Non-detection of Chlamydia species in carotid atheroma using generic primers by nested PCR in a population with a high prevalence of Chlamydia pneumoniae antibody

BACKGROUND: The association of Chlamydia pneumoniae with atherosclerosis is controversial. We investigated the presence of C. pneumoniae and other Chlamydia spp. in atheromatous carotid artery tissue. METHODS: Forty elective carotid endarterectomy patients were recruited (27 males, mean age 65 and 13 females mean age 68), 4 had bilateral carotid endarterectomies (n= 44 endarterectomy specimens). Control specimens were taken from macroscopically normal carotid artery adjacent to the atheromatous lesions (internal controls), except in 8 cases where normal carotid arteries from post mortem (external controls) were used. Three case-control pairs were excluded when the HLA DRB gene failed to amplify from the DNA. Genus specific primers to the major outer membrane protein (MOMP) gene were used in a nested polymerase chain reaction (nPCR) in 41 atheromatous carotid specimens and paired controls. PCR inhibition was monitored by spiking with target C. trachomatis. Atheroma severity was graded histologically. Plasma samples were tested by microimmunofluorescence (MIF) for antibodies to C. pneumoniae, C. trachomatis and C. psittaci and the corresponding white cells were tested for Chlamydia spp. by nPCR. RESULTS: C. pneumoniae was not detected in any carotid specimen. Twenty-five of 38 (66%) plasma specimens were positive for C. pneumoniae IgG, 2/38 (5%) for C. trachomatis IgG and 1/38 (3%) for C. psittaci IgG. CONCLUSIONS: We were unable to show an association between the presence of Chlamydia spp. and atheroma in carotid arteries in the presence of a high seroprevalence of C. pneumoniae antibodies in Northern Ireland

Transmission patterns of smallpox: systematic review of natural outbreaks in Europe and North America since World War II

BACKGROUND: Because smallpox (variola major) may be used as a biological weapon, we reviewed outbreaks in post-World War II Europe and North America in order to understand smallpox transmission patterns. METHODS: A systematic review was used to identify papers from the National Library of Medicine, Embase, Biosis, Cochrane Library, Defense Technical Information Center, WorldCat, and reference lists of included publications. Two authors reviewed selected papers for smallpox outbreaks. RESULTS: 51 relevant outbreaks were identified from 1,389 publications. The median for the effective first generation reproduction rate (initial R) was 2 (range 0–38). The majority outbreaks were small (less than 5 cases) and contained within one generation. Outbreaks with few hospitalized patients had low initial R values (median of 1) and were prolonged if not initially recognized (median of 3 generations); outbreaks with mostly hospitalized patients had higher initial R values (median 12) and were shorter (median of 3 generations). Index cases with an atypical presentation of smallpox were less likely to have been diagnosed with smallpox; outbreaks in which the index case was not correctly diagnosed were larger (median of 27.5 cases) and longer (median of 3 generations) compared to outbreaks in which the index case was correctly diagnosed (median of 3 cases and 1 generation). CONCLUSION: Patterns of spread during Smallpox outbreaks varied with circumstances, but early detection and implementation of control measures is a most important influence on the magnitude of outbreaks. The majority of outbreaks studied in Europe and North America were controlled within a few generations if detected early

Association of circulating Chlamydia pneumoniae DNA with cardiovascular disease: a systematic review

BACKGROUND: Chlamydia pneumoniae antigens, nucleic acids, or intact organisms have been detected in human atheroma. However, the presence of antibody does not predict subsequent cardiovascular (CV) events. We performed a systematic review to determine whether the detection of C. pneumoniae DNA in peripheral blood mononuclear cells (PBMC) was associated with CV disease. METHODS: We sought studies of C. pneumoniae DNA detection in PBMC by polymerase chain reaction (PCR) among patients with CV disease or other clinical conditions. We pooled studies in which CV patients were compared with non-diseased controls. We analyzed differences between studies by meta-regression, to determine which epidemiological and technical characteristics were associated with higher prevalence. RESULTS: Eighteen relevant studies were identified. In nine CV studies with control subjects, the prevalence of circulating C. pneumoniae DNA was 252 of 1763 (14.3%) CV patients and 74 of 874 (8.5%) controls, for a pooled odds ratio of 2.03 (95% CI: 1.34, 3.08, P < 0.001). Prevalence was not adjusted for CV risk factors. Current smoking status, season, and age were associated with C. pneumoniae DNA detection. High prevalence (>40%) was found in patients with cardiac, vascular, chronic respiratory, or renal disease, and in blood donors. Substantial differences between studies were identified in methods of sampling, extraction, and PCR targets. CONCLUSIONS: C. pneumoniae DNA detection was associated with CV disease in unadjusted case-control studies. However, adjustment for potentially confounding measures such as smoking or season, and standardization of laboratory methods, are needed to confirm this association

Pockenausbrüche nach dem zweiten Weltkrieg in Deutschland

Hintergrund: Seit 1980 gelten die Pocken als ausgerottet. Es ist jedoch nicht auszuschließen, dass der Erreger der Pocken, das Variola-Virus, aus nicht vernichteten oder aus nach der Eradikation nicht an eines der beiden WHO-Referenzzentren (WHO Collaborating Smallpox Laboratories) abgegebenen Stämmen zu bioterroristischen Anschlägen genutzt wird. Aufgrund der Weiterentwicklung des molekularen Engineerings steigt zudem die Gefahr der Erzeugung neuer Pockenviren. Ziel der Arbeit: Die Auswertung von klinischen und epidemiologischen Daten, aus denen Schlussfolgerungen für die Ausbruchskontrolle dieser lebensbedrohlichen Krankheit abgeleitet werden. Methoden: Es handelt sich hier um eine Volltext-Handrecherche in den Hauptpublikationsorganen des öffentlichen Gesundheitswesens in Deutschland von 1945 bis 1975. Ergebnis und Diskussion: Nach dem zweiten Weltkrieg ereigneten sich in Deutschland zwölf Pockenausbrüche, die hier hinsichtlich folgender Kenndaten ausgewertet werden: Beginn der Kontagiosität, Schutzwirkung der Impfung, Booster-Effekt bei der Wiederimpfung und Ansteckungsorte. Insgesamt erkrankten 95 Personen, von denen 10 verstarben. 81 der erkrankten Personen waren geimpft und entwickelten zu 91 % nur leichte Symptome. Leicht Erkrankte stellten nach primärer Fehldiagnose durch ihre weitere Teilnahme am öffentlichen Leben ein besonderes Risiko für die Weiterverbreitung des Erregers dar. Die hier dargestellten Daten zeigen ein niedriges Infektionsrisiko für die ersten drei Krankheitstage, wodurch antiepidemische Maßnahmen und die Kontaktverfolgung erleichtert werden. Die meisten Infektionen fanden im Krankenhaus statt, dies unterstreicht die Bedeutung einer guten Vorbereitung auch von peripheren Krankenhäusern. Die hier dargestellten Daten dokumentieren die Erfahrungen aus Deutschland und sollten zur Planung medizinischer und epidemiologischer Maßnahmen zur Ausbruchskontrolle hinzugezogen werden.Background: Even though smallpox was declared eradicated by WHO in 1980, it cannot be ruled out that the etiological variola virus could be used as a biological weapon. Undestroyed viruses from biowarfare programmes, virus strains left undetected in a freezer or dangerous recombinant poxvirus constructs could cause dangerous outbreaks in a relatively unprotected population. Objectives: Despite an abundance of studies performed during the eradication of smallpox, epidemiological data for preparedness planning and outbreak control in modern, industrialized countries are scarce. Material and methods: Full-text hand search for the period from 1945 to 1975 in the main German public health journals. Results: After World War II 12 smallpox outbreaks occurred in Germany. They were studied with the focus on the period of contagiousness, the protective effect of vaccination, booster-effect of revaccination and the place of infection. A total of 95 individuals contracted smallpox, including 10 fatalities. Despite having been previously vaccinated, 81 vaccinated persons came down with smallpox, yet 91% of them developed only mild symptoms. These patients presented a high risk for spreading the infection to contact persons due to misinterpretation of symptoms and the continuing social contacts. Basically, the risk of transmission in the first 2 to 3 days after onset of symptoms was low, thus facilitating antiepidemic measures. The importance of hospital preparedness is emphasized by the fact that most infections occurred in hospitals. Conclusion: The data analyzed provide valuable information for today’s outbreak response planning and counter bioterrorism preparedness

Chlamydia trachomatis heat shock proteins 60 and 10 induce apoptosis in endocervical epithelial cells

The potential role of chlamydial heat shock proteins (cHSP) 60 and cHSP10 in apoptosis of primary cervical epithelial cells was investigated