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Chlamydophila Pneumoniae

para>Avoid tetracyclines in pregnant women.

INPATIENT CONSIDERATIONS

  • Usually outpatient care. Those with severe pneumonia or coexisting illness may require hospitalization.
  • Pneumonia severity index can help predict morbidity and need for hospitalization (7).

Admission Criteria/Initial Stabilization

Infection in debilitated or hospitalized patients can be severe; ventilatory support for respiratory failure

Discharge Criteria

Reversal of respiratory distress, tolerating PO medications, otherwise stable medically, and clinically stable for discharge

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Monitor patients weekly until well.
  • Follow-up CXR can document resolution.
  • Reinfection is possible.

PROGNOSIS

  • Pneumonia is more likely to be life-threatening in older adults and patients with other underlying pulmonary disease (e.g., asthma, chronic obstructive pulmonary disease [COPD]) or the immune compromise (e.g., diabetes), with an overall 0.5-29% mortality rate.
  • Death usually from secondary infection or underlying comorbidity

COMPLICATIONS

  • Reactive airway disease
  • Erythema nodosum
  • Endocarditis
  • Pericarditis or myocarditis
  • Meningoencephalitis
  • Possible association with atherosclerotic disease: C. pneumoniae has been cultured from atherosclerotic plaque in patients with coronary artery disease and stroke. Treatment for C. pneumoniae has not been shown to affect cardiovascular mortality.
  • C. pneumoniae infection is associated with an increased risk for lung cancer (9).
  • ARDS is rare.

REFERENCES

11 Blasi F, Tarsia P, Aliberti S. Chlamydophila pneumoniae. Clin Microbiol Infect. 2009;15(1):29-35.22 Centers for Disease Control and Prevention. Chlamydophila pneumoniae infection. http://www.cdc.gov/pneumonia/atypical/chlamydophila.html. Accessed 2014.33 Thibodeau KP, Viera AJ. Atypical pathogens and challenges in community-acquired pneumonia. Am Fam Physician. 2004;69(7):1699-1706.44 Kumar S, Hammerschlag MR. Acute respiratory infection due to Chlamydia pneumoniae: current status of diagnostic methods. Clin Infect Dis. 2007;44(4):568-576.55 Burillo A, Bouza E. Chlamydophila pneumoniae. Infect Dis Clin North Am. 2010;24(1):61-71.66 Hvidsten D, Halvorsen DS, Berdal BP, et al. Chlamydophila pneumoniae diagnostics: importance of methodology in relation to timing of sampling. Clin Microbiol Infect. 2009;15(1):42-49.77 Lutfiyya MN, Henley E, Chang LF, et al. Diagnosis and treatment of community-acquired pneumonia. Am Fam Physician. 2006;73(3):442-450.88 Shefet D, Robenshtock E, Paul M, et al. Empiric antibiotic coverage of atypical pathogens for community acquired pneumonia in hospitalized adults. Cochrane Database Syst Rev. 2005;(2):CD004418.99 Zhan P, Suo LJ, Qian Q, et al. Chlamydia pneumoniae infection and lung cancer risk: a meta-analysis. Eur J Cancer. 2011;47(5):742-747.

ADDITIONAL READING

Conklin L, Adjemian J, Loo J, et al. Investigation of a Chlamydia pneumoniae outbreak in a federal correctional facility in Texas. Clin Infect Dis. 2013;57(5):639-647.

CODES

ICD10

  • J16.0 Chlamydial pneumonia

ICD9

  • 483.1 Pneumonia due to chlamydia

SNOMED

  • 233609002 Chlamydial pneumonia

CLINICAL PEARLS

  • Consider C. pneumoniae in well-appearing young patients presenting with CAP.
  • Culture is the gold standard for diagnosis of C. pneumoniae. Serodiagnosis is used for acute infection.
  • Tetracyclines or macrolides are initial drugs of choice.