Eva Hjelm

High incidence of Chlamydia pneumoniae in sclerotic heart valves of patients undergoing aortic valve replacement

Chlamydia pneumoniae has previously been demonstrated in the atherosclerotic lesions of various arteries, including the coronary arteries, and has been proposed to play a role in the pathogenesis of atherosclerosis. A prospective study of the incidence of C. pneumoniae in the sclerotic valves of patients undergoing aortic valve replacement because of aortic stenosis and in the aortic valves of cases dying of non-cardiac reasons and undergoing forensic autopsy was undertaken. The results were correlated to serological markers of past (IgG) or persistent (IgA) C. pneumoniae infection. C. pneumoniae, as determined by the polymerase chain reaction (PCR), was detected in the aortic valve in 19/39 (49%) patients and in 1/11 (9%) autopsy controls (p = 0.018) and confirmed by electron microscopy in one patient. There was no significant difference in the incidence rate of IgG or IgA antibody positivity between PCR-positive and PCR-negative cardiac patients. These results extend the hypothesis of a pathogenic role of C. pneumoniae in atherosclerosis to include also aortic valve sclerosis.

Serology of Chlamydia in Relation to Asthma and Bronchial Hyperresponsiveness

Antibodies to the 3 strains of chlamydia were measured in the sera of 197 subjects; 122 with asthma-related symptoms and 75 from the general population. The subjects underwent a structured interview, spirometry, a methacholine provocation test and skin-prick tests. For chlamydia antibodies, IgG titer values of > or = 1:512 and/or IgM > or = 1:16 were regarded as evidence of a current or recent infection while IgG levels < 1:512 and > 1:32 were regarded as indicative of a previous infection. For Chlamydia pneumoniae, a relationship was found between current or recent infection and wheezing (odds ratio (OR) 6.0, confidence intervals (CI) 1.3-28) and also between IgA antibodies and bronchial hyperresponsiveness (BHR) (OR 3.3, CI 1.3-8.3). For Chlamydia trachomatis, serological signs of a previous infection were found significantly more often in subjects who reported having had asthma at some time: (OR 3.2, CI 1.4-7.1), asthma during the last year (OR 3.2, CI 1.4-7.1), wheezing during the last year (OR 4.2, CI 1.6-6.6) and in those who had BHR (OR 2.7, CI 1.2-6.1). We conclude that a relationship may exist between Chlamydia pneumoniae and Chlamydia trachomatis infections and asthma-related symptoms and BHR.

Subacute bartonella infection in Swedish orienteers succumbing to sudden unexpected cardiac death or having malignant arrhythmias.

During the period 1979-92, an increasing number of sudden unexpected cardiac deaths (SUCD) occurred in young, Swedish, male elite orienteers. Myocarditis was the most common diagnosis in the 16 victims, and in 4 cases was also associated with fatty infiltration mimicking arrhythmogenic right ventricular cardiomyopathy (ARVC). Tissues from autopsies of 5 orienteers were tested for Bartonella by PCR targeting the gltA (citrate-synthase) gene. The products were then sequenced. Antibodies to B. henselae, B. quintana and B. elizabethae were measured by indirect fluorescence antibody assay. Bartonella spp. DNA was detected in the hearts of 4 deceased orienteers, and in the lung of a fifth deceased case. The sequences were close to B. quintana in 2 cases and identical to B. henselae in 3. Four of these 5 cases, as well as 2 additional cases of elite orienteers with ARVC, indicated antibodies to Bartonella. It is suggested that Bartonella-induced silent subacute myocarditis, eventually leading to electric instability, caused the increased SUCD rate among the Swedish orienteers. It is further suggested that Bartonella infection may be a major pathogenetic factor in the development of ARVC-like disease. Although the mode of transmission is unknown, both zoonotic/vector-borne and parenteral person-to-person transmission may be involved.During the period 1979-92, an increasing number of sudden unexpected cardiac deaths (SUCD) occurred in young, Swedish, male elite orienteers. Myocarditis was the most common diagnosis in the 16 victims, and in 4 cases was also associated with fatty infiltration mimicking arrhythmogenic right ventricular cardiomyopathy (ARVC). Tissues from autopsies of 5 orienteers were tested for Bartonella by PCR targeting the gltA (citrate-synthase) gene. The products were then sequenced. Antibodies to B. henselae, B. quintana and B. elizabethae were measured by indirect fluorescence antibody assay. Bartonella spp. DNA was detected in the hearts of 4 deceased orienteers, and in the lung of a fifth deceased case. The sequences were close to B. quintana in 2 cases and identical to B. henselae in 3. Four of these 5 cases, as well as 2 additional cases of elite orienteers with ARVC, indicated antibodies to Bartonella. It is suggested that Bartonella-induced silent subacute myocarditis, eventually leading to electric instability, caused the increased SUCD rate among the Swedish orienteers. It is further suggested that Bartonella infection may be a major pathogenetic factor in the development of ARVC-like disease. Although the mode of transmission is unknown, both zoonotic/vector-borne and parenteral person-to-person transmission may be involved.

Serological and Epidemiological Analysis of the Prevalence of Bartonella spp. Antibodies in Swedish Elite Orienteers 1992-93

The emergence of the popular, physically demanding and highly nature-interactive sport of orienteering was marked in Sweden by an elevated rate of sudden unexpected cardiac deaths in young competitors during the years 1979-92, with a common underlying cause or causes suspected. Subsequently, sera were collected during 1992-93 from the elite segment of orienteers holding a nationally ranked position, and a survey compiling various epidemiological data was performed. In this study, a total of 1136 sera were analyzed by indirect-fluorescent antibody assay for the presence of IgG antibodies against 3 Bartonella spp.: B. henselae, B. elizabethae and B. quintana. In total, 31% (355/1136) were seropositive for at least 1 species of Bartonella, with titers ranging up to 1/512; 350/1136 (31%) had antibodies against B. elizabethae, 34/1136 (3.0%) against B. henselae and 16/1136 (1.4%) against B. quintana. Males and females showed equal rates of 31% seropositivity to Bartonella spp. (males 241/766; females 114/370). In comparison, 322 time-matched sera from healthy blood donors had antibodies to Bartonella spp. in 6.8% of cases (p < 0.001). The observed high prevalence of Bartonella spp. antibodies found in Swedish elite orienteers may be indicative of a connection with risk factors for the development of myocarditis and sudden unexpected cardiac deathThe emergence of the popular, physically demanding and highly nature-interactive sport of orienteering was marked in Sweden by an elevated rate of sudden unexpected cardiac deaths in young competitors during the years 1979-92, with a common underlying cause or causes suspected. Subsequently, sera were collected during 1992-93 from the elite segment of orienteers holding a nationally ranked position, and a survey compiling various epidemiological data was performed. In this study, a total of 1136 sera were analyzed by indirect-fluorescent antibody assay for the presence of IgG antibodies against 3 Bartonella spp.: B. henselae, B. elizabethae and B. quintana. In total, 31% (355/1136) were seropositive for at least 1 species of Bartonella, with titers ranging up to 1/512; 350/1136 (31%) had antibodies against B. elizabethae, 34/1136 (3.0%) against B. henselae and 16/1136 (1.4%) against B. quintana. Males and females showed equal rates of 31% seropositisity to Bartonella spp. (males 241/766; females 114/370). In comparison, 322 time-matched sera from healthy blood donors had antibodies to Bartonella spp. in 6.8% of cases (p < 0.001). The observed high prevalence of Bartonella spp. antibodies found in Swedish elite orienteers may be indicative of a connection with risk factors for the development of myocarditis and sudden unexpected cardiac death.

Bartonella Infections in Deer Keds (Lipoptena cervi) and Moose (Alces alces) in Norway

ABSTRACT Infections with Bartonella spp. have been recognized as emerging zoonotic diseases in humans. Large knowledge gaps exist, however, relating to reservoirs, vectors, and transmission of these bacteria. We describe identification by culture, PCR, and housekeeping gene sequencing of Bartonella spp. in fed, wingless deer keds (Lipoptena cervi), deer ked pupae, and blood samples collected from moose, Alces alces, sampled within the deer ked distribution range in Norway. Direct sequencing from moose blood sampled in a deer ked-free area also indicated Bartonella infection but at a much lower prevalence. The sequencing data suggested the presence of mixed infections involving two species of Bartonella within the deer ked range, while moose outside the range appeared to be infected with a single species. Bartonella were not detected or cultured from unfed winged deer keds. The results may indicate that long-term bacteremia in the moose represents a reservoir of infection and that L. cervi acts as a vector for the spread of infection of Bartonella spp. Further research is needed to evaluate the role of L. cervi in the transmission of Bartonella to animals and humans and the possible pathogenicity of these bacteria for humans and animals.

Migratory birds, ticks, and Bartonella

Bartonella spp. infections are considered to be vector-borne zoonoses; ticks are suspected vectors of bartonellae. Migratory birds can disperse ticks infected with zoonotic pathogens such as Rickettsia and tick-borne encephalitis virus and possibly also Bartonella. Thus, in the present study 386 tick specimens collected in spring 2009 from migratory birds on the Mediterranean islands Capri and Antikythera were screened for Bartonella spp. RNA. One or more ticks were found on 2.7% of the birds. Most ticks were Hyalomma rufipes nymphs and larvae with mean infestation rates of 1.7 nymphs and 0.6 larvae per infested bird. Bartonella spp. RNA was not detected in any of the tick specimens.

Antibodies to Chlamydia pneumoniae in Young Swedish Orienteers

During 1992-93 sera from 1790 Swedish elite orienteers were tested for antibodies to Chlamydia pneumoniae. The reason for this was that a cluster of 16 cases of sudden unexpected cardiac death had occurred among Swedish orienteers and DNA from C. pneumoniae had been found in the myocarditic heart and in the lung in 1 of 2 deceased athletes in whom testing was feasible; in addition, C. pneumoniae IgG was found in all 5 cases where serum was available. Among the orienteers, the prevalence rates of IgG antibodies in males and females were 54% (n = 1194) and 50% (n = 596), respectively. The corresponding figures for 319 male and female blood donors were 60% (n = 169) and 53% (n = 150), respectively. These differences are not statistically significant. Male orienteers had a lower prevalence of IgA antibodies than male blood donors (19% and 26%, respectively; p < 0.05), while no such difference was found in females (16% and 18%). The prevalence of IgM antibodies was < 1% in all groups. Neither the performance level of the orienteers nor the place of residence affected the antibody prevalence. In conclusion, Swedish orienteers do not show a higher prevalence of antibodies to C. pneumoniae than healthy blood donors.During 1992-93 sera from 1790 Swedish elite orienteers were tested for antibodies to Chlamydia pneumoniae. The reason for this was that a cluster of 16 cases of sudden unexpected cardiac death had occurred among Swedish orienteers and DNA from C. pneumoniae had been found in the myocarditic heart and in the lung in 1 of 2 deceased athletes in whom testing was feasible; in addition, C. pneumoniae IgG was found in all 5 cases where serum was available. Among the orienteers, the prevalence rates of IgG antibodies in males and females were 54% (n = 1194) and 50% (n =596), respectively. The corresponding figures for 319 male and female blood donors were 60% (n = 169) and 53% (n =150), respectively. These differences are not statistically significant. Male orienteers had a lower prevalence of IgA antibodies than male blood donors (19% and 26%, respectively; p < 0.05), while no such difference was found in females (16% and 18%). The prevalence of IgM antibodies was < 1% in all groups. Neither the performance level of the orienteers nor the place of residence affected the antibody prevalence. In conclusion, Swedish orienteers do not show a higher prevalence of antibodies to C. pneumoniae than healthy blood donors.

Cervical, Urine and Vaginal Specimens for Detection of Chlamydia trachomatis by Ligase Chain Reaction in Women: A Comparison

Screening for Chlamydia trachomatis in women is generally done using only one specimen from each patient in order to minimize costs. In this study the aim was to compare the performances of vaginal, cervical and urinary specimens in a population of young women with sparse symptoms. During 1998, specimens from 1,001 women at the Departments of Venereology and Youth Health Care at the University Hospital of Uppsala, Sweden were examined by both ligase chain reaction and cell culture for detection of C. trachomatis. The samples from the cervix, vagina and urine were tested by ligase chain reaction, while specimens for cell culture were collected from the cervix and urethra. The prevalence of genital C. trachomatis infections was 5.1%. A single urine specimen had a sensitivity of 80.0%, while the sensitivity of a single vaginal specimen was 96.0%. The specificity was 100% for the urine specimens and 99.4% for the vaginal specimens. The sensitivity and specificity of a single cervical specimen was 92.0% and 99.6%, respectively. Although the urine ligase chain reaction seemed to have the lowest sensitivity of the compared specimens for testing of C. trachomatis infections in this population, the differences in sensitivity between urine, cervical and vaginal specimens were not statistically significant.

Serology of Respiratory Viruses in Relation to Asthma and Bronchial Hyperresponsiveness

Do individuals with serological evidence of infections with respiratory viruses have an increased prevalence of asthma or bronchial hyperresponsiveness (BHR)? Antibodies to four common respiratory viruses were measured in the sera of 81 subjects without a history of a recent respiratory infection. The subjects underwent an interview, spirometry, a methacholine provocation test and skin prick tests. In sera where virus antibodies were found, IgG titer values of > or = 1:40 were regarded as evidence of a recent infection. A significant relationship was found between serological markers of a recent respiratory syncytial (RS) virus infection and physician diagnosed asthma (odds ratios (OR) 14.5, 95% confidence intervals (CI) 1.4-151) or BHR (OR 12.7, 95% CI 1.2-132)(p < 0.05). Furthermore, the total blood eosinophil count was significantly higher in subjects with serological signs of a current or recent RS virus infection than in those without such signs (364 +/- 198 x 10(6)/L and 175 +/- 118 x 10(6)/L respectively, p < 0.05). In conclusion, a recent RS viral infection may be an important factor in the induction of symptoms and signs suggestive of asthma.

Significance of terminalαDgal(1-4)βDgal residues in urinary tract epithelium

A monoclonal antibody to a terminal residue ofαDgal(1-4)βDgal, known as part of the receptor for p-fimbriatedEscherichia coli, was used to study the occurrence of this carbohydrate residue in urinary tract tissue from different animal species and man. Sections of bladder, ureter, and kidney tissue from man, monkey, guinea pig, rat, and mouse were investigated by an avidin-biotin-peroxidase staining method that proved useful for demonstrating carbohydrate structures in tissues. TerminalαDgal(1–4)βDgal residues were widely distributed in epithelial cells of the urinary tract in most of the species studied. Cells expressing this carbohydrate were also demonstrated in urinary sediment from healthy women. Experimental infection could not prove that this terminal structure alone was essential for establishment of pyelonephritis.