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Clinical Microbiology Reviews, January 2002, p. 1-20, Vol. 15, No. 1
0893-8512/01/$04.00+0     DOI: 10.1128/CMR.15.1.1-20.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Chlamydia pneumoniae and Atherosclerosis: Critical Assessment of Diagnostic Methods and Relevance to Treatment Studies

Jens Boman1 and Margaret R. Hammerschlag2*

Department of Virology, Umeå University, Umeå, Sweden,1 Division of Pediatric Infectious Diseases, Department of Pediatrics, State University of New York Downstate Medical Center, Brooklyn, New York2

A number of studies have found that inflammation of the vessel wall plays an essential role in both the initiation and progression of atherosclerosis and erosion and fissure and the eventual rupture of plaques. Chlamydia pneumoniae is one of the infectious agents that have been investigated as possible causes of this inflammation. Initial studies of the association of C. pneumoniae and cardiovascular disease (CVD) were seroepidemiologic, and these were followed by studies in which the organism was identified in vascular tissue from patients with CVD by electron microscopy, PCR and immunocytochemical staining (ICC). C. pneumoniae has also been isolated by culture from vascular tissue in a small number patients. However, no single serologic, PCR, or ICC assay has been used consistently across all studies. The assays used are also not standardized. Recent studies of serologic and PCR assays for diagnosis of C. pneumoniae infection have suggested that there may be substantial interlaboratory variation in the performance of these tests. It now appears that some of the inconsistency of results from study to study may be due, in part, to lack of standardized methods. Although initial seroepi-demiologic studies demonstrated a significantly increased risk of adverse cardiac outcome in patients who were seropositive, subsequent prospective studies found either small or no in-creased risk. In addition to the lack of consistent serologic criteria, recent evaluations have demonstrated inherent problems with performance of the most widely used serologic methods. Most importantly, we do not have a reliable serologic marker for chronic or persistent C. pneumoniae infection.

* Corresponding author. Mailing address: Department of Pediatrics, Box 49, SUNY Downstate Medical Center, 450 Clarkson Ave., Brooklyn, NY 11203-2098. Phone: (718) 245-4075. Fax: (718) 245-2118. E-mail: mhammerschlag{at}pol.net.

Clinical Microbiology Reviews, January 2002, p. 1-20, Vol. 15, No. 1
0893-8512/01/$04.00+0     DOI: 10.1128/CMR.15.1.1-20.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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