Persistent Infection with Chlamydia pneumoniae following Acute Respiratory Illness

Abstract

Chlamydia pneumoniae is emerging as a significant cause of respiratory disease, including pneumonia and bronchitis, in humans. In this recently completed study of infection due to C. pneumoniae in patients presenting with pneumonia to SUNY Health Science Center at Brooklyn, we identified two individuals for whom cultures were positive on multiple occasions over a 1-year period. To determine the frequency of persistent respiratory infection with C. pneumoniae, follow-up specimens were obtained from nine individuals with culture-documented C. pneumoniae infection. Five of these individuals had persistent infection: four had a flulike illness characterized by pharyngitis, and one had bronchitis with prominent bronchospasm. All five individuals appeared to have acute C. pneumoniae infection as determined by results of serologic tests (titers of IgM antibody for all individuals were greater than or equal to 1:16). For three patients, cultures remained positive for 11 months despite therapy with 10- to 21-day courses of tetracycline or doxycycline. These observations suggest that persistent infection with C. pneumoniae may follow acute infection and may persist for many months. Infection with C. pneumoniae may be very difficult to eradicate with use of currently available antibiotics even if there is a clinical response to therapy.

Recurrent Pneumonia due to Persistent Chlamydia Pneumoniae Infection.

“…With the development of PCRtechniques for the clinical laboratory, it is now possible to detect C. pneumoniae-specific DNAin clinical specimens. Recurrent respiratory symptoms have been reported to occur in somepatients with a continuous PCRor who have been culture positive for C. pneumoniae (3)(4)(5). These observations were also noted in our cases.…”

“…However, in the present cases, we could not eradicate the C. pneumoniae from the nasopharynxwith a two to three weekcourse of treatment with macrolide or tetracycline and symptomsrecurred. Similar observations have also been madein previous reports (3)(4)(5). Recently, long-term macrolide therapy trials have been undertaken for eradication of C. pneumoniae from deep tissues, secondary prevention of cardiovascular diseases or improvement or prevention of asthma symptoms (13)(14)(15)(16)(17).…”

“…Infection with C. pneumoniaeusually is mild, although patients with underlying medical conditions can become quite ill. There have been some reports of persistent respiratory infection with C. pneumoniae, the symptomsof which were often recurrent or persistent (3)(4)(5). Here, wereport two cases of recurrent C. pneumoniae pneumonia even with appropriate antibiotic therapy.…”

Importance of acute Mycoplasma pneumoniae and Chlamydia pneumoniae infections in children with wheezing

“…Considering that therapy with inhaled steroids was equivalent in both groups with regard to drugs used and the length of treatment, this benefit seems to be related to clarithromycin's activity. Preliminary experience in adults suggests that M. pneumoniae and C. pneumoniae may prove difficult to eradicate with the currently available antibiotic regimens [29]. HAMMERSCHLAG et al [29] described a number of subjects who remained culture-positive for C. pneumoniae despite treatment with one or more courses of tetracycline or doxycycline of up to 3 weeks' duration.…”

“…Preliminary experience in adults suggests that M. pneumoniae and C. pneumoniae may prove difficult to eradicate with the currently available antibiotic regimens [29]. HAMMERSCHLAG et al [29] described a number of subjects who remained culture-positive for C. pneumoniae despite treatment with one or more courses of tetracycline or doxycycline of up to 3 weeks' duration. Even when a subject becomes culture-negative, this does not necessarily mean that the organism has been eradicated; it may persist in the body in a latent form [30].…”