Rapidly Increasing Incidence of Ocular Non-Hodgkin Lymphoma

A recent report suggesting that ocular adnexal non-Hodgkin lymphoma (NHL) may be related to Chlamydia psittaci infection underscores the need for reliable epidemiologic data for this malignancy. We examined population-based incidence data from the Surveillance, Epidemiology, and End Results (SEER) Program. During 1992-2001 in the 12 SEER areas, ocular (i.e., eye and adnexa) NHL rates per 100,000 person-years for both sexes were highest among Asians/Pacific Islanders, lower in whites, and lower still in blacks. Incidence increased with advancing age and showed little difference by sex, in contrast to other (extranodal and nodal) NHLs, which occurred predominantly in males. From 1975-2001, there was a rapid and steady increase in incidence of ocular NHL, with annual increases of 6.2% and 6.5% among white males and females, respectively, with no evidence of peaking. By contrast, other NHLs showed evidence of peaking in recent years. The distinctive patterns of ocular NHL call for further studies to identify risk factors and mechanisms, including the potential role of C. psittaci or other infections.

Chlamydia trachomatis IncA is localized to the inclusion membrane and is recognized by antisera from infected humans and primates

Chlamydia psittaci produces a collection of proteins, termed IncA, IncB, and IncC, that are localized to the chlamydial inclusion membrane. In this report we demonstrate that IncA is also produced by Chlamydia trachomatis. C. trachomatis IncA is structurally similar to C. psittaci IncA and is also localized to the inclusion membrane. Immunoblot analysis demonstrated that sera from C. trachomatis-infected patients and from experimentally infected monkeys both recognized C. trachomatis IncA.

Comparison of azithromycin and erythromycin in the treatment of atypical pneumonias

An open, randomized, multicentre study compared the efficacy and safety of the prototype, azalide, azithromycin, and erythromycin in the treatment of atypical pneumonias. Azithromycin was administered for five days at a dosage of 250 mg bd on day 1 and 250 mg once daily on days 2 to 5. Erythromycin was given for ten days at 500 mg qid. Causative pathogens were identified by serological methods. Of 57 patients treated with azithromycin, Mycoplasma pneumoniae and Chlamydia psittaci were identified in 31 and eight patients, respectively. Of 44 patients treated with erythromycin, M. pneumoniae and C. psittaci were identified in 24 and eight patients, respectively. There were no therapeutic failures in either treatment group. Side effects were observed in one of 57 patients on azithromycin and in six of 44 patients on erythromycin. Azithromycin appears to be as effective as erythromycin in the treatment of atypical pneumonias and better tolerated.

Persistent infection of mouse fibroblasts (L cells) with Chlamydia psittaci: evidence for a cryptic chlamydial form

When monolayers of mouse fibroblasts (L cells) were infected with enough Chlamydia psittaci (strain 6BC) to destroy most of the host cells, 1 in every 10(5) to 10(6) originally infected cells gave rise to a colony of L cells persistently infected with strain 6BC. In these populations, the density of L cells and 6BC fluctuated periodically and reciprocally as periods of host cell increase were followed by periods of parasite multiplication. Successive cycles of L-cell and 6BC reproduction were sustained indefinitely by periodic transfer to fresh medium. Isolation of L cells and 6BC from persistent infections provided no evidence that there had been any selection of variants better suited for coexistence. Persistently infected populations consisting mainly of inclusion-free L cells yielded only persistently infected clones, grew more slowly, and cloned less efficiently. They were also almost completely resistant to superinfection with high multiplicities of either 6BC or the lymphogranuloma venereum strain 440L of Chlamydia trachomatis. These properties of persistently infected L cells may be accounted for by assuming that all of the individuals in these populations are cryptically infected with 6BC and that cryptic infection slows the growth of the host cell and makes it immune to infection with exogenous chlamydiae. According to this hypothesis, the fluctuations in host and parasite density occur because some factor periodically sets off the conversion of cryptic chlamydial forms into reticulate bodies that multiply and differentiate into infectious elementary bodies in a conventional chlamydial developmental cycle.

Detection of chlamydiosis in a shipment of pet birds, leading to recognition of an outbreak of clinically mild psittacosis in humans

Avian chlamydiosis was detected in a shipment of > 700 pet birds from a Florida bird distributor that were sold to nine Atlanta-area pet stores in August 1995. Respiratory illness among persons who had recently acquired birds from this shipment was reported to local public health officials. The attack rate of acute respiratory illness was 10.7% among persons in households exposed to birds from the implicated flock vs. 1.8% among control households (odds ratio, 6.60; 95% confidence interval, 1.39-31.2). Illness and serological evidence of infection in the absence of symptoms were more common among persons in households with recently purchased birds that were sick or that had died and among persons who had had direct contact with the birds. Clinical psittacosis or serological evidence of Chlamydia psittaci infection was found in 30.7% of households with birds from the infected flock. Mild illnesses and asymptomatic infections in exposed persons were unusual features of this outbreak.

Chronic follicular conjunctivitis associated with Chlamydia psittaci or Chlamydia pneumoniae

We determined whether patients with chronic conjunctivitis in whom direct fluorescent antibody (DFA) tests revealed genus-specific chlamydial antigens (but not species-specific Chlamydia trachomatis antigens) were infected with Chlamydia psittaci or Chlamydia pneumoniae. Patients were divided into a case group of possible non-trachomatis chlamydial conjunctivitis and a control group of nonchlamydial conjunctivitis on the basis of examination and DFA testing. Species-specific primers were used to amplify C. trachomatis, C. psittaci, and C. pneumoniae DNA with polymerase chain reaction (PCR). Four (27%) of 15 samples from the case group were positive for C. psittaci or C. pneumoniae DNA, whereas none of 24 control samples were positive. Sequencing revealed a C. pneumoniae, an avian C. psittaci, and two mammalian C. psittaci strains. A short course of oral antibiotic treatment appears to be inadequate for patients with non-trachomatis chlamydial conjunctivitis. Ocular infections due to C. pneumoniae and C. psittaci may be more common than previously recognized and can be identified by DFA and PCR.

Analysis of the complete nucleotide sequence of Chp1, a phage which infects avian Chlamydia psittaci

We report the complete nucleotide sequence of bacteriophage Chp1. The genome was found to be 4877 bases long and it potentially codes for 11 proteins. Open reading frames (ORFs) 6 and 7 lie within ORFs 2 and 1 respectively but are in a second reading frame. No significant DNA homology was found when Chp1 was compared to the EMBL database. The N-terminal amino acid sequences of the three structural proteins VP1, VP2 and VP3 were determined and it was found that they were encoded by ORFs 1, 2 and 3 respectively. Amino acid homology studies revealed that VP1 has homology with the major structural protein of bacteriophages phi X174 and S13, and that the protein inferred from ORF 4 shows homology to the A proteins of phi X174, S13 and G4. The genome of Chp1 has an organization similar to that of phi X174 although it is 509 bases smaller. We propose that Chp1 is a member of the Microviridae but that it is sufficiently different to warrant its own subfamily which we have called the Chlamydiavirinae.

Infective endocarditis with glomerulonephritis associated with cat chlamydia (C. psittaci) infection

A patient with glomerulonephritis and endocarditis is described who had evidence of feline Chlamydia psittaci infection. Treatment with antichlamydial drugs resulted in resolution of the glomerulonephritis and the endocarditis. It is recommended that screening for chlamydia is included in the investigation of patients with suspected or obscure endocarditis.

No evidence for an association of ocular adnexal lymphoma with Chlamydia psittaci in a cohort of patients from the Netherlands

Extra-nodal marginal zone B cell lymphomas (MZBCLs) of the mucosa-associated lymphoid tissues (MALT) arise at sites of chronic antigenic stimulation due to organ-specific autoimmunity or infections, like Helicobacter pylori-associated chronic gastritis and Borrelia burgdorferi dermatitis. Recently, conflicting data have been published regarding a possible association between Chlamydia psittaci and ocular adnexal MZBCL. In the present study, we analyzed a cohort of ocular adnexal MZBLs from the Netherlands for the presence of C. psittaci DNA. We found no evidence for the presence of C. psittaci DNA in any of the tumor samples studied. Our data do not support a role for C. psittaci in the pathogenesis of ocular adnexal lymphomas in patients from the Netherlands.

Psittacosis: a clinical review

The records of the Public Health Laboratory at Leeds were searched and cases in which a four-fold rise of antibodies to Chlamydia psittaci had occurred were reviewed. Clinical and epidemiological features of these cases are presented. The importance of birds as a potential source of infection is emphasised.

INHIBITION OF THE GROWTH OF AGENTS OF THE PSITTACOSIS GROUP BY D-CYCLOSERINE AND ITS SPECIFIC REVERSAL BY D-ALANINE

Moulder, James W. (University of Chicago, Chicago, Ill.), Dorothy L. Novosel, and Julius E. Officer. Inhibition of the growth of agents of the psittacosis group by d-cycloserine and its specific reversal by d-alanine. J. Bacteriol. 85:707-711. 1963.-d-Cycloserine inhibited multiplication of four members of the psittacosis group in chick embryo yolk sac. d-Alanine reversed each inhibition. In infections with the agent of mouse pneumonitis, the most sensitive member of the psittacosis group tested, d-alanine competitively antagonized the growth inhibition produced by d-cycloserine. Of a number of other potential reversing agents, only dl-alanyl-dl-alanine reversed the effect of d-cycloserine on mouse pneumonitis agent. The significance of the susceptibility of the psittacosis group to d-cycloserine is discussed in light of the known mode of action of this antibiotic on bacteria.

[Abortion in humans caused by Chlamydophila abortus (Chlamydia psittaci serovar 1)]

On a farm housing cattle and goats an abortion storm occurred affecting 50% of the goats during the lambing season 2000/2001. In one of three investigated caprine abortions Chlamydophila abortus could be identified as etiology. During this time a pregnant woman (pregnancy week 19/20) had contact with aborting goats. She developed a severe generalized infection and aborted. The placenta contained Chlamydophila abortus shown by immunohistochemistry and PCR. Aim of the present case report is to alert veterinarians about the potential zoonotic risk of ovine/caprine abortions.

Chlamydia species as a cause of community-acquired pneumonia in Canada

Chlamydia pneumoniae has been implicated as a cause of community-acquired pneumonia (CAP) in several studies. However, there has been no comprehensive study of the role of Chlamydia species (C. pneumoniae, C. psittaci (avian and feline strains) and C. pecorum) as a cause of CAP. The aim of the present study was to determine the role of C. pneumoniae, C. psittaci and C. pecorum as causes of CAP. A prospective cohort observational study of CAP was conducted at 15 teaching centres in eight Canadian provinces between January 1996-October 1997. Acute (n=539) and convalescent (n=272) serum samples were obtained for determination of antibody titres to C. pneumoniae, C. psittaci, C. pecorum, C. trachomatis, Mycoplasma pneumoniae, Legionella pneumophila serogroups I-VI, Streptococcus pneumoniae and various respiratory viruses. Twelve of 539 (2.2%) patients had acute C. pneumoniae pneumonia and an additional 32 (5.9%) had possible acute infection. C. pneumoniae was the sole pathogen in 16 of 42 (38.1%) of these patients. The most common copathogens were S. pneumoniae, respiratory syncytial virus and influenza virus type A. C. pneumoniae pneumonia patients were older and more likely to show congestive heart failure compared to bacteraemic S. pneumoniae patients. The latter had a lower mean diastolic blood pressure, a higher white blood cell count and a lower arterial carbon dioxide tension. Two patients had antibody titres suggestive of recent infection with the feline strain of C. psittaci. Although numerically Chlamydia pneumoniae is an important cause of community-acquired pneumonia, no distinctive clinical features associated with this pathogen were detected in the present study. Feline Chlamydia psittaci may cause a few cases of community-acquired pneumonia. Avian Chlamydia psittaci should be considered only if there is a compatible epidemiological history.

Neurological complications of chlamydial infections: case report and review

We describe a patient with Chlamydia pneumoniae infection who presented with cerebellar dysfunction, followed by respiratory failure requiring mechanical ventilation. C. pneumoniae is an important respiratory pathogen, and other clinical manifestations, including neurological syndromes, are being increasingly recognized. Meningoencephalitis and other neurological complications have also been described in patients with infections due to Chlamydia psittaci and Chlamydia trachomatis. Chlamydial infections should be included in the differential diagnosis of neurological syndromes, including cerebellar dysfunction.

Transmission of chlamydiae by the housefly

The ability of the housefly to carry viable Chlamydia trachomatis and to transmit a chlamydial ocular infection was studied under laboratory conditions. After feeding flies (Musca domestica) on suspensions of egg yolk sac infected with C. trachomatis serotypes A or B (responsible for hyperendemic trachoma) the agents were reisolated from flies' intestines for up to 6 hours and from their legs and/or proboscises for up to 2 hours. It was found that the viability of chlamydiae is dependent on the protective effect of yolk concentration in the original inoculum. Results of experiments with guinea-pig inclusion conjunctivitis as an animal model show that under laboratory conditions flies can readily transmit this chlamydial ocular infection from one animal to another. These results suggest that under field conditions flies can play an important role in the transmission of trachoma, particularly in areas with favourable conditions such as a large reservoir of infection among children with severe trachoma, copious eye discharge caused by trachoma and associated bacterial infections, a large fly population, and close proximity of children in large family groups.

Intracellular forms of meningopneumonitis virus

Electron micrographs of intracellular memngopneumonitis virus have shown several types of particles which are presumably representative of different stages of a life cycle. They are: (a) Elementary bodies-dense particles 250 to 300 mmicro in diameter with very dense central granules. (b) Intermediate forms-less dense than elementary bodies and larger. They are 300 to 400 mmicro in diameter, contain a very dense central granule, and often have two or three limiting zones, (c) Circles 400 to 500 mmicro in diameter-homogeneous structures with single membranes and no internal granules. They are often elongated and constricted at the center in the manner of budding yeast cells, (d) Circles 500 to 600 mmicro in diameter with single membranes.mdash;One, two, and three dense granules may be present in some of these structures, (e) "Larger" structures, circular to elliptical, often with discontinuities or ruptures in their membranes. They sometimes seem to have internal septa. It has been inferred from these observations that the virus can multiply by binary fission or by multiple endosporulation and that elementary bodies are a spore-like stage.