Chlamydophila pneumoniae infection is not associated with primary biliary cholangitis / La infección por Chlamydophila pneumoniae no está asociada con colangitis biliar primaria

ANTECEDENTES: La colangitis biliar primaria (CBP) es una enfermedad hepática inflamatoria crónica colestásica de causa desconocida. Varios patógenos virales y bacterianos han sido propuestos como factores que podrían gatillar una respuesta inmune por mimetismo molecular, o directamente estar relacionados en la persistencia del daño biliar. Existen reportes controversiales respecto al rol de en la patogenia de CBP. OBJETIVOS: Investigar marcadores de infección de séricos y en hígado de pacientes con CBP. PACIENTES Y MÉTODOS: Veinte pacientes diagnosticados con CBP y 20 pacientes control con otras enfermedades hepáticas crónicas no colestásicas fueron estudiados. Se determinaron anticuerpos séricos anti- (IgG). Se realizó detección inmunohistoquímica de antígenos de en hígado. Se extrajo DNA de hígado para amplificación de la secuencia específica de rRNA 16S de por PCR. Fueron usados controles de amplificación de DNA bacteriano y humano. Los pacientes firmaron consentimiento informado. Se realizó un metaanálisis de la diferencia de riesgo de CBP en pacientes infectados por y en un grupo control. RESULTADOS: Los anticuerpos séricos fueron positivos en 30% de los pacientes con CBP y 50% de los controles (p = NS). Antígenos de no fueron detectados en tejido hepático de pacientes con CBP ni de controles. No se amplificó ADN bacteriano en ninguna de las muestras. El metaanálisis de la diferencia de riesgo mostró gran heterogeneidad de los estudios, por lo que no se realizó una estimación de diferencia de riesgo agrupada. DISCUSIÓN: No encontramos asociación entre infección por y CBP. En la evidencia actual, un estudio presenta resultados a favor de la asociación entre y CBP y tres estudios resultados en contra.,

Primary biliary cholangitis (PBC) is a chronic cholestatic inflammatory liver disease of unknown cause. Several viral and bacterial pathogens have been proposed as factors that could either trigger an immune response by molecular mimicry or directly be involved in the persistence of biliary damage. There are conflicting reports respecting the role of in the pathogenesis of PBC. To investigate markers of infection in serum and liver tissue from patients with PBC. Twenty patients with diagnosis of PBC and 20 control patients with other non-cholestatic chronic liver diseases were studied. Serum anti- antibodies (IgG) were determined. Liver tissue was available for immunohistochemistry detection of antigens. DNA was extracted from liver tissue and a specific sequence of 16S rRNA gene was amplified by CPR. Adequate controls of bacterial and human DNA amplification were used. Informed consent was obtained from patients. A meta-analysis of risk difference of PBC in Chlamydophila pneumoniae infected patients and in the control groupwas performed. Serum antibodies were positive in 30% of patients with PBC and 50% of controls (p = NS). antigens were not detected in liver tissue neither of patients with PBC nor controls. Bacterial DNA did not amplify in any of the samples, despite good amplification of internal and external controls. Risk difference meta-analysis showed high heterogeneity between studies. Therefore, we did not estimate a pooled risk difference. Our results do not support the association between infection and PBC. In the current literature only one study shows an association between and PBC, but other three studies do not support it.

Evidencia molecular de la infección por Chlamydophila pneumoniae en reptiles de Argentina / Molecular evidence of Chlamydophila pneumoniae infection in reptiles in Argentina

En la región central de Argentina, las características epidemiológicas y moleculares de las infecciones por Chlamydophila pneumoniae en reptiles son desconocidas. Para detectar C. pneumoniae, se usó la reacción en cadena de la polimerasa anidada que amplifica el gen rpoB en muestras de hisopado cloacal de 19 reptiles. Once (57,89 %) reptiles resultaron positivos. La secuenciación y el análisis filogenético corroboraron la presencia de esta bacteria. No se detectó ADN de C. pneumoniae en la faringe ni IgM anti-C. pneumoniae en el suero de los cuidadores; sin embargo, ellos presentaron títulos muy elevados de IgG anti-C. pneumoniae. La detección de ADN de C. pneumoniae en los reptiles demostró la circulación de este agente en el centro recreativo donde se realizó este estudio, lo que podría explicar la exacerbada respuesta inmunitaria en los cuidadores; este hallazgo sugiere la presencia de un potencial ciclo zoonótico. Se reporta aquí por primera vez la detección de C. pneumoniae en reptiles en Argentina

In the central area of Argentina, the epidemiological and molecular characteristics of Chlamydophila pneumoniae infections in reptiles are still unknown. A nested polymerase chain reaction of the rpoB gene was used to detect C. pneumoniae in cloacal swab samples from 19 reptiles at a recreational area. Eleven (57.89%) reptiles were positive; the sequencing and phylogenetic analysis confirmed the presence of this bacterium. Neither C. pneumoniae DNA in the caregivers'pharynges nor IgM antibodies anti-C. pneumoniae in their serum samples were detected; however, caregivers presented very high titers of IgG anti-C. pneumoniae. The detection of C. pneumoniae DNA in reptiles demonstrated the circulation of this agent in the recreational area and could be responsible for the exacerbated immune response of the personnel handling the reptiles, which suggests a potential zoonotic cycle. This is the first report of the detection of C. pneumoniae in reptiles in Argentina

Caracterização epidemiológica e fatores de risco associados à infecção por Chlamydophila abortus em ovinos deslanados do semiárido brasileiro / Epidemiological characterization and risk factors associated with Chlamydophila abortus infection in sheep in Brazilian semiarid

O objetivo do presente trabalho foi determinar as prevalências de propriedades positivas e animais soropositivos para Chlamydophila abortus em ovinos deslanados da região semiárida do Nordeste do Brasil, bem como identificar fatores de risco. Foram colhidas amostras de sangue de 476 ovinos procedentes de 72 propriedades em 14 municípios na mesorregião do Sertão, Estado da Paraíba. Para o diagnóstico sorológico da infecção por Chlamydophila abortus foi utilizada a reação de fixação de complemento (RFC). Uma propriedade foi considerada positiva quando apresentou pelo menos um animal soropositivo. Das 72 propriedades usadas 38 (52,8%) apresentaram pelo menos um animal soropositivo, e dos 476 animais 94 (19,7%) foram soropositivos. Participação em exposições (odds ratio =4,31; IC 95% =1,80-10,35; p=0,011) foi identificada como fator de risco. Sugere-se que a infecção por Chlamydophila abortus encontra-se disseminada em ovinos da região, e baseando-se na análise de fatores de risco, recomenda-se o controle sanitário nas exposições de animais.

The aim of this investigation was to determine the flock-level and animal-level prevalences of Chlamydophila abortus in sheep from the semiarid region of Northeastern Brazil, as well as to identify risk factors. Blood samples were collected from 476 sheep of 72 flocks in 14 counties in the Sertão mesoregion, state of Paraíba. For the serological diagnosis of Chlamydophila abortus infection the complement fixation test (FC) was carried out. A flock was positive when presented at least one seropositive animal. From the 72 flocks, 38 (52.8%) presented at least one seropositive sheep, and 94 (19.7%) of the 476 animals were seropositive. Participation in animal expositions (odds ratio= 4.31; 95% CI= 1.80-10.35; p=0.011) was identified as risk factor. It is suggested that C. abortus infection is spread in sheep of the region, and based on the risk factor analysis sanitary control in animal expositions is recommended.

Seroprevalence and risk factors associated with Chlamydophila abortus infection in dairy goats in the Northeast of Brazil / Soroprevalência e fatores de risco associados com a infecção por Chlamydophila abortus em caprinos leiteiros do Nordeste brasileiro

Few data are available on the prevalence and risk factors of Chlamydophila abortus infection in goats in Brazil. A cross-sectional study was carried out to determine the flock-level prevalence of C. abortus infection in goats from the semiarid region of the Paraíba State, Northeast region of Brazil, as well as to identify risk factors associated with the infection. Flocks were randomly selected and a pre-established number of female goats > 12 mo old were sampled in each of these flocks. A total of 975 serum samples from 110 flocks were collected, and structured questionnaire focusing on risk factors for C. abortus infection was given to each farmer at the time of blood collection. For the serological diagnosis the complement fixation test (CFT) using C. abortus S26/3 strain as antigen was performed. The flock-level factors for C. abortus prevalence were tested using multivariate logistic regression model. Fifty-five flocks out of 110 presented at least one seropositive animal with an overall prevalence of 50.0% (95%; CI: 40.3%, 59.7%). Ninety-one out of 975 dairy goats examined were seropositive with titers >32, resulting in a frequency of 9.3%. Lend buck for breeding (odds ratio = 2.35; 95% CI: 1.04-5.33) and history of abortions (odds ratio = 3.06; 95% CI: 1.37-6.80) were associated with increased flock prevalence.

São escassos os trabalhos publicados sobre a prevalência e fatores de risco associados à infecção por Chlamydophila abortus em caprinos no Brasil. Foi conduzido um estudo transversal para determinar a prevalência de rebanhos positivos para a infecção por C. abortus em caprinos do semiárido do Estado da Paraíba, Nordeste do Brasil, bem como identificar os fatores de risco associados com a infecção. Os rebanhos foram selecionados aleatoriamente e um número pré-estabelecido de cabras com idade >12 meses foi amostrado por rebanho. No total, foi colhido sangue de 975 animais procedentes de 110 rebanhos, e no momento da colheita foi aplicado um questionário epidemiológico a cada proprietário. Para o diagnóstico sorológico foi utilizado o teste de fixação de complemento (FC) usando a estirpe de C. abortus S26/3 como antígeno. Os fatores de risco para a prevalência de C. abortus em nível de rebanho foram testados com o uso de modelo de regressão logística multivariada. Cinquenta e cinco rebanhos dos 110 analisados apresentaram pelo menos um animal soropositivo, com uma prevalência de 50,0% (IC 95%: 40,3-59,7%). Noventa e um animais entre os 975 examinados foram soropositivos com título >32, resultando em uma frequência de 9,3%. Compartilhar reprodutores (odds ratio = 2,35; IC 95%: 1,04-5,33) e histórico de abortamentos (odds ratio = 3,06; IC 95%: 1,37-6,80) foram associados com o aumento da prevalência de rebanhos.

Detection of the ompA gene of Chlamydophila pecorum in captive birds in Argentina / Detección del gen ompA de Chlamydophila pecorum en aves en cautiverio, en la Argentina

Bacteria belonging to the family Chlamydiaceae cause a broad spectrum of diseases in a wide range of hosts, Including humans, other mammals and birds. However, very little is known about chlamydial infections in birds in our region. In the present study, we examined 28 clinically normal birds In illegal captivity that were confiscated in the province of Córdoba, Argentina. The objective was to detect Chlamydophila spp. in cloacal swabs by genetic analysis of the ompA gene. Nested-PCR of the ompA gene identified five samples as Chlamydophila pecorum and the sequence analysis demonstrated the presence of the ompA gene of C. pecorum In these birds. On the other hand, Chlamydophila psittaci was not detected. These birds could be either asymptomatic reservoirs or subclinical carriers of C. pecorum. This is the first report of the detection of C. pecorum in Argentina.

Las bacterias que pertenecen a la familia Chlamydiaceae causan un extenso espectro de enfermedades en una amplia gama de huéspedes, incluidos los seres humanos, otros mamíferos y aves. Sin embargo, se sabe muy poco acerca de las infecciones por clamidias en aves de nuestra reglón. Esta Investigación examinó 28 aves clínicamente normales mantenidas en cautiverio ¡legal, que fueron confiscadas en Córdoba, Argentina. El objetivo fue detectar Chlamydophila spp. en hisopados cloacales por análisis del gen ompA. La PCR anidada del gen ompA reveló la presencia de Chlamydophila pecorum en cinco muestras. El análisis de secuencias demostró la presencia del gen ompA de C. pecorum en estas aves. Por el contrario, Chlamydophila psittaci no se detectó. Estas aves pueden ser reservónos asintomáticos o portadores subclínlcos de C. pecorum. Este es el primer informe de la detección de C. pecorum en la Argentina.

Seroprevalence of antibodies to chlamydophila abortus in ovine in the state of Alagoas, Brazil

The goal of this study was to perform a seroepidemiological investigation and to identify risk factors associated with infection of Chlamydophila abortus of sheep herds in the Brazilian state of Alagoas. The study was conducted with samples of 274 ewes with ages equal to or higher than 24 months in 25 herds and in 23 towns located in three regions of the state (Sertão, Agreste and Eastern Alagoas). Anti-C. abortus antibodies were detected using the microcomplement fixation test. The risk factors, were determined based on questionnaires consisting of objective questions, about the farmer and general characteristics of the herd like size, sanitary situation and reproductive management. Among 274 sera samples analyzed for C. abortus, 59 (21.5 percent) were positive with titers >32, 187 (68.3 percent) negative and 28 (10.2 percent) suspect with titers >16. In the 23 towns studied, 20 had positive animals. Among herds 21 (77.7 percent) of had positive animals. The only variable which appeared to be significant in the multivariate analysis was the region, and Sertão was the most significant (p<0.001; OR=3.48; T.I. 1.79 - 6.76). Results indicate that infection by Chlamydophila abortus is widespread on sheep farms in the State of Alagoas. Others studies, however, have to be conducted to isolate the agent in order to confirm the role of the bacteria is reproductive disturbances in sheeps. In addition to that, control and prophylactic measures along with health promoting programs have to be encouraged on the studied farms so that infection reates are reduced.

Chlamydia pneumoniae and stroke: is there a direct relationship? / Chlamydia pneumoniae e acidente vascular cerebral aterotrombótico: existe relação direta?

OBJECTIVE: To investigate the possible relationship between atherothrombotic stroke and Chlamydia pneumoniae. METHOD: 150 patients with carotid atherothrombosis were enrolled. The casuistic was divided in three groups: ischemic stroke (IS): 65 patients; transient ischemic attack (TIA): 26 patients; and control: 59. The IS or TIA onset was up to 30 days from the beginning of the study. Carotid atheromatoses was diagnosed by Doppler-ultrasonography. Patients with cardioembolic risk or non-atherothrombotic origin were excluded. Comparisons were done between the three groups, and within each group according to the different age sub-groups, to the main arteries affected, and to the atherogenic risk factors. Bacteria detection was done using polimerase chain reaction. RESULTS: Only one patient tested positive for C. pneumoniae belonging to the control group. CONCLUSION: These results do not suggest that C. pneumoniae participated in the onset of IS or TIA or that it has a role in carotid plaque destabilization.

OBJETIVO: Investigar a possível relação entre Chlamydia pneumoniae e acidente vascular cerebral aterotrombótico (AVC). MÉTODO: 150 pacientes com aterotrombose carotídea foram estudados. A casuística foi dividida em 3 grupos: AVC: 65 pacientes; ataque isquêmico transitório (AIT): 26 pacientes e controles: 59. O início do AVC ou AIT era até 30 dias da inclusão no estudo. A ateromatose carotídea foi diagnosticada por ultrassonografia com Doppler. Os pacientes com risco cárdio-embólico ou sem evidência de aterotrombose foram excluídos. Foram estabelecidas comparações entre os 3 grupos e dentro de cada grupo, formado sub-grupos de acordo com diferentes idades, território arterial comprometido e fatores de risco. A detecção da bactéria foi feita por reação de polimerização em cadeia. RESULTADOS: Somente um paciente, pertencente ao grupo controle, teve resultado positivo. CONCLUSÃO: Estes achados não sugerem que a C. pneumoniae participe no desencadeamento do AVC ou AIT ou que tenha papel na desestabilização da placa.

Ocorrência e fatores de risco para Chlamydophilaabortus em ovinos e caprinos no estado de Pernambuco: [revisão] / Occurrence and risk factors for Chlamydophilaabortus infection in sheep and goats in Pernambuco: [revision]

Objetivou-se com este estudo identificar os fatores de risco associados à infecção por Chlamydophila abortus em caprinos e ovinos nas regiões do Litoral/ Zonada Mata e Agreste do Estado de Pernambuco. Foram colhidas 290 amostras de soros para pesquisa de anticorpos contra clamídia em 12 propriedades. Para identificar os fatores de risco foram aplicados questionários junto aos proprietários. A freqüência de animais soro-reagentes nos rebanhos estudados foi de 10,3%, sendo 12,0% para caprinos e 8,1% para ovinos, identificando-se 11/12 (91,6%) focos da infecção. Registra-se a primeira ocorrência de anticorpos anti-C. abortus em caprinos no estado de Pernambuco e em ovinos no Brasil. Os fatores derisco associados à infecção em caprinos foram a raça (OR=9,10) e o manejo intensivo (OR=6,41) e para ovinosnão foram encontradas associações significativas para nenhum fator analisado. Concluiu-se que a infecção porChlamydophila sp. encontra-se disseminada em criações de caprinos e ovinos da Zona da Mata e Agreste do Estado de Pernambuco. Medidas de controle devem ser implantadas nos criatórios estudados, enfocando principalmente os fatores de risco identificados neste estudo para reduzir a possibilidade de infecção por este agente.

The study aimed to identify risk factors associated with Chlamydophila abortus infection in sheep and goats from the Litoral/Zona da Mata and Agreste region of Pernambuco state, Brazil. Serum samples (n=290) were analyzed to detect Chlamydophila spp. antibodies in 12 farms. Questionnaires were applied to identify risk factors. Frequency ofserum-reactive animals were 10.3% (12.0% in ewes and 8.1% in goats) and 1/12 (91.6%) infection focuses were identified. This is the first report on anti-Chlamydophhila abortus antibodies in goats and sheep in Pernambuco and Brazil, respectively. Risk factorsassociated with goat infection were breed (OR=9.10) and management (OR=6.41). No significant associations in any of the analyzed factors were found for sheep. In summary, Chlamydophila sp. infection is disseminated in sheep and goat herds in the region. Control measures should be established, focusing primarily risk factor identified in this study, to reduce the possibility of infection by the agent.

Anticuerpos contra Chlamydophilaen pacientes con infarto agudo del miocardio y riesgo coronario, y su relación con la muerte / Antibodies against Chlamydophila in patients with acute myocardial infarction and coronary risk and their association with mortality

OBJETIVO: Determinar si los anticuerpos contra Chlamydophila pneumoniae en pacientes con infarto agudo del miocardio y factores de riesgo coronario se asocian con la muerte. MATERIAL Y MÉTODOS: Se hizo un estudio observacional, prospectivo, transversal y comparativo. Se incluyeron en el estudio 100 sujetos que, entre 1999 y 2000, estuvieron hospitalizados en la Unidad Coronaria del Hospital de Especialidades del Centro Médico La Raza, del Instituto Mexicano del Seguro Social. Se trataba de una muestra constituida por pacientes de ambos sexos, mayores de 18 años, con infarto agudo del miocardio y riesgo coronario. Mediante microinmunofluorescencia indirecta se identificaron anticuerpos contra Chlamydophila pneumoniae, Chlamydophila psitacii y Chlamydia trachomatis. De entre los 100 sujetos, se eligieron al azar 33, a quienes se les determinaron anticuerpos contra Chlamydophila, no sólo durante su estancia en el hospital, sino también al salir de éste y a los tres meses de haber sufrido el infarto agudo del miocardio. Se calcularon las medias y las desviaciones geométricas estándares para los títulos de anticuerpos contra Chlamydophila, y se determinó la razón de momios y el intervalo de confianza al 95 por ciento entre los factores de riesgo coronario y la muerte. RESULTADOS: Setenta por ciento de los pacientes de la muestra inicial presentaron anticuerpos contra Chlamydophila pneumoniae; no se identificaron anticuerpos contra Chlamydophila psitacii y Chlamydia trachomatis. No se observó una fuerza de asociación estadísticamente significativa con la muerte en pacientes con infarto agudo del miocardio y factores de riesgo coronario. De los 33 individuos de la submuestra, 25 presentaron anticuerpos contra Chlamydophila pneumoniae, y en 83 por ciento de estos últimos casos, se registró un descenso de dichos anticuerpos a los tres meses de haberse presentado el infarto agudo del miocardio. CONCLUSIONES: A pesar de que en pacientes con infarto agudo del miocardio y riesgo coronario se presentó un incremento en la frecuencia de seropositividad a Chlamydophila pneumoniae, no se observó una fuerza de asociación estadísticamente significativa de ello con la muerte.

Neumonía adquirida en la comunidad que se hospitaliza: estudio etiológico / Community acquired pneumonia in a hospitalized community: etiological study

BACKGROUND: Community-acquired pneumonia (CAP) that requires hospitalization, is a common and serious disease. A permanent assessment in specialized centers, to define therapeutic guidelines according to local epidemiological factors, is mandatory. AIM: To study the etiology of CAP requiring hospital admission. PATIENTS AND METHODS: Adult patients with CAP, admitted to the Clinical Hospital of the University of Chile between 1999 and 2001 were studied. A clinical, radiological and microbiological assessment was done in all patients. Blood and sputum cultures and serology for Chlamydia and Mycoplasma pneumoniae were performed. RESULTS: Thirty one patients aged 62 +/- 18 years, 12 female, met inclusion criteria. An etiologic diagnosis was made in 74 per cent of cases, (52 per cent definitive, 22 per cent probable). Frequency of definitive diagnosis was: 25 per cent Mycoplasma pneumoniae, 19 per cent Chlamydia pneumoniae and 13 per cent Streptococcus pneumoniae. Mixed etiology was found in 16 per cent and a final diagnosis was not obtained in 26 per cent of the cases. No correlation was found between clinical and radiological patterns, and the etiologic agent. C reactive protein and erythrosedimentation rate were significantly higher in CAP due to Chlamydia and Streptococcus pneumoniae. CONCLUSIONS: The higher frequency of Mycoplasma and Chlamydia pneumoniae, than previously reported, suggests that atypical agents should be considered in the initial antimicrobial therapy prescribed to these patients.