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S. Elchahal, P. Langer, D. S. Chu; Chronic Follicular Conjunctivitis Associated With Chlamydia Pneumoniae IgG and IgA Seropositivity. Invest. Ophthalmol. Vis. Sci. 2008;49(13):6052.
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Describe the association of C. pneumoniae seropositivity with chronic follicular conjunctivitis, and the diagnostic utility of anti-chlamydial serologic testing.
We performed a chart review of 5 patients who presented with a history of idiopathic chronic conjunctivitis ranging from weeks to several months duration. Prior to presentation, the patients had undergone various treatments including antibiotics, steroids, and anti-allergy agents, without resolution of signs or symptoms. A diagnosis of chronic follicular conjunctivitis was made, and serologic studies including IgG, IgA, and IgM antibodies to C. pneumoniae, C. trachomatis, and C. psittaci were obtained. DNA PCR and conjunctival biopsies were also performed. Based on the laboratory results, patients underwent antibiotic therapy and were followed for clinical improvement.
The predominant finding in 4 of the 5 cases was IgG and IgA seropositivity against C. pneumoniae, with seronegative results to C. pneumoniae IgM, C. trachomatis, and C. psittaci. In 1 patient IgA seropositivity against C. pneumoniae was present in addition to IgG against C. pneumoniae, C. trachomatis and C. psittaci. DNA PCR was negative in those cases in which it was performed. Pathology of the conjunctival biopsies were consistent with chronic conjunctivitis, and no intracytoplasmic chlamydial inclusion bodies were found in any of the cases. Treatment with azithromycin (2 patients), doxycycline (1 patient), or both (2 patients) was initiated, and patients were followed for clinical improvement. Resolution of symptoms and disease inactivity was achieved in 4 patients, while 1 patient continued to experience symptoms similar to presentation. Repeat anti-C. pneumoniae IgG, IgA, and IgM serologic studies were obtained 2-6 months after initiation of treatment in 3 of the 5 patients, with 2 patients exhibiting a decrease in IgG titer (1:512 to 1:256 and 1:256 to 1:64, respectively), and the patient with continued disease activity exhibiting an increase in IgG titer (1:256 to 1:512).
Limited documentation exists relating C. pneumoniae seropositivity in cases of chronic follicular conjunctivitis. For clinicians treating patients presenting with chronic conjunctivitis unresponsive to conventional measures, obtaining serologic studies for C. pneumoniae may identify this association and direct subsequent treatment with azithromycin or doxycycline. The utility of serologic testing as a means of following the level of disease activity and response to treatment would benefit from further research and additional data correlating these entities.
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