Skip to main content
Thorax logoLink to Thorax
. 1996 Feb;51(2):185–189. doi: 10.1136/thx.51.2.185

Clinical picture of community-acquired Chlamydia pneumoniae pneumonia requiring hospital treatment: a comparison between chlamydial and pneumococcal pneumonia.

M T Kauppinen 1, P Saikku 1, P Kujala 1, E Herva 1, H Syrjälä 1
PMCID: PMC473034  PMID: 8711653

Abstract

BACKGROUND: The importance of Chlamydia pneumoniae as a cause of pneumonia has remained controversial. The clinical picture of C pneumoniae and Streptococcus pneumoniae in patients admitted to hospital with community-acquired pneumonia was compared during a C pneumoniae epidemic in Finland. METHODS: Group I consisted of 24 patients in whom serological testing and bacterial culture indicated an association with C pneumoniae only, group II comprised nine patients with both C pneumoniae and S pneumoniae, and group III consisted of 13 patients with S pneumoniae only. RESULTS: The patients with C pneumoniae suffered from headache more frequently than the other patients (group I, 46%; group II, 11%; and group III, 15%) and had received antimicrobial treatment more often before admission to hospital (group I, 54%; groups II and III, 0%). The patients with C pneumoniae produced few good sputum samples and had suffered from respiratory symptoms longer than those with S pneumoniae (group I, 10 days; groups II and III, 4 days). C reactive protein values on admission were lowest in group I and highest in group II. The antimicrobial treatment provided in hospital covered C pneumoniae in 36% of cases in group I and 0% in group II, while S pneumoniae was covered in all patients. C pneumoniae and S pneumoniae together were associated with more severe disease and a longer stay in hospital. CONCLUSIONS: Pneumonia caused by C pneumoniae was milder but clinically resembled that caused by S pneumoniae, and required hospital treatment even among young patients. Mixed infections were common and should be taken into account when planning antimicrobial treatment for community-acquired pneumonia. Further studies with more patients are needed to evaluate the severity of C pneumoniae pneumonia.

Full text

PDF
185

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bartlett J. G., Finegold S. M. Bacteriology of expectorated sputum with quantitative culture and wash technique compared to transtracheal aspirates. Am Rev Respir Dis. 1978 Jun;117(6):1019–1027. doi: 10.1164/arrd.1978.117.6.1019. [DOI] [PubMed] [Google Scholar]
  2. Berdal B. P., Scheel O., Ogaard A. R., Hoel T., Gutteberg T. J., Anestad G. Spread of subclinical Chlamydia pneumoniae infection in a closed community. Scand J Infect Dis. 1992;24(4):431–436. doi: 10.3109/00365549209052628. [DOI] [PubMed] [Google Scholar]
  3. Chirgwin K., Roblin P. M., Gelling M., Hammerschlag M. R., Schachter J. Infection with Chlamydia pneumoniae in Brooklyn. J Infect Dis. 1991 Apr;163(4):757–761. doi: 10.1093/infdis/163.4.757. [DOI] [PubMed] [Google Scholar]
  4. Edelstein P. H. Laboratory diagnosis of infections caused by legionellae. Eur J Clin Microbiol. 1987 Feb;6(1):4–10. doi: 10.1007/BF02097182. [DOI] [PubMed] [Google Scholar]
  5. Ekman M. R., Grayston J. T., Visakorpi R., Kleemola M., Kuo C. C., Saikku P. An epidemic of infections due to Chlamydia pneumoniae in military conscripts. Clin Infect Dis. 1993 Sep;17(3):420–425. doi: 10.1093/clinids/17.3.420. [DOI] [PubMed] [Google Scholar]
  6. Ekman M. R., Leinonen M., Syrjälä H., Linnanmäki E., Kujala P., Saikku P. Evaluation of serological methods in the diagnosis of Chlamydia pneumoniae pneumonia during an epidemic in Finland. Eur J Clin Microbiol Infect Dis. 1993 Oct;12(10):756–760. doi: 10.1007/BF02098463. [DOI] [PubMed] [Google Scholar]
  7. Fang G. D., Fine M., Orloff J., Arisumi D., Yu V. L., Kapoor W., Grayston J. T., Wang S. P., Kohler R., Muder R. R. New and emerging etiologies for community-acquired pneumonia with implications for therapy. A prospective multicenter study of 359 cases. Medicine (Baltimore) 1990 Sep;69(5):307–316. doi: 10.1097/00005792-199009000-00004. [DOI] [PubMed] [Google Scholar]
  8. Frydén A., Kihlström E., Maller R., Persson K., Romanus V., Anséhn S. A clinical and epidemiological study of "ornithosis" caused by Chlamydia psittaci and Chlamydia pneumoniae (strain TWAR). Scand J Infect Dis. 1989;21(6):681–691. doi: 10.3109/00365548909021698. [DOI] [PubMed] [Google Scholar]
  9. Gaydos C. A., Eiden J. J., Oldach D., Mundy L. M., Auwaerter P., Warner M. L., Vance E., Burton A. A., Quinn T. C. Diagnosis of Chlamydia pneumoniae infection in patients with community-acquired pneumonia by polymerase chain reaction enzyme immunoassay. Clin Infect Dis. 1994 Jul;19(1):157–160. doi: 10.1093/clinids/19.1.157. [DOI] [PubMed] [Google Scholar]
  10. Gillespie S. H., Ullman C., Smith M. D., Emery V. Detection of Streptococcus pneumoniae in sputum samples by PCR. J Clin Microbiol. 1994 May;32(5):1308–1311. doi: 10.1128/jcm.32.5.1308-1311.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Grayston J. T., Campbell L. A., Kuo C. C., Mordhorst C. H., Saikku P., Thom D. H., Wang S. P. A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR. J Infect Dis. 1990 Apr;161(4):618–625. doi: 10.1093/infdis/161.4.618. [DOI] [PubMed] [Google Scholar]
  12. 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 Jan;149(1):169–173. [PubMed] [Google Scholar]
  13. Grayston J. T., Golubjatnikov R., Hagiwara T., Hahn D. L., Leinonen M., Persson K., Saikku P., Treharne J., Wang S. P., Yamazaki T. Serologic tests for Chlamydia pneumoniae. Pediatr Infect Dis J. 1993 Sep;12(9):790–791. doi: 10.1097/00006454-199309000-00027. [DOI] [PubMed] [Google Scholar]
  14. Grayston J. T., Kuo C. C., Wang S. P., Altman J. A new Chlamydia psittaci strain, TWAR, isolated in acute respiratory tract infections. N Engl J Med. 1986 Jul 17;315(3):161–168. doi: 10.1056/NEJM198607173150305. [DOI] [PubMed] [Google Scholar]
  15. Hammers-Berggren S., Granath F., Julander I., Kalin M. Erythromycin for treatment of ornithosis. Scand J Infect Dis. 1991;23(2):159–162. doi: 10.3109/00365549109023394. [DOI] [PubMed] [Google Scholar]
  16. Harmoinen A., Perko M., Grönroos P. Rapid quantitative determination of C-reactive protein using LKB 8600 Reaction Rate Analyser. Clin Chim Acta. 1981 Mar 19;111(1):117–120. doi: 10.1016/0009-8981(81)90430-7. [DOI] [PubMed] [Google Scholar]
  17. Helms C. M., Viner J. P., Sturm R. H., Renner E. D., Johnson W. Comparative features of pneumococcal, mycoplasmal, and Legionnaires' disease pneumonias. Ann Intern Med. 1979 Apr;90(4):543–547. doi: 10.7326/0003-4819-90-4-543. [DOI] [PubMed] [Google Scholar]
  18. Holloway Y., Boersma W. G., Kuttschrütter H., Snijder J. A. Minimum number of pneumococci required for capsular antigen to be detectable by latex agglutination. J Clin Microbiol. 1992 Feb;30(2):517–519. doi: 10.1128/jcm.30.2.517-519.1992. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Jalonen E., Paton J. C., Koskela M., Kerttula Y., Leinonen M. Measurement of antibody responses to pneumolysin--a promising method for the presumptive aetiological diagnosis of pneumococcal pneumonia. J Infect. 1989 Sep;19(2):127–134. doi: 10.1016/s0163-4453(89)91864-1. [DOI] [PubMed] [Google Scholar]
  20. Kleemola M., Saikku P., Visakorpi R., Wang S. P., Grayston J. T. Epidemics of pneumonia caused by TWAR, a new Chlamydia organism, in military trainees in Finland. J Infect Dis. 1988 Feb;157(2):230–236. doi: 10.1093/infdis/157.2.230. [DOI] [PubMed] [Google Scholar]
  21. Leinonen M., Luotonen J., Herva E., Valkonen K., Mäkelä P. H. Preliminary serologic evidence for a pathogenic role of Branhamella catarrhalis. J Infect Dis. 1981 Dec;144(6):570–574. doi: 10.1093/infdis/144.6.570. [DOI] [PubMed] [Google Scholar]
  22. Macfarlane J. T., Finch R. G., Ward M. J., Macrae A. D. Hospital study of adult community-acquired pneumonia. Lancet. 1982 Jul 31;2(8292):255–258. doi: 10.1016/s0140-6736(82)90334-8. [DOI] [PubMed] [Google Scholar]
  23. Marrie T. J., Grayston J. T., Wang S. P., Kuo C. C. Pneumonia associated with the TWAR strain of Chlamydia. Ann Intern Med. 1987 Apr;106(4):507–511. doi: 10.7326/0003-4819-106-4-507. [DOI] [PubMed] [Google Scholar]
  24. Saikku P., Wang S. P., Kleemola M., Brander E., Rusanen E., Grayston J. T. An epidemic of mild pneumonia due to an unusual strain of Chlamydia psittaci. J Infect Dis. 1985 May;151(5):832–839. doi: 10.1093/infdis/151.5.832. [DOI] [PubMed] [Google Scholar]
  25. Sundelöf B., Gnarpe J., Gnarpe H., Grillner L., Darougar S. Chlamydia pneumoniae in Swedish patients. Scand J Infect Dis. 1993;25(4):429–433. doi: 10.3109/00365549309008523. [DOI] [PubMed] [Google Scholar]
  26. Sweet R. L., Schachter J., Robbie M. O. Failure of beta-lactam antibiotics to eradicate Chlamydia trachomatis in the endometrium despite apparent clinical cure of acute salpingitis. JAMA. 1983 Nov 18;250(19):2641–2645. [PubMed] [Google Scholar]
  27. Thom D. H., Grayston J. T., Wang S. P., Kuo C. C., Altman J. Chlamydia pneumoniae strain TWAR, Mycoplasma pneumoniae, and viral infections in acute respiratory disease in a university student health clinic population. Am J Epidemiol. 1990 Aug;132(2):248–256. doi: 10.1093/oxfordjournals.aje.a115654. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES