***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Ocular adnexal MALT lymphoma ( OAML ) is linked to Chlamydophila psittaci ( Cp ) infection . Viability and infectivity of Cp , demonstrated by growth in culture , has not been yet investigated in these patients . We conducted a single-center prospect i ve case-control study to assess the prevalence , viability and infectivity of Cp in 20 OAML patients and 42 blood donors registered in a 6-month period . The presence of Cp in conjunctival swabs and peripheral blood mononuclear cells ( P BMC ) of patients and donors was assessed by TETR-PCR and in vitro cultures . From an epidemiological point of view , OAML patients often resided in rural areas , and reported a history of chronic conjunctivitis and prolonged contact with household animals ( 85 % vs. 38 % of donors ; p = 0.00001 ) . Cp was detected in lymphoma tissue in 15 ( 75 % ) patients .  Cp DNA was detected in conjunctival swabs and /or P BMC from 10 ( 50 % ) patients and in P BMC from 1 ( 2 % ) donor ( p = 0.01 ) . Viability and infectivity of Cp , demonstrated by growth in culture , were confirmed in conjunctival swabs and /or P BMC from 5 ( 25 % ) patients , but not in donors ( p = 0.002 ) . This prospect i ve study demonstrates , for the first time , that Cp present in the conjunctiva and P BMC of OAML patients is capable to grow and be isolated in cell cultures .  Cp infection is common in OAML patients and exceptional in blood donors . Epidemiological data of OAML patients ( prolonged contact with household animals and chronic conjunctivitis ) are consistent with Cp exposure risk Infectious agents have been identified as a major cause of specific types of human cancers worldwide . Several microorganisms have been identified as potential aggravators of ocular adnexal neoplasms ; however , given the rarity of these neoplasms , large epidemiological studies are difficult to coordinate . This study aim ed to conduct an exhaustive search for pathogenic DNA in lymphoproliferative disorders ( LPD ) of the ocular adnexa in a total of 70 patients who were diagnosed with LPD of the ocular adnexa between 2008 and 2013 . Specimens were screened for bacterial , viral , fungal , and parasitic DNA by multiplex polymerase chain reaction ( PCR ) and quantitative real-time PCR . Among cases of conjunctival mucosa-associated lymphoid tissue lymphoma , human herpes virus (HHV)-6 , HHV-7 , chlamydia , Epstein-Barr virus ( EBV ) and bacterial 16S ribosomal DNA were detected . In cases of IgG4-related ocular disease , similar pathogens were detected but in a larger number of patients . Our PCR assays detected DNAs of various infectious agents in tumor specimens , especially HHV6 , HHV7 , and EBV , with different positive rates in various types of LPD . Chronic inflammatory stimulation or activation of oncogenes from these infectious agents might be involved in the pathogenesis of LPD of the ocular adnexa Purpose : Chlamydia psittaci ( Cp ) has been associated to ocular adnexal lymphomas ( OAL ) with variable geographic distribution . Herein , we used multiple Chlamydia detection tools to identify Cp elementary bodies – containing cell and to assess Cp prevalence in both nodal and extranodal lymphomas . Experimental Design : TETR-PCR , immunohistochemistry , immunofluorescence , electron microscopy , and laser-capture microdissection were done in 35 OALs to define their effect in Chlamydia detection and , moreover , to identify the Cp cellular carrier . Cp prevalence was screened by TETR-PCR in 205 extraorbital lymphomas and 135 nonneoplastic controls . Results : Twenty-six ( 74 % ) OALs were associated with Cp infection : immunohistochemistry , immunofluorescence , and laser-capture microdissection-assisted PCR showed that monocytes/macrophages were the Cp carriers ; electron microscopy showed the presence of intact Cp elementary bodies into these cells . Immunohistochemistry and TETR-PCR showed a 70 % concordance rate ( P = 0.001 ) . Cp DNA was equally prevalent in non-OAL , nodal , and extranodal lymphomas : among the latter , it was more common in diffuse large B-cell lymphomas of the skin ( P = 0.03 ) and Waldeyer 's ring . Conclusions : This multiparametric approach shows , for the first time , that monocytes/macrophages are the carriers of Cp , Cp seems preferentially associated with lymphomas arising in organs primarily exposed to antigens . The clinical implication s of these findings deserve to be prospect ively investigated CHLAMYDIA AND OCULAR ADNEXAL LYMPHOMAS AN INDIAN EXPERIENCE : Ocular adnexal lymphomas ( OALs ) are a heterogeneous group of malignancies , majority being extranodal mucosa-associated lymphoid tissue ( MALT ) type . Different geographical regions have reported association of Chlamydia with OALs ( MALT type ) . In India , role of Chlamydia in OALs remains unexplored . The aim of this study was to detect Chlamydia and to correlate with clinicopathological features of OALs in India . The clinicopathological features of 41 OAL cases were studied prospect ively . Chlamydia DNA was detected by genus specific PCR amplifying major outer membrane protein ( MOMP ) gene followed by DNA sequencing .  Chlamydia immunoexpression was evaluated by immunofluorescence and immunohistochemistry . The results were correlated with clinicopathological features including follow-up and survival . Chlamydia genome was detected in 3/41 ( 7.3 % ) OAL cases by PCR . Direct sequencing revealed C. trachomatis in 3 positive cases . Immunofluorescence and immunohistochemistry showed Chlamydia antigen in 5/41 and 1/41 cases respectively . Immunofluorescence demonstrated higher sensitivity than immunohistochemistry . A significant association was observed between Chlamydia positivity and orbital location ( P=0.05 ) . Follow-up revealed relapse in 2 Chlamydia positive cases ( P=0.056 ) . Our results demonstrate for the first time presence of C. trachomatis genome in 7.3 % OAL cases in India . As no other reports are documented , more detailed studies from different regions within India are needed to explore status of Chlamydia in OALs BACKGROUND An association between ocular adnexal MALT lymphoma ( OAL ) and Chlamydia psittaci ( Cp ) infection has been proposed , and recent reports suggest that doxycycline treatment causes tumor regression in patients with Cp-related OAL . The effectiveness of doxycycline treatment in Cp-negative OAL has not been tested . METHODS In a prospect i ve trial , 27 OAL patients ( 15 newly diagnosed and 12 having experienced relapse ) were given a 3-week course of doxycycline therapy . Objective lymphoma response was assessed by computerized tomography scans or magnetic resonance imaging at 1 , 3 , and 6 months after the conclusion of therapy and every 6 months during follow-up . Cp infection in patients was determined by touchdown enzyme time-release polymerase chain reaction ( TETR-PCR ) . Statistical tests were two-sided . RESULTS Eleven patients were Cp DNA-positive and 16 were Cp DNA negative . Doxycycline was well tolerated . At a median follow-up of 14 months , lymphoma regression was complete in six patients , and a partial response ( > or = 50 % reduction of all measurable lesions ) was observed in seven patients ( overall response rate [ complete and partial responses ] = 48 % ) . Lymphoma regression was observed in both Cp DNA-positive patients ( seven of 11 experienced regression ) and Cp DNA-negative patients ( six of 16 experienced regression ) ( 64 % versus 38 % ; P = .25 , Fisher 's exact test ) . The three patients with regional lymphadenopathies and three of the five patients with bilateral disease achieved objective response . In relapsed patients , response was observed both in previously irradiated and nonirradiated patients . The 2-year failure-free survival rate among the doxycycline-treated patients was 66 % ( 95 % confidence interval = 54 to 78 ) , and 20 of the 27 patients were progression free . CONCLUSIONS Doxycycline is a fast , safe , and active therapy for Cp DNA-positive OAL that was effective even in patients with multiple failures involving previously irradiated areas or regional lymphadenopathies . The responses observed in PCR-negative OAL may suggest a need for development of more sensitive methods for Cp detection and investigation of the potential role of other doxycycline-sensitive bacteria PURPOSE To measure the genomic DNA of ocular infectious pathogens in ocular fluids and to analyze the clinical relevance of these pathogens in uveitis and endophthalmitis . DESIGN Prospect i ve clinical case series . PARTICIPANTS A total of 500 patients with infectious uveitis and endophthalmitis were examined at Tokyo Medical and Dental University , Tokyo Medical University , Kyushu University , Osaka University , and Kyoto Prefectural University , all in Japan . METHODS Genomic DNA of bacteria , fungi , parasites , and viruses in collected intraocular sample s were examined by comprehensive polymerase chain reaction ( PCR ) . Sample s were analyzed first by multiplex PCR and quantitative real-time PCR for human herpes viruses ( HHVs ) 1 through 8 and toxoplasma . Subsequently , sample s were examined by broad-range real-time PCR for bacterial 16S and fungal 18S/28S ribosomal DNA ( rDNA ) . MAIN OUTCOME MEASURES Infectious uveitis and endophthalmitis diagnoses were obtained when using the PCR system . Calculations of the positivity and the diagnostic parameters such as sensitivity , specificity , positive predictive value ( PPV ) , and negative predictive value ( NPV ) also were evaluated . RESULTS In all of the tested infectious uveitis and endophthalmitis patients , either herpes simplex virus type 1 ( n = 18 ) , herpes simplex virus type 2 ( n = 4 ) , varicella-zoster virus ( n = 55 ) , Epstein-Barr virus ( n = 17 ) , cytomegalovirus ( n = 68 ) , HHV type 6 ( n = 2 ) , toxoplasma ( n = 6 ) , bacterial 16S ( n = 33 ) , or fungal 18S/28S ( n = 11 ) genome was detected . Neither HHV type 7 nor HHV type 8 DNA was detected in any of the sample s. Of the 21 false-negative results found during the PCR analyses , 12 cases were negative for patients clinical ly suspected of having bacterial endophthalmitis . Conversely , false-positive results for the comprehensive PCR examinations occurred in only 3 cases that subsequently were found to have bacterial 16S rDNA . Diagnostic parameters for the sensitivity , specificity , PPV , and NPV of our PCR examinations were 91.3 % , 98.8 % , 98.6 % , and 92.4 % , respectively . CONCLUSIONS Use of our comprehensive PCR assay to examine ocular sample s in patients with endophthalmitis and uveitis seems to be clinical ly useful for detecting infectious antigen DNA . Thus , this PCR method is a reliable tool for both diagnosing ocular disorders and further screening of patients for intraocular infections . FINANCIAL DISCLOSURE(S ) The author(s ) have no proprietary or commercial interest in any material s discussed in this article PURPOSE The pathogenic association between Chlamydophila psittaci ( Cp ) and ocular adnexal marginal zone lymphoma ( OAMZL ) and the efficacy of doxycycline monotherapy have been investigated in retrospective series with variations in stage , management , and follow-up duration . To our knowledge , this is the first international phase II trial aim ed at clarifying Cp prevalence and activity of first-line doxycycline in a homogeneous series of consecutive patients with newly diagnosed stage I OAMZL . PATIENTS AND METHODS Forty-seven patients were registered . Tumor tissue , conjunctival swabs , and peripheral blood from 44 patients were assessed for seven Chlamydiaceae infections by three polymerase chain reaction protocol s. Thirty-four patients with measurable or parametrable disease were treated with doxycycline and assessed for chlamydial eradication and lymphoma response ( primary end point ) . RESULTS Cp DNA was detected in biopsies of 39 patients ( 89 % ) ; no other Chlamydiaceae were detected . Twenty-nine patients had Cp DNA in baseline swabs and /or blood sample s and were evaluable for chlamydial eradication , which was achieved in 14 patients ( 48 % ) . Lymphoma regression was complete in six patients and partial in 16 ( overall response rate , 65 % ; 95 % CI , 49 % to 81 % ) ; 11 had stable disease , and one had progressive disease . At a 
    Output:
    
The involvement of C psittaci in OAL is highly variable , with the highest prevalence in Italy and Korea .
Chlamydia is associated with MALT histotype