Naslov
Mycoplasma and Chlamydia: very important agents of pneumonia

Autori
Puljiz, Ivan ; Kuzman, Ilija

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
3rd Croatian Congress on Infectious Diseases with international participation-abstract book / - Zagreb : HDI HLZ, 2002

Skup
3rd Croatian Congress on Infectious Diseases with international participation

Mjesto i datum
Dubrovnik, Hrvatska, 12.10.2002. - 15.10.2002

Vrsta sudjelovanja
Predavanje

Vrsta recenzije
Domaća recenzija

Ključne riječi
Mycoplasma; Chlamydia; pneumonia

Sažetak
Objectives: Mycoplasma pneumoniae and Chlamydia pneumoniae are the most common causes of community-acquired pneumonia. Pneumonia caused with these pathogens is usually associated with nonsevere clinical manifestations but the features will vary depending upon the patient`s age, the presence of co-pathogens, or the existence of co-morbid conditions. The clinical characteristics and laboratory findings in pneumonias caused by Mycoplasma pneumoniae and Chlamydia pneumoniae are very similar, sometimes identical. The aim of the present study was to analyze and describe the epidemiological, clinical, laboratory, radiological and therapeutic features of these two diseases and evaluate the role of M. pneumoniae and Chlamydia pneumoniae in community-acquired pneumonia. Methods: We retrospectively evaluated 147 patients with pneumonia caused by Mycoplasma pneumoniae and 89 patients with pneumonia caused by Chlamydia pneumoniae. All patients were hospitalized at the University Hospital for Infectious Diseases &#8220 ; Dr Fran Mihaljević&#8221 ; in Zagreb during a three years period from January 1, 1998 through December 31, 2000. They were chosen out of a large number of 2308 hospitalized patients with pneumonia. Chlamydia pneumoniae pneumonia was diagnosed using micro-IF method utilizing C. pneumoniae elementary bodies (Chlamydia Sero FIA, Savyon Diagnostic LTD) as antigen to detect IgG, IgA and IgM antibodies specific to C. pneumoniae. A 4-fold or greater increase in titer for any immunoglobulin class between paired sera, an IgG titer > 512 or IgM titer > 16 in any serum was considered to be diagnostic of C. pneumoniae pneumonia. Mycoplasma pneumoniae etiology was determined with ELISA by using P1 membrane protein as antigen (Savyon Diagnostic LTD). With this method, patients were positive for M. pneumoniae if they had a 2-fold incerase in antibodies in the paired sera or IgM antibodies present in at least one serum sample. We analyzed medical history, clinical signs, symptoms and laboratory findings in all our patients. Results: Two thousands three hundred and eight patients were hospitalized with community-acquired pneumonia (CAP) during the 3 years study period. Among these, one thousand two hundred eighty five (55, 68 %) were patients with atypical pneumonia. Serology test was performed in 774 (33, 65 % of all patients with pneumonia, and 60, 23 % of patients with atypical pneumonia) and aetiological agents were identified in 429 (33, 39 % of atypical pneumonia and 55, 43 % of patients which obtained serology test) patients. Mycoplasma pneumoniae was confirmed in 147 (6, 37 % of all CAP, 11, 44 % of atypical pneumoniae or 34, 27 of patients with proved aetiological agent) patients and Chlamydia pneumoniae in 89 (3, 86 % of all CAP, 6, 96 % of atypical pneumonia and 20, 79 of patients with proved aetiology) patients. Co-pathogens were confirmed in 11 (7, 48 %) patients with M. pneumoniae and 11 (12, 56 %) patients with C. pneumoniae. M. pneumoniae most frequently affected older children and younger adults and C. pneumoniae affected usually adults. The average age was 24, 64 &plusmn ; 13, 5 (SD, range 3 &#8211 ; 69) in Mycoplasma group and 42, 12 &plusmn ; 17, 92 (SD, range 10 &#8211 ; 85) in Chlamydia group. Men were affected more frequently than women in both groups of patients (69, 40 % vs. 82, 02 %). The mean duration of illness prior to hospitalization was 6, 2 &plusmn ; 2, 67 vs. 6, 5 &plusmn ; 2, 64 days and 51, 02 % vs. 44, 95 % of patients received antibiotic treatment in the community. Comorbidity was less common among patients with M. pneumoniae than C. pneumoniae (6, 12 % vs. 15, 73 %). The majority of M. pneumoniae patients (87, 95 %) were hospitalized in the summer and fall months (August &#8211 ; December). In contrast, patients with C. pneumoniae did not show seasonal associations. Patients in two aetiological groups had similar symptoms at admission to the hospital. The most common clinical manifestations were fever (97, 96 % vs. 97, 75 %), cough (97, 28 % vs. 82, 02 %) and headache (53, 06 % vs. 59, 55 %). Mycoplasma group had more common catarrhal symptoms (hoarseness, sore throat, tracheitis) than Chlamydia group (30, 61 % vs. 10, 24 %). The mean white blood cells count was 9, 87 x10 9/ml &plusmn ; 3, 91 (SD ; range 3, 8-35, 8) in Mycoplasma group and 10, 32 x10 9/ml&plusmn ; 4, 30 (SD ; range 4.6-29, 0) in Chlamydia group. Erythrocyte sedimentation was accelerated in both diseases with significant differences (47, 64 &plusmn ; 24, 79 ; SD ; range 6-112 vs. 58, 82 &plusmn ; 24, 46 SD ; range 8-130). Serum level C-reactive protein was increased in both groups (Mycoplasma: 100, 9 &plusmn ; 82, 73 ; SD ; range 2-331 vs. Chlamydia: 178, 3 &plusmn ; 129, 81 ; SD ; range 4.496). The serum level of AST was normal in 75, 51 % of Mycoplasma patients and 61, 80 % of Chlamydia patients. The serum level of ALT was normal in 80, 27 % vs. 66, 29 % patients. The mean level AST was 22, 58 &plusmn ; 16, 67 (SD ; range 8-137) vs. 33, 93 &plusmn ; 31, 91 (SD ; range 11-212) and ALT 27, 52 &plusmn ; 37, 13 (SD ; range 7-383) vs. 41, 22 &plusmn ; 43, 77 (SD ; range 9-247). The radiological manifestations of pneumonia in the majority of patients in both groups were interstital (90, 48 vs. 88, 76 %). Pleural effusion was recorded in 3, 36 % patients of M. pneumoniae and 1, 12 % patients suffering from Chlamydia pneumoniae. In 2, 72 % patients in the Mycoplasma group and in 10, 11 % patients in the Chlamydia group fever was continued more than 96 hours after admission to the hospital. The patients were treated with the following antibiotics: azithromycin (Mycoplasma 75, 51% and 62, 92 Chlamydia), clarithromycin (11, 57 % vs. 17, 98 %) and doxycycline (8, 16 % vs. 8, 99 %). The duration of fever longer than 96 hours was recorded in 1, 80 % of patients treated with azithromycin, 6, 06 % treated with clarithromycin and 10, 00 % treated with doxycycline. Conclusions: M. pneumoniae was the most frequent proved pathogen of pneumonia in our hospitalized patients, followed by C. pneumoniae. There are no characteristic complaints, signs or radiological findings that distinguish M. pneumoniae from C. pneumoniae. CAP caused by C. pneumoniae is a more severe disease than CAP caused by M. pneumoniae. Azithromycin proved as the most efficient antibiotic, but good results were also achieved with doxycycline and clarithromycin.

Izvorni jezik
Engleski

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Kliničke medicinske znanosti

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