Tick-borne pathogens Bartonella spp., Borrelia burgdorferi sensu lato, Coxiella burnetii and Rickettsia spp. may trigger endocarditis

BACKGROUND

Infections caused by tick-borne pathogens such as Bartonella spp., Borrelia burgdorferi s.l., Coxiella burnetii, and Rickettsia spp. are capable of causing serious lesions of the mitral and aortic valves, leading to a need for valve replacement.

OBJECTIVES

The aim of the study was to determine whether such cases are sporadic or frequent. An additional goal was to establish effective diagnostic methods to detect these infections.

MATERIAL AND METHODS

The study involved 148 patients undergoing valve replacement. Blood samples were drawn for serological testing. Samples of the removed mitral and aortic valves were tested with polymerase chain reaction and immunohistochemical staining.

RESULTS

Specific antibodies to Bartonella spp. were detected in 47 patients (31.7%) and in 1 of the healthy controls (1%) (p < 0.05). Antibodies to B. burgdorferi spirochetes were found in 18 of the patients (12.2%) and in 6 blood donors from the control group (5.8%) (p < 0.1). Antibodies to Rickettsia spp. were detected in 12 (8.1%) and to C. burnetii phase I and II antigens in the serum of 1 patient. All the participants in the control group were seronegative to C. burnetii and Rickettsia spp. antigens. Polymerase chain reaction (PCR) tests for detection of Bartonella spp., B. burgdorferi s.l., C. burnetii and Rickettsia spp. DNA in the valve samples were all negative. Inflammation foci with mononuclear lymphoid cells in the aortic and mitral valves were seen in sections stained with hematoxiline and eozine. In sections dyed using the indirect immunofluorescence method with hyperimmune sera, Bartonella spp. and Rickettsia spp. were found.

CONCLUSIONS

The results obtained indicate that laboratory diagnostics for patients with heart disorders should be expanded to include tests detecting tick-borne zoonoses such as bartonelloses, Lyme borreliosis, rickettsioses and Q fever.

Bactericidal Activity of Octenidine to Various Genospecies of Borrelia burgdorferi, Sensu Lato Spirochetes in Vitro and in Vivo

The aim of our studies was to invent a reliable method for detection of the bactericidal activity of disinfectants against Borrelia burgdorferi in suspension (in vitro) and in cell line cultures (in vivo). In the suspension method, 0.01% octenidine at 20°C and 35°C was bactericidal to Borrelia afzeli; Borrelia garini, B. burgdorferi sensu stricto after 5 minutes treatment. Increase of the temperature to 35°C speed up the bactericidal effect to 1 minute. The bactericidal action of octenidine towards B. burgdorferi spirochetes growing in fibroblasts was less effective and needed a longer time to kill them than in the suspension.

Francisella tularensis/Rickettsia spp. co-infections in patients with skin changes and lymphadenopathy

INTRODUCTION

Tularemia and spotted fever group rickettsioses (SFG) can be transmitted by ticks and have a number of common clinical symptoms. Most characteristic are a maculopapular or vesicular rash or an eschar at the site of the tick or insect bite accompanied by painful lymph nodes. The aim of this study was to determine whether Rickettsia spp./Francisella tularensis mixed infections occurred in patients with similar symptoms who were diagnosed with either Rickettsia spp. or F. tularensis infection.

MATERIAL AND METHODS

Thirty-six cases from 2011-2014, including 15 individuals with clinically and serologically recognized SFG and 21 with tularemia, were analyzed retrospectively using immunofluorescence for detection of Rickettsia spp. or ELISA for detection of F. tularensis.

RESULTS

Of the 36 cases examined, specific high titers of antibodies to Rickettsia spp. were found in 1 (4.4%) patient with tularemia and specific high titers of antibodies to F. tularensis were detected in 1 (6.7%) patient with SFG.

CONCLUSIONS

The results of our study show that in infections with fever, enlarged lymph nodes and skin lesions after tick and insect bites, laboratory testing of both diseases - SFG rickettsiosis and tularemia - should be implemented. Identification of F. tularensis and Rickettsia spp. mixed infections is crucial in order to administer appropriate antibiotics and to avoid treatment failure and relapse.

An outbreak of leptospirosis imported from Germany to Poland

BACKGROUND

Leptospirosis is a zoonotic disease caused by spirochetes of the Leptospiraceae family. In both humans and animals the main route of infection is indirect contact - through water or other products contaminated with urine containing spirochetes. Infection most commonly occurs through ingestion of water or food contaminated with Leptospira spp.

OBJECTIVES

The aim of the study was to characterize cases of leptospirosis imported to Poland from Germany in 2014 and to analyze methods that are helpful for making a diagnosis.

MATERIAL AND METHODS

The 10 patients examined were reported as suspected leptospirosis cases on the basis of clinical symptoms and epidemiological investigations. They originated from different regions of Poland and had been working together at a strawberry plantation in the Cloppenburg district of Lower Saxony in Germany. Blood and urine samples were tested by PCR and serum samples by serology. All ELISA positive and negative cases were examined using a reference microscopic agglutination test (MAT).

RESULTS

In the tested group, 6 individuals (60%) were seropositive according to the ELISA, and 2 of them were confirmed by the MAT. The PCR results for the blood and urine samples were negative.

CONCLUSIONS

Using the ELISA in the diagnosis of leptospirosis allowed the disease to be identified much faster, differentiating classes of antibodies and recognizing levels of them that are too low to be detectable by the MAT.

Borrelia miyamotoi - new etiologic agent of neuroborreliosis?

Borrelia miyamotoi spirochetes discovered in Ixodes persulcatus ticks in Japan, in 1994 and documented in ticks and rodents in moderate climate zone of northern hemisphere. They belong to tick-borne relapsing fever group spirochetes. Borrelia miyamotoi is an etiologic agent of B.miyamotoi disease with acute febrile illness, including fever, headache, dizziness, fatigue, chills, and muscle and joint pain. Recurrence of fever has been observer in more than 10% patients. In some patients meningoencephalitis, encephalitis and cranial neuritis were observed. Laboratory recognition is based mainly upon PCR testing. Serological testing is limited due to inaccessibility of tests.

Bacterial tick-borne diseases caused by Bartonella spp., Borrelia burgdorferi sensu lato, Coxiella burnetii, and Rickettsia spp. among patients with cataract surgery

Background

Clinical data have shown that tick-borne diseases caused by Borrelia burgdorferi sensu lato, Bartonella spp., Coxiella burnetii, and Rickettsia spp. can affect the central nervous system, including the eye. The aim of this study was to establish a relationship between the incidence of cataract and evidence of bacterial infections transmitted by ticks.

Material/Methods

Fluid with lenticular masses from inside of the eye and blood from 109 patients were tested by PCR and sequencing. Sera from patients and the control group were subjected to serological tests to search specific antibodies to the bacteria.

Results

Microbiological analysis revealed the presence of Bartonella sp. DNA in intraoperative specimens from the eye in 1.8% of patients. Serological studies have shown that infections caused by B. burgdorferi sensu lato and Bartonella sp. were detected in 34.8% and 4.6% of patients with cataract surgery, respectively.

Conclusions

Presence of DNA of yet uncultured and undescribed species of Bartonella in eye liquid indicates past infection with this pathogen. Specific antibodies to B. burgdorferi sensu lato and Bartonella sp. are detected more frequently in patients with cataract compared to the control group. This could indicate a possible role of these organisms in the pathological processes within the eyeball, leading to changes in the lens. Further studies are needed to identify Bartonella species, as well as to recognize the infectious mechanisms involved in cataract development.

Q fever outbreaks in Poland during 2005-2011

BACKGROUND

Q fever is a health problem affecting humans and animals worldwide. In Poland, previous studies have pointed to 2 sources of outbreaks of the disease: the importation of infected animals and their products, and natural domestic foci. In the last decade, 5 outbreaks have occurred in cattle farms in south Poland in Malopolskie, Podkarpackie, Opolskie, and Silesian provinces. The aim of this study was to characterize the Q fever foci in Poland.

MATERIAL AND METHODS

A total of 279 individuals were included. Levels of serum IgM and IgG antibodies to phase I and II C. burnetii antigens were assayed by indirect immunofluorescence method. Bacterial DNA from all specimens were detected with PCR with primer pairs specific to the htpAB-associated repetitive element, and amplicons were sequenced.

RESULTS

Infection was recognized in 67 individuals out of 279 tested in all foci. Twenty-five individuals presented clinical symptoms of acute Q fever. DNA of C. burnetii was found in 8 human blood samples obtained from 3 farm workers and 5 family members.

CONCLUSIONS

The described outbreaks demonstrate that the main source of human infections in Poland is infected cattle.

Prevalence of rickettsioses in Poland in 2006-2012

INTRODUCTION

Tick-borne diseases, such as rickettsioses, anaplasmosis, Lyme boreliosis and bartonellosis are often difficult to correctly diagnose. All these disease are present in Poland.

OBJECTIVES

The aim of the study was to estimate a prevalence of Rickettsia spp. infections in humans in Poland in 2006 to 2012 based on the results made in the Laboratory of Rickettsiae, Chlamydiae and Spirochetes, NIPH-NIH in Warsaw.

MATERIAL AND METHODS

The levels of Rickettsia spp. and Anaplasma phagocytophilum IgM and IgG antibodies were determined by indirect immunofluorescent assay (IFA). From 2006 to 2012, serum samples derived from 180 humans suspected for rickettsioses, including 84 patients suspected for the infections with typhus and spotted fever group (SFG) rickettsiae, and 96 patients suspected for anaplasmosis.

RESULTS

Specific serum antibodies to the SFG rickettsiae have been detected in 5 persons (2.7%). Granulocytic anaplasmosis has been recognized in 9 patients (4.9%). While the reporting and registration of rickettsioses are obligatory in Poland less than 50% of detected cases are reported.

CONCLUSIONS

Presented date indicate that in Poland rickettsioses are often unrecognized resulting in their underestimation. If research for rickettsiosis are made immediately after infection, antibodies will not be detect.

Characteristics of Bartonella spp. infections in Poland in the years 2009-2012 identified in the laboratory of National Institute of Public Health--National Institute of Hygiene

INTRODUCTION

Various Bartonella species, (Gram-negative aerobic bacilli) are etiologic agents ofzoonotic diseases called bartonelloses, which manifest with different symptoms depending on the bacterial species, reservoir and vector. In Poland and Europe, the most common bacterial species of the genus Bartonella is Bartonella henselae.

MATERIAL AND METHODS

[corrected] Serum samples derived from patients with clinical symptoms suggesting Bartonella spp. infection, sent in 2009-2012 to the Laboratory of Rickettsiae, Chlamydiae and Spirochaetes of National Institute of Public Health--National Institute of Hygiene in Warsaw were tested. Levels of specific IgM and IgG antibodies to B. henselae and B. quintana antigens were detected with indirect immunofluorescence method (IFA).

RESULTS

Six hundred sixty three serum samples were examined from humans with clinical symptoms suggestive bartonellosis, in 2009-2012. Specific antibodies for B. henselae were detected in 435 patients (65.6%). IgM antibodies were found in 93 patients (21.4%) including 11 patients (2.5%) with IgM only. IgG antibodies were identified in 424 people (78.6%) of whom 342 had IgG antibodies only. The antibodies of both classes were detected in 82 people (18.9%). B. quintana infections were not found. The majority of samples for study of bartonellosis were submitted in the autumn. In patients with confirmed bartonellosis, the most common symptoms of disease were lymphadenopathy (86 people, 13%), fever (13 patients, 2%) and nodular changes in various organs (13 patients, 2%).

CONCLUSIONS

Infections caused by Bartonella spp. in Poland should be monitored to acquire the information on the frequency and distribution of disease in the country and their clinical course.

[Leptospira spp. and Coxiella burnetii infections occuring in Radomskie District in people of selected professional groups]

INTRODUCTION

Leptospirosis and Q fever are a zoonotic diseases with global occurring.

OBJECTIVES

The aim of this study was to determine the prevalence of Leptospira spp. and C. burnetii in humans, who have contacts with infected animals or are exposed to an environment potentially contaminated with these bacteria. MATERIAL AND METHODS. Blood serum samples originating from 177 veterinarians and farmers and 134 garbage collectors (blood samples) were examined. Control group consisted 43 blood samples derived from blood donors. For the detection of specific IgM and IgG antibodies of Leptospira spp., enzyme-linked immunosorbent assay (ELISA) was used. Indirect immunofluorescence method (IFA) was used for detection of specific IgG C. burnetii antibodies. DNA of Leptospira spp. and C. burnetii was detected by PCR method with appropriate pairs of primers.

RESULTS

Specific IgG C. burnetii antibodies of phase II were detected in sera of 4.4% of the farmers and veterinarians, and in 12% of garbage men. Antibodies in blood donors was not found. Antibodies of Leptospira spp. were present in the serum of 23.6% of farmers and veterinarians, 26.2% of garbage men and 14% of blood donors. C. burnetii DNA was detected in one sample derived from the veterinarian (1.1%). Leptospira spp. DNA was not detected in tested material. Blood samples from farmers, veterinarians and garbage collectors showed the higher prevalence of antibodies of Leptospira spp. and C. burnetii as compared to the control group (blood donors).

CONCLUSIONS

Beside farmers and veterinarians, garbage collectors should be consider as high risk group of contracting leptospirosis and Q fever. Both leptospirosis as well as Q fever should be considered in the differential diagnosis in humans with animals and animals' material contact when they reveal flu-like symptoms.

Q fever at the turn of the century

Q fever is an infectious zoonotic disease characterized by sudden fever, headache, and atypical pneumonia, caused by Coxiella burneti--an obligatory intracellular parasite. Based on phylogenetic analysis of the genes sequences, the classification was changed and C. burnetii species was included to the gamma subgroup of the proteobacteria, Legionellales order and Coxiellaceae family. This analysis showed more than 99% sequence similarity of 16SrRNA gene among the strains isolated in different regions of the world. Q fever is a widespread in the world zoonosis. Its main reservoir in the rural environment are farm animals: cows, sheep, goats, and urban pets such as dogs, cats, rabbits. In acute infection these bacteria are detected in various internal organs such as lungs, liver, spleen, and in excretion in urine, faeces and milk. During childbirth, they occur in large number in the amniotic fluid and placenta. Recently, it has been found that free-living amoeba Acanthamoeba castellani may also be a reservoir of the pathogen. The intra-amoebal location of C. burnetii cells was observed.

Susceptibility of Polish Bartonella henselae strains

Due to the fastidious nature of B. henselae and the limited number of available isolates worldwide, there are few data on its in vitro susceptibility to antibiotics. We determined the minimal inhibitory concentrations (MIC) of ten antimicrobial agents against 11 feline isolates of B. henselae by Etest method. The lowest MICs were obtained for rifampicin < or = 0.002 mg/L. MICs of all isolates were < 0.016 mg/L for ampicilin, amoxicillin/clavulanic acid, tetracycline and ranged from 0.016 to 0.032 mg/L for azithromycin. The MICs for two tested fluoroquinolones: ciprofloxacin and levofloxacin ranged from 0.016 to 0.125 mg/L. The highest MICs were obtained for gentamicin ranging from 0.025 to 2.0 mg/L. Sulphonamide resistance genes sul 1, sul 2, sul 3 were not found in any of the tested isolates. Etest methodology seems to be a reliable method for determination of B. henselae susceptibility, however standardization is strongly desired.

Borrelia burgdorferi sensu lato as activators of the complement system in in vitro model

INTRODUCTION

The following parameters were analyzed: C5a, which is significant in classical and alternative pathways of the complement system activation, and factor H, the major function of which is to regulate the alternative pathway. Factor H, in the case of Borrelia infection, is combined by CRASPs proteins of spirochetes, and thus prevents C3b molecules from contact with the pathogen, opsonisation and lysis of bacteria.

MATERIAL AND METHODS

The experimental material in the model for the presented work consisted of whole blood of healthy persons (without the presence of antibodies anti-Borrelia) and persons with clinical symptoms of Lyme disease, which was stimulated with three genospecies of spirochetes recognized as pathogenic in Poland and Europe: B. afzelii, B. burgdorferi s.s. and B. garinii.

RESULTS

The increase in the level of C5a in the experimental model after in vitro stimulation of whole blood with three genospecies Borrelia can be treated as an indicator of an effective activation of the complement's cascade. The increase in level C5a in the plasma relies on the genospecies and the strongest is for B. garinii. The decrease in the level of factor H, observed after the incubation of whole blood with three genospecies Borrelia, shows that this parameter was included in the spirochetes' mechanisms acting against factors of the innate immunity system of a host, which prevents lysis of bacteria via the alternative pathway.

CONCLUSIONS

The results obtained on the basis of the in vitro model can be analysed from the aspect of spirochetes' real contact with a host's organism during the bite of infected ticks. Despite blocking of the alternative pathway, Borrelia initiate the activation cascade regardless of antibodies via the first contact of a host's organism with spirochetes, or in accordance with antibodies during the infection or subsequent contact with bacteria.

[Ticks infected with bacteria pathogenic to humans in municipal parks in Warsaw]

The aim of the study was to detect bacteria pathogenic to humans, such as Borrelia burgdorferi sensu lato, Rickettsia spp, and Coxiella burnetii in ticks found in municipal parks in Warsaw, including The Royal Łazienki Park, Mokotów Fields, Józef Sowiński Park, Ujazdów Park and Fort Bema Park. To detect microorganisms PCR technique was used. It was shown that 6.1% of the ticks in Warsaw's parks are infected with B. burgdorferi sensu lato, and 2.9% with Rickettsia spp. Analysis of sequencing results revealed in examined ticks the presence of B. burgdorferi sensu stricto and R. helvetica.

Inhibition of fibroblast apoptosis by Borrelia afzelii, Coxiella burnetii and Bartonella henselae

Apoptosis is a genetically controlled mechanism of cell death involved in the regulation of tissue homeostasis. The aim of this study was to investigate the influence of Borrelia afzelii, Coxiella burnetii, and Bartonella henselae bacteria on apoptosis measured as the level of caspase 3 activity in human fibroblast cells HEL-299. Our findings show that C. burnetii bacteria may inhibit the process of apoptosis in the host cells for a long time. This can permit intracellular survival in the host and mediatingthe development of chronic disease.

[Case of TIBOLA/DEBONEL (tick - borne lymphadenopathy/Dermacentor spp. - borne necrosis - erythema - lymphadenopathy) in Poland]

Rickettsia slovaca was recognized as the causative agent of the disease named tick - borne lymphadenopathy (TIBOLA) or Dermacentor spp.- borne necrosis - erythema lymphadenopathy (DEBONEL). Generally, this ricketsiosis is considered a mild disease but the disease is considered a mild rickettsiosis, but severe symptoms can appeare, especially in untreated patients. Described infection is the first case of TIBOLA/DEBONEL found in Poland. The patient had typical symptoms, such as enlarged painful cervical lymph nodes and maculo - papular rash. Milium on the scalp behind the ear concha, was a probably scar formation associated with typical eschar. The diagnosis was confirmed by detection of 128 titer in MIF tests with R. rickettsii and R. slovaca antigens and four-fold decrease after treatment.

Tick-borne infections as a cause of heart transplantation

Many bacterial species can be a cause of various heart diseases, such as: Borrelia burgdorferi sensu lato, Coxiella burnetii and Bartonella spp. The aim of the present studies was to establish if any tick-borne infections can contribute to serious heart disorders resulting in the need for heart transplantation. Myocardium, aortic and mitral valve samples from hearts removed from patients undergoing heart transplantation were tested. The presence of Bartonella spp., Borrelia afzeli and C. burnetii bacteria in malfunctioning human hearts has been shown. DNA of Bartonella spp., B. burgdorferi and C. burnetii were detected in various parts of tested hearts. DNA of B. afzelii and Bartonella spp. were found in the aortic valves. DNA of C. burnetii was detected in the myocardium. Mixed infections with Bartonella spp. and C. burnetii were also observed. Obtained results indicate that diagnosis of Bartonella spp., B. burgdorferi C. burnetii and Rickettsia spp. infections should be considered in cases of infectious endocarditis with negative blood cultures.

Interactions between Borrelia burgdorferi and mouse fibroblasts

Borrelia burgdorferi spirochetes are an infectious agent of Lyme borreliosis. The aim of our studies was to investigate the fate of engulfed B. burgdorferi cells in L-929 mouse fibroblasts and to observe development of intracellular infection in vitro after 2 and 48 h. Electron microscopic studies reveal consecutive stages of B. burgdorferi spirochetes penetration to mouse fibroblasts in vitro. It has been observed, as a first step attachment and engulfment of spirochetes followed by formation of vacuoles. After 48 hours of infection, vacuoles of fibroblastic cells have been seen full of B. burgdorferi bacteria and latter they have been released from infected cells to extracellular space. It can be the evidence that B. burgdorferi multiply intracellulary.

Chlamydia pneumoniae infection in patients after kidney transplantation treated with spiramycin

INTRODUCTION

Previous research has pointed to a role of Chlamydia pneumoniae infection in the development of chronic renal allograft dysfunction, chronic liver rejection, and vasculopathy in the transplanted heart. The aim of this study was to evaluate the presence of C. pneumoniae prior to and after kidney transplantation as well as to determine the role of spiramycin therapy among kidney transplant recipients.

MATERIALS AND METHODS

The study group consisted of 50 patients (25 pairs) who received kidney transplants from cadaveric donors. One of the 2 kidneys from a donor was transplanted to a patient randomized to spiramycin (2 x 3 million U/d orally for 3 months; group S) and the other to a patient assigned as control (group C). Markers of infection were assessed on day 1 posttransplantation and 3 months later (average, 94 days). All 50 patients were examined for the presence of bacterial DNA in peripheral blood leukocytes using real-time polymerase chain reaction (PCR) and for titers of serum anti C. pneumoniae immunoglobulin (IgG) and IgA antibodies using microimmunofluorescence (MIF). C. pneumoniae infection was diagnosed by the presence of C. pneumoniae DNA in peripheral blood leukocytes or positive antibodies of both classes.

RESULTS

C. pneumoniae infection was initially diagnosed in 14 patients among group S and 8 patients among group C (P = not significant [ns]) and after 3 months in 12 and 9 patients, respectively (P = ns). Conversion from positive to negative C. pneumoniae status occured in 7 patients among group S and 1 patient among group C (P = .04). Conversion from negative to positive C. pneumoniae status occured in 5 patients from group S and 2 patients from group C (P = ns).

CONCLUSIONS

These results suggest a possible role for spiramycin treatment of C pneumoniae infection in kidney allograft recipients. C. pneumoniae infection diagnosis and treatment should be considered to be routine for every patient awaiting transplantation.

[Diagnostics of cat scratch disease and present methods of bartonellosis recognition--a case report]

Bartonella infections including cat scratch disease (CSD) is a group of infectious diseases which are diagnosed sporadically. Because of this fact the number of CSD cases in Poland is underestimated and their incidence is markedly lower in comparison to other European countries. The aim of our report is to present various diagnostic methods and possibilities on the basis of two cases with symptoms of CSD. The efficiency of specific Bartonella antibiotic therapy is also discussed.

[Activity of the caspase-3 in the culture of peripheral blood mononuclear cells stimulated with Borrelia burgdorferi antigens]

OBJECTIVE

To investigate whether the decreased rate of apoptosis of peripheral blood mononuclear cells occurs in patients with chronic Lyme arthritis (LA), which could contribute to persistent inflammation in those patients.

METHODS

PBMC from 7 patients with LA and 6 healthy persons (control--C) were incubated for 48 hours without stimulation (negative control) or under antigenic stimulation with Borrelia burgdorferi s.l. spirochetes: Borrelia afzelii VS46110 (B.a.), B. garinii 20047 (B.g.) or B. burgdorferi sensu stricte B-31 (B.ss.). Concentration of the apoptosis mediator active caspase-3, was measured by ELISA in the culture homogenate.

RESULTS

Mean active caspase-3 concentration was higher in LA than in C in unstimulated culture. Increase of active caspase-3 concentration under antigenic stimulation occurred in C (significant for B.g.), but not in LA.

CONCLUSIONS

1) apoptosis rate of PBMC increases in presence of B. burgdorferi s.l., which may be a defense mechanism of this pathogen; 2) in late LA there is increased baseline susceptibility of PBMC to apoptosis, but exposition to B. burgdorferi s.l. seem not to exert further pro-apoptotic effect. This altered response to pro-apoptotic stimuli may be related to persistent inflammatory pathology in this group of patients.

Bartonella henselae in Ixodes ricinus ticks removed from dogs

Bartonella spp. is an etiologic agent of vector-borne infections. Bartonella spp. was searched for in adult Ixodes ricinus ticks removed from dogs and cats using specific polymerase chain reaction (PCR) and sequence analysis of gltA gene. Bartonella henselae DNA was detected in 5 of 102 tested ticks. All PCR-positive ticks were removed from dogs. Four of were engorged, one was unfed. The data demonstrate that B. henselae is able to inhabit ticks. This is the first report about the existence of B. henselae in ticks removed from dogs. It is, however, an open issue that needs further investigation if ticks consist a new competent vector involved in transmission of bartonellosis.

Presence of Bartonella spp. in various human populations

Bartonella spp. bacteria are significant human pathogens and the agents of bacterial zoonosis acquired from an animal companion. The aim of the study was to determine the seroprevalence of two of the most common Bartonella species B. henselae and B. quintana in various human populations. The studied groups included: alcoholics, intravenous drug users, veterinarians, cats' owners. Blood samples were collected and cultured on chocolate agar plates and in mouse fibroblasts L-929 cell line culture. The levels of Bartonella henselae IgM and IgG antibodies were determined by indirect immunofluorescence assay. Specific B. henselae IgG were detected in 48.3% of homeless alcoholics, in 45.0% veterinarians and in 53.3% cats' owners. The differences in the prevalence of B. henselae antibodies between the studied groups and a control group were statistically supported. No homeless intravenous drug users had specific B. henselae and B. quintana antibodies. High titers of B. quintana IgG antibodies were detected in two homeless alcoholics. Bartonella spp. was cultured on chocolate blood agar plates from blood samples from 2 alcoholics. The isolates were identified as B. henselae by PCR amplification of the riboflavin synthase gene (ribC). The results prove that B. henselae and B. quintana, emerging human pathogens, are present and widely distributed in Poland in such specific risk groups as: alcoholics, veterinarians and cats' owners.

[Concentration of sFas and sFasL in the supernatant of PBMC culture from the patients with late lyme borreliosis]

OBJECTIVE

Persistent, inadequate inflammatory response present in late Lyme borreliosis may be driven by activated T lymphocytes. We estimated synthesis of extracellular proteins: soluble Fas receptor (sFas) and its ligand (sFasL), which might protect T lymphocytes from physiologic apoptosis, in the peripheral blood mononuclear cell (PBMC) culture from patients with late borreliosis.

METHODS

Lyme borreliosis group (LB) consisted of 20 patients with Lyme borreliosis present for >6 months. Six patients without any active infection constituted the control group (K). PBMC were incubated for 7 days with phytohemaglutinine or suspension of Borrelia afzeli (Ba), B. garinii (Bg) and B. burgdorferi sensu stricto (Bss) spirochetes. sFas and sFasL concentrations were measured in the culture supernatant with ELISA.

RESULTS

In LB mean sFasL concentration was increased significantly under stimulation with phytohemaglutinine, Ba and Bg, and, with borderline significance, with Bss, in comparison with unstimulated culture. sFas also tended to increase, which was significant with phytohemaglutinine and borderline with Bg. In K sFas and sFasL was not significantly increased under antigenic stimulation.

CONCLUSIONS

Increased synthesis of antiapoptotic factors by PBMC from patients with late borreliosis incubated with B. burgdorferi antigens may suggest impaired apoptosis of T lymphocytes contributing to persistent inflammatory response in this patients.

Concentration of TGF-beta1 in the supernatant of peripheral blood mononuclear cells cultures from patients with early disseminated and chronic lyme borreliosis

PURPOSE

The aberrant inflammatory response is probably involved in the pathogenesis of chronic Lyme borreliosis, including chronic Lyme arthritis and neuroborreliosis. Transforming growth factor-beta 1 (TGF-beta1) is an important anti-inflammatory and immunomodulatory cytokine and its deficient synthesis is linked to exaggerated inflammation and immune response.

MATERIAL AND METHODS

Peripheral blood mononuclear cells (PBMC) from 25 patients with Lyme borreliosis and 6 controls were incubated for 7 days with suspension of Borrelia afzeli, B. garinii and B. burgdorferi sensu stricto spirochetes. TGF-beta1 concentration in culture supernatants was measured with ELISA. Results were analyzed according to disease duration (group I--chronic borreliosis, n=20; group II--early borreliosis, n=5) and clinical form (LA--arthritis, NB--neuroborreliosis).

RESULTS

TGF-beta1 concentration was increased in supernatants of PBMC cultures of patients with early neuroborreliosis, in comparison with chronic borreliosis and controls. In chronic, but not in early borreliosis, there was a tendency for decrease of TGF-beta1 synthesis under stimulation with B. burgdorferi spirochetes.

CONCLUSIONS

Impaired synthesis of TGF-beta1 by mononuclear cells seems to be present in patients with chronic forms of Lyme borreliosis when compared to those with early stage of the disease. It may be a factor contributing to the persistence of inadequate inflammatory response in patients in whom chronic form of the disease develops.

Chlamydia Pneumoniae Infection and Ischemic Heart Disease in Hemodialysis Patients

INTRODUCTION

Ischemic heart disease and other atherosclerotic complications are the prominent causes of death among hemodialyzed end-stage renal disease (ESRD) patients and renal transplant recipients. Numerous articles in recent years have raised the possibility of an infective factor, especially Chlamydia pneumoniae, in the development of atherosclerosis and its complications. The aim of this study was to assess the incidence of chronic C pneumoniae infection and its association with ischemic heart disease and atherosclerosis in a population of patients with ESRD awaiting renal transplantation.

MATERIAL AND METHODS

The studied group consisted of 164 subjects: 99 ESRD patients (heart disease [HD] group) who were hospitalized for vascular access creation (27), pretransplantation nephrectomy (47), or kidney transplantation (25), and a control group of 65 subjects consisting of 50 healthy blood donors and 15 multiorgan donors. C pneumoniae was detected in vascular wall fragments, kidney biopsy specimens and peripheral blood monocytes using real time polymerase chain reaction (PCR). Serum immunoglobulin IgG and IgA anti-C pneumoniae antibodies were detected using Enzyme-linked immunosorbent assay (ELISA) and a lipid profile (cholesterol, high-density lipoprotein [HDL], low-density lipoprotein [LDL], and triglycerides [TG]) was obtained. Data on cardiovascular disease events, smoking history, diabetes, hypertension, cause, and length of renal failure were collected and analyzed. The existence of atherosclerotic lesions was detected using ultrasound (US) Doppler examination of aortic bifurcation. Chronic C pneumoniae infection was diagnosed on the basis of detection of both IgA and IgG antibodies and/or the detection of C pneumoniae DNA in vascular wall fragments or peripheral blood monocytes. After a follow-up of 32 months, data on cardiovascular events and patient history were collected again.

RESULTS

Chronic C pneumoniae infection affected 46.5% (46/99) of HD patients and 9% (6/65) of controls (P < .05). Among HD patients, 26.3% (26/99) had ischemic heart disease (IHD) versus 6% in the control group. Among C pneumoniae-infected HD patients, IHD was more frequent (39.1%) than in noninfected HD patients (15%; P < .05). Within the 32-month observation period of the HD group, cardiac pain was observed in 11 (24%; 11/46) infected patients versus 3 (5.7%; 3/53) patients without C pneumoniae infection (P < .05). Exacerbation of previously diagnosed IHD was observed in 8 (44%; 8/18) cases in the C pneumoniae-infected group versus 0 (0%; 0/8) in the uninfected patients (P < .05).

CONCLUSIONS

Chronic C pneumoniae infection affects hemodialysis patients more frequently than healthy subjects. Hemodialysis patients with C pneumoniae infection are at the greater risk of exacerbation of existing IHD.

Chlamydia Pneumoniae Infection: An Additional Factor for Chronic Allograft Rejection

INTRODUCTION

Chronic rejection (CHR) of organ allografts, one of the most significant problems in modern transplantation, is not fully understood. This study sought to evaluate the influence of selected parameters on late kidney transplant function.

PATIENTS AND METHOD

The studied group consisted of eighty-six patients who received allogeneic transplants between 1988 and 1999 for leukocyte Chlamydia pneumoniae-DNA, immunoglobulin (Ig)A/IgG anti-C pneumoniae, blood lipids, ischemic damage in the donor and during organ preservation, HLA mismatch, and acute rejection episodes.

RESULTS

Eighty-six patients were segregated as 26 patients (30%) with histologically proven chronic graft rejection (CHR[+]) and 59 patients (70%) without (CHR[-]). The presence of C pneumoniae-DNA in peripheral blood leukocytes was significantly more frequent in CHR(+) than CHR(-) group (46% vs 20%). Patients with leukocytes positive for C pneumoniae-DNA more frequently (50%) had CHR than patients negative for C pneumoniae-DNA (22%). CHR(+) patients showed significantly lower HDL levels (47 mg/dL vs 58 mg/dL) and higher triglyceride levels (193 mg/dL vs 148 mg/dL). To study the cumulative effect of differences between the CHR(+) and CHR(-) groups, we applied a multiple binary logistic regression analysis. An econometric model enabled us to calculate the probability of CHR for a given patient taking into account covariates chosen by means of stepwise selection: the presence of C pneumoniae-DNA in blood leukocytes, the use of continuous pulsatile perfusion in hypothermia, myocardial infarction occurrence, and triglyceride concentrations.

CONCLUSION

The presence of C pneumoniae-DNA in peripheral blood leukocytes increased the risk of CHR, which may be predicted by a multifactor analysis of chosen parameters.

Presence of Chlamydia pneumoniae in patients with and without atherosclerosis

Data published over the past decade show that Chlamydia pneumoniae is likely associated with the development of atherosclerosis. The aim of this study was to ascertain whether C. pneumoniae infections occur more frequently in patients with atherosclerosis than in healthy subjects. A total of 517 persons were studied. Serum samples, leukocytes, and tissue samples were assayed for the presence of C. pneumoniae-specific IgG and IgA antibodies and C. pneumoniae DNA. C. pneumoniae DNA was found in renal, iliac, and brachial vessels, but it was not detected in radial arteries. C. pneumoniae DNA was found most often in directional coronary atherectomy tissue specimens (11/41, 26.8%), but it was also found in the leukocytes of 14.9% (28/188) of patients with atherosclerosis and 24.6% (28/114) of patients without atheroma changes in vessels. Specific IgG and IgA antibodies were present in 63.8 and 49.9% of atheroma patients, respectively. The prevalence of C. pneumoniae antibodies differs significantly in patients with and without atherosclerosis (for IgG, p=0.002, and for IgA, p=0.006). The identification of persons with chlamydial infection of atherosclerotic arteries necessitates the examination of vascular tissues obtained during revascularization procedures. Serological investigation alone cannot identify individuals with vascular chlamydial infections. Detection of C. pneumoniae DNA in peripheral blood mononuclear cells does not seem to be the exclusive marker of persistent vascular infection. A more easily accessible parameter that allows prediction of chlamydial vascular infection is required.

[Association between carotid atherosclerosis, inflammatory markers and Chlamydia pneumoniae infection]

BACKGROUND AND PURPOSE

The aim of this study was to assess the correlation between morphological markers of carotid atherosclerosis, such as intima-media thickness (IMT) and the cross-sectional plaque area with markers of inflammation and C. pneumoniae infection.

MATERIAL AND METHODS

The study involved a group of 128 persons (63 females, 49.2%), including 54 atherothrombotic stroke patients. The IMT and cross-sectional plaque area of common and internal carotid arteries were measured by ultrasonography. We assessed the C-reactive protein (CRP) and fibrinogen blood level, white blood cell (WBC) count, levels of IgA and IgG antibodies against C. pneumoniae , additionally the presence of C. pneumoniae DNA in WBCs was detected by PCR. We also considered the following risk factors: hypertension, diabetes, obesity and smoking.

RESULTS

The multiple regression analysis showed the strongest and independent correlations of WBC with the IMT (r=0.32; p=0.0003) and plaque area (r=0.24; p=0.008) increase. Also other factors, such as smoking (r=0.19; p=0.026), hypertension (r=0.18; p=0.023) and CRP concentration (r=0.17; p=0.036) showed a significant correlation with carotid IMT. C. pneumoniae -specific IgG antibodies level showed a significant correlation with IMT only in the linear regression analysis, but not in the multiple regression analysis. C. pneumoniae DNA presence results did not reveal a significant correlation with either IMT or the carotid plaque area.

CONCLUSION

Inflammatory markers, especially the WBC count and CRP level, showed an independent and stronger correlation with carotid atherosclerosis than markers of C. pneumoniae infection.

Seroepidemiological studies of Chlamydia pneumoniae infections in 1-36 months old children with respiratory tract infections and other diseases in Poland

Presence of specific IgM, IgG and IgA antibodies against Chlamydia pneumoniae was evaluated in children aged 1 week to 36 months to investigate the role of C. pneumoniae in respiratory infections and other diseases. Serum samples were obtained from 150 hospitalized children, including 123 children presenting the clinical symptoms of various respiratory tract infections, two children with acute diarrhoea, two children with meningitis, 14 children with urinary tract infection, and 9 children with non-infectious diseases. Levels of specific C. pneumoniae IgM, IgG and IgA serum antibodies were measured by enzyme-linked immunoassay (ELISA). C. pneumoniae IgM antibodies were detected in 16 (13.0 %) of 123 children with respiratory tract infections. Specific IgG antibodies were found in sera of 11 children under 12 months old. Among 27 children without symptoms of a respiratory tract disease, specific C. pneumoniae IgM were found in two (7.4%) children, including one child with meningitis and another child with urinary tract infection. Specific IgA antibodies were not found in any tested child. All cases of C. pneumoniae infections were identified within two calendar years out of eight that were analyzed, i.e. in 1997 and 2000. The incidence of C. pneumoniae infections varied seasonally, with most children infected in autumn. C. pneumoniae IgM antibodies were detected more often in girls (17.9%) then in boys (7.2%). C. pneumoniae infections occur among small children in central Poland. The results of this study indicate that C. pneumoniae may play a role in the etiology of respiratory tract infections in infants and young children.

[Chlamydia pneumoniae infection in patients with advanced carotid atherosclerosis]

Despite the growing number of scientific reports showing different markers of infection caused by Chlamydia pneumoniae in patients with advanced atherosclerosis, there is still no clear confirmation of a pathogenetic link between this infection and atherogenesis. The aim of the present study was to investigate the presence C. pneumoniae DNA in peripheral blood mononuclear cells and carotid endarterectomy samples obtained from patients with advanced atherosclerosis according to the presence specific antibodies against C. pneumoniae in serum. The levels of IgG, IgM and IgA antibodies to C. pneumoniae were determined by enzyme immunoassay (EIA) in sera of 36 patients with advanced atherosclerosis undergoing carotid endarterectomy. The presence of C. pneumoniae DNA in the carotid samples and in peripheral blood mononuclear cells was investigated by a nested polymerase chain reaction (PCR). We have not confirm the presence of C. pneumoniae DNA either in the carotid endarterectomy samples or in peripheral blood mononuclear cells, both in patients having the specific antibodies against C. pneumoniae and in seronegative patients. In the studied group of patients with advanced carotid atherosclerosis there was no correlation between the presence of specific antibodies against C. pneumoniae and the presence of C. pneumoniae DNA in endarterectomy samples and peripheral blood mononuclear cells.

Carotid intima-media thickness better differentiates between groups of stroke patients and persons without cerebrovascular disease than other conventional and novel risk factors

When measured by ultrasound, the morphological markers of carotid atherosclerosis such as intima-media thickness (IMT) and cross-sectional plaque area have been associated with the risk of ischaemic stroke. We set out to determine whether the morphological parameters of the carotid arteries made it possible to better differentiate between groups of older atherothrombotic stroke patients and persons without cerebrovascular disease than conventional and novel risk factors of stroke. Of the total number of 623 persons examined, 54 stroke patients (mean age 63.3 years) and 74 controls without cerebrovascular disease (mean age 66.3 years) fulfilled the inclusion criteria for this investigation and were enrolled in the case-control study. After adjustment for age, gender and education level, the strongest associations were found between stroke and carotid IMT [odds ratio (OR) = 10.6; 95% confidence interval (CI): 4.3-26.9] and plaque area (OR = 5.4; 95%CI: 2.3-13.1). Other risk factors showed weaker associations with stroke occurrence. Of the clinical risk factors, a significant association was found between stroke and coronary heart disease (OR = 3.5; 95%CI: 1.2-10.2), hypertension (OR = 3.2; 95%CI: 1.5-7.2) and smoking (OR = 2.7; 95%CI: 1.1-6.4). From the laboratory-derived risk factors a significant association was found between stroke and triglyceride levels (OR = 4.4; 95%CI: 1.9-10.0), and an inverse correlation was observed between stroke occurrence and HDL-cholesterol level (OR = 0.4; 95%CI: 0.2-0.8). The carotid IMT and plaque area, measured with the use of ultrasonography, showed a better correlation with stroke occurrence than currently recognised clinical and biochemical risk factors. The intima-media thickness and plaque area of the carotid arteries could be useful parameters in the development of strategies to identify patients at high risk of atherothrombotic ischaemic stroke.

[Rudolf Stefan Weigl--scientist and human being]

Rudolf Stefan Weigl died in 1957, 45 years ago. This year we are celebrating 120 anniversary of his birthday. He was a great Polish scientist who led research on Rickettsia prowazeki and epidemic typhus. R. Weigl developed a method of R. prowazeki culture in louse gut and elaborated the technology of epidemic typhus vaccine production. He and his co-workers introduced first vaccination of medical staff, people from endemic area in Poland and missionaries working in Asia. He was an international authority on prophylactics and control of rickettsial epidemic typhus.

Bartonella henselae and Borrelia burgdorferi infections of the central nervous system

To investigate the role of B. henselae in patients with symptoms suggesting neuroborreliosis, serum and cerebrospinal fluid samples were tested with serological and PCR methods. Among 17 examined patients, in 12 cases Borrelia burgdorferi infections were detected, in 1 case Bartonella henselae infection was ascertained, and in two patients mixed B. burgdorferi and B. henselae infections were found. These results indicate that mixed infections should be taken into consideration in establishing diagnosis of neurological disorders. Further study of this conclusion is needed.

[Modern possibilities of bioterrorism diagnosis]

One of the most important components of early detecting and response to biological attack are microbiological diagnostic methods. In order to provide the effectiveness of diagnosis continuous training in detection of potentially dangerous bioterrorist agents is needed. Basic information about selected microbiological agents most dangerous for public health, belonging to A and B CDC categories are presented in the article. The most potent biological weapon mentioned in the last decade is anthrax. Other potential bioterrorist agents discussed in this article are Francisella tularensis, Yersinia pestis, Brucella species and Coxiella burnetii.

[Prevalence of Borrelia burgdorferi antibodies in healthy population in Poland]

The aim of the study was to estimate the prevalence of Borrelia burgdorferi antibodies among healthy population of randomly selected voivodeships in Poland. The presence of antibodies was tested by ELISA. Of 1000 blood samples taken from healthy blood donors, antibodies were detected in 11-13% of samples. The results indicate a contact with infecting agent and a possibility of asymptomatic course of the Lyme borreliosis. Frequencies of B. burgdorferi antibodies in blood donors in spring and in autumn were compared. An increase in the proportion of persons positive for IgM antibodies in September may indicate a seasonal transmission and possibility of Lyme borreliosis acquirement according to the biological activity of ticks.

[Attempt of estimation of Q fever endocarditis frequency in Poland]

Up to now no Q fever endocarditis (caused by rickettsia Coxiella burnetii) has been diagnosed in Poland. Potential endocarditis caused by Coxiella burnetii strains can be related to a group of strains present in Poland or sensitivity of Polish Population. The aim of the study was to estimate frequency of Q fever endocarditis is patients of National Institute of Cardiology and to characterize Coxiella burnetii strains and correlation between frequency of Q fever endocarditis and the group of strains. In all patients infective endocarditis and valvular heart disease were diagnosed. In all cases vegetations on TTE or TEE and negative blood cultures were confirmed. No fungal antigens or elevated anti-Candida and anti-Aspergillus antibodies were found. Serological investigations as far as it concerns C. burnetii antibodies were negative in all cases. No Coxiella burnetii infection were found in patients with infective endocarditis and negative blood cultures in the National Institute of Cardiology. However due to high probability of occurrence of such an infection in Poland further investigations in other centers would be useful.

[Prevalence of chlamydia pneumoniae antibodies in patients with coronary heart disease]

A possible role of infectious agents in the pathogenesis and progression of cardiovascular system diseases has been postulated by many scientists. The purpose of our study was to evaluate the correlation between Chlamydia pneumoniae infections and coronary heart disease. A group of 211 patients including: 120 patients with coronary heart disease (CHD) [63 patients enrolled for precutaneous coronary interventions (PTCA), 14 with proven restenosis after PTCA and 43 after coronary artery bypass grafting with recurrence of CHD symptoms], 17 patients suffering from congenital heart diseases or mitral valve stenosis with normal coronary angiograms and 74 healthy volunteers were tested. The levels of serum IgM, IgG and IgA antibodies for Chlamydia pneumoniae were measured with indirect microimmunofluorescence test (MRL Diagnostic, USA). C. pneumoniae specific IgG antibodies were detected in both, patients as well as healthy volunteers. They were seropositive with similar frequency (28.3% and 28.6% respectively). Among CHD patients, however, in PTCA/rest patients, specific C. pneumoniae antibodies have been detected more often (42.9%). Prevalence of C. pneumoniae specific antibodies correlated with patients' age, sex. There was no relation between behavioral habits (smoking) and presence C. pneumoniae antibodies.

[Seroprevalence of Bartonella henselae and Bartonella quintana infections in Poland in 1998-2001]

Bartonella henselae and Bartonella quintana infections result in illnesses with symptoms of severity ranging from mild lymphadenopathy (CSD) to systemic disease. The aim of the study was to estimate a prevalence of B. henselae and B. quintana infections in human in Poland. Serum samples collected from 265 patients in 1998-2001 were tested for the presence of antibodies specific to B. henselae and B. quintana. Levels of serum IgM and IgG antibodies to Bartonella henselae and Bartonella quintana were measured with indirect microimmunofluorescence test (MRL Diagnostic, USA). Cats' sera were assessed with indirect microimmunofluorescence test (MRL Diagnostic, USA) and goat immune serum anti-cat IgG FITC conjugate (Sigma, USA). Bartonella henselae specific antibodies were detected in 146 (57.0%) patients with lymphadenopathy. From that number 11.3% have shown specific Bartonella henselae IgM serum antibodies. Bartonella quintana infection was detected with serological methods in 4 patients. It has been found that CSD is a seasonal infection, with most cases occurring in autumn. Most cases of the disease have been recognized in children 8-16 years old. Most of CSD cases (30.1%) were detected in Mazowieckie voivodeship. There were no cases of CSD in Pomorskie, Podkarpackie, Lubuskie and Opolskie voivodeship. The seroprevalence of Bartonella sp. infections in cats was estimated on 86% (31/36). The highest titer of specific Bartonella henselae antibodies detected in cats was 1024. The number of detected Bartonella henselae infections in Poland is very low. It is very probable that the number of cases is underestimated in our country. Cat scratch disease is the most frequently clinically and serologically identified bartonellosis.

First cases of acute human granulocytic ehrlichiosis in Poland

The first three cases of acute human granulocytic ehrlichiosis in Poland are described. Blood samples were tested by an indirect immunofluorescence method to detect specific serum antibodies, and the polymerase chain reaction was used to detect ehrlichial DNA. Additionally, peripheral blood smears were examined for the presence of morulae. According to criteria of the Centers for Disease Control and Prevention, all three cases can be classified as confirmed granulocytic ehrlichiosis. Using the criteria recommended by a consensus group, however, two cases can be classified as confirmed granulocytic ehrlichiosis and one case as probable granulocytic ehrlichiosis.

[Influence of Chlamydia pneumoniae and cytomegalovirus infections on prevalence and the course of coronary artery disease]

Chlamydia pneumoniae (C. pneumoniae) as well as cytomegalovirus (CMV) are common pathogens found in about 50% of healthy western population. Many studies suggest a role of C. pneumoniae in development of coronary artery disease (CAD). CMV infection is also considered to increase risk of developing of CAD as well as restenosis after percutaneous coronary revascularization (PCI). The aim of our study was to evaluate a possible role of C. pneumoniae and CMV infections in both CAD development and course in patients (pts) undergoing PTCA. We enrolled 105 pts (mean age 56.4 years, 83 males) with angiographically documented CAD. Control group consisted of 63 healthy controls (mean age 47.25 years; 31 males). The study subjects were evaluated for presence of C. pneumoniae specific IgG antibodies (MIF test--MRL Diagnostic, USA; seroprevalence assumed when titre > or = 1/8). In 58 random PCI pts CMV specific IgG antibodies (ELISA Eti-Cytok-G PLUS--Dia Sorin) were evaluated. Pts were sampled at the time of PTCA. All PCI pts were assessed by angina questionnaire 5.9 +/- 2.6 months (mo) after the procedure with respect to clinical restenosis. C. pneumoniae IgG antibodies were detected in 37.1% of pts and in 22% of healthy controls (p < 0.05). After logistic regression was applied trend towards more frequent occurrence of C. pneumoniae specific IgG in CAD pts was shown (p = 0.10 OR = 2.4; 95% CI: 0.8-6.8). No significant correlation was found between anti-C. pneumoniae IgG presence or anti-CMV IgG titre and coronary atherosclerosis advancement. There was no significant difference in anti-CMV IgG titre between 9 pts who developed clinical restenosis 5.9 +/- 2.6 mo after PCI and the remaining pts. Our study results suggest a possible significant correlation between C. pneumoniae with CAD prevalence. We did not find a positive association of either infection markers with coronary atherosclerosis advancement. We did not find correlation of clinical restenosis after PCI with markers of CMV infection.