title: Chlamydia pneumoniae in elderly patients with stroke (C-PEPS): a case-control study on the seroprevalence of Chlamydia pneumoniae in elderly patients with acute cerebrovascular disease.
abstract: OBJECTIVE
  Multiple studies have suggested an association between Chlamydia pneumoniae infection and atherosclerotic vascular disease. We investigated whether serological markers of C. pneumoniae infection were associated with acute stroke or transient ischaemic attack (TIA), exclusively in elderly patients.
  
  
  METHODS
  One-hundred white patients aged over 65 years admitted with acute stroke or TIA, and 87 control patients admitted with acute non-cardiopulmonary, non-infective disorders were recruited prospectively. Using an enzyme-linked immunosorbent assay kit, the presence of C. pneumoniae immunoglobulins IgA, IgG, IgM in patients' sera was determined.
  
  
  RESULTS
  The seroprevalence of C. pneumoniae-specific IgA, IgG, IgM were 63, 71, and 14% in the stroke/TIA group (median age = 80), and 62, 65, and 17% in the control group (median age = 80), respectively. Using a logistic regression statistical model, adjusting for age and sex, history of hypertension, smoking, diabetes, ischaemic heart disease (IHD), ischaemic electrocardiogram (ECG), the odds ratios (ORs) of having a stroke/TIA in relation to C. pneumoniae-specific IgA, IgG, IgM were 1.04, 1.24, 0.79 (p = NS). Further analysis identified 43 acute stroke/TIA cases and 44 controls without history of IHD or ischaemic ECG or both. After adjusting for history of hypertension, smoking, diabetes, age and sex, the ORs in this subgroup were 1.40 for IgA [95% confidence interval (CI) 0.53-3.65; p = 0.49], 2.41 for IgG (95% CI 0.90-6.46; p = 0.08) and 1.55 for IgM (95% CI 0.45-5.40; p = 0.49).
  
  
  CONCLUSIONS
  Although a high seroprevalence of C. pneumoniae in elderly patients was confirmed, no significant association between serological markers of C. pneumoniae infection and acute cerebrovascular events was found. There was, however, a weak trend towards increased ORs for acute cerebrovascular disease in a subgroup of C. pneumoniae seropositive elderly patients without any history of IHD or ischaemic ECG.
authors.affiliation: Department of Medicine for Elderly People, Whipps Cross University Hospital, London, UK. JNgeh@aol.com
authors.forename: Joseph
authors.initials: J
authors.lastname: Ngeh
authors.forename: Sandeep
authors.initials: S
authors.lastname: Gupta
authors.forename: Colin
authors.initials: C
authors.lastname: Goodbourn
authors.forename: Barnabas
authors.initials: B
authors.lastname: Panayiotou
authors.forename: Geraldine
authors.initials: G
authors.lastname: McElligott
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D023521:Chlamydophila Infections / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D016993:Chlamydophila pneumoniae; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007070:Immunoglobulin A / Q000097:blood / Q000276:immunology; D007074:Immunoglobulin G / Q000097:blood / Q000276:immunology; D007075:Immunoglobulin M / Q000097:blood / Q000276:immunology; D002546:Ischemic Attack, Transient / Q000150:complications / Q000175:diagnosis / Q000382:microbiology; D008131:London; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications / Q000175:diagnosis / Q000382:microbiology; D012008:Recurrence; D016036:Seroepidemiologic Studies; D013223:Statistics as Topic; D020521:Stroke / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D014057:Tomography, X-Ray Computed
chemical_list: D000907:Antibodies, Bacterial; D015415:Biomarkers; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D007075:Immunoglobulin M