Evidence for Chlamydia pneumoniae infection in steroid-dependent asthma David L Hahn, MD*; Don Bukstein, MD*; Allan Luskin, MD*; and Howard Zeitz, MD† Background: Chlamydia pneumoniae is an obligate intracellular respiratory
strong association of C. pneumoniae
pathogen capable of persistent infection. Seroepidemiologic studies and the results
of open-label antimicrobial treatment of patients with non-steroid-dependent asthma
have suggested a potential role for C. pneumoniae in asthma.
12.5 for titers of 1:128 or greater).8 C.Objective: To evaluate the results of antimicrobial treatment in patients with pneumoniae is a plausible candidate as
uncontrolled steroid-dependent asthma and serologic evidence suggesting C. pneu-Methods: Three nonsmoking asthmatic patients (aged 13 to 65 years) whose
symptoms remained poorly controlled despite daily administration of inhaled and
oral steroid (10 to 40 mg/d). All met serologic criteria for current or recent C.
tion and inflammation.10–12 The culture
Results: After prolonged treatment (6 to 16 weeks) with clarithromycin or
for C. pneumoniae infection in the ini-
azithromycin all three patients were able to discontinue oral steroids. All three
patients have remained well controlled with inhaled antiasthma therapy only during
3 to 24 months of postantibiotic therapy observation. Conclusions: In adolescent and adult asthmatic patients, Chlamydia pneumoniae
infection may contribute to symptoms of asthma that are poorly controlled by
linking C. pneumoniae infection to
steroids. Serologic evidence for C. pneumoniae infection should be sought in such
patients. A trial of appropriate antibiotic therapy may be helpful in those patients
with high titers of anti-C. pneumoniae IgG antibodies.
Ann Allergy Asthma Immunol 1998;80:45–9.
obtained from three patients who de-veloped
asthma following clinical respiratoryillnesses and who also had serologic
treated chronic Chlamydia trachomatis
met clinical and spirometric criteria for
moniae, is a human pathogen recog-
stimuli. Spirometric criteria for revers-
*Dean Medical Center, Madison, Wisconsin.
†Rush-Presbyterian-St. Luke’s Medical Cen-
gestive of a role for C. pneumoniae
and Grayston,14 we measured C. pneu-
Received for publication March 3, 1997. moniae-specific IgM and IgG antibod-
Accepted for publication in revised form June
patients. C. pneumoniae-specific IgA
ter of IgG specific for C. pneumoniae
role of C. pneumoniae as an important
IgE antibodies specific for C. pneu-moniae have been associated with cul-
cough, shortness of breath and wheeze.
ing was positive only with Alternaria.
tentative diagnosis of mild asthma wasmade and he was treated with an albu-
Table 1. Summary of Clinical and Serologic Data
C. pneumoniae Patient Age, Pre-bronchodilator FEV1 Antibody Titer Pre-Antibiotic Rx Post-Antibiotic Rx
Ͻ1:8 ND 1:512 1.78L (49% predicted) 3.67L (102% predicted)
Ͻ1:8 1:16 1:512 1.62L (61% predicted) 1.91L (74% predicted)
Ͻ1:8 1:64 1:512 1.50L (37% predicted) 2.48L (61% predicted)
ANNALS OF ALLERGY, ASTHMA, & IMMUNOLOGY
ters of anti-C. pneumoniae IgG (1:512)
strongly suggested C. pneumoniae in-
fection, all three patients received pro-
The optimal length of therapy for C.pneumoniae respiratory infection has
major target organs in chronic C. pneu-
not been established. Acute C. pneu-moniae infection. Nevertheless, high
moniae respiratory infections often re-
infections.24 Because Chlamydia tra-
tients reported here suggests that C.chomatis-specific IgA, but not IgG,
pneumoniae infection also might be a
dency in some cases of severe asthma.
chronic C. pneumoniae infection. IgG
antibodies against C. pneumoniae were
ma-inciting antigens. C. pneumoniae-
identify patients with chronic C. pneu-moniae respiratory infection. Because
tional Heart, Lung, and Blood Insti-tute. February, 1997.
jects. Culture diagnosis is difficult be-
animal model, non-cultivable C. pneu-moniae may be transformed to a culti-
5. Grayston JT. Chlamydia pneumoniae,
strain TWAR. Chest 1989;95:664 –9.
growth of C. pneumoniae in vitro32 and
chitis. J Infect Dis 1993;168:1231–5. C. pneumoniae antibody titers in pa-
8. Hahn DL, Dodge R, Golubjatnikov R.
Association of Chlamydia pneumoniae
will be required to elucidate further the
gested that steroid treatment of patients
who are infected with C. pneumoniae
their role in asthma: Chlamydia pneu-moniae in adult patients. Eur Respir
ters of C. pneumoniae-specific anti-
bodies, a trial of appropriate antibiotic
continues to rise in the elderly.34 Since
chronic C. pneumoniae infection has
ogy of experimental Chlamydia pneu-moniae pneumonitis in mice. J Infect
It is possible that chronic infection, as
otic effective against Chlamydia pneu-pneumoniae infection in mice: effect
1. Shelhamer JH, Levine SJ, Wu T, et al.
2. Expert Panel Report II. Guidelines for
ANNALS OF ALLERGY, ASTHMA, & IMMUNOLOGY
al. Chronic Chlamydia pneumoniae in-
29. Thom DH, Grayston JT. Chlamydia
bridge University Press, 1986:329 –32. pneumoniae strain TWAR infections:
descriptions, diagnosis, and treatment.
R, et al. Evidence of persistent Chla-
Mediguide Infect Dis 1990;10:1– 4.
30. Hahn DL. Treatment of Chlamydia
determinations for Chlamydia pneu-pneumoniae infection in adult asthma:
16. Saikku P. Chronic Chlamydia pneu-
Grayston JT. Reactivation of Chla-moniae infections. In: Allegra L, Blasi
mydia pneumoniae lung infection in
24. Alifano M, De Pascalis R, Sofia M, et
wara T, et al. Serologic tests for Chla-mydia pneumoniae. Pediatr Infect Dis
Davies P. Chlamydia pneumoniae an-
specific IgA antibody to Chlamydiatrachomatis in the diagnosis and treat-
et al. Respiratory infection with Chla-mydia pneumoniae in middle-aged and
pneumoniae. In: Allegra L, Blasi F,
crobiol Infect Dis 1994;13:785–92.
eds. Chlamydia pneumoniae infection.
20. Hahn DL. Evidence for Chlamydiapneumoniae infection in asthma. In:
tion. Eur J Epidemiol 1992;8:882– 4. Request for reprints should be addressed to:
to Chlamydia pneumoniae in military
28. Peeling RW, Hahn D, Dillon E. Chla-mydia pneumoniae infection and adult-
Focused Real-Time Dynamic Programming for MDPs:Robotics Institute, Carnegie Mellon UniversityFRTDP guides outcome selection by maintaining a prior-ity value at each node that estimates the benefit of directingReal-time dynamic programming (RTDP) is a heuris-search to that node. Priority-based outcome selection bothtic search algorithm for solving MDPs. We present amodified algorithm called F
Information Technology Committee Security Update This paper describes the security incidents in the past year and brings the reports up to the current date Action requested Does the paper have resource implications? No Risk Assessment Does the paper include a risk analysis? Yes If ‘Yes’, in which section(s) of the paper are they described? The entire paper Equality and Diversity Has