chlamydia, ReA - an interesting one

[Guest guest]

I had not been aware of any direct, conclusive evidence linking

chlamydial persistence, despite abx, to any disease. In chlamydia-

associated " reactive " arthritis, Nanagara (who did a similar study on

borrelia) demonstrated persistence of C. trachmoatis in the joint.

This study is ten years old and so far (only a little searching) I

have not found significant subsequent work taking up this angle. Does

anyone know what is the current leading treatment for chronic

chlamydia-associated reactive arthritis / Reiters syndrome? Are

patients told this is probably an aseptic illness?

Arthritis Rheum. 1995 Oct;38(10):1410-7. Related Articles, Links

Alteration of Chlamydia trachomatis biologic behavior in synovial

membranes. Suppression of surface antigen production in reactive

arthritis and Reiter's syndrome.

Nanagara R, Li F, Beutler A, Hudson A, Schumacher HR Jr.

KhonKaen University, Thailand.

OBJECTIVE. To investigate the biologic state of Chlamydia and its

surface antigen expression in the synovial membranes of patients with

Chlamydia-associated reactive arthritis/Reiter's syndrome (ReA/RS).

METHODS. Expression of chlamydial lipopolysaccharide (LPS), major

outer membrane protein (MOMP), and elementary body (EB) antigens was

studied by gold labeling immunoelectron microscopy on 6 synovial

membrane and 2 synovial fluid (SF) pellet samples from 6 patients

with Chlamydia-associated arthritis. The study findings were compared

with 24-hour cultures of HeLa cells infected with Chlamydia

trachomatis EB. RESULTS. Persistent C trachomatis infection was found

in all 6 synovial membrane samples from patients who had either early

or chronic arthritis. The infection persisted despite antibiotic

treatment, including a 1-month course of doxycycline therapy. Most

persistent organisms were atypical reticulate bodies (RBs) found in

both fibroblasts and macrophages. Specific, but weak, immunogold

staining for all 3 antibodies was found on both intracellular RBs and

extracellular EBs. In the SF samples, Chlamydia surface antigens were

detected only in phagosomes containing degraded electron-dense

materials. CONCLUSION. The synovial membrane biopsies conducted in

this study of Chlamydia-associated ReA/RS revealed atypical RBs with

diminished MOMP and LPS expression. Such altered organisms may escape

immune surveillance and contribute to disease chronicity; moreover,

these organisms may be difficult to detect and treat in some ReA/RS

patients.

PMID: 7575691 [PubMed - indexed for MEDLINE]