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 ~  Abstract
 ~  Materials and Me...
 ~  Results
 ~  Discussion
 ~  References

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Year : 2004  |  Volume : 22  |  Issue : 3  |  Page : 185-187
 

A pilot study of chlamydia trachomatis pneumonia in infants


Department of Microbiology, Maulana Azad Medical College, New Delhi - 110 002, India

Date of Submission07-Aug-2003
Date of Acceptance24-Sep-2003

Correspondence Address:
Department of Microbiology, Maulana Azad Medical College, New Delhi - 110 002, India

 ~ Abstract 

Chlamydia trachomatis is currently recognized as one of the most common sexually transmitted pathogen and a major cause of perinatally acquired infection. Vertical transmission of infection from mother to the infant may result in the development of conjunctivitis and pneumonia. The study was conducted with the aim of determining the prevalence of C. trachomatis pneumonia and to identify its clinical manifestations. Nasopharyngeal aspirates were collected from 50 infants (4-24 weeks of age) with pneumonia. C. trachomatis was detected in nasopharyngeal aspirates by direct fluorescent antibody (DFA) staining. Using DFA, C. trachomatis was found in 12.5% of infants. C. trachomatis pneumonia was associated with the age group of 4-12 weeks, cough of more than 7 days duration, presence of conjunctivitis, milder grade of pneumonia and absence of fever. The study showed a high prevalence of C. trachomatis pneumonia in infants.

How to cite this article:
Chawla R, Bhalla P, Sachdev H P. A pilot study of chlamydia trachomatis pneumonia in infants. Indian J Med Microbiol 2004;22:185-7


How to cite this URL:
Chawla R, Bhalla P, Sachdev H P. A pilot study of chlamydia trachomatis pneumonia in infants. Indian J Med Microbiol [serial online] 2004 [cited 2019 Nov 22];22:185-7. Available from: http://www.ijmm.org/text.asp?2004/22/3/185/11216


Chlamydia trachomatis (serovars D-K) is currently recognized as one of the most common sexually transmitted pathogen and a major cause of perinatally acquired infection.[1] Vertical transmission of infection from mother to the infant may result in the development of conjunctivitis and pneumonia.[2] During pregnancy, 5-26% women are estimated to be suffering from endocervicitis due to C. trachomatis.[3] 15-37% of infants born to the infected women develop conjunctivitis and 1-22% develop pneumonia.[2] Incidence of pneumonia due to C. trachomatis is estimated to be 5-10 cases per1000 live births[4] whereas the prevalence is estimated to be 30%[5]. In the United States, C. trachomatis is reported to be responsible for between one-third and one-half of all cases of pneumonia in the first six months of life[5].
The aim of this study was to determine the prevalence of C. trachomatis as a cause of pneumonia in infants in our hospital and to identify the clinical manifestations of chlamydial pneumonia.

 ~ Materials and Methods Top

A total of 50 infants, aged between 4 weeks and 24 weeks, presenting with either difficulty in breathing or cough with tachypnoea were included in the study. Further classification of pneumonia was done according to the WHO guidelines.[6] On admittance, a complete physical examination and routine laboratory tests were performed. Nasopharyngeal aspirates for direct fluorescence antibody (DFA) staining and routine bacteriological culture were obtained by passing an infant feeding tube through each nostril and 0.2 mL of specimen was aspirated by syringe suction.
C. trachomatis elementary bodies were detected in the nasopharyngeal secretions by staining with fluorescein labelled monoclonal antibodies specific to the major outer membrane protein of all 15 serovars of C. trachomatis (Syva MicroTrakÒ Chlamydia trachomatis Direct Specimen Test, Behring Diagnostics Inc., Cupertino, California). The nasopharyngeal specimen was spotted onto the well of the slide, air-dried, methanol fixed, stained and examined under fluorescence microscope as per manufacturer's instructions. Slides were considered positive if they contained ³ 10 typical apple green coloured C. trachomatis elementary bodies while those with no cellular material present were rejected as representing inadequate specimen collection.
Nasopharyngeal secretions were inoculated on 5% sheep blood agar, heated blood agar and MacConkey agar plates for routine bacteriological culture. Isolates were identified by standard bacteriological methods.[7] C. trachomatis pneumonia was diagnosed on the basis of a positive DFA test.

 ~ Results Top

The bacterial species that were detected in the nasopharyngeal aspirates were Streptococcus pneumoniae (8), Chlamydia trachomatis (6),  Escherichia More Details coli (6), Klebsiella pneumoniae   (4), Haemophilus influenzae (1) and Staphylococcus aureus (1). A single bacterial pathogen was recovered from 16 cases while two bacterial pathogens were detected among 2 infants. S. pneumoniae  was isolated alone in 6 cases while it was associated with K. pneumoniae  and H. influenzae in one case each. C. trachomatis was the only aetiological agent in all the six cases where it was detected.
Out of the 50 nasopharyngeal aspirates subjected to DFA, 2 (4%) were found to be inadequate for comment. Six of the remaining 48 samples (12.5%) were found to be positive for C. trachomatis, three of them had ³ 100 elementary bodies per slide while two had 50-99 and one had 10-49 elementary bodies per slide.
C. trachomatis pneumonia was found to be more common among infants between 4-12 weeks of age and those who had cough of more than 7 days duration, presence of conjunctivitis, milder grade of pneumonia, absence of fever and hyperinflation [Table - 1].

 ~ Discussion Top

In this study, C. trachomatis pneumonia was documented in 12.5 % of the cases by DFA. Using the same method, Dereli et al[1] and Paisley et al[8] detected C. trachomatis in nasopharyngeal specimens in 21.6 and 23% cases of infant pneumonia respectively. Although isolation by culture remains the gold standard for diagnosing C. trachomatis infections in infants,[2] DFA has been reported to be a sensitive (93%) and specific (98%) test in comparison to culture for the detection of C. trachomatis in nasopharyngeal specimens from infants with pneumonia.[8]
C. trachomatis pneumonia is usually characterized by its insidious onset within the first three months of life. If not recognized and treated, it shows a tendency to persist. The most remarkable features of the disease are the afebrile course, paroxysms of staccato coughing, tachypnoea, inspiratory rales and hyperinflation.[5],[9],[10] Infants with C. trachomatis pneumonia in this study displayed the clinical and radiologic manifestations usually suggestive of chlamydial pneumonia. Infant pneumonia due to C. trachomatis may be difficult to differentiate from that attributable to respiratory syncytial virus, parainfuenza virus, adenovirus, cytomegalovirus, Pneumocystis carinii and Ureaplasma urealyticum.[11] The demonstration of these pathogens was, however, not attempted in our study. Studies using the most complete and reliable diagnostic methods could also identify an etiological agent in only about 50% cases of childhood pneumonias.[12] While in the present study bacterial aetiology could be established in 18 (36%) cases.
This pilot study revealed C. trachomatis to be one of the common aetiologic agents in infants with pneumonia, further prospective studies comprising larger patient groups with comparable controls are required to determine the spectrum and the incidence of the disease in our country. 

 ~ References Top

1.Dereli D, Coker M, Ertem E, Serter D, Tanaç R, Tez E. Chlamydial infections in infants. J Trop Pediatr 1996;42:233-236.   Back to cited text no. 1    
2.Hammerschlag MR. Chlamydial infections in infants and children. In: Sexually Transmitted Diseases , 3rd ed. Holmes KK, Mårdh PA, Sparlin PF, Lemon SM, Stamm WE, Piot P, Wasserheit JN, Eds. (Mc-Graw Hill, New York) 1999:1155-1164.  Back to cited text no. 2    
3.Stamm WE. Chlamydia trachomatis infections of the adult. In: Sexually Transmitted Diseases, 3rd ed. Holmes KK, Mårdh PA, Sparlin PF, Lemon SM, Stamm WE, Piot P, Wasserheit JN, Eds. (Mc-Graw Hill, New York) 1999:407-422.  Back to cited text no. 3    
4.Harrison HR, Alexander ER. Chlamydial infections in infants and children. In: Sexually Transmitted Diseases, 2nd ed. Holmes KK, Mårdh PA, Sparlin PF, Weisner PJ, Eds. (Mc-Graw Hill, New York) 1990:811-820.  Back to cited text no. 4    
5.Harrison HR, English MG, Lee CK, Alexander ER. Chlamydia trachomatis infant pneumonitis: Comparison with matched controls and other infant pneumonitis. N Engl J Med 1978;298:702-708.  Back to cited text no. 5    
6.Acute respiratory infections in children: Case management in small hospitals in developing countries - A manual for Doctors and other Senior Health Workers. Geneva, World Health Organization 1990, Document WHO / ARI / 90.5.   Back to cited text no. 6    
7.Collee JG, Fraser AG, Marmion BP, Simmons A. Mackie and McCartney practical medical microbiology: 14th ed. (Churchill Livingstone, Edinburgh) 1996.  Back to cited text no. 7    
8.Paisley JW, Lauer BA, Melinkovich P, Gitterman BA, Feiten DJ, Berman S. Rapid diagnosis of Chlamydia trachomatis pneumonia in infants by direct immunofluorescence microscopy of nasopharyngeal secretions. J Pediatr 1986;109:653-655.  Back to cited text no. 8    
9.Tipple MA, Beem MO, Saxon EM. Clinical characteristics of the afebrile pneumonia associated with Chlamydia trachomatis infection in infants less than 6 months of age. Pediatrics 1979;63:192-197.  Back to cited text no. 9    
10.Radkowski MA, Kranzler JK, Beem MO, Tipple MA. Chlamydia pneumonia in infants: radiography in 125 cases. Am J Roentgenol 1981;137:703-706.  Back to cited text no. 10    
11.Davies HD, Wang EEL. Special pulmonary syndromes. In: Principles and practice of pediatric infectious diseases, 1st ed. Long SS, Pickering LK, Prober CG, Eds. (Churchill Livingstone, New York) 1997:269-271.  Back to cited text no. 11    
12.Wang EEL, Long SS. Acute uncomplicated pneumonia. In: Principles and practice of pediatric infectious diseases, 1st ed. Long SS, Pickering LK, Prober CG, Eds. (Churchill Livingstone, New York) 1997:250-57.  Back to cited text no. 12    
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