Pathogenesis of chlamydial infections

Chlamydia antibodies and self-reported symptoms of oligo-amenorrhea and hirsutism: a new etiologic factor in polycystic ovary syndrome?

OBJECTIVE

To investigate whether the systemic inflammation induced by chlamydial infections might be associated with symptoms of polycystic ovary syndrome (PCOS).

DESIGN

Nested case-control study.

SETTING

A questionnaire including questions about hirsutism and oligo-amenorrhea was distributed to a representative sample of women (at age 31) from the general population-based Northern Finland Birth Cohort. Those who reported both symptoms were defined as symptomatic (n=81).

PATIENT(S)

A representative sample of women (at age 31) from the general population-based Northern Finland Birth Cohort.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

To test the presence of serum antibodies to Chlamydia pneumoniae (IgG titers ≥32) and Chlamydia trachomatis (IgG titers ≥8) by microimmunofluorescence in symptomatic and control women.

RESULT(S)

Antibodies were investigated in 79 symptomatic and 1427 control women (C. pneumoniae) and in 79 symptomatic and 425 control women (C trachomatis). C. trachomatis antibodies (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.3-4.6) and C. pneumoniae antibodies (OR, 1.5; 95% CI, 1.0-2.4) were more commonly present in symptomatic women, and the simultaneous presence of elevated highly sensitive C-reactive protein levels strengthened this association.

CONCLUSION(S)

Chronic inflammation, which is associated with chlamydial infections, could contribute to the pathogenetic processes that lead to the metabolic and hormonal disorders of PCOS.

High rate of seropositivity of Chlamydia pneumoniae IgA in male patients with nonalcoholic steatohepatitis

The aim of this study was to investigate if there was any relationship between nonalcoholic steatohepatitis and the rate of Chlamydia pneumoniae seropositivity in a male population. Fifteen men with nonalcoholic steatohepatitis and 20 healthy men were enrolled in the study. The seropositivity rate of Chlamydia pneumoniae immunoglobulin A in the nonalcoholic steatohepatitis and control groups was 53.3 and 5%, respectively. The rate of Chlamydia pneumoniae immunoglobulin A positivity was significantly higher in the nonalcoholic steatohepatitis group than the controls (P = 0.002), while such a difference did not occur for Chlamydia pneumoniae immunoglobulin G positivity (P > 0.05). There is an association between nonalcoholic steatohepatitis and persistent Chlamydia pneumoniae infection as a probable causative or triggering agent. These findings suggest that further studies are necessary to clarify this association.

Tryptophan recycling is responsible for the interferon-gamma resistance of Chlamydia psittaci GPIC in indoleamine dioxygenase-expressing host cells

Comparative genomics indicates that vast differences in Chlamydia sp. host range and disease characteristics can be traced back to subtle variations in gene content within a region of the chromosome termed the plasticity zone. Genes required for tryptophan biosynthesis are located in the plasticity zone; however, the complement of genes encoded varies depending on the chlamydial species examined. Of the sequenced chlamydia genomes, Chlamydia psittaci GPIC contains the most complete tryptophan biosynthesis operon, encoding trpRDCFBA. Immediately downstream of the trp operon are genes encoding kynureninase and ribose phosphate pyrophosphokinase. Here, we show that, in GPIC, these genes are transcribed as a single transcript, the expression of which is regulated by tryptophan. Complementation analyses, using various mutant Escherichia coli isolates, indicate that the tryptophan biosynthesis, kynureninase and ribose phosphate pyrophosphokinase gene products are functional. Furthermore, growth of C. psittaci GPIC in HeLa cells, cultured in tryptophan-free medium, could be rescued by the addition of anthranilate, kynurenine or indole. In total, our results indicate that this complement of genes enables GPIC to recycle tryptophan and thus accounts for the interferon-gamma resistant phenotype displayed in indoleamine-2,3-dioxygenase-expressing host cells.

Regulation of tryptophan synthase gene expression in Chlamydia trachomatis

We previously reported that Chlamydia trachomatis expresses the genes encoding tryptophan synthase (trpA and trpB). The results presented here indicate that C. trachomatis also expresses the tryptophan repressor gene (trpR). The complement of genes regulated by tryptophan levels in C. trachomatis is limited to trpBA and trpR. trp gene expression was repressed if chlamydiae-infected HeLa cells were cultured the presence of tryptophan and induced if grown in tryptophan-depleted medium or in the presence of IFN-gamma. Furthermore, expression of the trp genes in strains which encode a functional tryptophan synthase is repressed when infected cells are cultured in the presence of the tryptophan precursor indole. Results from experiments with cycloheximide, an inhibitor of eukaryotic protein synthesis, indicate that in addition to the absolute size of the intracellular tryptophan pool, host competition for available tryptophan plays a key role in regulating expression of the trp genes. The tryptophan analogue, 5-fluorotryptophan, repressed trp gene expression and induced the formation of aberrant organisms of C. trachomatis. The growth-inhibitory properties of 5-fluorotryptophan could be reversed with exogenous tryptophan but not indole. In total, our results indicate that the ability to regulate trp gene expression in response to tryptophan availability is advantageous for the intracellular survival of this organism. Furthermore, the fact that C. trachomatis has retained the capacity to respond to tryptophan limitation supports the view that the in vivo antichlamydial effect of IFN-gamma is via the induction of the tryptophan-degrading enzyme, indoleamine 2,3-dioxygenase.

Polymorphisms in Chlamydia trachomatis tryptophan synthase genes differentiate between genital and ocular isolates

We previously reported that laboratory reference strains of Chlamydia trachomatis differing in infection organotropism correlated with inactivating mutations in the pathogen's tryptophan synthase (trpBA) genes. Here, we have applied functional genomics to extend this work and find that the paradigm established for reference serovars also applies to clinical isolates - specifically, all ocular trachoma isolates tested have inactivating mutations in the synthase, whereas all genital isolates encode a functional enzyme. Moreover, functional enzyme activity was directly correlated to IFN-gamma resistance through an indole rescue mechanism. Hence, a strong selective pressure exists for genital strains to maintain a functional synthase capable of using indole for tryptophan biosynthesis. The fact that ocular serovars (serovar B) isolated from the genital tract were found to possess a functional synthase provided further persuasive evidence of this association. These results argue that there is an important host-parasite relationship between chlamydial genital strains and the human host that determines organotropism of infection and the pathophysiology of disease. We speculate that this relationship involves the production of indole by components of the vaginal microbial flora, allowing chlamydiae to escape IFN-gamma-mediated eradication and thus establish persistent infection.

Comparison of individuals with and without specific IgA antibodies to Chlamydia pneumoniae: respiratory morbidity and the metabolic syndrome

STUDY OBJECTIVES

To determine whether a correlation exists between markers for persistent Chlamydia pneumoniae infection, respiratory morbidity, and the metabolic syndrome.

DESIGN

Case-control study. A group of individuals with serologic markers (specific IgA > or = 1/128) suggestive of persistent C pneumoniae infection were compared with a group of control subjects without IgA antibodies (< 1/32).

SETTING

Apoteksgårdens Health Care Center, Kopparberg, Sweden.

PARTICIPANTS

One hundred case subjects (61 men and 39 women) and 100 control subjects matched for age and gender (mean age, 55 years).

MEASUREMENTS AND RESULTS

Individuals completed a questionnaire on respiratory symptoms and smoking habits. Body mass index (BMI) was calculated, BP, and peak expiratory flow (PEF) were determined. Blood specimens were drawn for determination of high-sensitivity C-reactive protein (hsCRP), blood glucose level, serum lipids, and Chlamydia antibodies. No significant difference was found between case subjects and control subjects regarding myocardial infarctions, stroke, diabetes type II, BP, BMI, hsCRP, blood glucose levels, and serum lipids. Symptoms of both asthma and chronic bronchitis were more common in case subjects, as were symptoms of chronic upper respiratory tract infections (p < 0.005). Case subjects with asthma or chronic bronchitis had more chronic upper respiratory tract disorders (p < 0.05). Symptoms of chronic respiratory tract diseases increased parallel to increasing specific C pneumoniae IgA antibody titers (p < 0.0005). PEF percentage of the predictive value was inversely correlated (p < 0.0005) to IgA antibody titers.

CONCLUSION

The data show that persistent increased levels of C pneumoniae IgA antibodies were associated with pronounced respiratory dysfunction. These data provide additional evidence suggesting that IgA antibodies may be a marker for persistent C pneumoniae infection.

Molecular basis defining human Chlamydia trachomatis tissue tropism. A possible role for tryptophan synthase

Here we report the cloning and sequencing of a region of the chlamydiae chromosome termed the "plasticity zone" from all the human serovars of C. trachomatis containing the tryptophan biosynthesis genes. Our results show that this region contains orthologues of the tryptophan repressor as well as the alpha and beta subunits of tryptophan synthase. Results from reverse transcription-PCR and Western blot analyses indicate that the trpBA genes are transcribed, and protein products are expressed. The TrpB sequences from all serovars are highly conserved. In comparison with other tryptophan synthase beta subunits, the chlamydial TrpB subunit retains all conserved amino acid residues required for beta reaction activity. In contrast, the chlamydial TrpA sequences display numerous mutations, which distinguish them from TrpA sequences of all other prokaryotes. All ocular serovars contain a deletion mutation resulting in a truncated TrpA protein, which lacks alpha reaction activity. The TrpA protein from the genital serovars retains conserved amino acids required for catalysis but has mutated several active site residues involved in substrate binding. Complementation analysis in Escherichia coli strains, with defined mutations in tryptophan biosynthesis, and in vitro enzyme activity data, with cloned TrpB and TrpA proteins, indicate these mutations result in a TrpA protein that is unable to utilize indole glycerol 3-phosphate as substrate. In contrast, the chlamydial TrpB protein can carry out the beta reaction, which catalyzes the formation of tryptophan from indole and serine. The activity of the chlamydial Trp B protein differs from that of the well characterized E. coli and Salmonella TrpBs in displaying an absolute requirement for full-length TrpA. Taken together our data indicate that genital, but not ocular, serovars are capable of utilizing exogenous indole for the biosynthesis of tryptophan.

Indicators of infection with Chlamydia pneumoniae are associated with expansion of abdominal aortic aneurysms

PURPOSE

Chlamydia Pneumoniae has been shown to be associated with atherosclerosis, myocardial infarction, and abdominal aortic aneurysms (AAAs). The possible association between AAA expansion and C pneumoniae infection was therefore assessed.

METHODS

Blood samples were taken from patients with an AAA that was considered for surgical repair after having been diagnosed by means of the Chichester aneurysm screening program (UK) as having an initially infrarenal aortic diameter of 3.0 to 5.9 cm. The patients were examined prospectively for as long as 11.5 years (mean, 4.1 years) with ultrasound scanning. Of 110 patients considered for surgery, 90 men and 10 women had blood samples taken. Their IgG and IgA antibodies against C pneumoniae were measured by means of a microimmunofluorescence test. Unpaired t tests, multiple linear regression analyses, and logistic regression analyses were used for statistical analysis.

RESULTS

A total of 44% (95% CI, 31%-55%) of the men with an AAA had an IgA titer of 64 or more, an IgG titer of 128 or more, or both, compared with 10% of the women with an AAA (OR = 7.2; 95% CI, 1.05-160.8). A titer of IgG of 128 or more was significantly associated with higher expansion (5.3 vs 2.6 mm per year), even after adjustment for initial AAA size and age. A significant positive correlation between both IgA and IgG titers and mean annual expansion was observed (r = 0.28; 95% CI, 0.05-0.49; and r = 0.45; 95% CI, 0.24-0.62, respectively), persisting after adjusting for initial AAA size and age. An IgG titer of 128 or more was present significantly more often in cases with an expansion greater than 1 cm annually (adjusted OR = 12.6; 95% CI, 1.37-293).

CONCLUSION

A high proportion of men with an AAA has signs of infection with C pneumoniae. The progression of their AAAs was positively correlated with the presence of indicators of C pneumoniae infection.

Antibodies against Chlamydia pneumoniae predict the need for elective surgical intervention on small abdominal aortic aneurysms

OBJECTIVE

to compare the ability of two independent Chlamydia pneumoniae antibody tests to predict need for small abdominal aortic aneurysm (AAA) repair.

PATIENTS AND METHODS

annual scans were offered to 149 screening diagnosed small AAA (<5 cm). Serum samples were collected for measuring IgA and IgG-antibodies to C. pneumoniae by microimmunofluorescence (MIF) test and the new ELISA (Labsystems).

RESULTS

a significant concordance was found between MIF and ELISA titres with Kappa values of 0.29 for S-IgA and 0.42 for S-IgG. IgG antibodies measured by ELISA were most predictive for cases expanding operation recommendable sizes with a sensitivity and specificity of 80% and 66%, respectively.

CONCLUSION

the simpler EIA has a high correlation with the MIF test and both were predictive for the natural history of AAA. Chlamydia antibody test may be used to identify individuals who might benefit from follow-up and anti-chlamydia treatment.

Chlamydial colonization of multiple mucosae following infection by any mucosal route

Chlamydia trachomatis inoculated by any mucosal route colonized multiple murine mucosae and, in most cases, the spleen, liver, and kidneys. Cell-to-cell transmission, systemic dissemination, and autoinoculation of infectious fluids may have contributed to chlamydial spread. Intermucosal trafficking of protective T cells cannot be accurately evaluated by using live chlamydial challenges.

Immunoglobulin A antibodies against Chlamydia pneumoniae are associated with expansion of abdominal aortic aneurysm

BACKGROUND

The aim of this study was to examine the possible association between the progression of small abdominal aortic aneurysm (AAA) and chronic infection with Chlamydia pneumoniae.

METHODS

Patients from a hospital-based mass screening programme for AAA with annual follow-up (mean 2.7 years) were included. After initial interview, 139 men aged 65-73 years with a small AAA underwent examination and blood sampling. Immunoglobulin (Ig) G and IgA titres against C. pneumoniae were measured by a microimmunofluorescence test.

RESULTS

Some 83 (95 per cent confidence interval 74-93) per cent of the men had an IgA titre of 20 or more, or an IgG titre of 32 or more. Men with an IgA titre of 20 or more had a 48 per cent higher AAA expansion rate than those with a titre of less than 20 (3.1 versus 2.1 mm/year; P < 0.05). Multiple linear and logistic regression analyses showed that an IgA titre of 20 or more was a significant independent predictor of increased AAA expansion, adjusted for known risk factors of expansion. Initial AAA size and serum total cholesterol level were also predictors of expansion.

CONCLUSION

A high proportion of men with a small AAA had signs of chronic infection with C. pneumoniae. Aneurysm progression correlated with evidence of chronic C. pneumoniae infection.

A review of Chlamydia pneumoniae and atherosclerosis

Chlamydia pneumoniae is a Gram-negative obligate intracellular bacterium that causes acute upper and lower respiratory infections. Its distribution is worldwide. Seroepidemiological studies have shown an association between C. pneumoniae and atherosclerosis, and the risk of acute myocardial infarction. Several studies had detected C. pneumoniae in atherosclerotic lesions from coronary and carotid arteries, in abdominal aortic aneurysms (AAA), and in sclerotic aortic valves. One study consistently succeeded in culturing C. pneumoniae from an atherosclerotic lesion, indicating the presence of viable organisms. However, the pathogenicity is unknown, and the significance of detecting the organism is unresolved. In two minor controlled clinical trials, patients with ischaemic heart disease were randomised into antibiotic-treated and placebo groups. Both trials showed a significant reduction in serious endpoints in patients receiving macrolide. Macrolide therapy thus seems to improve the outcome of severe ischaemic heart disease. It is not known whether this is caused by eradicating C. pneumoniae organisms, or by the macrolide's non-specific anti-inflammatory effect. Since both C. pneumoniae and inflammation are found in the AAA wall, it may be considered that macrolide would also improve the outcome of AAA and other diseases related to vascular surgery. In order to confirm this, randomised trials with macrolide therapy are needed, as well as diagnostic methods that can differentiate between individuals who are or are not infected with C. pneumoniae. The latter are needed in order to clarify the impact of the presence of C. pneumoniae and to avoid indiscriminate use of antimicrobials.

Differential Sensitivity of Distinct Chlamydia trachomatis Isolates to IFN-γ-Mediated Inhibition

Resistance to the mouse pneumonitis (MoPn) strain of Chlamydia trachomatis has been mapped to MHC class II-restricted, IL-12-dependent CD4+ T cells that secrete a type 1 profile of proinflammatory cytokines, which includes IFN-γ and TNF-α. The relative contribution of IFN-γ is controversial, however, due to variation in results presented by different laboratories. To determine whether C. trachomatis strain differences contributed to this apparent conflict, the relative resistance of IFN-γ-deficient mice to murine and human strains of C. trachomatis was compared. All human serovars were much more sensitive to the direct inhibitory actions of IFN-γ than the MoPn strain. Furthermore, genital clearance of human serovar D in the C57BL/6 mouse was mediated by class II-independent mechanisms that probably involved local production of IFN-γ by cells of the innate immune system. TNF-α also contributed indirectly to host resistance against all strains tested. The differential susceptibility of distinct C. trachomatis strains to effector cytokines such as IFN-γ could not have been predicted by interstrain biologic variation or by the profile of cytokines stimulated during infection. These findings indicate that strain variation should be considered in situations where related isolates of a given parasite produce conflicting data in models of infection and immunity. They also suggest that stimulation of mucosal IFN-γ activity is a relevant goal for a human chlamydial vaccine.

Is vasculitis a significant component of atherosclerosis?

Although atherosclerosis was linked to infections many decades ago, only recently there has been a renewed interest to study this association further. These research endeavors have provided a substantial amount of knowledge concerning the mechanisms that may link inflammation, immunity, and infections to the molecular and cellular events in the arterial wall leading to atherosclerotic lesions.

Role of nitric oxide in the inhibition of cytochrome P450 in the liver of mice infected with Chlamydia trachomatis

In this study, we attempted to determine the effect of a systemic infection with Chlamydia trachomatis on cytochrome P450(CYP)-dependent metabolism in mice. Furthermore, we wanted to assess if these effects were mediated through NO. BALB/c(H-2d) female mice were inoculated intraperitoneally with the C. trachomatis mouse pneumonitis (MoPn) biovar, and induction of NO synthase (NOS) was detected by measuring [NOx] levels and inducible NOS protein content in peritoneal macrophages by Western blotting. Recovery of C. trachomatis from liver, lung, and spleen peaked at 4 days postinfection. Following cotreatment with N(G)-nitro-L-arginine methyl ester (L-NAME), an inhibitor of NO synthase, there was a significant increase in the intensity and the length of the infection. Six days after inoculation with C. trachomatis, CYP1A- and CYP2B-mediated metabolism in the liver of the mice was diminished up to 49% of control levels. However, when animals were treated with N(G)-nitro-L-arginine methyl ester at days 4 and 6 postinfection, the decrease in the metabolism of CYP1A and CYP2B was largely blocked. These results suggest that C. trachomatis infection can depress cytochrome P450 in a manner similar to other types of infections and that NO is likely to be a mediator of this depression. This finding may be of significance to patients taking drugs that are metabolized by phase I enzymes during infections with some bacteria such as C. trachomatis.

Demonstration of Chlamydia pneumoniae in patients with chronic pharyngitis

12 patients with longstanding throat symptoms, who were also positive by PCR (polymerase chain reaction) for Chlamydia pneumoniae were selected for a longitudinal study to determine whether C. pneumoniae is an aetiological agent for chronic pharyngitis. Specimens for culture and PCR detection of C. pneumoniae were taken from the retropharyngeal wall and blood specimens were taken for serology. Biopsies were taken from the mucosal membrane of the retropharyngeal wall for histological and immunohistochemical studies. C. pneumoniae was cultured from 4 cases. 10 patients had specific humoral antibodies to C. pneumoniae and 9 had high and increasing specific antibody titres to C. pneumoniae suggesting ongoing infection. The organism was demonstrated in the tissue from the retropharyngeal mucosal membrane by immunohistochemistry in 9 patients. The findings suggest that C. pneumoniae may be an aetiological agent for chronic pharyngitis.

Distinct Homing Pathways Direct T Lymphocytes to the Genital and Intestinal Mucosae in Chlamydia-Infected Mice

Immunity to genital tract infection with Chlamydia trachomatis is mediated by type 1 CD4+ T lymphocytes. To define the signals that govern lymphocyte trafficking to the genital mucosa, integrins expressed by infiltrating T cells and endothelial addressins displayed on local vasculature were characterized during the course of infection. All T cells expressed the αLβ2 heterodimer that binds vascular ICAM-1, and most displayed enhanced levels of the α4β1 integrin that interacts with VCAM-1. αE and β7low integrin chains were detected on approximately 15 and 30% of infiltrating T cells, respectively. Lymphocytes derived from the spleen or draining lymph nodes expressed this same integrin profile, suggesting that cells are recruited to the genital mucosa from the systemic circulation without significant selection pressure for these markers. Immunofluorescent staining for the corresponding vascular addressins revealed intense expression of VCAM-1 on small vessels within Chlamydia-infected genital tracts and up-regulation of ICAM-1 on endothelial, stromal, and epithelial cells. Mucosal addressin cell adhesion molecule-1 was not detected within genital tissues. These results indicate that T lymphocyte homing to the genital mucosa requires the interaction of αLβ2 and α4β1 with endothelial ICAM-1 and VCAM-1, respectively, which is the same pathway that directs lymphocytes to systemic sites of inflammation. Homing pathways defined for the intestinal mucosa and assumed to be relevant to all mucosal sites are not well represented in the genital tract. The identification of T lymphocyte trafficking pathways shared between systemic and mucosal tissues should facilitate vaccine strategies aimed at maximizing immune responses against Chlamydia and other pathogens of the urogenital tract.

Neither interleukin-6 nor inducible nitric oxide synthase is required for clearance of Chlamydia trachomatis from the murine genital tract epithelium

Female mice bearing targeted mutations in the interleukin-6 or inducible nitric oxide synthase locus mounted effective immune responses following vaginal infection with Chlamydia trachomatis. Chlamydial clearance rates, local Th1 cytokine production, and host antibody responses were similar to those of immunocompetent control mice. Therefore, neither gene product appears to be critical for the resolution of chlamydial infections of the urogenital epithelium.

Molecular mimicry and Chlamydia trachomatis infection of eukaryotic cells

A new experimental model for microbe-host-cell interaction is proposed in which a molecular mimic of heparan sulfate is used by Chlamydia to attach to the mammalian cell surface. A heparan-sulfate-like ligand, bound to the surface of Chlamydia, mediates infectivity by bridging the microorganism and mammalian cell receptors.

Binding of Chlamydia trachomatis serovar L2 to collagen types I and IV, fibronectin, heparan sulphate, laminin and vitronectin

Chlamydia trachomatis serovar L2 elementary bodies were tested for binding to 125I-labelled components of the extracellular matrix. C. trachomatis bound high levels of collagen type I and heparan sulphate, whereas the binding to collagen type IV, fibronectin, laminin and vitronectin was substantially less. Preliminary characterization showed that chlamydial surface proteins are essential for binding to occur. Our results suggest that a selective affinity for C. trachomatis to a limited number of components of the extracellular matrix may have important implications mediating attachment to host cell surfaces and localization of chlamydiae in other tissues, such as joints.

Immune specificity of murine T-cell lines to the major outer membrane protein of Chlamydia trachomatis

The antigenically variant Chlamydia trachomatis major outer membrane protein (MOMP) is a target of antibody-mediated neutralization in vitro, and it is an important protein for designing a subunit vaccine. Knowledge of MOMP T-cell determinants will be essential to elicit rapid and strong immune responses following an encounter with infectious organisms. C. trachomatis-specific T-cell lines were derived from MOMP-immunized BALB/c mice and selected with intact organisms. We used these short-term T-cell lines to identify determinants of MOMP that could be recognized by T cells following processing of the intact organism. T-cell line proliferation in response to overlapping MOMP peptides showed that only a peptide encompassing the third variable segment (VS3) elicited a strong proliferative response. We further mapped determinants within the VS3 peptide and found that a sequence-conserved portion of the VS3 peptide elicited T-cell proliferation of T-cell lines from BALB/c mice. Thus, unlike the response to several MOMP peptides with unselected T cells, development of short-term T-cell lines with intact organisms restricted the repertoire of antigens capable of being recognized by MOMP-specific T cells.

Azithromycin in the treatment of uncomplicated genital chlamydial infections

Chlamydia trachomatis is among the most prevalent of sexually transmitted diseases and causes serious sequelae, especially in women. A major difficulty facing the clinician has been the effective treatment of patients with chlamydial infections, since existing drugs require 7 or more days of multidose therapy, and hence considerable commitment from the patient. Many patients, especially those who are minimally symptomatic or asymptomatic, are likely to be noncompliant when given such multiple day regimens and thus may fail therapy. Azithromycin is an azalide antibiotic that has a minimum inhibitory concentration against C. trachomatis of between 0.03 and 0.25 mg/L, as well as good in vitro activity against other sexually transmitted pathogens that are often present concurrently. Azithromycin also achieves high intracellular concentrations, which may be beneficial in eradicating Chlamydia, an obligate intracellular pathogen. More importantly, azithromycin has high tissue bioavailability and a tissue half-life of between 2 and 4 days. These pharmacokinetic properties imply that the dosing period for azithromycin can be greatly reduced while still achieving high antimicrobial activity at sites of infection. Clinical experience to date shows that a single 1 g oral dose of azithromycin is as effective as a standard 7-day twice daily regimen of doxycycline and more effective than 7 days of ciprofloxacin in eradicating uncomplicated chlamydial genital infections. As such, azithromycin is the first single-dose therapy for the treatment of urethritis and cervicitis due to C. trachomatis. Single-dose therapy for chlamydial infection, which could be administered under supervision in the clinic, would be a significant advance in the management and public health control of chlamydial infections.

Prevalence of antibody to Chlamydia pneumoniae TWAR in japan

Chlamydia pneumoniae TWAR is a newly recognized Chlamydia species that is a pathogen of respiratory tract infection. To clarify the endemic status of C. pneumoniae in Japan, we evaluated the incidence of C. pneumoniae antibody in 1,330 serum samples (660 from outpatients, 600 from normal individuals, and 70 from cord blood). The antibody titer was determined by a microimmunofluorescence test by using the elementary body of C. pneumoniae TW-183 as the antigen. Immunoglobulin G antibody titers of 1:32 or higher were regarded as evidence of past infection. The detection rate of C. pneumoniae antibody rapidly increased in subjects between the ages of 4 and 7 years, reached 44% in subjects between the ages of 8 and 11 years, and was about 50% in older subjects. The rate did not differ between healthy subjects and outpatients. These results suggest that C. pneumoniae infection is highly endemic in Japan as it is in Western countries. However, the antibody prevalence was high in the low age groups in Japan compared with that in Western countries.