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July 10, 1991, Vol 266, No. 2 >
ARTICLE | July 10, 1991

Association of Chlamydia pneumoniae (Strain TWAR) Infection With Wheezing, Asthmatic Bronchitis, and Adult-Onset Asthma FREE

David L. Hahn, MD; Ruth W. Dodge, MS; Rjurik Golubjatnikov, PhD, MPH
[+] Author Affiliations

Presented, in part, at the Third Annual Wisconsin Research Network Conference, Wausau, Wis, November 3-4, 1989.

Reprint requests to Arcand Park Clinic, 3434 E Washington Ave, Madison, WI 53704 (Dr Hahn).


JAMA. 1991;266(2):225-230. doi:10.1001/jama.1991.03470020051031
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Article
References

Objective.  —To study the clinical characteristics of respiratory tract illness caused by Chlamydia pneumoniae.

Design.  —Prospective clinical, bacteriologic, and serologic study. Secondarily, a matched comparison of patients with and without evidence of C pneumoniae infection (serologic titers ≥1:64 and <1:16, respectively).

Setting.  —Four primary care (family practice) clinics in Madison, Wis, and nearby towns.

Patients.  —The study included 365 white males and females (mean age, 34.2 years).

Main Outcome Measures.  —Association of acute C pneumoniae infection with signs and symptoms of respiratory illness and the relationship of C pneumoniae antibody titer with wheezing at the time of enrollment in the study, and with the diagnosis of asthmatic bronchitis.

Results.  —Nine (47%) of 19 patients with acute C pneumoniae infection had bronchospasm during respiratory illness, and there was a strong quantitative association of C pneumoniae titer with wheezing at the time of enrollment in the study (P =.01). In the matched study, C pneumoniae antibody was significantly associated with asthmatic bronchitis after, but not before, respiratory illness (odds ratio, 7.2; 95% confidence interval, 2.2 to 23.4). Four infected patients had newly diagnosed asthma after illness, and four others had exacerbation of previously diagnosed asthma. There was no serologic evidence of coexisting Mycoplasma pneumoniae, Chlamydia trachomatis, or respiratory viral infection in 96% of patients with asthmatic bronchitis and asthma.

Conclusions.  —Some Cpneumoniae antibody titers, although not diagnostic of chlamydial infection by present criteria, probably represent acute reinfection or ongoing chronic infection. Repeated or prolonged exposure to C pneumoniae may have a causal association with wheezing, asthmatic bronchitis, and asthma.(JAMA. 1991;266:225-230)

REFERENCES

1 +
Grayston JT, Kuo C-C, Campbell LA, Wang S-P.  Chlamydia pneumoniae sp nov for Chlamydia strain TWAR. Int J Syst Bacteriol . 1989;;39:88-90.
2 +
Grayston JT, Kuo C-C, Wang S-P, Altman J.  A new Chlamydia psittaci strain, TWAR, isolated in acute respiratory tract infections. N Engl J Med . 1986;;315:161-168.
3 +
Pether JVS, Noah ND, Lau YK Taylor JA, Bowie JC.  An outbreak of psittacosis in a boys' boarding school. J Hyg . 1984;;92:337-343.
4 +
Pether JVS, Wang S-P, Grayston JT.  Chlamydia pneumoniae, strain TWAR, as the cause of an outbreak in a boys' school previously called psittacosis. Epidemiol Infect . 1989;;103:395-400.
5 +
Grayston JT, Wang S-P, Kuo C-C, Campbell LA.  Current knowledge on Chlamydia pneumoniae, strain TWAR, an important cause of pneumonia and other acute respiratory diseases. Eur J Microbiol Infect Dis . 1989;;8:191-202.
6 +
Grayston JT.  Chlamydia pneumoniae, strain TWAR. Chest . 1989;;95:664-669.
7 +
Grayston JT, Campbell LA, Kuo C-C, et al.  A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR. J Infect Dis . 1990;;161:618-625.
8 +
McComb D, Puzniak C.  Micro-cell culture methods for isolation of Chlamydia trachomatis. Appl Microbiol . 1974;;28:727-729.
9 +
Stephens R, Kuo C-C, Tam M.  Sensitivity of immunofluorescence with monoclonal antibodies for detection of Chlamydia trachomatis inclusions in cell culture. J Clin Microbiol . 1982;;16:4-7.
10 +
Mansel J, Rosenow E, Smith T, Martin J.  Todays practice of cardiopulmonary medicine: Mycoplasma pneumoniae pneumonia. Chest . 1989;;95:639-646.
11 +
Kenney G, Grayston J.  Eaton PPLO (Mycoplasma pneumoniae) complement fixing antigen: extraction with organic solvents. J Immunol . 1965;;95:19-25.
12 +
Schacter J, Dawson C.  Psittacosis-lymphogranuloma venereum agents/TRIC agents.  In: Lenette EH, Schmidt NF, eds. Diagnostic Procedures for Viral, Rickettsial and Chlamydial Infections . Washington, DC: American Public Health Association; 1979;:1021-1060.
13 +
Casey H. Standardized Diagnostic Complement Fixation Method and Adaption to Microtest, 1: Laboratory Branch Complement Fixation Method; 2: Adaption of LBCF Method to Micro Technique . Atlanta, Ga: Centers for Disease Control, Bureau of Laboratories; 1965;:1-19.
14 +
The GLIM Working Party. The GLIM (Generalised Linear Interactive Modelling) System . Oxford, England: Royal Statistical Society. 1986;; Release 3.77.
15 +
Grayston JT, Wang S-P, Foy HM, Kuo C-C.  Seroepidemiology of Chlamydia trachomatis infection.  In: Mardh PA, ed. Chlamydial Infections . New York, NY: Elsevier Science Publishing Co Inc; 1982;:405-419.
16 +
Frydén A, Kihlström E, Maller R, Persson K, Romanus V, Anséhn S.  A clinical and epidemiological study of 'ornithosis' caused by Chlamydia psittaci and Chlamydia pneumoniae (strain TWAR). Scand J Infect Dis . 1989;;21:681-691.
17 +
Chirgwin K, Roblin P, Gelling M, Hammerschlag MR, Schacter J.  Infection with Chlamydia pneumonia (TWAR) in Brooklyn. Clin Res . 1989;;37:865A. Abstract.
18 +
Grayston JT, Kuo C-C, Wang S-P, et al.  Clinical findings in TWAR respiratory tract infections.  In: Oriel D, Ridgeway G, eds. Chlamydial Infections: Proceedings of the Sixth International Symposium on Human Chlamydial Infections . New York, NY: Cambridge University Press; 1986;:337-340.
19 +
Kleemola M, Saikku P, Visakorpi R, Wang S-P, Grayston JT.  Epidemics of pneumonia caused by TWAR, a new Chlamydia organism, in military trainees in Finland. J Infect Dis . 1988;;157:230-236.
20 +
Thom DH, Grayston JT, Wang S-P, Kuo C-C, Altman J.  Chlamydia pneumoniae strain TWAR, Mycoplasma pneumoniae, and viral infections in acute respiratory disease in a university student health clinic population. Am J Epidemiol . 1990;;132:248-256.
21 +
Oates JJ, Wood AJJ.  A new approach to the treatment of asthma. N Engl J Med . 1989;;321:1517-1527.
22 +
Tager IB, Weiss ST, Speizer FE.  Occurrence of asthma, nonspecific bronchial hyperresponsiveness, and atopy. Chest . 1987;;91( (suppl) ):114S-119S.
23 +
Bell TA, Kuo C-C, Wang S-P, Grayston JT.  Experimental infection of baboons (Papio cynophalus anubis) with Chlamydia pneumoniae strain 'TWAR.' J Infect . 1989;;19:47-49.
24 +
Tattersfield AE.  The site of the defect in asthma: neurohumoral, mediator or smooth muscle? Chest . 1987;;91( (suppl) ):184S-188S.
25 +
Busse WW.  The relationship between viral infections and onset of allergic diseases and asthma. Clin Exp Allergy . 1989;;19:1-9.
26 +
Morrison RP, Lyng K, Caldwell HD.  Chlamydial disease pathogenesis: ocular hypersensitivity elicited by a genus-specific 57-kD protein. J Exp Med . 1989;;169:663-675.
27 +
Beem MO, Saxon EM, Tipple MA. Chlamydial Infections of Infants . Philadelphia, Pa: WB Saunders Co; 1990;:807-811.
28 +
Weiss SG, Newcomb RW, Beem MO.  Pulmonary assessment of children after chlamydial pneumonia of infancy. J Pediatr . 1986;;108:659-664.
29 +
Dunlop EMC, Goh BT, Darougar S, Woodland R.  Triple-culture tests for diagnosis of chlamydial infection of the female genital tract. Sex Transm Dis . 1985;;12:68-71.
30 +
Patton DL, Kuo C-C, Wang S-P, Halbert S.  Distal tubal obstruction induced by repeated Chlamydia trachomatis salpingeal infections in pigtailed macaques. J Infect Dis . 1987;;155:1292-1299.
31 +
Brunham RC, Maclean IW, Binns B, Peeling RW.  Chlamydia trachomatis: its role in tubal infertility. J Infect Dis . 1985;;152:1275-1282.
32 +
Osser S, Persson K.  Immune response to genital chlamydial infection and influence of Chlamydia pneumoniae (TWAR) antibodies. Eur J Clin Microbiol Infect Dis . 1989;;8:532-535.
33 +
Grayston JT, Wang S-P, Yeh L-J, Kuo C-C.  Importance of reinfection in the pathogenesis of trachoma. Rev Infect Dis . 1985;;7:717-725.
34 +
Orie NGM, Sluiter HJ, Vries KD, Tammeking GJ, Witkop J.  The host factor in bronchitis.  In: Orie NGM, Sluiter HJ, eds. Bronchitis: An International Symposium, 27-29 April 1960, University of Gronigen, the Netherlands . Springfield, Ill: Charles C Thomas Publisher; 1961;:44-59.
35 +
Williamson HA, Schultz P.  An association between acute bronchitis and asthma. J Fam Pract . 1987;;24:35-38.
36 +
Grayston JT.  TWAR: a newly discovered Chlamydia organism that causes acute respiratory tract infections. Infect Med . 1988;;5:215-248.
37 +
Pedersen P, Weeke ER.  Epidemiology of asthma in Denmark. Chest . 1987;;91( (suppl) ):107S-114S.

Figures

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Grayston JT, Kuo C-C, Campbell LA, Wang S-P.  Chlamydia pneumoniae sp nov for Chlamydia strain TWAR. Int J Syst Bacteriol . 1989;;39:88-90.
2 +
Grayston JT, Kuo C-C, Wang S-P, Altman J.  A new Chlamydia psittaci strain, TWAR, isolated in acute respiratory tract infections. N Engl J Med . 1986;;315:161-168.
3 +
Pether JVS, Noah ND, Lau YK Taylor JA, Bowie JC.  An outbreak of psittacosis in a boys' boarding school. J Hyg . 1984;;92:337-343.
4 +
Pether JVS, Wang S-P, Grayston JT.  Chlamydia pneumoniae, strain TWAR, as the cause of an outbreak in a boys' school previously called psittacosis. Epidemiol Infect . 1989;;103:395-400.
5 +
Grayston JT, Wang S-P, Kuo C-C, Campbell LA.  Current knowledge on Chlamydia pneumoniae, strain TWAR, an important cause of pneumonia and other acute respiratory diseases. Eur J Microbiol Infect Dis . 1989;;8:191-202.
6 +
Grayston JT.  Chlamydia pneumoniae, strain TWAR. Chest . 1989;;95:664-669.
7 +
Grayston JT, Campbell LA, Kuo C-C, et al.  A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR. J Infect Dis . 1990;;161:618-625.
8 +
McComb D, Puzniak C.  Micro-cell culture methods for isolation of Chlamydia trachomatis. Appl Microbiol . 1974;;28:727-729.
9 +
Stephens R, Kuo C-C, Tam M.  Sensitivity of immunofluorescence with monoclonal antibodies for detection of Chlamydia trachomatis inclusions in cell culture. J Clin Microbiol . 1982;;16:4-7.
10 +
Mansel J, Rosenow E, Smith T, Martin J.  Todays practice of cardiopulmonary medicine: Mycoplasma pneumoniae pneumonia. Chest . 1989;;95:639-646.
11 +
Kenney G, Grayston J.  Eaton PPLO (Mycoplasma pneumoniae) complement fixing antigen: extraction with organic solvents. J Immunol . 1965;;95:19-25.
12 +
Schacter J, Dawson C.  Psittacosis-lymphogranuloma venereum agents/TRIC agents.  In: Lenette EH, Schmidt NF, eds. Diagnostic Procedures for Viral, Rickettsial and Chlamydial Infections . Washington, DC: American Public Health Association; 1979;:1021-1060.
13 +
Casey H. Standardized Diagnostic Complement Fixation Method and Adaption to Microtest, 1: Laboratory Branch Complement Fixation Method; 2: Adaption of LBCF Method to Micro Technique . Atlanta, Ga: Centers for Disease Control, Bureau of Laboratories; 1965;:1-19.
14 +
The GLIM Working Party. The GLIM (Generalised Linear Interactive Modelling) System . Oxford, England: Royal Statistical Society. 1986;; Release 3.77.
15 +
Grayston JT, Wang S-P, Foy HM, Kuo C-C.  Seroepidemiology of Chlamydia trachomatis infection.  In: Mardh PA, ed. Chlamydial Infections . New York, NY: Elsevier Science Publishing Co Inc; 1982;:405-419.
16 +
Frydén A, Kihlström E, Maller R, Persson K, Romanus V, Anséhn S.  A clinical and epidemiological study of 'ornithosis' caused by Chlamydia psittaci and Chlamydia pneumoniae (strain TWAR). Scand J Infect Dis . 1989;;21:681-691.
17 +
Chirgwin K, Roblin P, Gelling M, Hammerschlag MR, Schacter J.  Infection with Chlamydia pneumonia (TWAR) in Brooklyn. Clin Res . 1989;;37:865A. Abstract.
18 +
Grayston JT, Kuo C-C, Wang S-P, et al.  Clinical findings in TWAR respiratory tract infections.  In: Oriel D, Ridgeway G, eds. Chlamydial Infections: Proceedings of the Sixth International Symposium on Human Chlamydial Infections . New York, NY: Cambridge University Press; 1986;:337-340.
19 +
Kleemola M, Saikku P, Visakorpi R, Wang S-P, Grayston JT.  Epidemics of pneumonia caused by TWAR, a new Chlamydia organism, in military trainees in Finland. J Infect Dis . 1988;;157:230-236.
20 +
Thom DH, Grayston JT, Wang S-P, Kuo C-C, Altman J.  Chlamydia pneumoniae strain TWAR, Mycoplasma pneumoniae, and viral infections in acute respiratory disease in a university student health clinic population. Am J Epidemiol . 1990;;132:248-256.
21 +
Oates JJ, Wood AJJ.  A new approach to the treatment of asthma. N Engl J Med . 1989;;321:1517-1527.
22 +
Tager IB, Weiss ST, Speizer FE.  Occurrence of asthma, nonspecific bronchial hyperresponsiveness, and atopy. Chest . 1987;;91( (suppl) ):114S-119S.
23 +
Bell TA, Kuo C-C, Wang S-P, Grayston JT.  Experimental infection of baboons (Papio cynophalus anubis) with Chlamydia pneumoniae strain 'TWAR.' J Infect . 1989;;19:47-49.
24 +
Tattersfield AE.  The site of the defect in asthma: neurohumoral, mediator or smooth muscle? Chest . 1987;;91( (suppl) ):184S-188S.
25 +
Busse WW.  The relationship between viral infections and onset of allergic diseases and asthma. Clin Exp Allergy . 1989;;19:1-9.
26 +
Morrison RP, Lyng K, Caldwell HD.  Chlamydial disease pathogenesis: ocular hypersensitivity elicited by a genus-specific 57-kD protein. J Exp Med . 1989;;169:663-675.
27 +
Beem MO, Saxon EM, Tipple MA. Chlamydial Infections of Infants . Philadelphia, Pa: WB Saunders Co; 1990;:807-811.
28 +
Weiss SG, Newcomb RW, Beem MO.  Pulmonary assessment of children after chlamydial pneumonia of infancy. J Pediatr . 1986;;108:659-664.
29 +
Dunlop EMC, Goh BT, Darougar S, Woodland R.  Triple-culture tests for diagnosis of chlamydial infection of the female genital tract. Sex Transm Dis . 1985;;12:68-71.
30 +
Patton DL, Kuo C-C, Wang S-P, Halbert S.  Distal tubal obstruction induced by repeated Chlamydia trachomatis salpingeal infections in pigtailed macaques. J Infect Dis . 1987;;155:1292-1299.
31 +
Brunham RC, Maclean IW, Binns B, Peeling RW.  Chlamydia trachomatis: its role in tubal infertility. J Infect Dis . 1985;;152:1275-1282.
32 +
Osser S, Persson K.  Immune response to genital chlamydial infection and influence of Chlamydia pneumoniae (TWAR) antibodies. Eur J Clin Microbiol Infect Dis . 1989;;8:532-535.
33 +
Grayston JT, Wang S-P, Yeh L-J, Kuo C-C.  Importance of reinfection in the pathogenesis of trachoma. Rev Infect Dis . 1985;;7:717-725.
34 +
Orie NGM, Sluiter HJ, Vries KD, Tammeking GJ, Witkop J.  The host factor in bronchitis.  In: Orie NGM, Sluiter HJ, eds. Bronchitis: An International Symposium, 27-29 April 1960, University of Gronigen, the Netherlands . Springfield, Ill: Charles C Thomas Publisher; 1961;:44-59.
35 +
Williamson HA, Schultz P.  An association between acute bronchitis and asthma. J Fam Pract . 1987;;24:35-38.
36 +
Grayston JT.  TWAR: a newly discovered Chlamydia organism that causes acute respiratory tract infections. Infect Med . 1988;;5:215-248.
37 +
Pedersen P, Weeke ER.  Epidemiology of asthma in Denmark. Chest . 1987;;91( (suppl) ):107S-114S.

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