Chlamydia Pneumoniae in the Etiology of the Keratoconjunctivitis Sicca in Adult Patients (a Pilot Study)
Authors:
J. Krásný; D. Hrubá 1; M. Netuková; V. Kodat; J. Tomášová Borovanská
Authors‘ workplace:
Oční klinika FN Královské Vinohrady, Praha, přednosta prof. MUDr. P. Kuchynka, CSc.
; Vidia-Diagnostica, s. r. o., Praha
1
Published in:
Čes. a slov. Oftal., 65, 2009, No. 3, p. 102-106
Overview
Aim:
In the pilot study the authors refer to the possible connection between the appearance of keratoconjunctivitis sicca (KCS) and Chlamydia pneumoniae (CP) infection.
Materials and methods:
At the Department of Ophthalmology, 10 adult patients older than 45 years were followed up during the period of 5.5–7 years, where in the chronic folicular conjunctivitis caused by CP, the KCS was revealed as the same time.
Methods:
The chlamydial infection diagnosis was established due to the positivity to the familiar (anti-LPS) and species (anti-CP) immunoglobulins (IgG, IgM, and IgA) and to the conjunctival impression specimen, using the indirect immunofluorescence of specific monoclonal antibodies. The patients were treated by means of systemically administered macrolide antibiotics Azithromycine. After the termination of the treatment, the signs of the clinical inflammation of the conjunctival inflammation subsided but the KCS problems remained. After 6 years, the control examinations of the familiar and species antibodies of the CP were performed and the clinical findings of the KCS and its treatment were evaluated.
Results:
The decrease of the antibody levels was proved and objective findings and subjective symptoms of KCS in all patients subsided. Altogether 7 patients were without clinical signs of the KCS and without regular application of local artificial tears treatment. At the same time, in two thirds of the patients, the levels of the antibodies decreased or remained unchanged. In the last three patients, the signs of the dry eye decreased, but they didn’t disappeared permanently. These patients had to apply artificial tears several times a day. The suspect signs of this serologically active infection persisted despite the antibodies levels’ decrease.
Conclusion:
This pilot study until now didn’t confirm the direct dependence between the KCS and CP, but it didn’t exclude it as well.
Key words:
keratoconjunctivitis, Chlamydia pneumoniae.
Sources
1. Aldus, M.R., Grayston, J.T., Waring, S. et al.: Seroepidemiology of Chlamydia pneumoniae TWAR Infection in Seattle Families. J. Infect. Dis., 166, 1992: 646 – 49.
2. Balin, B.J., Gerard, H.C., Arking, E.J. et al.: Identification and Localization of C. Pneumoniae in the Alzheimeręs Brain. Med. Microbiol. Immunol., 187, 1998: 23 – 42.
3. Blasi, F., Boman, J., Esposito, G. et al.: Chlamydia pneumoniae DNA Detection in Peripheral Blood Mononuclear Cells is Predictive of Vascular Infection. J. Infect. Dis., 180, 1999: 2074–76.
4. Blasti, F., Fagetti, L., Allegra, L.: Chlamydia pneumoniae Detection in Atherosclerotic Plaque in Italy. J. Infect. Dis., 181, 2000, suppl. 3: 444–446.
5. Cunningham, A.F., Johnston, S.L., Julious, S.A. et al.: Chronic Chlamydia pneumoniae Infection and Asthma Exacerbations in Children. Eur. Respir., J. 11, 1998: 345–349
6. Dowel, V. et al.: Standardizing Chlamydia pneumoniae Assays: Recommendations from the Centers for Disease Control and Prevention (USA) and the Laboratory Centre for Disease Control (Canada). Clinical Infectious Diseases, 33, 2001: 492–503.
7. Dawson, Ch.R., Schachter, J., Stephens, R.D.: Chlamydial Keratoconjunctivitis. In: Pepose, J.S., Holland, N.G., Wihelmus, K.R.: Ocular Infection & Immunity. Mosby, St. Louis, 1995, pp. 818–829.
8. Dwzer, R., Treharne, J.D., Jones, B.R. et al.: Chlamydial Infection: Results of Microimmunofluorescence tests for the Detection of Type-specific Antibody in Certain Chlamydia Infection. Br. J. Vener. Dis., 48, 1972: 452–459.
9. Forsey, T., Darougar, S.: Acute Conjunctivitis Caused by an Atypical Chlamydia Strain 10L 207. Br. J. Ophthalmol., 68, 1984: 408.
10. Grayton, J.T.: Design of Future Intervention Studies for Chlamydia pneumoniae in Atherosclerosis. Am. Heart J., 138, 1999, 5 Pt 2:S556–S557.
11. Hahn, D.L.: Chlamydia pneumoniae, Asthma and CHOPD: What Is the Evidence? Annals of Allergy, Asthma & Immunol. 83, 1999: 271–288.
12. Kleemola, M., Saikku, P., Visakorpi, R. et al.: Epidemics of Pneumonia Cause by TWAR, a New Chlamydia Organism, in Military Trainees in Finland. J. Infect. Dis., 157, 1988: 230–236.
13. Koskiniemi, M., Gencay, M., Salonen, O. et al.: Chlamydia pneumoniae Associated with Central Nervous System Infections. Eur. Neurol., 36, 1996: 160–163.
14. Krásný, J., Borovanská, J., Hrubá, D.: Chlamydia pneumoniae – etiologie folikulární konjunktivitidy a následné keratokonjunktivitis sicca u dospělých pacientů. Čes. a slov. Oftal., 59, 2003: 325–333.
15. Krásný, J., Hrubá, D., Tomášová-Borovanská, J.: Chlamydiové infekce oka. In : Rozsíval, P. (Ed).: Moderní trendy v oftalmologii, Praha, Galen, 2005, s. 177–203.
16. Laurila, A.L., Anttila, T., Laara, E. et al.: Serological Evidence of an Association between Chlamydia pneumoniae Infection and Lung Cancer. Int. J. Cancer., 74, 1997: 31–34.
17. Lietman, T., Brooks, D., Moncada, J. et al.: Chronic Follicular Conjunctivitis Associated with Chlamydia psittaci and Chlamydia pneumoniae. Clin. Infect. Dis., 26, 1998: 1335–40.
18. Merayo-Lloves, J., Baltatzis, S., Foster, C.S.: Epstein-Barr Virus Dacryoadenitis Resulting in Keratoconjunctivitis Sicca in a Child. Am. J. Ophthalmol. 132, 2001: 922–923.
19. Pflugfelder, S.C., Beuerman, R.W.: Dry Eye and Ocular Surfare Disorders. New York, M. Dekker, 2004, p. 428.
20. Pflugfelder, S.C., Whitcher, J.P., Troy, E.D.: Sjogren Syndrome. In: Pepose, J.S., Holland, N.G., Wihelmus, K.R. (Ed): Ocular Infection & Immunity. St. Louis, Mosby, 1995, pp. 313–33.
21. Puolakkainen, M., Campbell, L.A., Kuo, C.C. et. al.: Serogical Response to Chlamydia pneumoniae in Patients with Sarcoidosis. J. Infection 33, 1996: 199–205.
22. Ridker, P.R., Kundsin, R.B., Stampfer, M.J. et al.: Prospective Study of Chlamydia pneumoniae IgG Seropositivity and Risk of Future Myocardial Infraction. Circulation, 99, 1999: 1161–64.
23. Schirmer, O.: Studies zur Physiologie und Pathologie der Tranenabsonderung und Tranenabfuhr. Graefes Arch. Clin. Exp. Ophthalmol., 56, 1903: 47–60.
24. Schumacher, H.R. Jr., Gerad, H.C., Arayssi, T.K. et al.: Lower Prevalence of C. pneumoniae DNA compared with C. trachomatis DNA in Synovial Tissue of Arthritis Pacients. Arthritis Rheum., 42, 1992: 1889–93.
25. Sodja, J.: Sérologický přehled chlamydiových protilátek. Zprávy CEM, 1998, č.7, s. 34 – 36.
26. Sriram, S., Mitchel, W., Stratton, C.: Multiple Sclerosis Associated with C. Pneumoniae Infection of the CNS. Neurology 50, 1998: 571–572.
27. van Bijsterveld, O.: Diagnostic Test in the Sicca Syndrome. Arch. Ophthalmol., 82, 1969: 10–14.
28. Weslen, L., Pahlson, C., Lindquist, O. et al.: An Increase in Sudden Unexpected Cardiac Deaths Among Young Swedish Orienteers During 1979-1992. E. Heart., J. 17, 1996: 902–10.
29. Willoughby, C.E., Barker, K., Kaye, S.B. et al.: Epstein-Barr Virus in the Tear Film in Sjorgen’s Syndrome and HIV Infection. J. Med. Virol., 68, 2002: 378–383.
30. Wu, L., Skinner, S.J., Lambie, N. et al.: Immunohistochemical Staining for C. pneumoniae is Increased in Lung Tissue from Subject with Chronic Obstructive Pulmonary Disease. Am. J. Respir. Crit. Care Med., 162, 2000: 1148–51.
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OphthalmologyArticle was published in
Czech and Slovak Ophthalmology
2009 Issue 3
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