Albrecht Oehme

Chlamydophila abortus Pelvic Inflammatory Disease

We report the first documented case of an extragestational infection with Chlamydophila abortus in humans. The pathogen was identified in a patient with severe pelvic inflammatory disease (PID) by sequence analysis of the ompA gene. Our findings raise the possibility that Chlamydiaceae other than Chlamydia trachomatis are involved in PID.

Co-infection with two Chlamydophila species in a case of fulminant myocarditis.

Objective:The aim of this study is to describe a case of fulminant myocarditis caused by co-infection with Chlamydophila pneumoniae and Chlamydophila psittaci in order to facilitate diagnosis and clinical management of patients suffering from this rare but life-threatening condition. Design:Case report. Setting:Intensive care unit of Innsbruck Medical University. Patient:A 24-yr-old patient admitted with septicemia and cardiac failure. Interventions:Cardiopulmonary resuscitation, extracorporal membrane oxygenation, implantation of an extracorporal cardiac assist device, and antibiotic treatment with erythromycin. Measurements and Main Results:Cp. pneumoniae and Cp. psittaci were identified by means of polymerase chain reaction and electron microscopy in the patient’s myocytes. Successful weaning off the ventricular assist device was performed within 2 wks after commencement of antibiotic therapy. Conclusions:This case report demonstrates co-infection with Cp. pneumoniae and Cp. psittaci to be a hitherto unknown cause of fulminant myocarditis. There is a particular risk of misdiagnosis of viral myocarditis, which must be avoided. Patients should be transferred to a center where extracorporal membrane oxygenation therapy and molecular diagnosis of all members of the family Chlamydiaceae are available.

Presence of Chlamydophila psittaci DNA in the Central Nervous System of a Patient with Status Epilepticus

This study reports an extraordinarily severe and prolonged course of neuroornithosis with generalized status epilepticus as an initial symptom. Direct invasion of the central nervous system by Chlamydophila psittaci was confirmed by the demonstration of specific DNA in the patients cerebrospinal fluid. The patient recovered slowly under administration of doxycycline.

Lack of association between Chlamydia Pneumoniae serology and endothelial dysfunction of coronary arteries

BackgroundRecent publications brought up the hypothesis that an infection with Chlamydia Pneumoniae (CP) might be a major cause of coronary artery disease (CAD). Therefore, we investigated whether endothelial dysfunction (ED) as a precursor of atherosclerosis might be detectable in patients with previous infection with CP but without angiographic evidence of CAD.MethodsWe included 16 patients (6 male / 10 female) of 52 consecutive patients with normal coronary angiography who had typical angina pectoris and pathologic findings in the stress test. Exclusion criteria were: active smoker, elevated cholesterol, hypertension, age > 65 years, diabetes mellitus, treatment with ACE-inhibitors, or known CAD. Blood sample analysis for serum titer against CP (aCP-IgG) was performed after coronary angiography. We looked for endothelial dysfunction analyzing the diameter of the left anterior descending coronary artery (LAD) before and after acetylcholine (ACh) i. c. Quantitative analysis of luminal diameter (LD) was performed in at least two planes during baseline conditions and after ACh for 2 minutes in dosages of 7.2 μg/min and 36 μg/min with an infusion speed of 2 ml/min. Using Doppler guide wire, the coronary flow velocity was measured continuously in the LAD. The coronary flow velocity reserve (CFVR) was measured after 20 μg adenosine i. c.Results10 patients had an elevated aCP-IgG (> 1:8). 6 patients with negative titers (aCP-IgG ≤ 1:8) served as control (CTRL). Both groups were comparable in age, gender, angina class, results of non-invasive stress-test and the baseline values of LD and flow. In the CP positive group 3 patients (30%) did not show an increase of LD after ACh as evidence of ED. In the CTRL group 4 patients (67 %) had ED. There was no association between aCP-IgG and changes of coronary blood flow after ACh. All patients showed normal CFVR (3.0 ± 0.27) irrespective of their aCP-IgG values.ConclusionIn patients with typical symptoms of coronary ischemia but without angiographically visible CAD and absence of other factors affecting the endothelial function, a previous infection with CP is not associated with endothelial dysfunction.

Genotyping of Chlamydia trachomatis strains from cultured isolates and nucleic acid amplification test-positive specimens.

Urogenital strains of Chlamydia trachomatis are divided into several serogroups (D-K). Since these serovars are represented with differing prevalence in the population a serotyping of strains is necessary, when characterising the epidemiological situation. The aim of this study was the genotyping of C. trachomatis strains, the comparison of the results with those of serotyping, and the genotyping of positive specimens using commercial nucleic acid amplification tests (NAAT). The Chlamydia trachomatis major outer membrane protein gene (omp1) from 55 isolated strains and 36 NAAT-positive specimens was amplified by polymerase chain reaction (PCR). The restriction fragment length polymorphism (RFLP) patterns of these amplicons were compared with those of reference strains. The genotypes E and F were found to be most prevalent. The results are discussed considering other studies, genovariants and epidemiology.

Prognose der postoperativen Endophthalmitis

ZusammenfassungFragestellung: Im Rahmen einer retrospektiven Studie sollte das Patientengut mit postoperativer Endophthalmitis bezüglich prognostischer Gesichtspunkte ausgewertet werden. Patienten und Methode: 20 Patienten (9 weiblich, 11 männlich), im Alter von 9–95 Jahren (Median 80 Jahre) mit postoperativer Endophthalmitis wurden im Zeitraum von 1991 bis 1997 in unserer Klinik behandelt. 16mal wurde eine Pars-plana-Vitrektomie (PpV) durchgeführt, weiterhin 2 vordere Vitrektomien und 2 Vorderkammerspülungen ohne Vitrektomie. Alle Patienten erhielten intraokular und systemisch Antibiotika. Der postoperative Beobachtungszeitraum betrug 4 bis 36 Monate (im Durchschnitt 14,0). Die mikrobiologische Untersuchung umfaßte Kulturen von Glaskörper, Vorderkammer und Bindehaut. Ergebnisse: Bei 80% der Patienten war der letzte Visus 1/20 und besser, bei 40% mindestens 0,4. Bei einem präoperativen Visus von mindestens Handbewegung (HB) war der postoperative Visus besser als bei einem schlechteren Ausgangsvisus (Lichtschein). Die chronischen Endophthalmitiden hatten ein besseres Visusergebnis als die akuten und subakuten Endophthalmitiden. Bei den chronischen und subakuten Verläufen war häufiger als bei den akuten Verläufen noch ein Visusanstieg in den ersten Monaten nach der Operation möglich. Bei 40% der akuten Verläufe stagnierte der Visusanstieg, oder der Visus wurde schlechter. Der postoperative Visus war bei Staphylococcus epidermidis- und Propionibacterium acnes-Infektionen am besten. Schlußfolgerung: Prognostische Faktoren der postoperativen Endophthalmitis sind der Visus, das Kulturergebnis und die Verlaufsform (akut, subakut, chronisch). Zum Zeitpunkt der Operation und der intravitrealen Antibiotikagabe sollte der Visus nicht schlechter als Handbewegungen sein, um postoperativ einen besseren Visus zu erreichen.SummaryBackground: The outcome of 20 patients is summarized in a retrospective study to identify clinical findings that influence the long-term prognosis of postoperative endophthalmitis. Patients: Between 1991 and 1997 a total of 20 patients with postoperative endophthalmitis were admitted. Median age was 80 years (range: 9–95), 11 patients were male, 9 female. Sixteen pars-plana vitrectomies, 2 anterior vitrectomies and 2 rinsings of the anterior chamber without vitrectomy were performed. Furthermore, all patients received intraocular and systemic antibiotic treatment. For microbiological investigation, specimens from vitreous, anterior chamber and conjunctiva were sent in. Long-term outcome was controlled for an average of 14 months after treatment of the endophthalmitis (range: 4–36 months). Results: At the end of treatment, 40% of patients had a visual acuity of 0.4 or better, 80% had 1/20 or better. Patients with a preoperative visual acuity of at least hand movement had a better postoperative visual outcome than patients with only light perception. Visual acuity was better in patients with chronic endophthalmitis than in patients with acute or subacute endophthalmitis. In patients with chronic or subacute endophthalmitis, improvement of visual acuity was found some months after the operation more often than in patients with acute endophthalmitis. However, in 40% of cases with an acute onset, no improvement or even worsening of the visual acuity was documented. Best postoperative results were found after infection with Staphylococcus epidermidis and Propionibacterium acnes. Conclusion: Important prognostic factors of postoperative endophthalmitis are visual acuity, the onset of the endophthalmitis (acute, subacute or chronic) and the microbiological findings. At the time of surgery and antibiotic treatment, visual acuity should be at least hand motion to expect an improvement in the visual outcome.