CHLAMYDIA-PNEUMONIAE ANTIBODY-TITERS ARE SIGNIFICANTLY ASSOCIATED WITH ACUTE STROKE AND TRANSIENT CEREBRAL-ISCHEMIA - THE WEST BIRMINGHAM STROKE PROJECT

Background and Purpose-Several studies have implied an association bet ween Chlamydia pneumoniae and atherosclerosis, Our research was design ed to investigate the association of this organism with strokes and tr ansient cerebral ischemia. Methods-Antibodies to C pneumoniae were mea sured ill 176 patients with stroke or transient cerebral ischemia and 1518 control subjects with noncardiovascular, nonpulmonary disorders. Acute infection or reinfection was defined by IgG greater than or equa l to 512 or IgM greater than or equal to 8 or fourfold rise in IgG, an d previous infection was defined by IgG 64 to 256 or IgA greater than or equal to 8. Logistic regression was used to examine the influences of ethnic origin, age, sex, smoking habit, diabetes mellitus, steroid medication, and social deprivation on antibody levels. Some patients u nderwent CT and carotid ultrasound examinations and cholesterol, trigl yceride, fibrinogen, and von Willebrand factor estimations. Results-We found that 13.6% of stroke/transient ischemic attack (TIA) patients a nd 5.7% of control subjects had antibody titers suggesting acute C pne umoniae (re)infection, while 32.4% of stroke/TIA patients and 12.7% of control subjects had titers suggesting previous infection (P<.05). St roke/TIA patients differed from control subjects in their levels of ac ute and previous infection, with adjusted odds ratios of 4.2 (95% CI, 2.5 to 7.1) and 4.4 (95% CI, 3.0 to 6.5), respectively. These did not differ notably between strokes resulting from major nonhemorrhagic inf arcts, small-vessel infarcts, or hemorrhage. Cholesterol, triglyceride , fibrinogen, and von Willebrand factor concentrations showed no appar ent association with titers. Conclusions-These data support the associ ation of cerebral vascular disease with previous C pneumoniae infectio n and the association of stroke and transient cerebral ischemia with r ecrudescence of infection.