Chlamydia pneumoniae and Exacerbations of Asthma in Adults

Miyashita, Naoyuki; Kubota, Yoshifumi; Nakajima, Masamitsu; Niki, Yoshihito; Kawane, Hiroshi; Matsushima, Toshiharu

doi:10.1016/s1081-1206(10)62992-4

Cited by 85 publications

(46 citation statements)

References 21 publications

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“…In one study of adults with asthma, infection with C. pneumoniae was responsible for 10% of all acute exacerbations [106], similar to rates reported in children aged 5-16 yrs experiencing an acute episode of wheezing [101]. The higher prevalence rates of C. pneumoniae among adults with asthma, as compared to age-matched controls, have also been linked to acute exacerbations [107].…”

Section: Exacerbationsmentioning

confidence: 66%

Atypical pathogens and respiratory tract infections

Blasi¹

2004

European Respiratory Journal

109

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The atypical respiratory pathogens Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila are now recognised as a significant cause of acute respiratory-tract infections, implicated in community-acquired pneumonia, acute exacerbations of chronic bronchitis, asthma, and less frequently, upper respiratory-tract infections.Chronic infection with C. pneumoniae is common among patients with chronic obstructive pulmonary disease and may also play a role in the natural history of asthma, including exacerbations. The lack of a gold standard for diagnosis of these pathogens still handicaps the current understanding of their true prevalence and role in the pathogenesis of acute and chronic respiratory infections.While molecular diagnostic techniques, such as polymerase chain reaction, offer improvements in sensitivity, specificity and rapidity over culture and serology, the need remains for a consistent and reproducible diagnostic technique, available to all microbiology laboratories.Current treatment guidelines for community-acquired pneumonia recognise the importance of atypical respiratory pathogens in its aetiology, for which macrolides are considered suitable first-line agents. The value of atypical coverage in antibiotic therapy for acute exacerbations of chronic bronchitis and exacerbations of asthma is less clear, while there is no evidence to suggest that atypical pathogens should be covered in antibiotic treatment of upper respiratory-tract infections. The term "atypical pathogen" most commonly refers to Chlamydia pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila. Once believed to be of little clinical significance, a wealth of data accumulated over the past decade suggests that these are important respiratory pathogens in a wide range of respiratory-tract infections (RTIs) and are capable of causing severe, as well as mild-to-moderate, illness.Although the role of atypical pathogens [1], and of C. pneumoniae in particular [2], has been reviewed previously, there has been little focus on appropriate coverage of these pathogens in treatment decisions for patients with RTIs. In addressing this issue, this review examines the role of atypical pathogens in the aetiology of upper and lower RTIs, in both adults and children, and discusses the value of appropriate coverage of these pathogens in empirical antibiotic prescribing.

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Section: Exacerbationsmentioning

confidence: 66%

Atypical pathogens and respiratory tract infections

Blasi¹

2004

European Respiratory Journal

109

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“…Most respiratory infections caused by C. pneumoniae are mild or asymptomatic. Many studies have suggested a possible association of C. pneumoniae infection and acute exacerbations of asthma and chronic obstructive pulmonary disease (14,15,19,26,30). Seroepidemiological studies showing antibody prevalence rates in a range of 50 to 70% suggest that C. pneumoniae is widely distributed and that nearly everybody is infected with the agent at some time (15,19,24).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Five PCR Assays for Detecting Chlamydophila pneumoniae DNA

Fukano

2004

Microbiology and Immunology

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We compared five different polymerase chain reaction (PCR) assays for the detection of Chlamydophila pneumoniae DNA using highly purified elementary bodies (EBs) and peripheral blood mononuclear cells (PBMCs) from healthy blood donors. The primers were as follows; two targeting the 16S rRNA gene, one targeting the ompA gene, one targeting the Pst‐I gene, and one targeting the 53 kDa outer membrane protein gene. The 16S rRNA touchdown enzyme time release (TETR) PCR, the ompA nested PCR and the 53 kDa nested PCR were the most sensitive assays and could detect one or more EB per assay. These three PCRs also had the same reproducibility, but the minimal amount of C. pneumoniae that could be reproducibly detected (10 of 10 testing positive) was 20 EBs. In a sample of specimens from healthy blood donors, we found 5 of 77 (6.5%) PBMCs specimens to have C. pneumoniae DNA according to the nested ompA PCR. Specimens with the 16S rRNA TETR and 53 kDa nested assays were found to have C. pneumoniae DNA 7 of 77 (9.1%) and 18 of 77 (23.4%) specimens, respectively. The other two assays failed to detect even a single positive. However, the detection rate decreased with repeated testing of the same samples. Our newly designed 53 kDa nested PCR may be as useful as the other four recommended PCR assays and may be a more useful assay for the detection of C. pneumoniae DNA from PBMCs.

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“…24 Because the Solomon Islands are a region that is highly endemic for malaria, 25 respiratory diseases, and viral infections, 26 recurrent C. pneumonae infections might also occur there frequently. High prevalence rates of IgA have been observed in chronic pulmonary diseases, 27,28 such as in the acute exacerbation of bronchial asthma, [29][30][31] suggesting a relationship with persistent respiratory disease. Wang and Grayston 18 reported the prevalence of IgG determined by the MIF method to be 15% in the Solomon Islands in a small number of serum samples collected in 1966.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of antibody to Chlamydia pneumoniae in residents of Japan, the Solomon Islands, and Nepal.

Shimizu

Nabeshima

Kikuchi

et al. 2002

The American Journal of Tropical Medicine and Hygiene

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Abstract. Sera of 4,050 residents from Japan, 276 from the Solomon Islands, and 602 from Nepal were tested by an enzyme-linked immunosorbent assay to determine the prevalence of antibody to Chlamydia pneumoniae. The prevalence of IgG and IgA antibodies was significantly higher in the Solomon Islands (64.9% and 82.2%) and Nepal (73.1%, and 69.8%) than in Japan (53.6% and 41.1%). These prevalence rates increased throughout the teenage years in the Solomon Islands and Japan and leveled off with age, whereas in Nepal the prevalence rates gradually increased with age. The prevalence of a high (> 3.0) IgA antibody index, which is suggestive of acute infection, was significantly higher in the Solomon Islands (34.8%) than in Japan (3.2%) and Nepal (10.5%). The prevalence of IgG antibody ranged from 46.4% to 67.7%, and the prevalence of IgA antibody ranged from 33.7% to 61.8% in the four difference areas of Japan. These findings indicate considerable differences in the prevalence of antibodies to C. pneumoniae by age in these nations and between the regions of Japan tested.

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Chlamydia pneumoniae and Exacerbations of Asthma in Adults

Abstract: Our data suggest that C. pneumoniae infection may trigger acute exacerbations of adult asthma.

Cited by 85 publications

References 21 publications

Atypical pathogens and respiratory tract infections

Atypical pathogens and respiratory tract infections

Comparison of Five PCR Assays for Detecting Chlamydophila pneumoniae DNA

Prevalence of antibody to Chlamydia pneumoniae in residents of Japan, the Solomon Islands, and Nepal.

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