Pneumonias caused by chlamydiae

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

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

According to the life cycle, two forms of chlamydia existence inside cells are distinguished:

• elementary bodies (size about 300 nm) - infectious, pathogenic form, capable of penetrating the cell, formed 20-30 hours after the penetration of chlamydia into the cell. When the cell wall ruptures, newly formed infectious elementary particles are released;
• Reticular (net) bodies - a non-infectious form; in this case, chlamydia are metabolically active, capable of division, but at the same time non-pathogenic. Reticular bodies originate from elementary bodies.

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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 those examined, with increasing age - in 80% of men and 70% of women. Chl. pneumoniae causes the development of acute or chronic bronchitis, pneumonia, pharyngitis, sinusitis, inflammation of the middle ear. In addition, the role of Chl. pneumoniae in the etiology of bronchial asthma, atherosclerosis, acute endo- and myocarditis, sarcoidosis, arthritis is currently being discussed.

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

Clinical features

Young people (5-35 years) are most often affected. In this age group, Chl. pneumoniae is the second most common cause of pneumonia after Mycoplasma pneumoniae.

The clinical picture of pneumonia caused by Chl. pneumoniae is similar to the clinical picture of mycoplasma pneumonia. The disease begins with a dry cough, initially persistent, unproductive, then with sputum production. The body temperature rises, it is usually subfebrile, although it can be high, but is not accompanied by chills. Headache, muscle pain, general weakness are disturbing, however, intoxication is not pronounced, the general condition is not severe. Pharyngitis is also characteristic. When auscultating the lungs, dry scattered wheezing is heard, much less often - fine bubbling wheezing in a certain area of the lungs (mainly in the lower sections).

In 10-15% of patients, the disease is severe, with pronounced intoxication syndrome, enlargement of the liver and spleen.

X-ray examination reveals mainly interstitial changes, perivascular, peribronchial infiltration, and increased pulmonary pattern. However, focal infiltrative darkening may be present. Quite often, clear X-ray changes may be absent.

A general peripheral blood test reveals leukopenia and an increase in ESR.

Diagnostic criteria

When making a diagnosis, the following basic principles must be taken into account:

• young age of patients (5-35 years), primarily teenagers and young adults get sick;
• persistent, prolonged cough;
• presence of clinical symptoms of pharyngitis and bronchitis;
• X-ray examination of the lungs reveals predominantly interstitial changes, a radiologically negative variant is possible;
• detection of Chl. pneumoniae in sputum using the immunofluorescence method and polymerase chain reaction; positive results of sputum culture on a medium with chicken embryos;
• increase in titers of antibodies to Legionella in the patient's blood in paired sera (10-12 days after the first study).

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Pneumonia caused by Chlamydia psittaci (psittacosis, ornithosis)

Chlamydia psittaci is found in parrots, poultry (ducks, turkeys), pigeons, canaries, and some seabirds (in certain species of gulls).

The infection is transmitted primarily by aerosol (inhalation of dust from feathers or excrement of infected birds). The causative agent of psittacosis can survive for a month in dry bird droppings. In rare cases, infection occurs through droplets of saliva from a patient coughing. Sexual transmission is also reported.

If the source of infection is parrots, they 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. The body temperature rises rapidly (up to 39°C and above), chills are observed, severe intoxication develops (severe headache, pronounced general weakness, myalgia, loss of appetite, possible repeated vomiting). From the 3rd-4th day, a dry cough appears, later mucopurulent sputum is released, sometimes with an admixture of blood. Pain in the chest is disturbing, intensifying with breathing and coughing.

Percussion of the lungs reveals dullness of the percussion sound (not always), auscultation reveals harsh breathing, fine-bubble, often dry wheezing. The above physical signs are most often detected in the lower lobe on the right.

Almost half of patients experience enlargement of the liver and spleen.

A severe course of the disease with damage to the nervous system is possible (lethargy, meningeal syndrome, sometimes delirium).

X-ray examination of the lungs reveals predominantly interstitial lesions (intensification and deformation of the pulmonary pattern) and expansion of the roots of the lungs. Against this background, small foci of inflammatory infiltration may also be detected.

In a general analysis of peripheral blood, leukopenia is detected (in most patients), less often the number of leukocytes is normal or increased (with leukocytosis, a shift in the leukocyte formula to the left is detected), an increase in ESR is noted.

The increase in body temperature, clinical manifestations of the disease and radiological changes can continue for about 4-6 weeks.

Diagnostic criteria

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

• indications in the medical history of household or professional contact with birds (the disease often occurs in poultry farm workers, pigeon breeders, poultry farmers, etc.);
• acute onset of the disease with severe intoxication syndrome, fever, cough, followed by the development of pneumonia;
• absence of symptoms of damage to the upper respiratory tract (rhinitis, tracheitis);
• predominantly interstitial changes in the lungs on X-ray examination;
• leukopenia combined with increased ESR;
• determination of antibodies to Chlamydia psittaci in the patient's blood using the complement fixation reaction. A titer of 1:16-1:32 or higher or an increase in antibody titers by 4 times or more when examining paired sera are of diagnostic value.

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Treatment of Chlamydia Pneumonia

Three types of chlamydia play a role in the development of pneumonia:

• Chl. psittaci - the causative agent of ornithosis;
• Chl. trachomatis is the causative agent of urogenital chlamydia and trachoma, causing pneumonia in newborns;
• Chl. pneumoniae is the causative agent of pneumonia, which has 2 subspecies: TW-183 and AR-39.

In 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
• Combating complications of acute pneumonia
• Physiotherapy, exercise therapy, breathing exercises for pneumonia
• Sanatorium and resort treatment and rehabilitation for pneumonia