pneumoniae
role of C. pneumoniae
as an important
IgE antibodies specific for C. pneu-
have been associated with cul-
cough, shortness of breath and wheeze.
ing was positive only with Alternaria.
tentative diagnosis of mild asthma wasmade and he was treated with an albu-
Table 1. Summary of Clinical and Serologic Data
Ͻ1:8 ND 1:512 1.78L (49% predicted) 3.67L (102% predicted)
Ͻ1:8 1:16 1:512 1.62L (61% predicted) 1.91L (74% predicted)
Ͻ1:8 1:64 1:512 1.50L (37% predicted) 2.48L (61% predicted)
ANNALS OF ALLERGY, ASTHMA, & IMMUNOLOGY
ters of anti-C. pneumoniae
strongly suggested C. pneumoniae
fection, all three patients received pro-
The optimal length of therapy for C.
respiratory infection has
major target organs in chronic C. pneu-
not been established. Acute C. pneu-
infection. Nevertheless, high
respiratory infections often re-
infections.24 Because Chlamydia tra-
tients reported here suggests that C.
-specific IgA, but not IgG,
infection also might be a
dency in some cases of severe asthma.
chronic C. pneumoniae
antibodies against C. pneumoniae
ma-inciting antigens. C. pneumoniae
identify patients with chronic C. pneu-
respiratory infection. Because
tional Heart, Lung, and Blood Insti-tute. February, 1997.
jects. Culture diagnosis is difficult be-
animal model, non-cultivable C. pneu-
may be transformed to a culti-
5. Grayston JT. Chlamydia pneumoniae
strain TWAR. Chest 1989;95:664 –9.
growth of C. pneumoniae
in vitro32 and
chitis. J Infect Dis 1993;168:1231–5.
antibody titers in pa-
8. Hahn DL, Dodge R, Golubjatnikov R.
Association of Chlamydia pneumoniae
will be required to elucidate further the
gested that steroid treatment of patients
who are infected with C. pneumoniae
their role in asthma: Chlamydia pneu-
in adult patients. Eur Respir
ters of C. pneumoniae
bodies, a trial of appropriate antibiotic
continues to rise in the elderly.34 Since
chronic C. pneumoniae
ogy of experimental Chlamydia pneu-moniae
pneumonitis in mice. J Infect
It is possible that chronic infection, as
otic effective against Chlamydia pneu-
infection in mice: effect
1. Shelhamer JH, Levine SJ, Wu T, et al.
2. Expert Panel Report II. Guidelines for
ANNALS OF ALLERGY, ASTHMA, & IMMUNOLOGY
al. Chronic Chlamydia pneumoniae
29. Thom DH, Grayston JT. Chlamydia
bridge University Press, 1986:329 –32.
strain TWAR infections:
descriptions, diagnosis, and treatment.
R, et al. Evidence of persistent Chla-
Mediguide Infect Dis 1990;10:1– 4.
30. Hahn DL. Treatment of Chlamydia
determinations for Chlamydia pneu-
infection in adult asthma:
16. Saikku P. Chronic Chlamydia pneu-
Grayston JT. Reactivation of Chla-
infections. In: Allegra L, Blasi
lung infection in
24. Alifano M, De Pascalis R, Sofia M, et
wara T, et al. Serologic tests for Chla-
. Pediatr Infect Dis
Davies P. Chlamydia pneumoniae
specific IgA antibody to Chlamydia
in the diagnosis and treat-
et al. Respiratory infection with Chla-
in middle-aged and
. In: Allegra L, Blasi F,
crobiol Infect Dis 1994;13:785–92.
eds. Chlamydia pneumoniae infection.
20. Hahn DL. Evidence for Chlamydia
infection in asthma. In:
tion. Eur J Epidemiol 1992;8:882– 4.
Request for reprints should be addressed to:
to Chlamydia pneumoniae
28. Peeling RW, Hahn D, Dillon E. Chla-
infection and adult-
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SEZIONE SCIENTIFICA - Revisione Cochrane per il medico di famiglia Questa rubrica presenta i risultati di PREVENZIONE DELLA una revisione sistematica pubblicata MALARIA NEI dalla Cochrane Collaboration nella VIAGGIATORI: QUALE Cochrane Library (www.cochrane.org). Volutamente limitato a un campo di ANTIMALARICO? ricerca circoscritto, quest’articolo ri-specchia lo stato