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Diabetic Foot Ulcers and Chlamydia pneumoniae: Innocent Bystander or Opportunistic Pathogen?

Lloyd E. King, Jr, MD, PhD; Tod Bushman, DPM; Charles W. Stratton, MD; William M. Mitchell, MD, PhD
Arch Dermatol. 2001;137(5):671-672. doi:.
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Chlamydia pneumoniae has not been searched for in cutaneous vessels and wounds although it induces vasculopathy and atherosclerosis in internal vessels. Chlamydia pneumoniae may play a role in the pathogenesis of chronic skin ulcers in diabetics,1 atherosclerosis, and other vasculopathies,2 autoimmune diseases such as multiple sclerosis3 and Reiter disease.4 We cultured and evaluated specimens of diabetic foot ulcers by immunohistochemistry to determine if Chlamydia pneumoniae was present and if specific antimicrobial therapy was helpful in patients with diabetic foot ulcers. Chlamydia pneumoniae was cultured from 4 of 9 patients, and immunostaining with anti–C pneumoniae antibodies detected intracellular inclusions in these samples from the 4 culture-positive diabetic foot ulcers. Chlamydiapneumoniae may be an opportunistic pathogen in chronic diabetic foot ulcers that leads to chronic inflammation, scarring, and poor wound healing.

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Representative culture evidence of Chlamydia pneumoniae in curettage biopsy samples from diabetic foot ulcers from patient 1. A, Immunofluorescent detection of cytoplasmic inclusions of C pneumoniae (arrowheads) in samples was achieved using primary mouse monoclonal antibody RR402, which is specific for the major outer membrane protein antigen of C pneumoniae (Washington Research Foundation, Seattle) and a fluoresceinated secondary antimouse IgG monoclonal antibody with Evans blue counterstain (original magnification ×100). B, Immunocytochemical localization of chlamydial inclusions was performed using a blend of primary monoclonal antibodies against C pneumoniae lipopolysaccharide and major outer membrane protein antigens (monoclonal blend 807; Chemicon Int, Temecula, Calif). Brown inclusion aggregates of these C pneumoniae antigens (arrowheads) were visualized using a peroxidase-labeled antimouse secondary monoclonal antibody and counterstained with hematoxylin (original magnification ×100).

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