title: Chlamydia pneumoniae infection in circulating human monocytes is refractory to antibiotic treatment.
abstract: BACKGROUND
  Recovery of the intracellular bacterium Chlamydia pneumoniae from atherosclerotic plaques has initiated large studies on antimicrobial therapy in coronary artery disease. The basic concept that antibiotic therapy may eliminate and prevent vascular infection was evaluated in vitro and in vivo by examining the antibiotic susceptibility of C pneumoniae in circulating human monocytes, which are thought to transport chlamydiae from the respiratory tract to the vascular wall.
  
  
  RESULTS
  Blood monocytes (CD14+) from 2 healthy volunteers were obtained before and after oral treatment with azithromycin or rifampin and then inoculated with a vascular C pneumoniae strain and continuously cultured in the presence of the respective antibiotic. Progress of infection and chlamydial viability was assessed by immunogold-labeling and detection of C pneumoniae-specific mRNA transcripts. Circulating monocytes from patients undergoing treatment with experimental azithromycin for coronary artery disease were examined for C pneumoniae infection by cell culture. Antibiotics did not inhibit chlamydial growth within monocytes. Electron microscopy showed development of chlamydial inclusion bodies. Reverse transcription-polymerase chain reaction demonstrated continuous synthesis of chlamydial mRNA for 10 days without lysis of the monocytes. The in vivo presence of viable pathogen not eliminated by azithromycin was shown by cultural recovery of C pneumoniae from the circulating monocytes of 2 patients with coronary artery disease.
  
  
  CONCLUSIONS
  C pneumoniae uses monocytes as a transport system for systemic dissemination and enters a persistent state not covered by an otherwise effective antichlamydial treatment. Prevention of vascular infection by antichlamydial treatment may be problematic: circulating monocytes carrying a pathogen with reduced antimicrobial susceptibility might initiate reinfection or promote atherosclerosis by the release of proinflammatory mediators.
authors.affiliation: Institute of Medical Microbiology and Hygiene, Medical University of Lübeck, Lübeck, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Gieffers
authors.forename: H
authors.initials: H
authors.lastname: Füllgraf
authors.forename: J
authors.initials: J
authors.lastname: Jahn
authors.forename: M
authors.initials: M
authors.lastname: Klinger
authors.forename: K
authors.initials: K
authors.lastname: Dalhoff
authors.forename: H A
authors.initials: HA
authors.lastname: Katus
authors.forename: W
authors.initials: W
authors.lastname: Solbach
authors.forename: M
authors.initials: M
authors.lastname: Maass
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D017963:Azithromycin / Q000494:pharmacology* / Q000627:therapeutic use; D002478:Cells, Cultured; D016993:Chlamydophila pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity / Q000648:ultrastructure; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D018950:Lipopolysaccharide Receptors / Q000276:immunology; D008297:Male; D008826:Microbial Sensitivity Tests; D016253:Microscopy, Immunoelectron; D008875:Middle Aged; D009000:Monocytes / Q000187:drug effects / Q000276:immunology / Q000382:microbiology*; D012333:RNA, Messenger / Q000032:analysis / Q000096:biosynthesis; D020133:Reverse Transcriptase Polymerase Chain Reaction; D012293:Rifampin / Q000494:pharmacology* / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000900:Anti-Bacterial Agents; D018950:Lipopolysaccharide Receptors; D012333:RNA, Messenger; D017963:Azithromycin; D012293:Rifampin