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(Stroke. 2006;37:796.)
© 2006 American Heart Association, Inc.

Original Contributions

Chronic Chlamydia pneumoniae Infection and Stroke in Cameroon

A Case-Control Study

Alfred K. Njamnshi; Kathleen Ngu Blackett; Josephine N. Mbuagbaw; Freedom Gumedze; Sandeep Gupta Charles S. Wiysonge

From the Faculty of Medicine and Biomedical Sciences (A.K.N.), University of Yaoundé I, Cameroon; Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences (K.N.B., J.N.M.), University of Yaoundé I, Cameroon; Department of Statistical Sciences (F.G.), University of Cape Town, South Africa; Department of Cardiology (S.G.), Whipps Cross University Hospital, London, UK; and Cardiac Clinic (C.S.W.), Department of Medicine, University of Cape Town, South Africa.

Correspondence to Kathleen Ngu Blackett, BP 20140 Yaounde Yaounde, Cameroon YDE 6. E-mail kathleen{at}peaslake.abel.co.uk

Background and Purpose— To determine the relationship between chronic Chlamydia pneumoniae infection and stroke in Cameroon.

Methods— Sixty-four consecutive stroke patients 26 to 80 years of age were enrolled at 2 tertiary hospitals in Yaoundé, Cameroon, between March 2000 and December 2001 and matched for age and sex to 64 controls. We measured IgG (1/64) and IgA (1/16) titers against C pneumoniae in both patients and controls using a validated microimmunofluorescence technique.

Results— There was no significant difference between cases and controls with respect to hypertension (P=0.2), smoking (P=0.53), alcohol intake (P=0.8), body mass index (P=0.49), waist-to-hip ratio (P=0.14), and diabetes (P=0.76). IgA antibodies were detected in 50 (78.1%) patients and 27 (42.2%) controls (odds ratio [OR] 4.29; 95% CI, 1.84 to 11.56; P=0.0002), and IgG antibodies in 41 (64.1%) patients and 35 (54.7%) controls (OR, 1.46; 95% CI, 0.68 to 3.22; P=0.29). For confirmed thrombotic stroke, the association with IgA antibodies became stronger (OR, 21.0; 95% CI, 3.38 to 868.45; P<0.0001), but there was still no association with IgG antibodies (OR, 1.86; 95% CI, 0.69 to 5.50; P=0.18).

Conclusions— Our study shows a strong statistical association between (IgA, and not IgG, as a serological marker of) chronic C pneumoniae infection and stroke for the first time in a resident indigenous African population. These findings, if confirmed, may have important policy implications (in terms of antibiotic use in stroke prevention) in sub-Saharan Africa.

Key Words: atherosclerosis • infection • stroke