Pneumonia associated with Chlamydia trachomatis infection in an infant

Influence of infection with Chlamydia trachomatis on pregnancy outcome, infant health and life-long sequelae in infected offspring

This chapter deals with genital chlamydial infections in pregnancy and postpartum. There is increasing evidence that Chlamydia trachomatis infection may result in a number of adverse pregnancy outcomes, including early and late abortion, intrauterine infections of the fetus, stillbirth, prematurity, premature rupture of the membranes (PROM) and postpartum endometritis. Ectopic pregnancy is commonly associated with a previous tubal chlamydial infection where immunological reactions seem to play a role. C. trachomatis infection may be acquired as an intrauterine infection, as well as during transit through the birth channel, and this may result in neonatal conjunctivitis and/or pneumonia. The role of chlamydial infection in the sudden death syndrome has also been considered, but evidence so far is minimal. Neonatal chlamydial infection may cause life-long sequelae, such as obstructive lung disease. Genital chlamydial infections have been associated with problems in insemination and attempts at in vitro fertilization. The chapter also deals with screening of pregnant women for C. trachomatis and the treatment of infected mothers and their offspring.

Serological evidence of Chlamydia trachomatis infection in non-immunocompromised adults with pneumonia

Serological evidence of Chlamydia trachomatis infection in three non-immunocompromised adults with pneumonia is presented. Complement fixation (CF) tests indicated chlamydial infections in all three patients. These illnesses would have been erroneously regarded as ornithosis if microimmunofluorescence (Micro-IF) tests had not been performed because the CF test detects genus-specific antibodies while the Micro-IF test reveals species-specific antibodies.

Infantile chlamydial pneumonia--a review based on 115 cases

Clinical manifestations, diagnostic studies and management of chlamydial pneumonia were reviewed in 115 infants and compared to those from 21 infants with interstitial pertussoid eosinophilic pneumonia. The identity of these two forms of subacute afebrile pneumonia is suggested. Chlamydial pneumonia is natally acquired, essentially occurs during the second and third month of life, and its frequency in the United States is surprisingly high. Gradual onset of respiratory tract symptoms, lack of possible infection from symptomatic persons, afebrile course and staccato cough represent the typical anamnesis. Presence of conjunctivitis and serous otitis is common. Distinctive diagnostic studies include slight eosinophilia (greater than or equal to 300 eosinophils/mm3), elevated serum immunoglobulins M and G, depressed PO2 and normal PCO2 in arterial blood under room air, and both interstitial infiltrates and hyperexpansion of the lungs on chest roentgenogram. Chlamydial cultures of nasopharyngeal secretions or tracheal aspirates, and determination of antichlamydial antibody titers in serum are indicated in establishing the etiology. Adequate management consists of antichlamydial chemotherapy and general supportive care, including chest physiotherapy and oxygen and parenteral fluids when needed.

[Chlamydia trachomatis as pathogen in pneumonia in a newborn infant (author's transl)]

A report is given of a newborn who developed signs of hepatitis two weeks after a normal birth, and only later respiratory symptoms of pneumonia. The infant had pronounced tachypnea, incresed immunoglobulins, eosinophilia and leucocytosis. X-rays in the initial stages showed interstitial infiltrates with alveolar hyperaeration, and in the later stages patchy alveolar infiltrates. Chlamydia trachomatis was cultured from the tracheal secretion. In making a differential diagnosis in cases of neonatal pneumonia infection with trachomatis must thus also be considered.

Colonisation of pregnant and puerperal women and neonates with Chlamydia trachomatis

Chlamydia trachomatis was cultured from cervical specimens of 14 (16.1%) of 231 women applying for legal abortion and from 23 (8.7%) of 273 puerperal women. The chlamydial isolation rate was related to the women's age. Of the pregnant and puerperal women under 20 years C trachomatis was isolated in 10% and 24% respectively; in those aged between 20 and 24 years the rates were 8.7% and 10.2% respectively whereas in those over 24 years the rates were 4.2% in both groups. Chlamydia were isolated more frequently from cervical specimens than from urethral specimens. However, if a cervical specimen alone had been examined the diagnosis would have been missed in three (17%) of 18 women. IgG antichlamydial antibodies (titre greater than or equal to 1/32) were detected by a micro-immunofluorescence test in samples of cord blood from 35 (25%) of 139 infants of the puerperal women. Of the 23 infants born to mothers harbouring chlamydia in the cervix C trachomatis was isolated from the conjuntival folds in five (22.5%). The chlamydial isolation rate from the eyes of the neonates was related to the time of sampling. None of the 108 infants examined between 6 and 7 days old was chlamydia-positive whereas chlamydia could be recovered from the conjunctival folds of four of them when re-examined from three to 23 days later.