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Chlamydia pneumoniae TWAR has been associated with coronary heart disease by seroepidemiologic studies and direct detection of the organism in atheromatous lesions of coronary arteries and aorta. In this study, 38 fresh tissue specimens from patients with coronary artery lesions that were treated by directional coronary atherectomy were tested for C. pneumoniae. Twenty-three specimens were from patients with primary lesions and 15 were from patients with restenoses. C. pneumoniae was detected by polymerase chain reaction (PCR), immunocytochemical stain (ICC), or both in 20 of 38 specimens. Using cell identity markers, the organism was localized to macrophages. Ultrastructural evidence of the organism was found in the 2 specimens examined by transmission electron microscopy, which were also positive by both ICC and PCR. C. pneumoniae was found more frequently in tissues from restenoses than in primary lesions (P = .17). There was no relation between the frequency of detection of the organism and C. pneumoniae-specific antibody titers.

An epidemic often provides an opportunity to obtain evidence of the etiologic association of a microorganism with disease. Chlamydia pneumoniae TWAR is a newly recognized organism whose relationship to disease is not completely understood. An outbreak of C. pneumoniae infections from November 1990 to February 1991 was studied in University of Washington students. Twelve TWAR infections were identified serologically in 54 students with acute respiratory disease. The organism was isolated from 7 of the 12 and identified by the polymerase chain reaction (PCR) in 2 that were isolation-negative. The organism was not found in any of the 42 serologically negative patients or in 51 control student patients without respiratory illness cultured in 1991. There was no evidence of infection with Mycoplasma pneumoniae or respiratory viruses in the 12 patients with C. pneumoniae infection. During the 4-month outbreak, there was an increase in total pneumonia cases. These findings provide evidence for an etiologic association of C. pneumoniae with pneumonia and bronchitis.

Chlamydia pneumoniae strain TWAR, the new third species of Chlamydia, is a common cause of pneumonia and other acute respiratory tract infections. About 10% of hospitalized and outpatient pneumonia cases have been associated with TWAR infection. TWAR is among the four or five most commonly identified causes of all pneumonia. Most TWAR infections are mild or asymptomatic, but occasionally severe pneumonia with death has been observed. Laboratory diagnosis is not generally available. Vigorous treatment with tetracycline or erythromycin is recommended. Both epidemic and endemic infections have been described in North America and the Nordic Countries. Population prevalence antibody studies suggest that TWAR infection is wide-spread throughout the world, that nearly everyone is infected and reinfected during their life-time, and that infection is common in all ages except those less than 5 years in temperate zone countries. The infection is transmitted from person to person, apparently with a long incubation period.

Colleagues-Chronic fatigue syndrome (CFS) is characterized by a prolonged (>6 months) debilitating fatigue in association with various respiratory, gastrointestinal, neurologic, and psychologic symptoms, typically following the development of an acute infectious-like illness [1]. Several investigators have postulated that the pathogenesis of the illness may involve a persistent and "inappropriate" immunologic response to any of several different infectious agents capable of producing persistent infection [2, 3]. Chlamvdia pneumoniae is a recently discovered respiratory tract pathogen that commonly produces community-acquired pneumonia [4, 5]. Chlamydial organisms typically produce persistent intracellular infections.

The effects of repeated infections with Chlamydia trachomatis, serovars F, D, and J, were examined in pig-tailed macaques. The fallopian tubes of three experimental monkeys were inoculated at the middle of the menstrual cycle on three consecutive months. Monkey 1 received homologous F; monkey 2 received heterologous F, D, and J; and monkey 3 received homologous inoculations in the right and heterologous inoculations in the left fallopian tubes. One control monkey (4) received repeated inoculations of HeLa cell materials only and remained normal throughout the experiment. Infection was confirmed by isolating the microorganism from both the endosalpinx and endocervix. Antibody to the infecting strains was demonstrated in sera, tears, and cervical secretions by using microimmunofluorescence. Mild chronic salpingitis developed in monkeys 1 and 3, and chronic follicular salpingitis developed in monkey 2. Peritubal and periadnexal scarring and endosalpingeal adhesion formation were produced after reinfection. The right fallopian tube of monkey 3 was distally obstructed (confirmed by hysterosalpingography). Systemic complications, including perihepatitis and conjunctivitis, were also documented in these monkeys. We conclude that repeated infections produced extensive tubal scarring, chronic salpingitis, and distal tubal obstruction, findings not apparent in primary infection.

Eight genital isolates of Chlamydia trachomatis that each contained two different serovars were identified by typing with serovar-specific monoclonal antibodies. Mixed infections were confirmed by using serovar-specific monoclonal antibodies in an indirect immunofluorescence assay. For some isolates, fluorescein/rhodamine double-label indirect immunofluorescence with mixtures of IgM and IgG monoclonal antibodies to Chlamydia provided direct visual confirmation of mixed infection. Two isolates contained serovars D and F, and two E and F; one isolate contained serovars Ba and E, one D and J, one I' and F, and one E and J. In a sample of 352 genital isolates of C. trachomatis consecutively typed by dot ELISA with monoclonal antibodies, seven (2%) demonstrated mixed serovars.

The trachoma and LGV organisms, the human pathogens of the species C. trachomatis, cause oculogenital infections and disease syndromes of the eye and genital tract. The incidence of the most prominent disease, endemic trachoma with eye-to-eye transmission, is decreasing all over the world. At the same time there is increasing recognition of high-frequency venereal infections with trachoma organisms and of the genital disease and occasional ocular disease that they cause. Laboratory techniques for diagnosis and investigation are improving, but work with these interesting intermediate agents remains more difficult than that with many other microorganisms. Proper recognition of the diseases is important because specific therapy is available.

A method of cell culture using HeLa 229 cells treated with DEAE-dextran was found to be successful in the primary isolation of trachoma-inclusion conjunctivitis (TRIC) organisms. The success of this method appeared to depend on the enhancement of infectivity by pretreatment of the cell monolayers with DEAEdextran and on centrifugation of the inoculum onto the cells. The method was shown to be as sensitive as that using the embryonated chick egg for isolation of trachoma organisms from experimental eye infections in monkeys, and was found to isolate a high rate of genital TRIC organisms from human cervical specimens, similar to the rate obtained in irradiated McCoy cells treated with DEAE-dextran.