Håkan Gnarpe

Mycoplasma and human reproductive failure: I. The occurrence of different mycoplasmas in couples with reproductive failure☆

An epidemiological study of the occurrence of different Mycoplasmas in seminal fluid and in cervical secretions from patients with reproductive failure and in 2 control groups is described. All patients underwent a series of fertility tests before inclusion in the study and those with abnormal findings were excluded. Group A consisted of 36 couples in whom no cause of infertility could be found and group B of 19 couples in whom serum antibodies agglutinating donor sperm in different titers were detected in the women but not in the men. 2 control groups consisted of 40 women in group C attending a prenatal clinic and 23 men in group D married to women in the 3rd-9th month of pregnancy. Among the subjects, sperm specimens were obtained from the men and cervical swabs from the women on the 2nd or 3rd day of the menstrual period and cultured for Mycoplasmas. Cervical swabs taken after postcoital tests, and cervical and sperm specimens taken during the luteal phase were also cultured. Cervical and sperm specimens from the controls were also cultured. In group A, large colony-forming Mycoplamas were found in cervical secretions of 7 women and in seminal fluid of 2 men. T-Mycoplasmas were found in both spouses in 28 couples and in 3 women and 2 men with negative partners. In group B, large colony-forming Mycoplasmas were found in 2 women and 1 man whose partners were negative. T-Mycoplasmas were isolated from both spouses in 17 of the 19 couples and from the wife only in 2 couples. In group C, classical Mycoplasmas were found in 3 and T-Mycoplasmas in 9 of the 40 cases. In group D, no classical Mycoplasmas were discovered but T-Mycoplasmas were found in 6 of the 23 cases. The observed difference in frequency of T-Mycoplasmas between patient and control groups was highly significant statistically. T-Mycoplasmas were found growing from the spermatozoa but not from the supernate in 7 of 10 specimens obtained from men in group B. In 2 of the remaining 3 specimens, T-Mycoplasmas were found both in spermatozoa and in the supernate, while in the last specimen, no growth was found.

Chlamydia Pneumoniae (TWAR): a common agent in acute bronchitis

Patients seeking medical attention for respiratory infections were investigated with serology and culture for Chlamydia pneumoniae to investigate the prevalence of C. pneumoniae in a specific geographical area and its association with respiratory disease. Evidence for C. pneumoniae infection was found in approximately 25% of cases. 71% of patients with C. pneumoniae had symptoms from the lower respiratory tract as compared to 29% of the others. We conclude that C. pneumoniae can be a major cause of acute bronchitis.

Endemic Prevalence of Chlamydia pneumoniae in Subjectively Healthy Persons

Subjectively healthy persons were investigated for the presence of Chlamydia pneumoniae (TWAR) with throat cultures using the HL (human lung) cell line. C. pneumoniae was isolated from 11/234 investigated persons.

Bordetella pertussis, Bordetella parapertussis, Mycoplasma pneumoniae, Chlamydia pneumoniae and Persistent Cough in Children

Material collected during a prospective pertussis vaccine trial in 1992-95 was examined for Bordetella pertussis (culture and serology), Bordetella parapertussis (culture), Mycoplasma pneumoniae and Chlamydia pneumoniae (PCR). From 64% (99/155) of episodes with cough for less than 100 d, 115 aetiological agents were identified in one southern and one northern subset of DT-recipients. The most common single agent was B. pertussis, representing 56%(64/115), with a median cough period of 51 d, followed by M. pneumoniae 26%(30/115), 23 d, C. pneumoniae 17% (19/115), 26 d, and B. parapertussis 2% (2/115). For co-infections, the median duration of cough was about 60 d. Spasmodic cough for 21 d or more (clinical WHO criteria for pertussis) was present in 82% (41/50) of infections with B. pertussis as single agent, 38% (17/45) with B. parapertussis, 38% (5/13) with C. pneumoniae, 26% (5/19) with M. pneumoniae and 30%(17/56) in cases where no aetiology was found. In children with cough for more than 100 d (n = 78) using all vaccine arms, B. pertussis was responsible in 83% (65/78), in 21%(16/78) together with other agents. Acellular vaccines were more efficient against serious disease than whole cell vaccine. Antibiotic treatment was more common at the southern (34%) study site than at the northern one (12%). The findings indicate that diagnosis should rely on laboratory confirmation, both for rational treatment of an individual case and for monitoring outbreaks.

Chlamydia pneumoniae in children with acute respiratory tract infections

Children seeking medical attention for acute respiratory tract infections were investigated for evidence of Chlamydia pneumoniae infection. Blood samples were obtained from 367 children. Nasopharyngeal or throat swabs for PCR analysis (polymerase chain reaction) were taken from 360 children. Serology was found to be useful for diagnosis of infection only in children aged 5 y. Using PCR, a prevalence of 8 and 10% of C pneumoniae was found in male and female children aged < 2 y; 17 and 19%, respectively, in the age group 2‐4 y and 32 and 21%, respectively, in the age group 5–16 y. We conclude that Chlamydia pneumoniae is a common finding in young children with respiratory tract infections. Younger children were more often found to have a moderate disease, but may have been ill for a long period.

Prevalence of Mycoplasma pneumoniae in subjectively healthy individuals

Subjectively healthy persons were investigated for the presence of Mycoplasma pneumoniae in throat cultures. During a peak period of M. pneumoniae incidence, 13.5% of 758 healthy volunteers were found to harbour the bacterium in the throat. The investigation was continued, and during a subsequent period of 11 months, the incidence of M. pneumoniae isolated decreased to 4.6% of 499 volunteers. All new blood donor sera 1990-1991 (422 sera) were screened for the presence of antibodies to M. pneumoniae; it was found that there was a fluctuating but significant number of individuals with positive serology based on a single test occasion.

Prevalence of Chlamydia pneumoniae in healthy children and in children with respiratory tract infections.

BACKGROUND Chlamydia pneumoniae causes respiratory tract infections in adults, but little is known about its significance for acute or persistent respiratory tract infections in children. METHODS We studied the prevalence of C. pneumoniae by polymerase chain reaction in children younger than the age of 11: 85 consecutive children with respiratory tract infections; and 93 children presumed to be healthy. Throat swabs for PCR analysis were taken from all children, and serology was done for 54 of the 85 sick children and from all but one of the presumed healthy children positive for C. pneumoniae by PCR. RESULTS PCR was positive in 38 (45%) of the sick children and in 5 (5.7%) of the healthy children. All but 2 of 19 sick children with serologic findings suggesting recent or ongoing infection with C. pneumoniae were positive by PCR. Most children positive for C. pneumoniae by PCR had upper respiratory tract infections. Four children had recurrent respiratory tract infections and otitis media with effusion treated by tubal insertion. CONCLUSION The findings suggest that C. pneumoniae is common among children with respiratory tract infections.

An association between chronic infection with Chlamydia pneumoniae and lung cancer. A prospective 2-year study.

This study assesses a possible relationship between chronic Chlamydia pneumoniae (Cpn) infection and lung cancer (LC). A total of 210 consecutive patients (136 M, 74 F) were diagnosed with LC during a 2‐year period. Blood was obtained from 128 M and 70 F patients for Cpn serology. Repeat blood specimens were taken after 3 months. Throat specimens for Cpn DNA analysis by PCR were taken from 110/136 M and 63/74 F. Seventy‐four cytobrush specimens were taken and also analyzed by polymerase chain reaction (PCR). Fifty (29 M, 21 F) bronchial biopsies and 8 (6 M, 2 F) tumors resected at surgery were analyzed for Cpn by immunohistochemistry (IHC). Males had significantly more often squamous‐cell carcinoma (SCC) than females. Other types of LC were more equally distributed between males and females. The difference between males and females regarding smoking history was significant, and male LC patients had significantly higher levels of IgG and/or IgA antibodies than female LC patients. Male and female LC patients had significantly higher prevalences of high antibody titers than controls. A high prevalence of unusually high titers of specific Cpn antibodies was found in male LC patients. This could indicate that LC may be induced by chronic Cpn infection, since stable high titers of Cpn antibodies, especially IgA, are a hallmark of chronic infections.

An unusual manifestation of chlamydia pneumoniae infection : meningitis, hepatitis, iritis and atypical erythema nodosum

A 37-year-old man was admitted to hospital with fever, muscle tenderness, headache and mild exanthema on the right thigh. During his hospital stay, the headache worsened and aseptic meningitis was diagnosed. A bilateral iritis developed, and the exanthema developed into an atypical erythema nodosum. In liver function tests, pathological results were recorded. Vasculitis was suspected but could not be confirmed. All serological tests proved negative except for a fourfold titre rise to Chlamydia pneumoniae. We concluded that the meningitis, hepatitis, iritis and atypical erythema nodosum were most probably due to a C. pneumoniae infection.

Chlamydia trachomatis among sexually active teenage girls. Lack of correlation between chlamydial infection, history of the patient and clinical signs of infection

Summary. Cultures for Chlamydia trachomatis were obtained from 1012 teenage girls attending an adolescence clinic mainly for family planning; C. trachomatis was isolated from 174 (17·2%). The proportion of chlamydia‐positive girls varied between 15·7% and 28·5% depending whether or not there were symptoms and signs of infection. Neither the history nor the finding at pelvic examination offered conclusive evidence for or against the presence of an infection with C. trachomatis. Of the chlamydia‐positive, untreated, asymptomatic girls, 17·5% developed symptoms of a genital infection within 3 months. There was a statistically significant difference in the proportion of positive cultures by the two investigators, suggesting that the procedure for specimen collection is of great importance.