Preliminary summary of Wheldon/Stratton work-in-progress

[Guest guest]

I ran a summary of the preliminary report I had

madeby Wheldon, and he offered a more succinct

version for us, They are still modifying the paper and

even adding some cases to the 5 existing. This is the

study and paper which Nelly had referred to a bit

back. Has some interesting and suggestive comments

about reponses to Cpn.

Jim

Preliminary summary of work-in-progress:

METRONIDAZOLE: A KEY COMPONENT OF A REGIMEN FOR THE

TREATMENT OF PERSISTENT CHLAMYDOPHILA (CHLAMYDIA)

PNEUMONIAE INFECTION.

B. Wheldon(a) and W. Stratton(

a)Consultant Medical Microbiologist, Department of

Medical Microbiology, Bedford Hospital, Kempston Road,

Bedford, UK MK42 9DJ. Corresponding Author. tel

01234355122 ext 5282; email

david.wheldon@...

b)Associate Professor of Pathology, The Vanderbilt

Clinic 4524-TVC, Vanderbilt University Medical Center,

21st & Edgehill St. Nashville, TN 37232-5310 USA email

charles.stratton@...

Diagnosis and treatment of chronic persistent

infections with Chlamydia pneumoniae are both

problematic. This is important because evidence is

accumulating that this organism has input into serious

multisystem diseases. The authors examine the dynamic

of chronic persistent infections with Chlamydia

pneumoniae and suggest that a host tryptophan

starvation strategy together with the administration

of protein-synthesis inhibitors may drive the organism

into a sluggish metabolic state which relies on

anaerobic pathways. They draw parallels with other

intracellular pathogens (e.g. Mycobacterium

tuberculosis) which are known to do this. Organisms in

this state would be expected to be killed by

metronidazole. The authors anticipate that, as

chlamydiae possess endotoxins, cidal treatment should

bring about symptoms of endotoxaemia. Seven patients

with symptoms suggestive of chronic persistent

Chlamydia pneumoniae infection (five of them with

positive IF serology) were treated with doxycycline

and a macrolide. When metronidazole was added to the

regimen the patients developed chills, sweats and

other symptoms suggestive of mild endotoxic reactions.

The authors make the point that these reactions

continued after the metronidazole had been

discontinued, suggesting a) treatment may purge immune

system cells (known to be a target of Chlamydia

pneumoniae) of the organism, and may have opened up

the constitution of the organism to the host immune

system. The study is flawed by the fact that it is

retrospective, and that endotoxin assay (which is not

a routine examination) was not undertaken.