Prospective Study of Respiratory Infections at the U.S. Naval Academy

Gray, Gregory C.; Schultz, Robert G.; Gackstetter, Gary D.; McKeehan, Jamie A.; Aldridge, Kathleen V.; Hudspeth, Marie K.; Malasig, Marietta D.; Fuller, Julie; McBride, Wayne Z.

doi:10.21236/ada408913

Cited by 6 publications

(3 citation statements)

References 1 publication

(1 reference statement)

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“…All laboratory personnel were blind to treatment groups. With the exceptions of blood cultures, blood counts, and sputum studies, respiratory infection work was conducted at the Navy Respiratory Disease Laboratory of the Naval Health Research Center in San Diego [9], as described elsewhere [10,11]. In brief, the testing included enrollment and 2-week-postenrollment pharyngeal cultures, for Streptococcus pyogenes and Streptococcus pneumoniae carriage, and acute respiratory infection viral and bacterial etiology studies, by culture, serological testing, and PCR tests.…”

Section: Study Populationmentioning

confidence: 99%

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Randomized, Placebo‐Controlled Clinical Trial of Oral Azithromycin Prophylaxis against Respiratory Infections in a High‐Risk, Young Adult Population

Gray¹,

Witucki²,

Gould³

et al. 2001

CLIN INFECT DIS

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Military Special Forces trainees undergo intense psychological and physical stressors that often lead to respiratory infection. During 1998-2000, 477 Navy Special Forces trainees were enrolled in a double-blind trial of oral azithromycin (1 g given weekly) plus a placebo injection, compared with benzathine penicillin G (1.2 million U) plus azithromycin placebo tablets. Among the 464 subjects with complete data, 44 developed acute respiratory infection (20 with pneumonia) during the 2 weeks of most intense training; of these subjects, 12 (27.3%) had evidence of Chlamydia pneumoniae infection and 7 (15.9%) had evidence of Mycoplasma pneumoniae infection. Trainees who received azithromycin were less likely than were trainees who received benzathine penicillin G to develop acute respiratory infection (risk ratio, 0.50; 95% confidence interval [CI], 0.28-0.92) and less likely at the end of training to report episodes of breathing difficulty (odds ratio [OR], 0.59; 95% CI, 0.34-1.01) or sore throat (OR, 0.66; 95% CI, 0.41-1.05). Compared with benzathine penicillin G prophylaxis, weekly oral azithromycin was superior in preventing respiratory infection in this population at transient high risk.

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Section: Study Populationmentioning

confidence: 99%

“…Methods are described elsewhere[10]. A 4-dilution rise in titer (IgG or IgM) or change in IgM from negative to positive was considered evidence of infection[10].c Because of small cell counts, data are OR (95% CI) determined with exact technique[12].…”

mentioning

confidence: 99%

Randomized, Placebo‐Controlled Clinical Trial of Oral Azithromycin Prophylaxis against Respiratory Infections in a High‐Risk, Young Adult Population

Gray¹,

Witucki²,

Gould³

et al. 2001

CLIN INFECT DIS

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“…This is a shorter period than expected for an IgM antibody response [14]. This may be due in part to the conscripts’ and the doctors’ difficulties in distinguishing C. pneumoniae infection from the many other respiratory infections often occurring in military camps [25]. The time of onset of illness is uncertain under such circumstances.…”

Section: Discussionmentioning

confidence: 99%

Chlamydophila pneumoniae diagnostics: importance of methodology in relation to timing of sampling

Hvidsten

Halvorsen

Berdal

et al. 2009

Clinical Microbiology and Infection

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The diagnostic impact of PCR-based detection was compared to single-serum IgM antibody measurement and IgG antibody seroconversion during an outbreak of Chlamydophila pneumoniae in a military community. Nasopharyngeal swabs for PCR-based detection, and serum, were obtained from 127 conscripts during the outbreak. Serum, drawn many months before the outbreak, provided the baseline antibody status. C. pneumoniae IgM and IgG antibodies were assayed using microimmunofluorescence (MIF), enzyme immunoassay (EIA) and recombinant ELISA (rELISA). Two reference standard tests were applied: (i) C. pneumoniae PCR; and (ii) assay of C. pneumoniae IgM antibodies, defined as positive if >or=2 IgM antibody assays (i.e. rELISA with MIF and/or EIA) were positive. In 33 subjects, of whom two tested negative according to IgM antibody assays and IgG seroconversion, C. pneumoniae DNA was detected by PCR. The sensitivities were 79%, 85%, 88% and 68%, respectively, and the specificities were 86%, 84%, 78% and 93%, respectively, for MIF IgM, EIA IgM, rELISA IgM and PCR. In two subjects, acute infection was diagnosed on the basis of IgG antibody seroconversion alone. The sensitivity of PCR detection was lower than that of any IgM antibody assay. This may be explained by the late sampling, or clearance of the organism following antibiotic treatment. The results of assay evaluation studies are affected not only by the choice of reference standard tests, but also by the timing of sampling for the different test principles used. On the basis of these findings, a combination of nasopharyngeal swabbing for PCR detection and specific single-serum IgM measurement is recommended in cases of acute respiratory C. pneumoniae infection.

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