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      Effects of Atypical Infections with Mycoplasma and Chlamydia on Asthma

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          Abstract

          Mycoplasma pneumoniae and Chlamydophila pneumoniae are atypical bacteria that are frequently found in patients with asthma. A definitive diagnosis of infection is often difficult to obtain because of limitations with sampling and detection. Numerous animal studies have outlined mechanisms by which these infections may promote allergic lung inflammation and airway remodeling. In addition, there is mounting evidence from human studies suggesting that atypical bacterial infections contribute to asthma exacerbations, chronic asthma, and disease severity. The role of antimicrobials directed against atypical bacteria in asthma is still under investigation.

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          Clarithromycin targets neutrophilic airway inflammation in refractory asthma.

          Heather Powell, Philippa Simpson, R. Scott … (2008)
          Patients with refractory asthma have persistent symptoms despite maximal treatment with inhaled corticosteroids and long-acting bronchodilators. The availability of add-on therapies is limited, and effective add-on therapies that target noneosinophilic airway inflammation are needed. Macrolide antibiotics, such as clarithromycin, have in vitro efficacy against IL-8 and neutrophils, key inflammatory mediators in noneosinophilic asthma. To determine the efficacy of clarithromycin in patients with severe refractory asthma and specifically in a subgroup of patients with noneosinophilic asthma. Subjects with severe refractory asthma (n = 45) were randomized to receive clarithromycin (500 mg twice daily) or placebo for 8 weeks. The primary outcome for this study was sputum IL-8 concentration. Other inflammatory outcomes assessed included sputum neutrophil numbers and concentrations of neutrophil elastase and matrix metalloproteinase (MMP)-9. Clinical outcomes were also assessed, including lung function, airway hyperresponsiveness to hypertonic saline, asthma control, quality of life, and symptoms. Clarithromycin therapy significantly reduced airway concentrations of IL-8 and neutrophil numbers and improved quality-of-life scores compared with placebo. Reductions in neutrophil elastase and MMP-9 concentrations were also observed. These reductions in inflammation were most marked in those with refractory noneosinophilic asthma. Clarithromycin therapy can modulate IL-8 levels and neutrophil accumulation and activation in the airways of patients with refractory asthma. Macrolide therapy may be an important additional therapy that could be used to reduce noneosinophilic airway inflammation, particularly neutrophilic inflammation, in asthma. Clinical trial registered with the Australian Clinical Trials Registry www.actr.org.au (No. 12605000318684).
          Article 0 comments Cited 122 times – based on 0 reviews     Review now
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            A link between chronic asthma and chronic infection.

            H. Chu, Paul G Cassell, Kathryn Martin … (2001)
            Asthma is a prevalent disease with marked effects on quality of life and economic societal burden. However, the cause of asthma and its pathophysiology are not completely defined. Recently, the possibility that chronic infection may play a role has been suggested. We sought to define the association between Mycoplasma and Chlamydia species and chronic asthma. We performed a comparison study of asthmatic patients and normal control subjects. Fifty-five patients with chronic stable asthma were compared with 11 normal control subjects by using PCR, culture, and serology for Mycoplasma species, Chlamydia species, and viruses from the nasopharynx, lung, and blood. Bronchoalveolar lavage cell count and differential, as well as tissue morphometry, were also evaluated. Computer-generated scoring for the degree of chronic sinusitis in asthmatic patients was additionally evaluated. Thirty-one of 55 asthmatic patients had positive PCR results for Mycoplasma (n = 25) or Chlamydia species (n = 6), which were mainly found on lung biopsy specimens or in lavage fluid. Only 1 of 11 normal control subjects had positive PCR results for Mycoplasma species. The distinguishing phenotype between asthmatic patients with positive and negative PCR results was the significantly greater number of tissue mast cells in the group with positive results. A significant number of patients with chronic stable asthma demonstrate the presence of Mycoplasma species, Chlamydia species, or both in their airways, with the distinguishing feature of increased mast cell number. These findings need further delineation but may help us to understand the pathophysiology of asthma and new treatment options.
            Article 0 comments Cited 70 times – based on 0 reviews     Review now
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              New insights into the pathogenesis and detection of Mycoplasma pneumoniae infections.

              James Atkinson, Ken B Waites, Mitchell F Balish (2008)
              Mycoplasma pneumoniae is a common cause of upper and lower respiratory tract infections in persons of all ages and may be responsible for up to 40% of community-acquired pneumonias. A wide array of extrapulmonary events may accompany the infections caused by this organism, related to autoimmunity or direct spread. This review includes a discussion of the latest knowledge concerning the molecular pathological basis of mycoplasmal respiratory disease, how the organism interacts with the host immune system and its association with the development of chronic conditions such as asthma, recent emergence of macrolide resistance and the status of laboratory diagnostic methods.
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                Author and article information

                Contributors
                Monica Kraft
                Journal
                Journal ID (nlm-ta): Immunol Allergy Clin North Am
                Journal ID (iso-abbrev): Immunol Allergy Clin North Am
                Title: Immunology and Allergy Clinics of North America
                Publisher: Published by Elsevier Inc.
                ISSN (Print): 0889-8561
                ISSN (Electronic): 1557-8607
                Publication date PMC-release: 22 September 2010
                Publication date (Print): November 2010
                Publication date (Electronic): 22 September 2010
                Volume: 30
                Issue: 4
                Pages: 575-585
                Affiliations
                [a ]Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, 4309 Medical Park Drive, Durham, NC 27704, USA
                [b ]Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Research Drive, MSRB M275, Durham, NC 27710, USA
                Author notes
                [∗ ]Corresponding author. monica.kraft@ 123456duke.edu
                Article
                Publisher ID: S0889-8561(10)00067-6
                DOI: 10.1016/j.iac.2010.08.003
                PMC ID: 7134684
                PubMed ID: 21029940
                SO-VID: 682208e7-d600-452b-a330-9ae90adfe3de
                Copyright © Copyright © 2010 Published by Elsevier Inc.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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                Subject: Article

                Keywords: atypical bacteria,asthma,mycoplasma pneumoniae,chlamydophila pneumoniae,exacerbation,antibiotics
                Data availability:
                Keywords: atypical bacteria, asthma, mycoplasma pneumoniae, chlamydophila pneumoniae, exacerbation, antibiotics

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