Evidence for Chlamydia pneumoniae infection in
steroid-dependent asthma
David L Hahn, MD*; Don Bukstein, MD*; Allan Luskin, MD*; and Howard Zeitz, MD†
Background: Chlamydia pneumoniae is an obligate intracellular respiratory
strong association of C. pneumoniae pathogen capable of persistent infection. Seroepidemiologic studies and the results of open-label antimicrobial treatment of patients with non-steroid-dependent asthma have suggested a potential role for C. pneumoniae in asthma.
12.5 for titers of 1:128 or greater).8 C. Objective: To evaluate the results of antimicrobial treatment in patients with
pneumoniae is a plausible candidate as uncontrolled steroid-dependent asthma and serologic evidence suggesting C. pneu- Methods: Three nonsmoking asthmatic patients (aged 13 to 65 years) whose
symptoms remained poorly controlled despite daily administration of inhaled and oral steroid (10 to 40 mg/d). All met serologic criteria for current or recent C. tion and inflammation.10–12 The culture Results: After prolonged treatment (6 to 16 weeks) with clarithromycin or
for C. pneumoniae infection in the ini- azithromycin all three patients were able to discontinue oral steroids. All three patients have remained well controlled with inhaled antiasthma therapy only during 3 to 24 months of postantibiotic therapy observation.
Conclusions: In adolescent and adult asthmatic patients, Chlamydia pneumoniae
infection may contribute to symptoms of asthma that are poorly controlled by linking C. pneumoniae infection to steroids. Serologic evidence for C. pneumoniae infection should be sought in such patients. A trial of appropriate antibiotic therapy may be helpful in those patients with high titers of anti-C. pneumoniae IgG antibodies.
Ann Allergy Asthma Immunol 1998;80:45–9.
obtained from three patients who de-veloped INTRODUCTION
asthma following clinical respiratoryillnesses and who also had serologic treated chronic Chlamydia trachomatis met clinical and spirometric criteria for moniae, is a human pathogen recog- stimuli. Spirometric criteria for revers- *Dean Medical Center, Madison, Wisconsin.
†Rush-Presbyterian-St. Luke’s Medical Cen- gestive of a role for C. pneumoniae and Grayston,14 we measured C. pneu- Received for publication March 3, 1997.
moniae-specific IgM and IgG antibod- Accepted for publication in revised form June patients. C. pneumoniae-specific IgA ter of IgG specific for C. pneumoniae role of C. pneumoniae as an important IgE antibodies specific for C. pneu- moniae have been associated with cul- CASE REPORTS
cough, shortness of breath and wheeze.
ing was positive only with Alternaria.
tentative diagnosis of mild asthma wasmade and he was treated with an albu- Table 1. Summary of Clinical and Serologic Data C. pneumoniae
Patient Age,
Pre-bronchodilator FEV1
Antibody Titer
Pre-Antibiotic Rx
Post-Antibiotic Rx
Ͻ1:8 ND 1:512 1.78L (49% predicted) 3.67L (102% predicted) Ͻ1:8 1:16 1:512 1.62L (61% predicted) 1.91L (74% predicted) Ͻ1:8 1:64 1:512 1.50L (37% predicted) 2.48L (61% predicted) ANNALS OF ALLERGY, ASTHMA, & IMMUNOLOGY ters of anti-C. pneumoniae IgG (1:512) strongly suggested C. pneumoniae in- fection, all three patients received pro- The optimal length of therapy for C. pneumoniae respiratory infection has major target organs in chronic C. pneu- not been established. Acute C. pneu- moniae infection. Nevertheless, high moniae respiratory infections often re- DISCUSSION
infections.24 Because Chlamydia tra- tients reported here suggests that C. chomatis-specific IgA, but not IgG, pneumoniae infection also might be a dency in some cases of severe asthma.
chronic C. pneumoniae infection. IgG antibodies against C. pneumoniae were ma-inciting antigens. C. pneumoniae- identify patients with chronic C. pneu- moniae respiratory infection. Because tional Heart, Lung, and Blood Insti-tute. February, 1997.
jects. Culture diagnosis is difficult be- animal model, non-cultivable C. pneu- moniae may be transformed to a culti- 5. Grayston JT. Chlamydia pneumoniae, strain TWAR. Chest 1989;95:664 –9.
growth of C. pneumoniae in vitro32 and chitis. J Infect Dis 1993;168:1231–5.
C. pneumoniae antibody titers in pa- 8. Hahn DL, Dodge R, Golubjatnikov R.
Association of Chlamydia pneumoniae will be required to elucidate further the gested that steroid treatment of patients who are infected with C. pneumoniae their role in asthma: Chlamydia pneu- moniae in adult patients. Eur Respir ters of C. pneumoniae-specific anti- bodies, a trial of appropriate antibiotic continues to rise in the elderly.34 Since chronic C. pneumoniae infection has ogy of experimental Chlamydia pneu-moniae pneumonitis in mice. J Infect It is possible that chronic infection, as otic effective against Chlamydia pneu- pneumoniae infection in mice: effect ACKNOWLEDGMENT
1. Shelhamer JH, Levine SJ, Wu T, et al.
2. Expert Panel Report II. Guidelines for ANNALS OF ALLERGY, ASTHMA, & IMMUNOLOGY al. Chronic Chlamydia pneumoniae in- 29. Thom DH, Grayston JT. Chlamydia bridge University Press, 1986:329 –32.
pneumoniae strain TWAR infections: descriptions, diagnosis, and treatment.
R, et al. Evidence of persistent Chla- Mediguide Infect Dis 1990;10:1– 4.
30. Hahn DL. Treatment of Chlamydia determinations for Chlamydia pneu- pneumoniae infection in adult asthma: 16. Saikku P. Chronic Chlamydia pneu- Grayston JT. Reactivation of Chla- moniae infections. In: Allegra L, Blasi mydia pneumoniae lung infection in 24. Alifano M, De Pascalis R, Sofia M, et wara T, et al. Serologic tests for Chla- mydia pneumoniae. Pediatr Infect Dis Davies P. Chlamydia pneumoniae an- specific IgA antibody to Chlamydia trachomatis in the diagnosis and treat- et al. Respiratory infection with Chla- mydia pneumoniae in middle-aged and pneumoniae. In: Allegra L, Blasi F, crobiol Infect Dis 1994;13:785–92.
eds. Chlamydia pneumoniae infection.
20. Hahn DL. Evidence for Chlamydia pneumoniae infection in asthma. In: tion. Eur J Epidemiol 1992;8:882– 4.
Request for reprints should be addressed to: to Chlamydia pneumoniae in military 28. Peeling RW, Hahn D, Dillon E. Chla- mydia pneumoniae infection and adult-



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