Association of Chlamydia species with ocular adnexal mucosa-associated lymphoid tissue lymphoma in Taiwan

Background Chronic antigenic stimulation, including autoimmune disorders and infection, may contribute to lymphoproliferation in specific tissues. Chlamydia species have been linked to ocular adnexal mucosa-associated lymphoid tissue lymphoma (OAML), with geographic variation in prevalence. This study explores the association between Chlamydia infection and OAML and correlates the presence of Chlamydia DNA with clinical features and treatment outcomes in Taiwan. Methods Pathology specimens from 71 patients diagnosed with primary OAML were analysed for the presence of Chlamydia species, including C. psittaci , C. pneumoniae and C. trachomatis DNA, using touchdown enzyme time-release PCR. Demographic and clinical data, including age, sex, lymphoma location, staging and treatment modalities, were compared between Chlamydia DNA-positive and negative groups. Treatment outcomes such as relapse rates, survival time and treatment response were also analysed. Results Among the 71 OAML specimens, 27 (38%) tested positive for C. trachomatis DNA, with two cases also positive for C. pneumoniae DNA. Chlamydia positivity was significantly associated with orbital involvement (p=0.020). No differences were found between the two groups in terms of disease staging, treatment methods, relapse rates, survival time and treatment response at last follow-up. Conclusions The study is the first regional report elucidating the association between Chlamydia and OAML in Taiwan. The findings suggest a possible link between C. trachomatis and orbital involvement in OAML. Further large-scale and prospective studies are needed to clarify the role of Chlamydia in OAML pathogenesis and to evaluate the potential benefits of antibiotic therapy in the patient population.