Pneumonia caused by chlamydia

It is now established that 3 types of chlamydia play a role in the development of pneumonia.

1. Chlamydia pneumoniae causes pneumonia, bronchitis, pharyngitis, sinusitis, otitis.
2. Chlamydia trachomatis is the causative agent of urogenital chlamydiosis and trachoma, causes pneumonia in newborns, and in adults it is extremely rare. Female genitalia are the reservoir and source of urogenital chlamydial infection. It is localized in the cervix in 5-13% of pregnant women, can be transmitted to a newborn and cause it trachoma and pneumonia (usually at the age of 6 months). Ch. Trachomatis causes the development of urethritis (in men and women), cervicitis and other pelvic inflammatory diseases, which, with a prolonged persistence of the pathogen leads to the formation of cicatricial changes in the fallopian tubes and infertility. LI, L2, L3-serotypes of Ch. Trachomatis cause the same venereal lymphogranuloma.
3. Chlamydia psittaci is the causative agent of ornithosis (psittacosis).

In accordance with the life cycle, two forms of the existence of chlamydia within the cells are distinguished:

• Elementary corpuscle (about 300 nm in size) is an infectious, pathogenic form capable of penetrating into the cell, formed 20-30 hours after the penetration of clavidia into the cell. When the cell wall breaks, newly formed infectious elementary particles are released;
• reticular (mesh) bodies - non-infectious form; in this case, chlamydia are metabolically active, capable of division, but at the same time are non-pathogenic. Reticular bodies come from elementary bodies.

[1], [2], [3]

Pneumonia caused by Chlamydia pneumoniae

Infections caused by Chl. Pneumoniae, are widespread. At the age of 20, specific antibodies to Chl. Pneumoniae are found in half of the examined, with an increase in age - in 80% of men and 70% of women. Chl.pneumoniae causes the development of acute or chronic bronchitis, pneumonia, pharyngitis, sinuititis, inflammation of the middle ear. In addition, the role of Chl is now discussed. Pneumoniae in the etiology of bronchial asthma, atherosclerosis, acute endo- and myocarditis, sarkovidosis, arthritis.

Chl infection. Pneumoniae is transmitted from person to person by airborne droplets.

Clinical Features

Most often, young people are ill (5-35 years old). In this age group Chl. Pneumoniae as the cause of pneumonia ranked second after Mycoplasma pneumoniae.

Clinical picture of pneumonia caused by Chl. Pneumoniae, is similar to the clinic of mycoplasmal pneumonia. The disease begins with a dry cough, at first it is stubborn, unproductive, then - with the separation of sputum. The body temperature rises, it is usually subfebrile, although it can be high, but it is not accompanied by chills. Disturbing headache, muscle pain, general weakness, but intoxication is not clearly expressed, the general condition is mild. Characteristic is the presence of pharyngitis. With auscultation of the lungs dry scattered rales are heard, and rarer - small bubbling rales in a certain area of the lungs (mainly in the lower parts).

In 10-15% of patients, the disease is severe, with a marked intoxication syndrome, an increase in the liver, spleen.

Radiologic examination reveals mainly interstitial changes, perivascular, peribronchial infiltration, enhancement of pulmonary pattern. However, it is possible to have focal and infiltrative darkening. Quite often, clear radiographic changes may be absent.

A general analysis of peripheral blood reveals leukopenia and increased ESR.

Diagnostic criteria

When making a diagnosis it is necessary to consider the following main points:

• young age of patients (5-35 years), first of all adolescents and young adults are ill;
• persistent prolonged cough;
• presence of a pharyngitis and bronchitis clinic;
• X-ray examination of the lungs reveals mainly interstitial changes, an X-ray negative variant is possible;
• revealing Chl. Pneumoniae in sputum with the use of immunofluorescent method and polymerase chain reaction; positive sputum culture results on the environment with chicken embryos;
• the growth of antibody titres to legionella in the blood of a patient in paired sera (10-12 days from the first study).

[4], [5], [6], [7], [8], [9], [10], [11], [12], [13]

Pneumonia caused by Chlamydia psittaci (psittacosis, ornithosis)

Chlamydia psittaci is found in parrots, domestic birds (ducks, turkeys), pigeons, canaries, some sea birds (in some species of gulls).

Infection is transmitted mainly by aerosol (inhalation of dust from feathers or excrement of infected birds). The causative agent of psittacosis can persist for a month in a dry bird litter. In rare cases, infection occurs through droplets of a patient's saliva when coughing. It is reported about the possibility of sexual transmission.

If the source of infection are parrots, talk about psittacosis, if other birds - the disease is called ornithosis.

Clinical Features

The incubation period of the disease is 1-3 weeks. Then the clinical picture of the disease develops. In most patients, it begins acutely. Fast body temperature rises (up to 39 ° C and above), chills are observed, severe intoxication develops (severe headache, pronounced general weakness, myalgia, appetite disappears, repeated vomiting is possible). From 3-4 days there is a dry cough, later mucopurulent sputum is separated, sometimes with an admixture of blood. Disturbing pain in the chest, worse with breathing and coughing.

With percussion of the lungs, dullness of percussion sound is detected (not always), with auscultation - hard breathing, finely bubbling, often dry rales. These physical signs are most often detected in the lower lobe on the right.

Almost half of the patients have an increase in the liver and spleen.

Perhaps a serious course of the disease with the defeat of the nervous system (inhibition, meningeal syndrome, sometimes nonsense).

Priroentgenological examination of the lungs mainly determines the interstitial lesion (strengthening and deformation of the pulmonary pattern) and the expansion of the roots of the lungs. Against this background, small foci of inflammatory infiltration can also be detected.

In the general analysis of peripheral blood, leukopenia is found (in most patients), less often - the number of white blood cells is normal or increased (leukocytosis shows a shift of the leukocyte formula to the left), there is an increase in ESR.

A rise in body temperature, clinical manifestations of the disease and radiological changes can last about 4-6 weeks.

Diagnostic criteria

When making a diagnosis, the following basic points should be taken into account:

• instructions in the anamnesis for domestic or professional contact with birds (the disease often occurs in workers of poultry farms, pigeon breeders, poultry farmers, etc.);
• acute onset of the disease with a marked syndrome of intoxication, fever, cough with the subsequent development of pneumonia;
• absence of symptoms of upper respiratory tract infection (rhinitis, tracheitis);
• predominantly interstitial changes in the lungs during X-ray examination;
• leukopenia in combination with an increase in ESR;
• the determination in the blood of a patient of antibodies to Chlamydia psittaci by the complement fixation reaction. Diagnostic value have a titer of 1: 16-1: 32 and higher, or an increase in antibody titers 4 times or more in the study of paired sera.

[14], [15], [16], [17], [18]

Treatment of pneumonia caused by chlamydia

In the development of pneumonia, three types of chlamydia play a role:

• Chl. Psittaci - causative agent of ornithosis;
• Chl. Trachomatis - causative agent of urogenital chlamydosis and trachoma that causes pneumonia in newborns;
• Chl. Pneumoniae is a causative agent of pneumonia with 2 subspecies: TW-183 and AR-39.

With pneumonia caused by chlamydia, new macrolides (azithromycin, roxithromycin, clarithromycin) and fluoroquinolones are highly effective. Alternative drugs are tetracyclines.

• Pneumonia - Treatment regimen and nutrition
• Antibacterial drugs for the treatment of pneumonia
• Pathogenetic treatment of pneumonia
• Symptomatic treatment of pneumonia
• Fighting complications of acute pneumonia
• Physiotherapy, exercise therapy, respiratory gymnastics with pneumonia
• Sanatorium treatment and rehabilitation for pneumonia