San-Ping Wang

Chlamydia pneumoniae, Herpes Simplex Virus Type 1, and Cytomegalovirus and Incident Myocardial Infarction and Coronary Heart Disease Death in Older Adults The Cardiovascular Health Study

BackgroundWhether serological evidence of prior infection with Chlamydia pneumoniae, herpes simplex virus type 1 (HSV-1), and cytomegalovirus (CMV) is associated with myocardial infarction (MI) and coronary heart disease (CHD) death remains a source of controversy. Methods and ResultsWe conducted a nested case-control study among participants in the Cardiovascular Health Study, a cohort study of persons aged ≥65 years. Cases experienced an incident MI and CHD death (n=213). Control subjects were matched to cases by age, sex, clinic, year of enrollment, and month of blood draw (n=405). Serum was analyzed for IgG antibodies to C pneumoniae, HSV-1, and CMV. After adjustment for other risk factors, the risk of MI and CHD death was associated with the presence of IgG antibodies to HSV-1 (odds ratio [OR] 2.0, 95% CI 1.1 to 3.6) but was not associated with the presence of IgG antibodies to either C pneumoniae (OR 1.1, 95% CI 0.7 to 1.8) or CMV (OR 1.2, 95% CI 0.7 to 1.9). Although there was little association with low to moderate C pneumoniae antibody titers (≤1:512), high-titer (1:1024) C pneumoniae antibody was associated with an increased risk (OR 2.2, 95% CI 1.1 to 4.4). ConclusionsAmong older adults, the presence of IgG antibodies to HSV-1 was associated with a 2-fold increase in the risk of incident MI and CHD death. For C pneumoniae, only high-titer IgG antibodies were associated with an increased risk of MI and CHD death. The presence of IgG antibodies to CMV was not associated with risk among the elderly.

Chlamydia pneumoniae and Atherosclerotic Risk in Populations: The Role of Seroepidemiology

While seroepidemiologic studies first suggested a possible association of prior infection with Chlamydia pneumoniae and atherosclerotic risk, the contribution of seroepidemiologic studies of C. pneumoniae and atherosclerotic risk remains a source of controversy, in part because the reported findings appear inconsistent. In general, cross-sectional studies of C. pneumoniae and atherosclerotic risk suggest an association, but recent reports from several prospective studies failed to demonstrate associations between the presence of IgG antibodies to C. pneumoniae and incident myocardial infarction. Evidence from other paradigms-pathologic, animal experimental, and molecular studies-supports a possible etiologic role for C. pneumoniae in atherothrombotic disease, raising questions about the contribution of seroepidemiologic studies. This review summarizes the major findings from seroepidemiologic studies in the context of other research paradigms, explores alternative explanations for the inconsistent findings, and suggests a further role for seroepidemiologic studies of C. pneumoniae and atherothrombotic risk.

The association between Chlamydia trachomatis serology and pelvic damage in women with tubal ectopic gestations.

Objective To determine whether pelvic damage is associated with positive Chlamydia trachomatis serology in women with tubal ectopic pregnancy. Design Cross-sectional retrospective study. Setting A prepaid health maintenance organization. Patients Two-hundred eighty-one women admitted with confirmed tubal ectopic pregnancy were interviewed for history of sexually transmitted diseases. Chlamydia serology was obtained for 135 subjects, and operative findings were available for 121 of these. Interventions None. Main Outcome Measure Pelvic damage, as determined by review of operative findings of the pelvis at the time of ectopic surgery. Results Pelvic damage was associated with positive chlamydia serology with an adjusted odds ratio of 4.2 (95% confidence interval: 1.8 to 9.7). Moderate and severe pelvic damage were more strongly associated with positive serology than mild damage. Conclusions Women with ectopic pregnancies and antibodies to C. trachomatis are more likely to have damaged pelves than women with ectopic pregnancies without such antibodies. Prevention or early treatment of C. trachomatis infection may reduce pelvic damage and, therefore, reduce incidence of ectopic pregnancy.

Current Knowledge of Chlamydia TWAR, an Important Cause of Pneumonia and Other Acute Respiratory Diseases

This article reviews current knowledge of the TWAR strain, a newly recognized chlamydia organism that causes acute respiratory infection, especially atypical pneumonia. Information is presented under the following topics: introduction and history of the organism; microbiology and classification, including the proposal for a new chlamydia species, Chlamydia pneumoniae; laboratory diagnosis by isolation and serology; endemic TWAR disease and evidence for etiology, including studies in university students, in hospitalized pneumonia patients in three cities, and in a health maintenance organization from 1963 to 1974 and from 1985 to 1987; epidemic TWAR disease both country-wide in Denmark, Norway and Sweden 1981–1983, and localized in Finland and other countries; treatment including laboratory determination of antibiotic and sulfa drug sensitivity of the TWAR organism; population TWAR antibody prevalence; and studies by other investigators.