#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Keratoconjunktivitis sicca (KCS) při folikulární konjunktivitidě u dospělých pacientů s etiologií Chlamydia pneumoniae (souhrnná dvanáctiletá studie)


Authors: J. Krásný;  D. Hrubá 1;  M. Netuková;  V. Kodat;  J. Pokorná
Authors‘ workplace: Oční klinika FN Královské Vinohrady, Praha, přednosta prof. MUDr. P. Kuchynka, CSc. ;  Vidia-Diagnostika s. r. o., Praha 1
Published in: Čes. a slov. Oftal., 67, 2011, No. 2, p. 42-50
Category: Original Article

Overview

Aim:
Following the previous study observing keratoconjunctivitis sicca (KCS) after treated follicular conjunctivitis of chlamydial etiology from the years 1999-2002, at this time the authors would like to point out the possible connection between KCS appearance and Chlamydia pneumoniae infection.

Material:
In the Department of Ophthalmology, during the period of 12 months (in the years 2009 – 2010), there were treated 11 adult patients (6 women and 5 men) in the age of 28 – 81 years (median, 50 years) with follicular conjunctivitis lasting on average 2.5 years and caused by Chlamydia pneumoniae, and simultaneously were diagnosed the symptoms of KCS, out of the total number of 37 examined patients with similar clinical findings.

Methods:
The diagnosis of chlamydial infection in clinical symptoms of follicular conjunctivitis and simultaneous signs of KCS was established partly according to the serologic positivity of chlamydial genus (anti-LPS) and/or species (anti-Ch. pneumoniae and anti-Ch.trachomatis) IgG, IgM, and IgA antibodies together with simultaneous anti-cHSP60 IgG positivity, further using conjunctival prints examined by means of indirect immunofluorescence method using specific monoclonal antibodies; in conjunctival smears and peripheral leucocytes was tested also the presence of Chlamydia pneumoniae DNA. The main subjective complaints of the patients were burning sensation, sticking, or foreign-body sensation; the itching and lacrimation were less common. Among clinical signs dominated the hyperemia and the edema of the lower fornix; the tortuosity of the vessels and the follicles were not always present. The KCS diagnosis was confirmed by Bengal rose staining. Results: In 10 patients, the positive IgA and/or IgM anti-Ch. pneumoniae antibodies were detected. Simultaneously, the positive anti-cHSP60 IgG were confirmed, out of them medium- and high-positive findings were in 7 patients, and anti-LSP antibodies IgA and/or IgM in 8 of them. Positive smears were found in 6 patients. In 2 persons of this group of treated patients, the general serologic findings were not significant, but the Chlamydia pneumoniae infection was confirmed by Chlamydia pneumoniae DNA positivity in peripheral leucocytes; in these 2 patients, the symptoms lasted for one half of the year. As the side findings were the confirmations of active Chlamydia trachomatis infection in other 4 patients of the whole group. The patients with Chlamydia pneumoniae infection were treated systemically by macrolide antibiotic azithromycine for 12 days. After the treatment, above all else the clinical signs of conjunctival inflammation disappeared, but remained KCS symptoms, which were disappearing only slowly. The optimal supporting therapies were lubricant drops with different concentration of sodium hyaluronide without preservatives. Control microbiological examinations during 6 months after the treatment termination confirmed negative smears findings, but the antibody levels were not decreased significantly.

Conclusion:
This study confirmed the possible connection between the KCS and Chlamydia pneumoniae infection in simultaneous clinical signs of follicular conjunctivitis. Along with that the study pointed out the necessity of simultaneous evaluating of the microbial findings and clinical symptoms to consider the systemic antibiotic treatment.

Key words:
follicular conjunctivitis, Chlamydia pneumoniae, Chlamydia trachomatis, keratoconjunctivitis sicca


Sources

1. Aldous, M. B., Grayston. J. T., Wang, S. P., Foy, H. M.: Seroepidemiology of Chlamydia Pneumoniae TWAR Infection in Seattle Families, 1966–1979. J Infect Dis, 166, 1992: 646–649.

2. Balin, B.J., Gerard, H.C., Arking, E.J. et al.: Identification and Localization of Chlamydia Pneumoniae in the Alzheimer’s Brain. Med Microbiol Immunol, 187, 1998: 23–42.

3. BenEzra, D. (ed): Blepharitis and Con­junctivitis – Guideline for Diagnosis and Treatment, Chapter 16: Dry Eye, Editorial Glosa, Barcelona, 2006, pp. 123–206, ISNB 84-7429-268-9.

4. Blasi, F., Boman, J., Esposito, G. et al.: Chlamydia Pneumoniae DNA Detection in Peripheral Blood Mononuclear Cells Is Predictive of Vascular Infection. J. Infect. Dis. 180, 1999: 2074–2076.

5. Blasti, F., Fagetti, L., Allegra, L.: Chla­my­dia Pneumoniae Detection in Atherosclerotic Plaque in Italy. J Infect Dis, 181, 2000; suppl. 3: 444–446.

6. Cunningham, A.F., Johnston, S.L., Julious, S.A., et al.: Chronic Chlamydia Pneumoniae Infection and Asthma Exacerbations in Children. Eur Respir. J. 11, 1998: 345 – 349

7. Dawson, Ch.R., Schachter, J., Ste­phens, R.D.: Chlamydial Kerato­conjunctivitis. In: Pepose, J.S., Holland, N.G., Wihelmus, K.R.: Ocular Infection & Immunity. Mosby, St. Louis, 1995, pp. 818–829, ISBN 0-8024-3422-7.

8. Di Pietro, M., Schiavoni, G., Del Pie­no, M. et al.: Chlamydia Pneumoniae and Atherosclerosis: the Role of Mast Cell. J Biol Regul Homeost Agents, 23, 2009: 65–69.

9. Dowel, V. et al.: Standardizing Chlamy­dia Pneumoniae Assays: Recommen­dations from the Centers for Disease Control and Prevention (USA) and the Laboratory Centre for Disease Control (Canada). Clin Infect Dis, 33, 2001: 492–503.

10. Dwyer, R., Treharne, J.D., Jones, B.R., Herring, J.: Chlamydial Infection: Results of Microimmunofluorescence tests for the Detection of Type-specific Antibody in Certain Chlamydia Infection. Br J Vener Dis. 48, 1972: 452 – 459.

11. Fainardi, E., Castellazi, M., Tamborino, C. et al.: Chlamydia Pneumoniae – specific Intratheal Oligoclonal Antibody Response in Predominantly Detected in a Subret of Multiple Sclerosis Patients with Progressive Forms J Neurovirol, 15, 2009: 425–433.

12. Forsey, T., Darougar, S.: Acute Con­junctivitis Caused by an Atypical Chlamydia Strain 10L 207. Br J Ophthalmol, 68, 1984: 408.

13. Fujita, M., Hatachi, S., Yagita, M.: Acute Chlamydia Pneumoniae Infection in the Pathogenesis of Autoimmune Diseases. Lupus, 18, 2009; 164–168.

14. Grayton, J.T.: Design of Future Intervention Studies for Chlamydia Pneumoniae in Atherosclerosis. Am Heart J, 138, 1999, 5 Pt 2: S556–S557.

15. Hahn, D.L.: Chlamydia Pneumoniae, Asthma and CHOPD: What Is the Evidence? Annals of Allergy, Asthma & Immunol, 83, 1999: 271–288.

16. Hightower, L. E.: Heat Shock, Stress Proteins, Chaperones and Proteotoxicity. Cell, 56, 1991: 191–197.

17. Hrubá, D., Kodat, V., Krásný, J.: Sérologické nálezy chlamydiových protilátek v České republice (kontrolní soubor studie: Chlamydia Pneumoniae v etiologii keratokonjunktivitis sicca). Čas Lék česk, 16, 2011: v tisku

18. Huittinen, T., Leinonen, M., Tenka­nen, L. et al.: Autoimmunity to Human Heat Shock Protein 60, Chlamydia Pneumoniae Infection, and Inflammation in Predicting Coronary Risk. Arterio­sclerosis Thrombosis and Vascular Biology, 22, 2002: 431–437.

19. Koskiniemi, M., Gencay, M., Salonen, O., et al.: Chlamydia Pneumoniae Associated with Central Nervous System Infections. Eur Neurol, 36, 1996: 160–163.

20. Krásný, J., Borovanská, J., Hrubá, D.: Chlamydia Pneumoniae – etiologie Ophthalmia neonatorum. Čes Slov Oftal, 59, 2003: 240–248.

21. Krásný, J., Borovanská, J., Hrubá, D.: Chlamydia Pneumoniae – etiologie folikulární konjunktivitidy a následné keratokonjunktivitis sicca u dospělých pacientů. Čes Slov Oftal, 59, 2003: 325–333.

22. Krásný, J., Borovanská-Tomášová, J., Hrubá D.: Relationship between Chlamydia trachomatis and Chlamydia Pneumoniae as the Cause of Neonatal conjunctivitis (Ophthalmia Neona­torum). Ophthalmologica, 219, 2005: 232–236.

23. Krásný, J., Hrubá, D., Tomášová-Borovanská, J.: Chlamydiové infekce oka. In : Rozsíval, P. (Ed).: Moderní trendy v oftalmologii, Praha, Galen, 2005, s. 177–203, ISBN 80-7262-326-5.

24. Krásný, J., Hrubá, D., Netuková, M., et al.: Keratokonjunktivitis sicca v pohledu možné chlamydiové infekce. Sborník XVI. Sjezdu ČOS, Nukleus HK, 2008, s. 45–46.

25. Krásný, J., Hrubá, D., Netuková, M., et al.: Chlamydia pneumoniae v etiologii keratokonjunktivitis sicca u dospělých pacientů. Čes Slov Oftal, 65, 2009: 102–106.

26. Krásný, J., Hrubá, D., Kodat, L., et al.: Sérologické nálezy u pacientů s keratokonjunktivis sicca a kontrolního souboru u chlamydiové infekce. Sborník XVIII. sjezdu ČOS, Nukleus HK, 2010, s. 113.

27. Kumar, S., Hammerschlag, M.R.: Acute Respiratory Infection Due to Chlamydia Pneumoniae: Current Status of Diagnostic Methods, CID 44, 2007: 568–576.

28. Lajunen, T., Vikatmaa, P., Bloigu, A. et al.: Chlamydial LPS and High-sensitivity CRP Levels in Serum Are Associated with an Elevated Body Mass Index in Patients with Cardiovascular Disease. Innate Immun. 14, 2008: 375–382.

29. Laurila, A.L., Anttila, T., Laara, E., et al.: Serological Evidence of an Association between Chlamydia Pneumoniae Infection and Lung Cancer. Int J Cancer, 74, 1997: 31–34.

30. Lietman, T., Brooks, D.,Moncada, J., et al.: Chronic Follicular Conjunctivitis Associated with Chlamydia Psittaci and Chlamydia Pneumoniae. Clin Infect Dis, 26, 1998: 1335–40.

31. Lutsey, P.L., Pankow, J.S., Bertoni, A.G. et al: Serogical Evidence of Infections and Type 2 Diabetes: the MultiEthnic Study of Atherosclerosis. Diabet. Med. 26, 2009: 149–152.

32. Merayo-Lloves, J., Baltatzis, S., Foster, C.S.: Epstein-Barr Virus Dacryoadenitis Resulting in KCS in a Child. Am J Ophthalmol, 132, 2001: 922–923.

33. Pflugfelder, S.C., Beuerman, R.W.: Dry Eye and Ocular Surface Disorders. New York, M. Dekker, 2004, p. 428, ISBN 0-8024-3422-7.

34. Pflugfelder, S.C., Whitcher, J.P., Troy, E.D.: Sjogren Syndrome. In: Pepose, J.S., Holland, N.G., Wihelmus, K.R.(Ed) : Ocular Infection & Immunity. St. Louis, Mosby, 1995, pp. 313–333, ISBN 0-8016-6757-7.

35. Puolakkainen, M., Campbell, L.A., Kuo, C.C. et al.: Serological Response to Chlamydia Pneumoniae in Patients with Sarcoidosis. J Infection, 33, 1996: 199–205.

36. Rantala, A., Lajunen, T., Juvonen, R. et al.: Chlamydia Pneumoniae Infection Is Associated with Elevated Body Mass Index in Young Men. Epid Infect, 17, 2009: 1–7.

37. Ridker, P.R., Kundsin, R.B., Stamp­fer, M.J., et al.: Prospective Study of Chlamydia Pneumoniae IgG Seropositivity and Risk of Future Myocardial Infraction. Circulation, 99, 1999: 1161–1164.

38. Schirmer, O.: Studies zur Physiologie und Pathologie der Tranenabsonderung und Tranenabfuhr. Graefes Arch. Clin. Exp. Ophthalmol. 56, 1903: 47–60.

39. Schumacher, H.R. Jr., Gerad, H.C., Arayssi, T.K., et al.: Lower Prevalence of Ch. Pneumoniae DNA compared with Ch. trachomatis DNA in Synovial Tissue of Arthritis Patients. Arthritis Rheum. 42, 1992: 1889–93.

40. Sodja, J.: Sérologický přehled chlamy­diových protilátek. Zprávy CEM 1998, č.7, s. 34–36.

41. Sriram, S., Mitchel, W., Stratton, C.: Multiple Sclerosis Associated with Ch. Pneumoniae Infection of the CNS. Neurology, 50, 1998: 571–572.

42. van Bijsterveld, O.: Diagnostic Test in the Sicca Syndrome. Arch. Ophthalmol. 82, 1969: 10–14.

43. Weslen, L., Pahlson, C., Lindquist, O., et al.: An Increase in Sudden Un­expected Cardiac Deaths Among Young Swedish Orienteers During 1979–1992. E Heart J, 17, 1996: 902–910.

44. Willoughby, C.E., Barker, K., Kaye, S.B., et al.: Epstein-Barr Virus in the Tear Film in Sjogrenęs Syndrome and HIV Infection. J. Med. Virol, 68, 2002: 378–383.

45. Wu, L., Skinner, S.J., Lambie, N et al.: Immunohistochemical Staining for C. pneumoniae Is Increased in Lung Tissue from Subject with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med, 162, 2000: 1148–51.

Labels
Ophthalmology
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#