Is it only inflammation or infection as well?

Rosa, Eduardo Maffini da; Viecceli, Camila; Tormen, William Cenci

doi:10.1590/S0066-782X2010001300020

LETTER TO THE EDITOR

Universidade de Caxias do Sul, Caxias do Sul, RS - Brazil

Mailing address

Key words: Chlamydophila pneumoniae; mycoplasma pneumoniae; coronary disease; inflammation, infection.

To the Editor,

We would like to congratulate the authors for the publication of their article in this Journal (Arq Bras Cardiol 2009; 92 (6): 439-45)¹.

Our study group in coronariopathies believes that the acute coronary syndrome (ACS) is a systemic inflammatory condition. However, we are not convinced that the etiology of the inflammatory process is infectious^12-5-4.

We hypothesize that the alterations in the inflammatory markers of ACS occur due to the underlying inflammatory process and that the activation of the immunological system can result in a transient increase in serum antibody titers.

Moreover, regarding the diagnosis of an infectious entity, we believe in the importance of the association of the serology and the clinical picture, considering that the isolated use of the serological method can yield false-positive results, including the cases where there is laboratory error. Therefore, we believe that the probability of a high antibody titer level is higher than the actual risk of having an infection.

Finally, we would like the authors' opinions on these observations.

References

1. Maia IL, Nicolau JC, Machado MN, Maia LN, Takakura IT, Rocha PRF, et al. Prevalência da Chlamydia pneumonia e Mycoplasma pneumonia em diferentes formas de doença coronária. Arq Bras Cardiol. 2009; 92 (6): 436-45.
2. Epstein SE, Zhu J. Lack of association of infectious agents with risk of future myocardial infarction and stroke: definitive evidence disproving the infection/coronary artery disease hypothesis? Circulation. 1999; 100 (13): 1366-8.
3. Ridker PM, Kundsin RB, Stampfer MJ, Poulin S, Hennekens CH. Prospective study of Chlamydia pneumoniae IgG seropositivity and risks of future myocardial infarction. Circulation. 1999; 99 (9): 1161-4.
4. Ridker PM, Hennekens CH, Buring JE, Kundsin R, Shih J. Baseline IgG antibody titers to Chlamydia pneumoniae, Helicobacter pylori, herpes simplex virus, and cytomegalovirus and the risk for cardiovascular disease in women. Ann Intern Med. 1999; 131 (8): 573-7.
5. Mendall MA, Carrington D, Strachan D, Patel P, Molineaux N, Levi J, et al. Chlamydia pneumoniae: risk factors for seropositivity and association with coronary heart disease. J Infect. 1995; 30 (2): 121-8.