Serologic evidence of a sporadic outbreak in Illinois of infection by Chlamydia (psittacosis-LGV agent) in patients with primary myocardial disease and respiratory disease

Current knowledge on Chlamydia pneumoniae, strain TWAR, an important cause of pneumonia and other acute respiratory diseases

This article reviews current knowledge of Chlamydia pneumoniae strain TWAR, a newly recognized Chlamydia organism that causes acute respiratory infection, especially atypical pneumonia. Information is included on the microbiology, classification and laboratory diagnosis of the organism. Details of a series of studies of both endemic and epidemic respiratory infections are reviewed to present information on both the clinical and epidemiological characteristics of infection with strain TWAR. Laboratory studies of antibiotic sensitivity and recommendations for treatment are presented.

Serological evidence of an association of a novel Chlamydia, TWAR, with chronic coronary heart disease and acute myocardial infarction

Paired sera from 40 male patients with acute myocardial infarction (AMI), 30 male patients with chronic coronary heart disease (CCHD), and 41 controls, matched for sex, age, time, and locality were investigated for antibodies to a novel type of Chlamydia sp, TWAR, and to chlamydial lipopolysaccharide (LPS) group antigen. 27 patients with AMI (68%), and 15 (50%) patients with CCHD had raised IgG (greater than or equal to 128) and/or IgA (greater than or equal to 32) titres in the microimmunofluorescence test with chlamydia TWAR. Both frequencies were significantly higher than in the controls (7, 17%). 26 (68%) of 38 patients with AMI also showed a significant seroconversion in enzyme immunoassay with LPS antigen; this response was absent in all patients with CCHD and all but 1 of the controls. Chronic chlamydial infection could be a factor in the pathogenesis of cardiovascular diseases.

Possible role of prostaglandins in the pathogenesis of cardiomyopathies

Alcohol, adriamycin, viruses and excess deposition of iron in the heart are known to induce cardiomyopathy. Altered immune response in the form of defective T cell function, overactive anti-body-producing B lymphocytes and circulating anti-heart antibodies; increased fibrous tissue in the heart, with a tendency to develop mural thrombi, arrhythmias and cardiac failure are some of the important features observed in these cases. Prostaglandins can modify immune response, regulate fibrous tissue and collagen biosynthesis, are believed to be involved in the pathogenesis of cardiac arrhythmias and failure. Ethanol, adriamycin, viruses and iron are known to alter prostaglandin(PG) synthesis. The altered PG function may play a major role in cardiomyopathy.

Natural course of peripartum cardiomyopathy

Twenty-seven patients presented in the puerperium with cardiomegaly, abnormal `ECG, and congestive cardiac failure and were considered to have peripartum cardiomyopathy (PPCM). The incidence of PPCM was significantly higher in women over 30 years of age, in women in their third or subsequent pregnancy, and in the presence of twins or toxemia. Within 6 months, 14 patients had normal sized hearts (group A), and 13 patients maintained cardiomegaly (group B).

The 14 patients in group A have been followed for 3 to 21 years (average 10.7 years). Two have died of unrelated causes. Of the remaining 12, eight are functional class I and four are functional class II. Eight patients had 21 subsequent pregnancies, with no permanent deterioration of cardiac function. Of 13 patients in group B, 11 (85%) have died of congestive cardiac failure. Their average survival was 4.7 years; six of 11 were dead in 3 years. Their clinical course was punctuated by repeated admissions for congestive cardiac failure. Six had pulmonary emboli, one had a systemic embolus, and three of six patients with subsequent pregnancies deteriorated in the puerperium. Of the two surviving patients, one is functional class I and the other is functional class II.

Therefore, in those patients in whom cardiomegaly persisted, the prognosis was poor, and subsequent pregnancies were likely to lead to permanent deterioration. In those in whom the heart size returned to normal the prognosis was excellent.