Chlamydia pneumoniae: An Important Pathogen in Chronic Bronchitis

  • J. Lorenz


Chronic bronchitis (CB) refers to the presence of chronic cough and recurrent increases in bronchial secretions sufficient to cause expectoration. It is clinically defined by international consensus as production of sputum on most days for a minimum of 3 months a year for at least 2 successive years that cannot be attributed to other pulmonary or cardiac causes [1, 2]. CB can occur with or without airflow limitation. Chronic obstructive pulmonary disease (COPD) is a disorder that is characterized by the presence of airflow obstruction due to CB or pulmonary emphysema [3]. The obstruction is dominant during expiration and is generally at best partially reversible. Reduced expiratory airflow and slow forced emptying of the lung are persistent and typically show progressive deterioration with age. CB is one of the most prevalent chronic diseases in adults, especially in males. In 1978, about 20% of the male working population in Germany fulfilled the diagnostic criteria [4]. In 1970, 10% of German adults over 50 years suffered from CB with chronic airflow obstruction [5]. In western developed countries COPD ranks among the three or four leading causes of death. In 1983 death rates of adults aged 55–65 in Europe and North American countries due to COPD were 17-90/100000 males and 7-30/100000 females [6]. Between 1966 and 1989 the age-adjusted death rates for COPD rose 71% in the USA [7]. Median survival of 62-year-old patients with COPD was 8 years, against 14 years in healthy subjects of the same age [8]. The observed development in morbidity and mortality appears to be related to trends in cigarette smoking in the decades before.


Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Patient Acute Exacerbation Chronic Bronchitis Acute Bronchitis 
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  1. 1.
    American Thoracic Society (1962) Chronic bronchitis, asthma, and pulmonary emphysema: a statement by the Committee on Diagnostic Standards for Nontuberculous Respiratory Diseases. Am Rev Respir Dis 85: 762–768Google Scholar
  2. 2.
    Medical Research Council (1965) Definition and classification of chronic bronchitis for clinical and epidemiological purposes. Lancet 1: 775–779Google Scholar
  3. 3.
    American Thoracic Society (1995) Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. Respir Crit Care Med 152: S78–S121Google Scholar
  4. 4.
    Fruhmann G (1978) Chronische Bronchitis und Berufsfähigkeit. Arbeitsmed Sozialmed Präventivmed 13: 215–218Google Scholar
  5. 5.
    Reichel G, Ulmer WT (eds) (1970) Luftverschmutzung und unspezifische Atemwegserkrankungen. Springer, Berlin Heidelberg New YorkGoogle Scholar
  6. 6.
    World Health Organisation (1986) Statistics annual of the World Health Organisation, WHO Publications, GenevaGoogle Scholar
  7. 7.
    Higgins MW, Thom T (1990) Incidence, prevalence, and mortality: intra-and intercountry differences. In: Hensley MJ, Saunders NA (eds) Clinical epidemiology of chronic obstructive pulmonary disease. Dekker, New York, pp 23–43Google Scholar
  8. 8.
    Farzin I, Ulmer WT (1980) Die Lebenserwartung von Patienten mit chronisch obstruktiver Atemwegserkrankung. Prax Pneumol 34: 158–168Google Scholar
  9. 9.
    Jeffery PK (1998) Structural and inflammatory changes in COPD: a comparison with asthma. Thorax 53: 129–136PubMedCrossRefGoogle Scholar
  10. 10.
    Murphy TF, Sethi S (1992) Bacterial infection in chronic obstructive pulmonary disease. Am Rev Respir Dis 146: 1067–1083PubMedGoogle Scholar
  11. 11.
    Gump DW, Phillips CA, Forsyth BR, Mclntosh FK, Lamborn KR, Stouch WH (1976) Role of infection in chronic bronchitis. Am Rev Respir Dis 113: 465–473PubMedGoogle Scholar
  12. 12.
    Ball P (1995) Epidemiology and treatment of chronic bronchitis and its exacerbations. Chest 108: S43–S52CrossRefGoogle Scholar
  13. 13.
    Monso E, Ruiz J, Rosell A, Manterola J, Fiz J, Morcra J, Ausina V (1995) Bacterial infection in chronic obstructive pulmonary disease: a study of stable and exacerbated outpatients using the protected specimen brush. Am J Respir Crit Care Med 152: 1316–1320PubMedGoogle Scholar
  14. 14.
    Cole P (1989) Host-microbe relationships in chronic respiratory infection. Respiration 55: S5–S8CrossRefGoogle Scholar
  15. 15.
    Wilson R (1995) Outcome predictors in bronchitis. Chest 108: S53–S57CrossRefGoogle Scholar
  16. 16.
    Amitani R, Wilson R, Read R (1991) Effects of human neutrophil elastase and bacterial proteinase enzymes on human respiratory epithelium. Am J Respir Cell Mol Biol 4: 26–32PubMedGoogle Scholar
  17. 17.
    Feldman C, Anderson R, Kanthakumar K (1994) Oxidant-mediated ciliary dysfunction in human respiratory epithelium. Free Radic Biol Med 17: 1–10PubMedCrossRefGoogle Scholar
  18. 18.
    Howard P (1970) A long-term follow-up of respiratory symptoms and ventilatory function in a group of working man. Br J Industr Med 27: 326–333Google Scholar
  19. 19.
    Bates DV (1973) The fate of the chronic bronchitic: a report of the ten-year follow-up in the Canadian Department of Veteran’s Affairs coordinated study of chronic bronchitis. Am Rev Respir Dis 108: 1043–1065PubMedGoogle Scholar
  20. 20.
    Fletcher C, Peto R (1977) The natural history of chronic airflow obstruction. BMJ 1: 1645–1648PubMedCrossRefGoogle Scholar
  21. 21.
    Kanner RE, Renzetti ADJr, Klauber MR, Smith CB, Golden CA (1978) Variables associated with changes in spirometry in patients with chronic obstructive lung disease. Am J Med 67: 44–50CrossRefGoogle Scholar
  22. 22.
    Anthonisen NR, Manfreda J, Warren CPW, Hershfield ES, Harding GKM, Nelson NA (1987) Antibiotic therapy in acute exacerbations of chronic obstructive pulmonary disease. Ann Intern Med 106: 196–204PubMedGoogle Scholar
  23. 23.
    Allegra L, Grassi C, Grossi E et al (1991) Ruolo degli antibiotici nel trattamento delle riacutizzazioni delia bronchite. Ital J Chest Dis 45: 138–148Google Scholar
  24. 24.
    Grossman RF (1997) Guidelines for the treatment of acute exacerbations of chronic bronchitis. Chest 112: S310–S313CrossRefGoogle Scholar
  25. 25.
    Grayston JT, Kuo C-C, Wang S-P, Altman J (1986) A new Chlamydia psittaci strain, TWAR, isolated in acute respiratory infections. N Engl J Med 315: 161–168PubMedCrossRefGoogle Scholar
  26. 26.
    Grayston JT, Aldous MB, Easton A, Wang S-P, Kuo C-C, Campbell LA, Altman J (1993) Evidence that Chlamydia pneumoniae causes pneumonia and bronchitis. J Infect Dis 168: 1231–1235PubMedCrossRefGoogle Scholar
  27. 27.
    Mordhorst CH, Wang S-P, Grayston JT (1992) Outbreak of Chlamydia pneumoniaeinfection in four farm families. Eur J Clin Microbiol Infect Dis 11: 617–620PubMedCrossRefGoogle Scholar
  28. 28.
    Blasi F, Cosentini R, Denti F, Allegra L (1994) Two family outbreaks of Chlamydia pneumoniae infections. Eur Respir J 7: 102–104PubMedCrossRefGoogle Scholar
  29. 29.
    Aymard M, Bebear C, Valette M, Lina B, Layani MP, De Barbeyrac B, Orfila J (1997) Rapport basé sur une enquête microbiologique et sur la literature existante. Etiologie virale des rhinopharyngites et otites aigües de l’enfant. Med Mal Infect 27: 456–471CrossRefGoogle Scholar
  30. 30.
    Mäkelä MJ, Puhakka T, Ruuskanen O, Leinonen M, Saikku P, Kimpimäki M, Blomqvist S, Hyypiä T, Arstila P (1998) Viruses and bacteria in the etiology of common cold. J Clin Microbiol 36: 536–542Google Scholar
  31. 31.
    Falck G, Heyman L, Gnarpe J, Gnarpe H (1994) Chlamydia pneumoniae (TWAR): a common agent in acute bronchitis. Scand J Infect Dis 26: 179–187PubMedCrossRefGoogle Scholar
  32. 32.
    Thom DH, Grayston JT, Campbell LA, Kuo C-C, Diwan VK, Wang S-P (1994) Respiratory infection with Chlamydia pneumoniae in middle-aged and older outpatients. Eur J Microbiol Infect Dis 13: 785–792CrossRefGoogle Scholar
  33. 33.
    Jonsson JS, Sigurdsson JA, Kristinsson KG, Guthnodottir M, Magnussen S (1997) Acute bronchitis in adults. How close do we come to its aetiology in general practice? Scand J Prim Health Care 15: 156–160PubMedCrossRefGoogle Scholar
  34. 34.
    Vernejoux JM, Texier-Mougin J, Rio P, Guizard AV, Tunon De Lara JM, Taytard A (1997) Bacterial infectious agents implicated in community-acquired lower airway infections. Rev Pneumol Clin 53: 138–143PubMedGoogle Scholar
  35. 35.
    Philit F, Etienne J, Calvet A (1992) Agents infectieux associés aux décompensations des bronchopathies chroniques obstructives et aux attaques d’asthme. Rev Mal Respir 9: 191–196PubMedGoogle Scholar
  36. 36.
    Beaty C, Grayston JT, Wang S-P, Kuo C-C, Reto CS, Martin TR (1991) Chlamydia pneumoniae, strain TWAR, infection in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 144: 1408–1410PubMedGoogle Scholar
  37. 37.
    Blasi F, Legnani D, Lombardo VM, Negretto GG, Magliano E, Pozzoli R, Chiodo F, Fasoli A, Allegra L (1993) Chlamydia pneumoniae infection in acute exacerbations of COPD. Eur Respir J 6: 19–22PubMedGoogle Scholar
  38. 38.
    Blasi F, Damato S, De Carli A, Cosentini R, Fagetti L, Raccanelli R, Pagani N, Arosio C, Campi E, Allegra L (1996) Evidence suggesting Chlamydia pneumoniae chronic infection in COPD. ICAAC, PosterGoogle Scholar
  39. 39.
    Von Hertzen L, Isoaho R, Koskinen R, Laippala P, Töyrylä M, Kivelä SL, Saikku P (1996) Chlamydia pneumoniae antibodies in chronic obstructive pulmonary disease. Int J Epidemiol 25: 658–664CrossRefGoogle Scholar
  40. 40.
    Von Hertzen L, Alakärppä H, Koskinen R, Liippo K, Surcel HM, Leinonen M, Saikku P (1997) Chlamydia pneumoniae infection in patients with chronic obstructive pulmonary disease. Epidemiol Infect 118: 155–164CrossRefGoogle Scholar
  41. 41.
    Verkooyen RP, Van Lent NA, Mousavi Joulandan SA, Snijder RJ, van denBosch JM, Van Helden HP, Verbrugh HA (1997) Diagnosis of Chlamydia pneumoniae infection in patients with chronic obstructive pulmonary disease by micro-immunofluorescence and ELISA. J Med Microbiol 46: 959–969PubMedCrossRefGoogle Scholar
  42. 42.
    Thom H, Grayston JT, Wang S-P, Kuo C-C, Altman J (1990) Chlamydia pneumoniaestrain TWAR, Mycoplasma pneumoniae and viral infections in acute respiratory disease in a University Student Health Clinic population. Am J Epidemiol 132: 228–256Google Scholar
  43. 43.
    Hahn DL, Saikku P (1995) Serologic evidence for Chlamydia pneumoniae infection in recently symtomatic asthma. Am J Respir Crit Care Med 151[Suppl]: A470Google Scholar
  44. 44.
    Kuo C-C, Jackson LA, Campbell LA, Grayston JT (1995) Chlamydia pneumoniae(TWAR). Clin Microbiol Rev 8: 451–461PubMedGoogle Scholar
  45. 45.
    Laurila AL, Von Hertzen L, Saikku P (1997) Chlamydia pneumoniae and chronic lung diseases. Scand J Infect Dis 104[Suppl]: 34–36Google Scholar
  46. 46.
    Hammerschlag MR, Chirgwin K, Roblin PM, Gelling M, Dumornay W, Mandel L, Smith P, Schachter J (1992) Persistent infection with Chlamydia pneumoniae following acute respiratory illness. Clin Infect Dis 14: 178–182PubMedCrossRefGoogle Scholar
  47. 47.
    Hanna L, Dawsen CR, Briones O, Thygeson P, Jarvetz E (1968) Latency in human infections with TRIC agents. J Immunol 101: 43–50PubMedGoogle Scholar
  48. 48.
    Yang YS, Kuo C-C, Chen WJ (1983) Reactivation of Chlamydia trachomatis lung infection in mice by cortisone. Infect Immun 39: 655–658PubMedGoogle Scholar
  49. 49.
    Batteiger BE, Fraiz J, Newhall WJ, Katz BP, Jones RB (1989) Association of recurrent chlamydial infection with gonorrhoea. J Infect Dis 159: 661–669PubMedCrossRefGoogle Scholar
  50. 50.
    File TM, Bartlett JG, Casell GH, Gaydos CA, Grayston JT, Hammerschlag MR, Jones RB, Kahn JB, Marrie TJ, Ramirez JA, Saikku P, Schachter J, Schumacher HR, Stamm WE, Stratton CW, Yu VL (1997) The importance of Chlamydia pneumoniae as a pathogen. The 1996 Consensus Conference on Chlamydia pneumoniae Infections. Infect Dis Clin Pract 6: S28–S31CrossRefGoogle Scholar
  51. 51.
    Shemer-Avni Y, Lieberman D (1995) Chlamydia pneumoniae-induced ciliostasis in ciliated bronchial epithelial cells. J Infect Dis 171: 1274–1278PubMedCrossRefGoogle Scholar
  52. 52.
    Surcel HM, Syriala H, Leinonen M, Herva E (1993) Cell-mediated immunity to Chlamydia pneumoniae measured as lymphocyte blast transformation in vitro. Infect Immun 61: 2196–2199PubMedGoogle Scholar
  53. 53.
    Pizzichini MMM, Pizzichini E, Efthemiadis A, Clelland L, Mahony JB, Dolovich J, Hargreave JB (1997) Markers of inflammation in induced sputum in acute bronchitis caused by Chlamydia pneumoniae. Thorax 52: 929–931PubMedCrossRefGoogle Scholar
  54. 54.
    Dalhoff K, Maass M (1996) Chlamydia pneumoniae pneumonia in hospitalized patients. Clinical characteristics and diagnostic value of polymerase chain reaction detection in BAL. Chest 110: 351–356PubMedCrossRefGoogle Scholar

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© Springer-Verlag Italia, Milano 1999

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  • J. Lorenz

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