Chronic respiratory disease in premature infants caused by Chlamydia trachomatis.

Abstract

SUMMARYThe relation between chronic respiratory disease and infection with Chlamydia trachomatis in premature infants was investigated to ascertain the aetiological importance of intrauterine C trachomatis infection and chronic respiratory disease in premature infants. Serum IgM antibodies against C trachomatis were-determined by enzyme linked fluorescence assay. Sections of lung tissues obtained by biopsy and at necropsy were also tested for the presence of antigens using fluorescein conjugated monoclonal antibodies to C trachomatis. Of 16 sera from premature infants with chronic respiratory diseases clinically diagnosed as bronchopulmonary dysplasia or the Wilson-Mikity syndrome, five had IgM antibodies to C trachomatis L2 strain by enzyme linked fluorescence assay (titre > 1/500). Of 37 sera from premature infants with extremely low birth weights, two had IgM antibodies to C trachomatis. No specific IgM antibody was detected in 31 neonates who showed raised serum IgM concentrations but who did not have respiratory tract symptoms. C trachomatis was identified from two specimens of lung tissue obtained at necropsy from premature infants with chronic respiratory disease positive for IgM antibody.These findings indicate the aetiological importance of intrauterine C trachomatis infection in chronic respiratory disease in premature infants.

Occurrence of Chlamydia trachomatis and Chlamydia pneumoniae in paediatric respiratory infections

“…These findings agree with previously published data, suggesting that Ct can be found in the lower respiratory tract of newborns and can lead to pneumonitis [12,15,21]. Evidence for the presence of Ct in the human placental tissue also exists [40][41][42].…”

Chlamydia trachomatis Infections in Neonates

“…Chlamydial etiology was proven in preterm infants suffering from severe acute respiratory distress within the first day of life, requiring mechanical ventillation and supplemental oxygen (Colarizi et al, 1996). It was documented being associated with chronic respiratory disease in premature infants as well, while the presence of specific IgM suggested intrauterine infections during late pregnancy (Mårdh, 2002;Numazaki et al, 1986Numazaki et al, , 2003. Since it occasionally has a serious impact on the fetus, prenatal C. trachomatis infection should be prevented by comprehensive screening programs during pregnancy.…”

“…C. trachomatis infection has been associated with seriously chronic, occasionally lethal forms of pulmonary disorders of ventilated preterm neonates. Despite the occasional presence and specific antibody response its etiologic role in bronchopulmonary dysplasia (BPD) has however not yet been confirmed (Attenburrow & Barker, 1986;López-Hurtado et al, 1999;Numazaki et al, 1986;Zar, 2005).…”

“…In such cases as these IgM antibody titers in serum generally rise quickly after birth and approach maximal titers approximately by the second week of life and may persist for up to 3 months (Mahony et al, 1986). The intrauterin transmission of the pathogen has revealed that not only common serum samples taken postnatally but even cord blood samples of infected infants may contain specific IgM (Gencay et al, 2001;Numazaki et al, 1986). …”

Evaluation of Diagnostic Assays for Neonatal and Infantile Chlamydial Infections.

“…A variety of organisms including Chlamydia have been implicated as the causative agents in premature delivery, chronic lung diseases (CLD) of preterm infants such as brochopulmonary dysplasia (BPD) or Wilson-Mikity syndrome (WMS) and premature rupture of membrane (PROM) (Harrison et al 1983; Rudd et al 1984; Numazaki et al 1986aNumazaki et al , 1989Berman et al 1987;Sawyer et al 1987; Sanchez and Regan 1988;Hammerschlag 1989). Moreover, the fact that neonates having the typical symptoms of WMS also manifest greatly elevated serum IgM levels suggests that OLD of this syndrome might arise from intrauterine infection (Fujimura et al 1983; Numazaki et al 1986b …”