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Semin Respir Crit Care Med 2000; 21(4): 285-294
DOI: 10.1055/s-2000-9857
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Chlamydia Pneumoniae Pneumonia

Thomas M. File, Jr., James S. Tan
  • Northeastern Ohio Universities College of Medicine, Rootstown, Ohio; and Summa Health System, Akron, Ohio
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Publication History

Publication Date:
31 December 2000 (online)

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ABSTRACT

Chlamydia pneumoniae is a common cause of community-acquired pneumonia. At present there is no ``gold'' standard for diagnosis and there is no easily accessible means of rapid diagnosis available. The best indication of acute C. pneumoniae infection is a fourfold rise in antibody titer, accompanying a positive polymerase chain reaction or culture. C. pneumoniae is usually associated with nonsevere clinical manifestations but the features will vary depending upon the occurrence as primary or reinfection syndrome, the presence of co-pathogens, or the existence of co-morbid conditions. C. pneumoniae has been described as a cause of severe disease requiring intensive care unit admission. Recommendations for therapy of C. pneumoniae pneumonia include macrolides, tetracyclines, or the new fluoroquinolones.

KEYWORD

Chlamydia pneumoniae, macrolides - tetracyclines - fluoroquinolines - pneumonia

REFERENCES

  • 1 Grayston J T, Kuo C C, Wang S P, Altman J. A new Chlamydia psittaci strain, TWAR, isolated in acute respiratory tract infection.  N Engl J Med . 1986;  315 161-168
    PubMedGoogle Scholar
  • 2 Kuo C C, Jackson L A, Campbell L A, Grayston J T. Chlamydia pneumoniae (TWAR).  Clin Microb Rev . 1995;  8 451-461
    PubMedGoogle Scholar
  • 3 Leinonen M. Pathogenetic mechanisms and epidemiology of Chlamydia pneumoniae Eur Heart J .  1993;  14(suppl K) 57-61
    PubMedGoogle Scholar
  • 4 Holland S M, Taylor H, Gaydos C A, Kappus E W, Quinn T C. Experimental infection with Chlamydia pneumoniae in nonhuman primates.  Infect Immun . 1990;  58 593-597
    PubMedGoogle Scholar
  • 5 Yang Z P, Kuo C C, Grayston J T. A mouse model of Chlamydia pneumoniae strain TWAR pneumonitis.  Infect Immun . 1993;  61 2037-2040
    PubMedGoogle Scholar
  • 6 Moazed T C, Kuo C C, Patton D L, Grayston J T, Campbell L A. Animal model. Experimental rabbit models of Chlamydia pneumoniae infection.  Am J Pathol . 1996;  148 667-676
    PubMedGoogle Scholar
  • 7 Laitinen K, Alakärppä H, Laurila A, Leinnon M. Animal models for Chlamydia pneumoniae infection.  Scand J Infect Dis . 1997;  104(suppl) 15-17
    PubMedGoogle Scholar
  • 8  Y ang, Kuo C C, Grayston J T. Systemic dissemination of Chlamydia pneumoniae following intranasal inoculation in mice.  J Infect Dis . 1995;  171 736-738
    PubMedGoogle Scholar
  • 9 Malinverni R, Kuo C C, Campbell L A, Grayston J T. Reactivation of Chlamydia pneumoniae lung infection in mice by cortisone.  J Infect Dis . 1995;  172 593-594
    PubMedGoogle Scholar
  • 10 Thom D H, Grayston J T, Campbell L A, Kuo C C, Diwan V K, Wang S P. Respiratory infection with Chlamydia pneumoniae in middle-aged and older adult outpatients.  Eur J Clin Microbiol Infect Dis . 1994;  13 785-792
    PubMedGoogle Scholar
  • 11 Kauppinen M, Saikku P. Pneumonia due to Chlamydia pneumoniae: Prevalence, clinical features, diagnosis, and treatment.  CID . 1995;  21 S244-S252
    PubMedGoogle Scholar
  • 12 Yang Z P, Cummings P K, Patton D L, Kuo C C. Ultrastructural lung pathology of experimental Chlamydia pneumoniae pneumonitis in mice.  J Infect Dis . 1994;  170 464-467
    PubMedGoogle Scholar
  • 13 Braun J, Latko S, Treharne J. Chlamydia pneumoniae-a new causatime agent of reactive arthritis and undifferentiated arthritis.  Ann Rheum Dis . 1994;  53 100-105
    PubMedGoogle Scholar
  • 14 Ljungström L, Franzén C, Schlaug M, Elowson S, Viidas U. Reinfection with Chlamydia pneumoniae may induce isolated and systemic vasculitis in small and large vessels.  Scand J Infect Dis . 1997;  104(suppl) 37-40
    PubMedGoogle Scholar
  • 15 Hahn D L. Evidence for Chlamydia pneumoniae in asthma. In: Allegra L, Blasi F, eds. Chlamydia pneumoniae infection Milan: Springer-Verlag Italia 1995: 65-75
    Google Scholar
  • 16 Kauppinen M T, Herva E, Kujala P, Leinonen M, Saikku P, Syrjälä H. The etiology of community-acquired pneumonia among hospitalized patients during a Chlamydia pneumoniae epidemic in Finland.  J Infect Dis . 1995;  172 1330-1335
    PubMedGoogle Scholar
  • 17 Cosentini R, Blasi F, Raccanelli R. Severe community-acquired pneumonia: A possible role for Chlamydia pneumoniae Respiration .  1996;  63 61-65
    CrossrefPubMedGoogle Scholar
  • 18 Troy C J, Peeling R W, Ellis A G. Chlamydia pneumoniae as a new source of infectious outbreaks in nursing homes.  JAMA . 1997;  277 1214-1218
    CrossrefPubMedGoogle Scholar
  • 19 Marston B J, Plouffe J F, Breiman R F. Preliminary findings of a community-based pneumonia incidence study. In: Barbaree JM, Breiman RF, Dufour AP, eds. Legionella Washington, DC: American Society for Microbiology 1993: 36-37
    Google Scholar
  • 20 Almirall J, Morató I, Riera F. Incidence of community-acquired pneumonia and Chlamydia pneumoniae infection: A prospective multi-centre study.  Eur Respir J . 1993;  6 14-18
    PubMedGoogle Scholar
  • 21 Bourke S J, Lightfoot N F. Chlamydia pneumoniae: Defining the clinical spectrum of infection requires precise laboratory diagnosis.  Thorax . 1995;  50(suppl 1) S43-S48
    PubMedGoogle Scholar
  • 22 File T M, Bartlett J G, Cassell G H. The importance of Chlamydia pneumoniae as a pathogen: The 1996 consensus conference on Chlamydia pneumoniae infections.  Infect Dis Clin Pract. 1997b;  6(suppl 2) S28-S31
    PubMedGoogle Scholar
  • 23 Kern D G, Neill M A, Schachter J. A seroepidemiologic study of Chlamydia pneumoniae in Rhode Island. Evidence of serologic cross-reactivity.  Chest . 1993;  104 208-213
    PubMedGoogle Scholar
  • 24 Grayston J T, Aldous M B, Easton A. Evidence that Chlamydia pneumoniae causes pneumonia and bronchitis.  J Infect Dis . 1993;  168 1231-1235
    PubMedGoogle Scholar
  • 25 Eckman M R, Leinonen M, Syrjälä H, Linnanmäki E, Kujala P, Saikku P. Evaluation of serological methods in the diagnosis of Chlamydia pneumoniae during an epidemic in Finland.  Eur J Clin Microbiol. 1993b;  12 756-760
    PubMedGoogle Scholar
  • 26 Hammerschlag M R. Diagnostic methods for intracellular pathogens.  Clin Microbiol Infect . 1996;  1(suppl 1) S3-S8
    PubMedGoogle Scholar
  • 27 Verkooyen R P, Hazenberg M A, van Haaswn H G. Age related interferences with Chlamydai pneumoniae microimmunofluorescence serology due to circulating rheumatoid factor.  J Clin Microbiol . 1992;  30 1289-1290
    PubMedGoogle Scholar
  • 28 Hyman C L, Roblin P M, Gaydos C A. Prevalence of asymptomatic nasopharyngeal carriage of Chlamydia pneumoniae in subjectively healthy adults.  Clin Infect Dis . 1995;  20 1174-1178
    PubMedGoogle Scholar
  • 29 Hammerschlag M R. Community-acquired pneumonia due to atypical organisms in adults: Diagnosis and treatment.  Infect Dis Clin Pract . 1999;  8 232-240
    PubMedGoogle Scholar
  • 30 Gaydos C A, Roblin P M, Hammerschlag M R, Hyman C L, Eiden J J, Schachter J, Quinn TC: Diagnostic utility of PCR-enzyme immunoassay, culture, and serology for detection of Chlamydia pneumoniae in symptomatic and asymptomatic patients. J Clin Microbiol .  1994;  32 903-905
    PubMedGoogle Scholar
  • 31 Ramirez J, Ahkee C, Tolentino A, Summersgill J. Diagnosis of Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila lower respiratory infections using polymerase chain reaction on a single throat swab specimen. 34th Interscience Conference on Antimicrobial Agents and Chemotherapy, Orlando, 1994, Abstract #D93
    Google Scholar
  • 32 Gaydos C A, Summersgill J T, Sahney N N, Ramirez J A, Quinn T C. Replication of Chlamydia pneumoniae in vitro human macrophages, endothelial cells, and aortic artery smooth muscle cells.  Infect Immun . 1996;  64 1614-1620
    PubMedGoogle Scholar
  • 33 Fang G D, Fine M, Orloff J. New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases.  Medicine . 1990;  69 307-315
    PubMedGoogle Scholar
  • 34 Marrie T J, Grayston J T, Wang S P, Kuo C C. Pneumonia associated with the TWAR strain of Chlamydia Ann Intern Med .  1987;  106 507-511
    PubMedGoogle Scholar
  • 35 Chirgwin K, Roblin P M, Gelling M, Hammerschlag M R, Schachter J. Infection with Chlamydia pneumoniae in Brooklyn.  J Infect Dis . 1991;  163 757-761
    PubMedGoogle Scholar
  • 36 Hyman C L, Augenbraun M H, Roblin P M, Schachter J, Hammerschlag M R. Asymptomatic respiratory tract infection with Chlamydia pneumoniae TWAR.  J Clin Microbiol . 1991;  29 2082-2083
    PubMedGoogle Scholar
  • 37 File Jr M T, Plouffe Jr F J, Breiman R F, Skelton S K. Clinical characteristics of Chlamydia pneumoniae infection as the sole cause of community-acquired pneumonia.  Clin Infect Dis . 1999;  29 426-428
    PubMedGoogle Scholar
  • 38 Kauppinen M T, Saikku P, Kujala P, Herva E, Syrjälä H. Clinical picture of community-acquired Chlamydia pneumoniae pneumonia requiring hospital treatment: A comparison between chlamydial and pneumococcal pneumonia.  Thorax . 1996;  51 185-189
    CrossrefPubMedGoogle Scholar
  • 39 Grayston J T, Diwan V K, Cooney M, Wang S P. Community- and hospital-acquired pneumonia associated with Chlamydia TWAR infection demonstrated serologically.  Arch Intern Med . 1989;  149 169-173
    CrossrefPubMedGoogle Scholar
  • 40 McConnell Jr T C, Plouffe J F, File T M, Mueller C F. Radiographic appearance of Chlamydia pneumoniae (TWAR strain) respiratory infections.  Radiology . 1994;  192 819-824
    PubMedGoogle Scholar
  • 41 Eckman M R, Grayston J T, Visakorpi R. An epidemic of infections due to Chlamydia pneumoniae in military conscripts.  Clin Infect Dis . 1993;  17 420-425
    PubMedGoogle Scholar
  • 42 Beaty C D, Grayston J T, Wang S P, Kuo C C, Reto C S, Martin T R. Chlamydia pneumoniae, strain TWAR, infection in patients with chronic obstructive pulmonary disease.  Am Rev Respir Dis . 1991;  144 1408-1410
    CrossrefPubMedGoogle Scholar
  • 43 Emre U, Roblin P M, Gelling M, Dumornay W, Rao M, Hammerschlag M R, Schachter J. The association of Chlamydia pneumoniae infection and reactive airway disease in children.  Arch Pediatr Adolesc Med . 1994;  148 727-732
    PubMedGoogle Scholar
  • 44 Weiss S, Quist J, Roblin P, Sokolovskaya N, Hammerschlag M, Schachter J. The relationship between Chlamydia pneumoniae (Cp) and bronchospasm in adults. 35th Interscience Conference on Antimicrobial Agents and Chemotherapy, San Francisco, 1995, Abstract #K39
    Google Scholar
  • 45 Grayston J T, Campbell L A. The role of Chlamydia pneumoniae in atherosclerosis.  Clin Infect Dis . 1999;  28 993-994
    PubMedGoogle Scholar
  • 46 Gregory W W, Rosenstein R B, Flouty C E. Azithromycin in the treatment of community-acquired pneumonia (CAP) due to Mycoplasma pneumoniae or Chlamydia pneumoniae [abstract]. Presented at the American Thoracic Society Annual Meeting, San Francisco, May 1997
    Google Scholar
  • 47 Gupta S, Leatham E W, Carrington D. Elevated Chlamydia pneumoniae antibodies cardiovascular events, and azithromycin in male survivors of myocardial infarction.  Circulation . 1997;  96 404-407
    PubMedGoogle Scholar
  • 48 Danesh J, Collins R, Peto R. Chronic infections and coronary heart disease: Is there a link?.  Lancet . 1997;  350 430-436
    CrossrefPubMedGoogle Scholar
  • 49 Hammerschlag M R. Antimicrobial susceptibility and therapy of infections caused by Chlamydia pneumoniae Antimicrob Agents Chemother .  1994;  38 1873-1878
    PubMedGoogle Scholar
  • 50 Blasi F, Consentini R, Legnani D, Denti F, Allegra L. Incidence of community-acquired pneumonia caused by Chlamydia pneumoniae in Italian patients.  Eur J Clin Microbiol Infect Dis . 1993;  12 696-699
    PubMedGoogle Scholar
  • 51 Block S, Hedrick J, Hammerschlag M R, Cassell G H, Craft J C. Comparative safety and efficacy of clarithromycin and erythromycin ethylsuccinate suspensions in the treatment of children with community acquired pneumonia.  Pediatr Infect Dis J . 1995;  14 471-477
    CrossrefPubMedGoogle Scholar
  • 52 Hammerschlag M R, Roblin P M, Cassell G. Microbiologic efficacy of azithromycin for the treatment of community-acquired lower respiratory tract infection due to Chlamydia pneumoniae Program Abstr 2nd Int Conf Macrolides, Azalides and Streptogramins. Abstr 1994 #283: 63
    Google Scholar
  • 53 Hammerschlag M R, Roblin P M, Campbell M, Klolokathis A, Powell M. Microbiologic efficacy of azithromycin for the treatment of community-acquired pneumonia due to Chlamydia pneumoniae in children. 3rd Int Conf Macrolides, Azalides and Streptogramins, Lisbon, Italy, 1996
    Google Scholar
  • 54 Hammerschlag M R, Chirgwin K, Roblin P M. Persistent infection with Chlamydia pneumoniae following acute respiratory illness.  Clin Infect Dis . 1992;  14 178-182
    PubMedGoogle Scholar
  • 55 Donowitz G, for the SPAR Multicenter CAP Study Group. Treatment of community-acquired pneumonia with Sparfloxacin and Cefaclor. Abstract of the 36th Interscience Conference on Antimicrob Agents Chemother, New Orleans, 1996
    Google Scholar
  • 56 File T M, Segreti J, Dunbar L. A multicenter randomized study comparing the efficacy and safety of intravenous and/or oral levofloxacin verses ceftriaxone and/or cefuroxime axetil in the treatment of adults with community-acquired pneumonia.  Antimicrob Agents Chemother . 1997;  41 1965-1972
    PubMedGoogle Scholar
  • 57 Mundy L M, Auwaerter P G, Oldach D. Community-acquired pneumonia: Impact of immune status.  Am J Respir Crit Care Med . 1995;  152 1309-1315
    CrossrefPubMedGoogle Scholar
  • 58 Ishida T, Hashimoto T, Arita M, Ito I, Osawa M. Etiology of community-acquired pneumonia in hospitalized patients: A 3-year prospective study in Japan [see comments].  Chest . 1998;  114 1588-1593
    CrossrefPubMedGoogle Scholar
  • 59 Ruiz-González A, Falguera M, Nogues A, Rubio-Caballero M. Is Streptococcus pneumoniae the leading cause of pneumonia of unknown etiology?.  <~>A microbiologic study of lung aspirates in consecutive patients with community-acquired pneumonia. Am J Med . 1999;  106 385-390
    PubMedGoogle Scholar
  • 60 Cassell G H, Drnec J, Waites K B, Pate M S, Duffy L B, Watson H L, McIntosh J C. Efficacy of clarithromycin against Mycoplasma pneumoniae J Antimicrob Chemother .  1991;  27(suppl A) 47-59
    PubMedGoogle Scholar
  • 61 File Jr M T, Tan J S, Plouffe J F. The role of atypical pathogens: Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumophila in respiratory infection.  Infect Dis Clin North Am . 1998;  12 569
    PubMedGoogle Scholar
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