I would like to comment on the interesting report by Emre et al1 associating Chlamydia pneumoniae infection and reactive airway disease in children. They found evidence for C pneumoniae infection in 25 (21.2%) of 118 children with acute episodes of wheezing; nine had positive cultures for C pneumoniae but did not have diagnostic antibody, 13 had diagnostic antibody but had negative cultures, and three had positive cultures and positive serologic results. They also report that eradication of the organism after the treatment of wheezing in children with positive cultures was associated with symptomatic and laboratory improvement. They hypothesize that chronic C pneumoniae infection can produce chronic airway inflammation and bronchial hyperresponsiveness. Their data also support their statement that use of serologic testing alone would have underestimated the prevalence of C pneumoniae infection in children.
An unanswered question raised by their data is: Did some children with negative cultures and