A study of prevalence of anti-chlamydia pneumoniae antibodies in adult and paediatric asthmatic patients

 

Vaishnavi Madavi^1*, Renu Bharadwaj²

 

Abstract              Background: Bronchial asthma is most commonly observed respiratory condition in adults and children. Various infections contribute to development and progress asthma. Chlamydia pneumonia is one of the infections contributing to asthma. Aim and objective: To study the Prevalence of Anti-Chlamydia pneumoniae antibodies in adult and paediatric asthmatic patients Methodology: Present study was a prospective laboratory-based study conducted on patients suffering from clinically diagnosed asthma. Data included sociodemographic data, detailed history, clinical examination and serological investigations. The sera were tested for presence of anti-Chlamydia using commercially available kits. Data was analysed with appropriate statistical tests. Results: Out of 100 patients, 30 were paediatric age group and 70 were adults. Majority of the paediatric patients in our study were in the age group of 9-12 years (56.7%) followed by 5-8 years (43.3%). Majority of the adult patients belonged to 51-60 years age group (27.1%). Male predominance was seen in all age groups. Prevalence of antiChlamydia pneumoniae antibodies was 70%.

 

INTRODUCTION

Asthma is a chronic inflammatory disorder of the airways in which many tissues play a role. The chronic inflammation is associated with increased airway hyperresponsiveness that leads to recurrent episodes of breathlessness, coughing, wheezing and tightness in chest; particularly at night or in the early morning. These episodes are associated with variable airflow obstructions which are reversible either spontaneously or after treatment.^1,2 Multiple risk factors play a role in the development and severity of asthma. Acute bacterial and viral infections may cause exacerbations in asthma, which prolong the disease leading to chronic asthmatic status. Amongst bacterial infections, Chlamydia pneumoniae is suspected to play a role in such cases.^3,4 The detection of anti-Chlamydial IgM, IgG and IgA antibodies is important to diagnose the acute and chronic infections and it also helps to assess response to treatment and prognosis of patients. The present study aims at finding out the seroprevalence of Chlamydia pneumoniae in asthma patients.

Aim and objective: To study the Prevalence of Anti-Chlamydia pneumoniae antibodies in adult and paediatric asthmatic patients

 

MATERIAL AND METHODS

Present study was a prospective laboratory based study. Study was conducted at department of chest and TB and department of paediatrics at a tertiary health care centre. Study population was patients department of chest and TB and department of paediatrics.

 

Inclusion criteria

1. Patients suffering from clinically diagnosed asthma
2. Patients or parents of patients willing to participate in the study

Exclusion criteria

1. Patients who had other respiratory tract diseases or cardiovascular diseases in addition to asthma.

Total 50 patients with clinically diagnosed asthma were taken as cases. Data was collected with pre tested questionnaire. Data included sociodemographic data, detailed history, clinical examination and serological investigations.

5cc of blood in adult and 3cc of blood in pediatric patients was collected in a sterile plain vacutainer. These vacutainers were kept at room temperature for 30 minutes allowing the blood to clot. Sera were separated by centrifugation at 1800rpm for 30 minutes. The separated sera were collected in Eppendorf vials and stored at -200C (in a deep freezer) until further testing. Haemolyzed samples were not processed and repeat blood samples were requested and collected.

The sera were tested for presence of anti-Chlamydia pneumoniae IgM, anti-Chlamydia pneumoniae IgG and anti-Chlamydia pneumoniae IgA antibodies using commercially available kits (NovaTec Chlamydia pneumoniae ELISA)

Serological findings were interpreted as follows:

The antibody titers were interpreted as –

NovaTec unit (NTU)         Interpretation

<11 NTU              Negative

11-14 NTU          Low titers

15-20 NTU          Moderate titers

>20 NTU              High titers

Data was entered in excel sheet. Data was analysed with SPSS version 20.

RESULTS

In our study, we studied 100 patients with clinically diagnosed asthma. Out of 100 patients, 30 were paediatric age group and 70 were adults. Table 1 shows Distribution of pediatric asthmatic patients according to their age and sex. Majority of the paediatric patients in our study were in the age group of 9-12 years (56.7%) followed by 5-8 years (43.3%). Among the 30 paediatric patients, 20 were male and 10 were females. Male to female ratio was 2:1. Males predominated females in the age group of 5-8 years and 9-12 years. Table 2 shows distribution of adult asthmatic patients according to age and sex. In our study, majority of the adult patients belonged to 51-60 years age group (27.1%). Second major group was 61-70 years contributing 20 % of all. Patients in the age group of 41-50 years and 21-30 years were 17.2% and 15.7% respectively. Patients in the age group of 31-40 years were 11.4% and above 70 years were 8.6%. Among adult patients, 40(57.1%) were male and 30(42.9%) were females. Male predominance was seen in all age groups. Out of 100 patients, 70% asthmatic patients showed presence of Chlamydia pneumoniae antibodies so the prevalence of antiChlamydia pneumoniae antibodies was 70%. Table 3 shows Comparison of anti-Chlamydia pneumoniae antibodies in pediatric and adult asthmatic patients. Among the adult patients 77.1% patients showed presence of Chlamydia pneumoniae antibodies and 22.9% showed absence of Chlamydia pneumoniae antibodies. In the paediatric age group 53.3% had Chlamydia pneumoniae antibodies and 46.7% did not have antibodies. Fisher’s Z-test was applied for comparison of anti-Chlamydia pneumoniae antibodies in pediatric and adult asthmatic patients. p value < 0.05 was considered statistically significant. Thus we can say that presence of Chlamydia pneumoniae antibodies was significantly more in adult patients than paediatric patients.

DISCUSSION

In the present study elderly children of the age 9-12 years were affected most by the disease. Different workers have reported different age groups to be commonly affected by the disease. The mentioned findings correlated well with those of Annagur et al.⁵ and Wazir et al.⁶. Both of them mentioned the age group of 10-15 years in their studies. Normann et al.⁷ using MIF test mentioned that 4 years is the commonest age in the pediatric asthmatic patients. However, the workers have not mentioned any specific reason for this low age group. Webley et al.⁸ reported an earlier age group in their study on pediatric asthma. This is also different from our study. However, in all the pediatric patients males outnumbered the females. Kopriva et al.⁹ and Youssef et al.¹⁰ also mentioned high prevalence of males in the suffering pediatric patients. The present study showed that, majority of the adult patients suffering from asthma belonged to the age group of 51-60 years followed by 61-70 years. This indicates that asthma (either acute or chronic) is a disease of sixth or seventh decade of life in this region. Many workers studying on asthma have found that it is a disease of fifth and sixth decade. Wark et al.¹¹ noted the mean age of 45 years in the adult patients in his study. Sävykoski et al.¹², Lieberman et al.¹³ and Torshizi et al.¹⁴ also reported similar findings. Agarwal et al.¹⁵ from India mentioned that the commonest age group was 51-60 years which correlates with our finding. It appears that in western countries the disease usually affects at the age of 45-50 years but in India it usually affects a decade later. It is apparent that repeated sub-clinical exposures of the respiratory tract to various infectious agents gradually increases the local immunity; however in a later decade when the immune status of the patient decreases, such patients are predisposed to long term disease like asthma. The workers in India and abroad have unanimously reported that males predominated over females for the clinical signs and symptoms of asthma^16,17. The only exceptions are of, Hahn et al.¹⁸ and Hahn et al.¹⁹ who studied patients of acute and chronic asthma and reported higher numbers of females being affected by the disease. Foschino Barbaro et al.²⁰ in his studies noted that almost equal numbers of males and females suffered from the disease. Comparing the pediatric and adult patients suffering from asthma with the presence of anti-Chlamydia pneumoniae antibodies in their blood, it was found that these antibodies are predominantly seen in adults (77.1%) as compared to children (53.3%) and the difference was statistically significant. It can be inferred from this that, C. pneumoniae infection in adults is usually a long standing chronic or persistent infection producing antibodies for a prolonged period in moderate to high titer. As against in pediatric patients, the immune apparatus is rather weak or immature and produces antibodies in low titer against a long standing infection.

 

CONCLUSION

In pediatric patients prevalence of anti-Chlamydia pneumoniae antibodies was 53.3% while in adults it was 77.1%.

 

REFERENCES

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