25 July, 2008

Chlamydia pneumoniae infection

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In the summer of 1994, I experienced an epidemic of whooping cough like
illness at an Junior high school in Yamaguchi Prefecture. I had consulted,
performed the physical examination, collected the sera, and taken the swabs
for the cultures of viruses and bacterias from the students with severe cough.

|||||Photo: one classroom of Mito Junior High school, Ooda, Yamaguchi. 1994.

|||||||||||||||||||||||||||||Photo: Epidemic curve of Mito junior high school.

(1) a case of upper respiratory infection(Case No 32).

|||||||A 13 year-old boy had started the cough, rhinorrea and sore throat on
|||||||June21 and gradually increased following 3 days. The cough was associated
|||||||with chest pain and was worsening during night without whooping.

|||||||During June 22 and 23, he had fever with maximum temperature of 38.4°C.

||||||||The physical examination on June 25 showed normal findings including
||||||||throat , chest auscultation. The white blood cell count was 7100/mm3 with
||||||||1% band, 60% segmented, 3% eosinophils, 1% basophils, 1% monocytes
||||||||and 34% lymphocytes. The C-reactive protein was negative. The cold
||||||||agglutinin titres were 1:32 (normal range <1:32).

|||||||||The Minocycline and cough remedies were prescribed upon a diagnosis
|||||||||of M. pneumoniae infection. The cough continued to July10. The cultures
|||||||||for Bordetella species, viruses and M. pneumoniae were negative. The serum
|||||||||antibody titers against M. pneumoniae were negative in both acute and
|||||||||convalescent sera.

i) Antibody titers against
Chlamydia pneumoniae
June 29 (day 9)|||||||||||||||| <1:81 -------1:512
July 15 (day25) |||||||||||||||<1:8||||||||||||||||1:2048

Chlamydia pneumoniae-specific DNA

July 6 -------------(day16) (+)
August 9----------(day25) (-)
September 1------(day38) (-)

|||||||||||||||||||||||||||||||||||Detection of Chlamydia pneumoniae- specific DNA

(2) A case of pneumonia (No.13)
A 15 year-old boy started the coughing on June 8. During June 9
and 11,he had fever with maximum temperature of 39.3°C. The cough
was associated with chest pain,nausea or vomiting and worsened night
without whoop. On June 20, he consulted a pediatrician of local hospital.

On physical examination, moist rale was audible in right lower lung.
The chest radiograph showed the infiltration in perihilar and right lower
|||||||||||||||||||||||||||||||||||Chest X-Ray showed bronchopneumonia. 15-year-old.

The white blood cell count was 6,300/mm3 with 2% band, 41%
segmented, 1% monocytes, 56% Lymphocytes. The C-reactive protein
was 4.7mg/dl. The cold agglutinin titers was 1:128.

Clarithromycin and cough remedies were prescribed with a tentative
diagnosis of Mycoplasma pneumoniae infection. The cough was waned
gradually and lasted to July 6. The culture of Bordetella species,
Mycoplazma pneumoniae and viruses were all negative.

1) Antibody titres against
Chlamydia pneumoniae
---------------------------------IgM ------IgG
June 20th-------(days 13) 1:16-------1:128
September 1th (days 85) <1:8------1:1024

2) Detection of
Chlamydia pneumoniae specific DNA
June 6th------(days 29) : (+)
August 19th (days 60) : (-)

1) Hagiwara K, Ouchi K, Tashiro N, Azuma M, Kobayashi K.
|||||||An epidemic of a pertussis-like illness caused by Chlamydia
2) Grayston JT, Kuo CC, Wang SP,: A new Chlamydia psittaci
|||||||strain, TWAR, isolated in acute respiratory tract infection. 
||||||| Dr. Grayston JT( School of Public Health and Community
||||||||||Medicine, University of Washington, Seattle) found that
||||||||||Chlamyia pneumoniae cause the respiratory tract infection in

3) Pether JVS, Wang San-Pin, Grayston JT:Chlamydia pneumoniae strain
|||||||TWAR, as the cause of an outbreak in a boys' school previously called
|||||||psittacosis. Epidem. Inf. 103:395-400. 1989.
||||||| From May to July 1980, 20 students and 4 staff were suffered from
|||||" bad cold" at a school in England. Antibody titers against Chlamydia
|||||psittaci were positive. But the extensive research failed to the transmission
|||||route. Nine years later, In 1989, Dr. Grayston examined the students sera
|||||and showed that it epidemic was caused by Chlamydia pneumoniae.

Any questions: write to Keiji Hagiwara MD keijihagiwara@gmail.com