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Paniagua R, Frías Y, De Jesús Ventura M, Rodríguez E, Hurtado ME, Alcántara G, Vázquez R, Ortiz R, Salcedo M, Rios ME, Kaji J, Amato D. C-Reactive Protein and Anti-Chlamydia Pneumoniae Antibodies as Risk Factors of Cardiovascular Death in Incident Patients on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686080302300207] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective Recently it has been pointed out that inflammation and infections caused by germs such as Chlamydia pneumoniae are independent cardiovascular risk factors for the general population, but information about these relationships in dialysis patients is scarce. This work was done to analyze the association of C-reactive protein (CRP) and IgG anti- Chlamydia pneumoniae antibodies (anti-Chlp-IgG) as independent cardiovascular risk factors in incident patients on continuous ambulatory peritoneal dialysis (CAPD). Design Single-cohort, prospective observational study. Setting Three CAPD centers from the Instituto Mexicano del Seguro Social, and one from the Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico. Patients A cohort of 75 adult incident patients on CAPD, without clinical signs of congestive heart failure, coronary heart disease, or peripheral arterial insufficiency. No restrictions for age, gender, or cause of renal failure were applied. Primary Outcome Mortality. Methods Demographic variables, body composition by electrical bioimpedance, serum glucose, urea, creatinine, lipids, homocysteine, nutritional markers (albumin, prealbumin, and transferrin), CRP, and anti-Chlp-IgG were measured and registered at the time of the first admission. When a patient died, the cause of death was determined by review of the clinical chart. Results Mean follow-up time was 10.25 patient-months. There were 14 cardiovascular deaths. CRP was positive (> 10 mg/L) in 64% of the patients, and anti-Chlp-IgG in 64%; 29% of the patients were positive for both markers. The relative risk for cardiovascular mortality was 6.23 for patients positive for either CRP or anti-Chlp-IgG, and increased to 9.52 when both markers were positive. Multivariate analysis revealed that CRP and anti-Chlp-IgG were stronger cardiovascular death predictors than age, diabetes, and nutritional status. Conclusion These data suggest that inflammation and the presence of Chlamydia pneumoniae infections are important predictors of cardiovascular death in patients on CAPD.
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Affiliation(s)
- Ramón Paniagua
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | - Yolanda Frías
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | - Maria De Jesús Ventura
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | - Ernesto Rodríguez
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
| | | | | | - Roberto Vázquez
- Hospital General de Zona IMSS, Juárez, Chihuahua, Mexico City, México
| | - Ruth Ortiz
- Hospital General de Zona IMSS, Juárez, Chihuahua, Mexico City, México
| | - Mario Salcedo
- Hospital General de Zona IMSS, Durango, Durango, Mexico City, México
| | - Maria Elena Rios
- Hospital General de Zona IMSS, Durango, Durango, Mexico City, México
| | - Julio Kaji
- Hospital Regional 1° de Octubre, ISSSTE, Mexico City, México
| | - Dante Amato
- Unidad de Investigación Médica en Enfermedades Nefrológicas, Hospital de Especialidades CMN S-XXI IMSS, Mexico City, México
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Prevalence of Chlamydophila pneumoniae in patients with pneumonia in the main university hospital in Alexandria. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2012. [DOI: 10.1016/j.ejcdt.2012.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Rizzo A, Paolillo R, Iafusco D, Prisco F, Romano Carratelli C. Chlamydia pneumoniae infection in adolescents with type 1 diabetes mellitus. J Med Microbiol 2012; 61:1584-1590. [PMID: 22859582 DOI: 10.1099/jmm.0.048512-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chlamydia pneumoniae, an intracellular bacterium, is associated with respiratory diseases, reinfectivity and chronic diseases such as cardiovascular disease, hypertension and stroke. The risk of infection is higher and infections are a serious clinical problem in patients with type 1 (insulin-dependent) diabetes mellitus (T1DM). Although diabetes mellitus and hyperglycaemia are considered possible risk factors for various types of aetiological agents, the epidemiological evidence concerning C. pneumoniae infection is scanty. The aim of the present study was to evaluate the impact of glycosylated haemoglobin (HbA1c) levels, an indicator of a hyperglycaemic state, on C. pneumoniae infection and disease chronicity; in addition we compared the duration of diabetes with the occurrence of C. pneumoniae infection. C. pneumoniae blood real time PCR and serology (IgG, IgA and IgM) assays by an ELISA method were performed. C. pneumoniae DNA was detected in 46.5 % [95 % confidence interval (CI) = 35.1-57.9 %] of the patients with T1DM; this prevalence is higher (P<0.05) than in non-diabetic paediatric controls, 10.5 % (95 % CI = 3.6-17.4 %). IgG/IgA C. pneumoniae antibody positivity was significantly (P≤0.05) more common in patients in poor metabolic control (HbA1c >9 %) versus patients in good metabolic control (HbA1c <7 %), suggesting that the metabolic control of the disease is compromised in the patients with T1DM. In conclusion, adolescents with T1DM were more likely to show signs of infection with C. pneumoniae compared with healthy adolescents and the results suggest an increased risk of progressing from an acute C. pneumoniae infection to a chronic form.
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Affiliation(s)
- Antonietta Rizzo
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, Faculty of Medicine and Surgery, Second University of Naples, Naples, Italy
| | - Rossella Paolillo
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, Faculty of Medicine and Surgery, Second University of Naples, Naples, Italy
| | - Dario Iafusco
- Department of Pediatrics, Second University, Naples, Italy
| | | | - Caterina Romano Carratelli
- Department of Experimental Medicine, Section of Microbiology and Clinical Microbiology, Faculty of Medicine and Surgery, Second University of Naples, Naples, Italy
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Yamaguchi H, Oshio I, Osaki T, Kurata S, Yamamoto Y, Kamiya S. Development of diabetes in non-obese diabetic mice promotes Chlamydia pneumoniae dissemination from lung to peripheral blood. Int J Exp Pathol 2006; 87:121-9. [PMID: 16623756 PMCID: PMC2517359 DOI: 10.1111/j.0959-9673.2006.00468.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We examined a possible association between development of diabetes in non-obese diabetic (NOD) mice and dissemination of Chlamydia (Chlamydophila) pneumoniae from lung to peripheral blood. By real-time reverse transcription-polymerase chain reaction (RT-PCR) with primers for C. pneumoniae 16S rRNA, following multiple intranasal inoculations, we detected bacteria in lung in NOD mice with diabetes (38.5%) as well as Institute of Cancer Research, USA (ICR) mice (40%), but prevalence of bacteria in NOD mice without diabetes (pre-diabetic NOD mice and non-diabetic retired NOD mice) was very low (4.8%). The bacteria were only detected in peripheral blood mononuclear cells (PBMCs) cultured with hydrocortisone of the NOD mice with diabetes (53.8%). Results of immunostaining with fluorescein isothiocyanate-conjugated antichlamydia monoclonal antibody also showed the presence of bacterial antigens in the lungs and the PBMCs judged as positive by the RT-PCR. However, C. pneumoniae from cultured PBMCs of all NOD mice was undetected by cultivation method with inclusion-forming units assay. In addition, no influence of C. pneumoniae intranasal inoculation on development of diabetes in NOD mice was confirmed. Thus, the development of diabetes in NOD mouse appears to be one of critical factors for promoting the dissemination of C. pneumoniae from lung to peripheral blood.
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MESH Headings
- Animals
- Antibodies, Bacterial/immunology
- Antibodies, Monoclonal/immunology
- Antigens, Bacterial/analysis
- Cells, Cultured
- Chlamydophila Infections/blood
- Chlamydophila Infections/immunology
- Chlamydophila Infections/microbiology
- Chlamydophila pneumoniae
- Diabetes Mellitus, Experimental/blood
- Diabetes Mellitus, Experimental/immunology
- Diabetes Mellitus, Experimental/microbiology
- Disease Susceptibility
- Fluorescent Antibody Technique/methods
- Interferon-gamma/analysis
- Leukocytes, Mononuclear/microbiology
- Lung/immunology
- Lung/microbiology
- Mice
- Mice, Inbred ICR
- Mice, Inbred NOD
- Reverse Transcriptase Polymerase Chain Reaction/methods
- Tumor Necrosis Factor-alpha/analysis
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Affiliation(s)
- Hiroyuki Yamaguchi
- Department of Basic Laboratory Sciences, Osaka University Graduate School of Medicine, Osaka, Japan.
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Ikejima H, Friedman H, Leparc GF, Yamamoto Y. Depletion of resident Chlamydia pneumoniae through leukoreduction by filtration of blood for transfusion. J Clin Microbiol 2005; 43:4580-4. [PMID: 16145110 PMCID: PMC1234142 DOI: 10.1128/jcm.43.9.4580-4584.2005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Current studies indicate that a significant percentage of healthy blood donors carry Chlamydia pneumoniae in their blood. Although the clinical significance of such findings is unknown, eradication of such bacteria from blood components may contribute to transfusion safety. Deletion of C. pneumoniae in Red Blood Cell (RBC) units was accomplished through leukoreduction by filtration. The presence of bacteria in RBC units before and after leukoreduction was assessed by real-time PCR using primers specific for C. pneumoniae 16S rRNA. The eluates of filters used for leukoreduction were also assessed by PCR and immunostaining with fluorescein isothiocyanate-conjugated chlamydial monoclonal antibodies specific for C. pneumoniae determination. Nineteen of 30 RBC units tested showed the presence of C. pneumoniae DNA. Leukofiltration resulted in a marked reduction of leukocytes as well as C. pneumoniae in terms of bacterial number and positive rate for the bacteria. The eluates of filters showed trapped bacteria determined by both PCR and immunostaining assays. Thus, leukoreduction with a filter is an effective method to significantly reduce resident C. pneumoniae levels in RBC components but may not be completely sufficient for total eradication of this pathogen.
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Affiliation(s)
- Hideaki Ikejima
- Department of Medical Microbiology and Immunology, University of South Florida College of Medicine, Tampa, 33612, USA
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Sessa R, Di Pietro M, Ratanarat R, Rassu M, Ronco C. Chlamydia pneumoniae as risk factor of cardiovascular disease in dialysis patients. Int J Artif Organs 2005; 28:3-7. [PMID: 15742303 DOI: 10.1177/039139880502800102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tsirpanlis G. Chlamydia pneumoniae and Atherosclerosis: No Way-Out or Long Way? Kidney Blood Press Res 2004; 27:134-42. [PMID: 15114030 DOI: 10.1159/000078146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Recently, Chlamydia pneumoniae is the microorganism frequently implicated in the infection-based inflammatory atherogenous hypothesis. Although in vitro experimental data and initial sero-epidemiologic, pathology-based studies and antibiotic trials supported this interesting hypothesis, later data are conflicting. Some confounding factors are the causes of uncertainty; lacking of standard methods for C. pneumoniae detection, co-existence of other atherosclerotic risk factors and anti-inflammatory effects of antibiotics used in clinical trials seem to be the principal ones. Standardization of methodology used, antibiotic trials with a different orientation-design and a vaccine preparation that eventually will be tested in clinical trials with a long follow-up, should provide a definite answer regarding the probability C. pneumoniae to be a main, a secondary or an irrelevant factor to atherosclerosis. Studies linking C. pneumoniae to inflammation and accelerated atherosclerosis in renal failure patients are accumulated but limitations are similar to the above mentioned.
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Yamaguchi H, Friedman H, Yamamoto M, Yasuda K, Yamamoto Y. Chlamydia pneumoniae resists antibiotics in lymphocytes. Antimicrob Agents Chemother 2003; 47:1972-5. [PMID: 12760877 PMCID: PMC155834 DOI: 10.1128/aac.47.6.1972-1975.2003] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Chlamydia pneumoniae infection of lymphocytes in blood has been well documented, and it is apparent that control of this pathogen in these cells may be critical in the development of chronic inflammatory diseases associated with infection by this bacterium. The activity of antibiotics against C. pneumoniae in lymphocytes was assessed in this study by utilizing an in vitro infection model with lymphoid cells. The results obtained indicated that although all of the antibiotics tested showed remarkable activity against bacterial growth in epithelial cells, C. pneumoniae in lymphocytes was less susceptible to antibiotics than was bacterial growth in epithelial cells, which are widely used for the evaluation of anti-C. pneumoniae antibiotics.
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Affiliation(s)
- Hiroyuki Yamaguchi
- Department of Medical Microbiology and Immunology, College of Medicine, University of South Florida, Tampa, Florida 33612, USA
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Vainio K, Vengen O, Hoel T, Fremstad H, Anestad G. Failure to detect Chlamydia pneumoniae in aortic valves and peripheral blood mononuclear cells from patients undergoing aortic valve replacement in Norway. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 2003; 34:660-3. [PMID: 12374356 DOI: 10.1080/00365540210147796] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The association of Chlamydia pneumoniae with atherosclerosis is still controversial. Reports from different laboratories have varied widely and "gold standards" for the detection of C. pneumoniae are lacking. In the present study, aortic valves and peripheral blood mononuclear cells from 48 patients undergoing aortic valve replacement were examined for the presence of C. pneumoniae using a nested PCR. C. pneumoniae-specific DNA was not detected in any of the clinical samples. No PCR inhibition was observed by spiking the samples with target C. pneumoniae. A total of 31/46 patients (67%) were seropositive for C. pneumoniae IgG. These results do not support the association of C. pneumoniae with aortic valves and peripheral blood mononuclear cells in patients with atherosclerotic aortic heart valve disease.
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Affiliation(s)
- Kirsti Vainio
- Division for Infectious Disease Control, Norwegian Institute for Public Health, Oslo.
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Smieja M, Mahony J, Petrich A, Boman J, Chernesky M. Association of circulating Chlamydia pneumoniae DNA with cardiovascular disease: a systematic review. BMC Infect Dis 2002; 2:21. [PMID: 12359046 PMCID: PMC130041 DOI: 10.1186/1471-2334-2-21] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2002] [Accepted: 10/01/2002] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Chlamydia pneumoniae antigens, nucleic acids, or intact organisms have been detected in human atheroma. However, the presence of antibody does not predict subsequent cardiovascular (CV) events. We performed a systematic review to determine whether the detection of C. pneumoniae DNA in peripheral blood mononuclear cells (PBMC) was associated with CV disease. METHODS We sought studies of C. pneumoniae DNA detection in PBMC by polymerase chain reaction (PCR) among patients with CV disease or other clinical conditions. We pooled studies in which CV patients were compared with non-diseased controls. We analyzed differences between studies by meta-regression, to determine which epidemiological and technical characteristics were associated with higher prevalence. RESULTS Eighteen relevant studies were identified. In nine CV studies with control subjects, the prevalence of circulating C. pneumoniae DNA was 252 of 1763 (14.3%) CV patients and 74 of 874 (8.5%) controls, for a pooled odds ratio of 2.03 (95% CI: 1.34, 3.08, P < 0.001). Prevalence was not adjusted for CV risk factors. Current smoking status, season, and age were associated with C. pneumoniae DNA detection. High prevalence (>40%) was found in patients with cardiac, vascular, chronic respiratory, or renal disease, and in blood donors. Substantial differences between studies were identified in methods of sampling, extraction, and PCR targets. CONCLUSIONS C. pneumoniae DNA detection was associated with CV disease in unadjusted case-control studies. However, adjustment for potentially confounding measures such as smoking or season, and standardization of laboratory methods, are needed to confirm this association.
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Affiliation(s)
- Marek Smieja
- Dept. of Pathology and Molecular Medicine, McMaster University, Hamilton ON, Canada
- Dept. of Medicine, McMaster University, Hamilton ON, Canada
| | - James Mahony
- Dept. of Pathology and Molecular Medicine, McMaster University, Hamilton ON, Canada
| | - Astrid Petrich
- Dept. of Pathology and Molecular Medicine, McMaster University, Hamilton ON, Canada
| | - Jens Boman
- Dept. of Virology, Umea University, Umea, Sweden
| | - Max Chernesky
- Dept. of Pathology and Molecular Medicine, McMaster University, Hamilton ON, Canada
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Muhlestein JB. Secondary prevention of coronary artery disease with antimicrobials: current status and future directions. Am J Cardiovasc Drugs 2002; 2:107-18. [PMID: 14727986 DOI: 10.2165/00129784-200202020-00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Over the past several decades, coronary artery disease (CAD) has become the major health problem in the Western world with more than 50% of deaths attributed to its complications. The exact causes of atherosclerosis are not clearly known, although multiple risk factors (e.g. hypertension, hyperlipidemia, diabetes mellitus, family history, and smoking) have been well described. However, these risk factors account for only about 50% of the total risk of CAD. Consequently, an ongoing search is under way to discover new risk factors for atherosclerosis as well as the basic underlying causes of progression. Although the evidence is not yet definitive, recent studies have shown that chronic infection by such bacterial organisms as Chlamydia pneumoniae, Helicobacter pylori, and a variety of dental pathogens may play a causative role in atherosclerosis. If this is true, then antimicrobial therapy may be helpful in the secondary prevention of CAD. Indeed, several small studies have already been completed testing this hypothesis. This article reviews the evidence associating these bacterial pathogens to CAD and presently available information regarding the use of antibiotics in the setting. At present, most studies evaluating the potential efficacy antimicrobials in the secondary prevention of CAD have tested the use of macrolide antibodies. Although several small preliminary studies have reported promising results favoring a clinical benefit from even short (<3 months) courses of antimicrobial therapy, the first large clinical trial, the Weekly Intervention with Zithromax for Atherosclerosis and its Related Disorders (WIZARD) study, did not show a statistically significant beneficial effect of a 3 month course of azithromycin over placebo by the end of up to 4 years follow-up. However, a statistically significant (p = 0.03) 33% reduction in death and myocardial infarction was found at 6 months, 3 months after the discontinuation of antibiotics. This robust clinical benefit, however, was not sustained over the ensuing 3.5 years of follow-up. These disappointing long-term outcomes of short-term therapy with antimicrobials may be explained by the recently discovered difficulty found in eradicating chronic vascular infections such as C. pneumoniae. It remains possible that longer term antimicrobial therapy or short-term use of more potent single agents or combinations, capable of effectively eradicating the offending organisms might provide added clinical benefit in the fight against CAD. Further studies are ongoing or planned to evaluate this potential. In the meantime, it is not presently recommended that antimicrobials be routinely prescribed for the secondary prevention of CAD.
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Affiliation(s)
- Joseph B Muhlestein
- University of Utah, Division of Cardiology, LDS Hospital, Salt Lake City, Utah 84143, USA. ldbmuhle@ihc,com
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