الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Summary
Asthma is a leading cause of chronic illness in childhood. Chlamydophila pneumoniae is a frequent causative agent of acute respiratory disease and has been recently reported as a possible cause of asthma.
The aims of the present study were to:
1) Study the serological evidence of Chlamydophila pneumoniae infection in our asthmatic children as well as control children.
2) Find an association of Chlamydophila pneumoniae infection with severity of asthma.
3) Study serum Chlamydophila pneumoniae heat shock protein 60 (Hsp60) in asthmatic patients. Its association with asthma severity, irreversible airway remodeling and airflow limitation.
A total of 150 asthmatic children, 84males (56%) and 66 (44%) females, their mean age was 7 ± 2.8 years, 45 with acute exacerbations representing 30% and 105 with chronic stable asthma representing 70%, were investigated for Chlamydophila pneumoniae IgG and Hsp60. Patients were attending the Pediatric Asthma and Allergy clinic as well as patients admitted inpatient in Pediatric Department of Benha University Hospitals in the period between July 2010 and August 2012. Some presented with asthma exacerbations and others were encountered with stable, persistent asthma symptoms. Fifty age and sex-matched healthy children were included as control group in our study.
All children were subjected to the following:
1- Full history taking.
2- Full clinical examination of the chest.
3- Pulmonary function test (Spirometry):
*PEFR (peak expiratory flow rate) and PEFR % were done as standardized for children on ”Jaeger” device, model 1995 used in asthma and allergy clinic of pediatric department of Benha university hospitals.
4- Grading of asthma severity: according to GINA guidelines (2011).
5- Chest X ray: to rule out other causes of chest diseases as pulmonary T.B and pneumonia.
6- Complete blood picture with differential white blood cells count and absolute eosinophilic count.
7- Urinalysis and stool analysis to exclude parasitic infestation.
8- Serologic analysis:
-Venous blood samples were obtained for serologic evidence of previous infection by Chlamydophila pneumoniae, as defined by serum IgG titer of ≥ 1:16 purified elementary bodies of Chlamydophila pneumoniae by ELISA.
-The children with positive IgG provided a serum specimen that was tested by means of ELISA for antibodies against the whole-molecule chalmydial Hsp60 dervied from Chlamydophila pneumoniae.
We found that:
*Body mass index was significantly lower in asthmatics than in healthy controls.
*Allergic rhinitis has the highest frequency (58%) of atopic manifestations among asthmatic children.
*A highly significant difference was observed between the asthmatic and control children regarding absolute eosinophilic count and the percentage of staff and segmented neutrophils.
*Positive Chlamydophila pneumoniae IgG was demonstrated in 73 (48.6%) asthmatic children and negative IgG in 77 (51.4%) asthmatic children. While in control children, positive IgG was demonstrated in 11 (22%) and negative IgG in 39 (78%), with highly significant difference.
*Positive Hsp60 was demonstrated in 27 (18%) asthmatic children and negative Hsp60 in 123 (82%). While in control children, positive Hsp60 in 3 (6%) and negative Hsp60 in 47 (94%), with significant difference.
*Highly significant frequency of positive cases of Chlamydophila pneumoniae IgG in rural than in urban residence.
*Significant frequency of positive cases of Chlamydophila pneumoniae IgG in medium and large sized family than in small family.
*Significant association between Chlamydophila IgG positivity and peak expiratory flow rate, and highly significant association between both asthma duration & peak expiratory flow rate % and Chlamydophila IgG positivity.
*The incidence Chlamydophila pneumoniae IgG and Hsp60 positivity in asthmatic children was significantly higher than in control healthy children. Also, they were significantly higher in asthmatic children with acute exacerbation than those in chronic stable asthma.
*There was a significantly higher percentage of C. pneumoniae IgG and Hsp60 positivity in asthmatics with longer duration of illness and diminished peak expiratory rate %.
* Incidence of severe persistent asthma among positive Chlamydophila pneumoniae IgG & Hsp60 asthmatics was significantly higher than in negative asthmatics.
In conclusion, this study provides serological evidence that chronic infection with Chlamydophila pneumoniae is more often present in patients with asthma than in healthy children. Our results support the correlation of asthma and chronic infection with Chlamydophila pneumoniae. So, provide further evidence that chronic infection with Chlamydophila pneumoniae is linked to asthma.
We recommend further multicenter studies on a larger scale of asthmatic children and controls to clarify more precisely the role of Chlamydophila pneumoniae in the initiation, persistence and / or exacerbation of asthma. And also, to explore the relationship between Hsp60 and asthma because this protein can be expected to be developed into a new treatment target for asthma.