25 July, 2008

An epidemic of a pertussis-like illness caused by Chlamydia pneumoniae

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In the beginning of June 1994. A telephone call from a school doctor of Mito
Junior High School, to my laboratory room, when I had been working as a
lecturer in the Department of Pediatrics, Yamaguchi University School of

Said ------- “ A numbers of students have been suffering from severe

||||||||||||||||||||||||||||coughing illness in my school. It is something different
||||||||||||||||||||||||||||from that of mycoplasma infection. Do you suggest me other idea ? “

It was summer, hot weather in Yamaguchi. It is curious phenomenonto such an
epidemic was occurred among junior high school students. After the phone call,
I decided to investigate this epidemic and to determine the causative microbe.

||||||||||||||||||||||Photo: Mito Junior High School, Ooda, Yamaguchi, Japan. 1994.

My first thought of causative microbes was a type of adenoviruses, bordetella

pertussis, or parapertussis. However, the culture for viruses, bacterias were all
negative. And finally, Chlamydia pnuemoniae was identified by the methods of
antibody titres and PCR analysis with the aids of Dr. Kazunobu Ouchi ( 2nd
department of Pediatrics, Kawasaki Medical School).

This was unexpected for me. Because previous reports of Chlamydia pneumoniae
infection showed that the clinical picture was similar to that of Mycoplazuma
pneumoniae infection. But in this epidemic the character of cough was different
from any other coughing illness.

I named this coughing illness as " chlamydia cold ", or "chlamydia flu".

||||||||||||||||||||||||||||||||||||||||||||||Summery of epidemic
1) When: June-July (summer in Japan), 1994.
2) Place: Mito town (Population: 6,500, Major industry: Agriculture),

||||||||||||||||||||Low mountain area, near Akiyoshi Limestone Plateau.
||||||||||||||||||||Yamaguchi Prefecture, Japan.
3) Setting: Junior high school, Total students: 230

|||||||||||||||||||||||(12-14 years old, Male: female=114:116)
4) Type of disease: a pertussis-like illness.

||||||||||||||||||||||The cough occurred continuously and worsened during the night
||||||||||||||||||||||and early in the morning. The cough became more severe during
||||||||||||||||||||||the first week, but no patients had whooping or cough paroxysms.
||||||||||||||||||||||The mean duration of cough in cases with URI was 17.4 days and
||||||||||||||||||||||that in cases with bronchitis and pneumonia was 30.4 days.
5) Numbers of ill students:
|||||||||||||||||||||Upper respiratory infection(126cases)
|||||||||||||||||||||Hospitalized students: 2 cases (exacerbation of Bronchial Asthma) .
|||||||||||||||||||||Five of the 19 teachers, and 54 members of 32 families of ill students .
6) Causative microorganism: Chlamydia pneumoniae.

|||||||||||||||||||||Cultures and /or serology for Mycoplasma pneumoniae ,
||||||||||||||||Bordetella pertussis, Bordetella parapertussis and viruses were
|||||||||||||||||||||all negative except for one case of adenovirus-type 1.

||||Photo: presentation at ICCAC meeting, The Moscone Center, September 1995.

1) Hagiwara K., Tashiro N, Ouchi K.: Outbreak of Chlamydia pneumoniae
|||||||infection in a junior high school; its symptomatology and detection of
|||||C. pneumoniae by PCR. The 35th Interscience Conference on
||||||Antimicrobial Agent and Chemotherapy. San Francisco, The Moscone
||||||Convention Center. September 1995.
2) Hagiwara K, Ouchi K, Tashiro N, Azuma M, Kobayashi K. An epidemic

Any questions: write to Keiji Hagiwara MD, E-mail: keijihagiwara@gmail.com