Abstract
Background
Chlamydia pneumoniae is a frequent causative agent of acute respiratory disease and has been recently reported as a possible case of asthma.
Objective
We assessed the prevalence of C. pneumoniae infections in adult patients with acute exacerbations of asthma.
Methods
One hundred sixty-eight adult patients with acute exacerbations of asthma and 108 control subjects matched for age, sex, and smoking status were studied. Nasopharyngeal swab specimens were obtained from all subjects and analyzed by isolation in cell culture and polymerase chain reaction (PCR) test for C. pneumoniae. Serum samples were also obtained and tested for C. pneumoniae-specific antibodies by the microimmunofluorescence test.
Results
C. pneumoniae was isolated from two (1.2%) asthma patients and none from controls and detected by PCR from nine (5.4%) cases and one (0.9%) control. Both culture positive specimens were also positive in PCR. Further, serologic evidence of acute C. pneumoniae infection was present in 15 (8.9%) of asthma patients and in three (2.8%) of controls (P = .048). The prevalence of C. pneumoniae-specific IgG and IgA was significantly higher in asthma cases than in controls (IgG >/= 1:16; 85.1% versus 67.6%, P = .001; IgA ≥ 1:16: 47.6% versus 16.7%, P < .001). Mean titer of IgG and IgA was also significantly greater in asthma cases than in controls (IgG: 38.8 versus 18.1, P = .0001; IgA: 17.2 versus 6.1, P = .0001).
Conclusion
Our data suggest that C. pneumoniae infection may trigger acute exacerbations of adult asthma.
REFERENCES
- 1.McIntosh K, Ellis EF, Hoffman LS. The association of viral and bacterial respiratory infections with exacerbations of wheezing in young asthmatic children. Pediatrics. 1973;82:578–590. doi: 10.1016/S0022-3476(73)80582-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Minor TE, Dick EC, DeMeo AN. Viruses as precipitants of asthmatic attacks in children. JAMA. 1974;227:292–298. [PubMed] [Google Scholar]
- 3.Huhti E, Mokka T, Nikoskelainen J, Halonen P. Association of viral and mycoplasma infections with exacerbations of asthma. Ann Allergy. 1974;33:145–149. [PubMed] [Google Scholar]
- 4.Beasley R, Coleman ED, Hermon Y. Viral respiratory tract infection and exacerbations of asthma in adult patients. Thorax. 1988;43:679–683. doi: 10.1136/thx.43.9.679. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Nicholson KG, Kent J, Ireland DC. Respiratory viruses and exacerbations of asthma in adults. BMJ. 1993;307:982–986. doi: 10.1136/bmj.307.6910.982. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Seggev JS, Lis I, Siman-Tov R. Mycoplasma pneumoniae is a frequent cause of exacerbation of bronchial asthma in adults. Ann Allergy. 1986;57:263–265. [PubMed] [Google Scholar]
- 7.Gil JC, Cedillo RL, Mayagoitia BG, Paz MD. Isolation of Mycoplasma pneumoniae from asthmatic patients. Ann Allergy. 1993;70:23–25. [PubMed] [Google Scholar]
- 8.Grayston JT, Campbell LA, Kuo C-C. A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR. J Infect Dis. 1990;161:618–625. doi: 10.1093/infdis/161.4.618. [DOI] [PubMed] [Google Scholar]
- 9.Grayston JT. Chlamydia pneumoniae, strain TWAR. Chest. 1989;95:664–669. doi: 10.1378/chest.95.3.664. [DOI] [PubMed] [Google Scholar]
- 10.Hahn DL, Dodge RW, Golubjatnikov R. Association of Chlamydia pneumoniae (strain TWAR) infection with wheezing, asthmatic bronchitis, and adult-onset asthma. JAMA. 1991;266:225–230. [PubMed] [Google Scholar]
- 11.Hahn DL, Golubjatnikov R. Asthma and chlamydial infection: a case series. J Family Pract. 1994;38:589–595. [PubMed] [Google Scholar]
- 12.Emre U, Roblin PM, Gelling M. The association of Chlamydia pneumoniae infection and reactive airway disease in children. Arch Pediatr Adolesc Med. 1994;148:727–732. doi: 10.1001/archpedi.1994.02170070065013. [DOI] [PubMed] [Google Scholar]
- 13.American Thoracic Society Definitions and classification of chronic bronchitis, asthma, and pulmonary emphysema. Am Rev Respir Dis. 1962;85:762–768. [Google Scholar]
- 14.Miyashita N, Matsumoto A, Soejima R. Evaluation of a direct fluorescent antibody assay for detection of Chlamydia pneumoniae. Jpn J Assoc Infect Dis. 1996;70:224–231. doi: 10.11150/kansenshogakuzasshi1970.70.224. [DOI] [PubMed] [Google Scholar]
- 15.Iijima Y, Miyashita N, Kishimoto T. Characterization of Chlamydia pneumoniae species-specific proteins immunodominant in humans. J Clin Microbiol. 1994;32:583–588. doi: 10.1128/jcm.32.3.583-588.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Kubota Y. A new primer pair for detection of Chlamydia pneumoniae by polymerase chain reaction. Microbiol Immunol. 1996;40:27–32. doi: 10.1111/j.1348-0421.1996.tb03313.x. [DOI] [PubMed] [Google Scholar]
- 17.Miyashita N, Kubota Y, Kimura M. Characterization of Chlamydia pneumoniae strain isolated from a 57-year-old man. Microbiol Immunol. 1994;38:857–864. doi: 10.1111/j.1348-0421.1994.tb02138.x. [DOI] [PubMed] [Google Scholar]
- 18.Wang S-P, Grayston JT, Kuo C-C. Serodiagnosis of Chlamydia trachomatis infection with the micro-immunofluorescence test. In: Hobson D, Holmes KK, editors. Nongonococcal urethritis and related infections. American Society for Microbiology; Washington DC: 1977. pp. 237–248. [Google Scholar]
- 19.Jauhiainen T, Tuomi T, Leinonen M. Interference of immunoglobulin G (IgG) antibodies in IgA antibody determinations for Chlamydia pneumoniae by microimmunofluorescence test. J Clin Microbiol. 1994;32:839–840. doi: 10.1128/jcm.32.3.839-840.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Grayston JT, Wang S-P, Kuo C-C. Current knowledge on Chlamydia pneumoniae, strain TWAR, an important cause of pneumonia and other acute respiratory diseases. Eur J Clin Microbiol Infect Dis. 1989;8:191–202. doi: 10.1007/BF01965260. [DOI] [PubMed] [Google Scholar]
- 21.Tomasi TB, Grey HM. Structure and function of immunoglobulin A. Progr Allergy. 1972;16:81–213. [PubMed] [Google Scholar]
- 22.Sarov I, Insler V, Sarov B. Specific serum IgA antibodies in the diagnosis of active viral and chlamydial infections. Proceedings of the European Symposium on New Horizons in Microbiology, Facolta di Medicina e Chirurgia A. Gemelli, Universita Cattolica del Sacro Cuore, Rome, Italy. Elsevier Science Publishers; Amsterdam: 1984. pp. 157–167. [Google Scholar]
- 23.Ekman M-R, Grayston JT, Visakorpi R. An epidemmic of infections due to Chlamydia pneumoniae in military conscripts. Clin Infect Dis. 1993;17:420–425. doi: 10.1093/clinids/17.3.420. [DOI] [PubMed] [Google Scholar]
- 24.von Hertzen L, Leinonen M, Surcel HM. Measurement of sputum antibodies in the diagnosis of acute and chronic respiratory infections associated with Chlamydia pneumoniae. Clin Diagn Lab Immunol. 1995;2:454–457. doi: 10.1128/cdli.2.4.454-457.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Hahn DL, Anttila T, Saikku P. Association of Chlamydia pneumoniae IgA antibodies with recently symptomatic asthma. Epidemiol Infect. 1996;117:513–517. doi: 10.1017/s0950268800059197. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Tattersfield AE. The site of the defect in asthma: neurohumoral, mediator or smooth muscle? Chest. 1987;91(Suppl):184S–188S. doi: 10.1378/chest.91.6_supplement.184s. [DOI] [PubMed] [Google Scholar]
- 27.Busse WW. The relationship between viral infections and onset of allergic diseases and asthma. Clin Exp Allergy. 1989;19:1–9. doi: 10.1111/j.1365-2222.1989.tb02336.x. [DOI] [PubMed] [Google Scholar]
- 28.Morrison RP, Lyng K, Caldwell HD. Chlamydial disease pathogenesis: ocular hypersensitivity elicited by a genus-specific 57-KDa protein. J Exp Med. 1989;169:663–675. doi: 10.1084/jem.169.3.663. [DOI] [PMC free article] [PubMed] [Google Scholar]