Chlamydia pneumoniae and Mycoplasma pneumoniae

 

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ABSTRACT

Mycoplasma. pneumoniae infection occurs worldwide and is the most common cause of community-acquired pneumonia (CAP) in 5- to 20-year-olds. The most reliable diagnostic test is the enzyme immunoassay, which allows immunoglobulin (Ig)G and IgM titration and presents 92% sensitivity and 95% specificity on paired samples. Potentially active drugs are tetracyclines, macrolides, ketolides, lincosamides, streptogamines, chloramphenicol, and fluoroquinolones. Chlamydia pneumoniae accounts for 6 to 20% of CAP cases, depending on several factors such as setting of the studied population, age group examined, and diagnostic methods used. The current gold standard for serological diagnosis of acute infection is microimmunofluorescence testing. Tetracyclines and erythromycin show good in vitro activity and so far have been the most commonly employed drugs in the treatment of C. pneumoniae infection. New macrolides, ketolides, and new fluoroquinolones are other potentially effective drugs.

REFERENCES

• 1 Reimann H A. An acute infection of the respiratory tract with atypical pneumonia.  JAMA. 1938;  111 2377-2384
  CrossrefPubMedGoogle Scholar
• 2 Marrie T J, Peeling R W, Fine M J, Singer D E, Coley C M, Kapoor W N. Ambulatory patients with community-acquired pneumonia: the frequency of atypical agents and clinical course.  Am J Med. 1996;  101 509-515
  PubMedGoogle Scholar
• 3 Marston B J, Plouffe J F, File T M et al.. Incidence of community-acquired pneumonia requiring hospitalisation.  Arch Intern Med. 1997;  157 1709-1718
  CrossrefPubMedGoogle Scholar
• 4 Eaton M D, Meiklejohn G, van Herick W. Studies on the etiology of primary atypical pneumonia: a filtrable agent transmissible to cotton rats, hamster and chick embryos.  J Exp Med. 1944;  79 649-668
  CrossrefPubMedGoogle Scholar
• 5 Chanock R M, Dienes L, Eaton M D. Mycoplasma pneumoniae: proposed nomenclature for atypical pneumonia organism (Eaton agent).  Science. 1963;  140 662
  PubMedGoogle Scholar
• 6 Chanock R M, Hayflick L, Barile M F. Growth on artificial medium of agent associated with atypical pneumonia and its identification as a PPLO.  Proc Natl Acad Sci USA. 1962;  48 41-49
  PubMedGoogle Scholar
• 7 Couch R B. Mycoplasma pneumoniae (primary atypical pneumonia). In: Mandell GL, Douglas RG, Bennett JE Principles and Practice of Infectious Diseases. New York; John Wiley and Sons 1995: 1484
  Google Scholar
• 8 Foy H M, Kenny G E, Cooney M K, Allan I D. Long-term epidemiology of infections with Mycoplasma pneumoniae .  J Infect Dis. 1979;  214 1666-1672
  PubMedGoogle Scholar
• 9 Foy H M, Kenny G E, McMahan R et al.. Mycoplasma pneumoniae pneumonia in an urban area.  JAMA. 1970;  214 1666-1672
  CrossrefPubMedGoogle Scholar
• 10 Murray H W, Masur H, Senterfit L B, Roberts R B. The protean manifestations of Mycoplasma pneumoniae infections in adults.  Am J Med. 1975;  58 229-242
  PubMedGoogle Scholar
• 11 Levine D P, Lerner A M. The clinical spectrum of Mycoplasma pneumoniae infections.  Med Clin North Am. 1978;  62 961-978
  PubMedGoogle Scholar
• 12 Rollins S, Colby T, Clayton F. Open lung biopsy in Mycoplasma pneumoniae pneumonia.  Arch Pathol Lab Med. 1986;  110 34-41
  PubMedGoogle Scholar
• 13 Marc E, Le Chaussain M, Moulin F et al.. Reduced lung diffusion capacity after Mycoplasma pneumoniae pneumonia.  Pediatr Infect Dis J. 2000;  19 706-710
  PubMedGoogle Scholar
• 14 Tablan O C, Reyes M P. Chronic interstitial pulmonary fibrosis following Mycoplasma pneumoniae pneumonia.  Am J Med. 1985;  79 268-270
  CrossrefPubMedGoogle Scholar
• 15 Koletsky R J, Weinstein A J. Fulminant Mycoplasma pneumoniae infection: report of a fatal case and a review of the literature.  Am Rev Respir Dis. 1980;  122 491-496
  PubMedGoogle Scholar
• 16 Halal F, Brochu P, Delage G. Severe disseminated lung disease and bronchiectasis probably due to Mycoplasma pneumoniae .  Can Med Assoc J. 1977;  117 1055-1056
  PubMedGoogle Scholar
• 17 Rollins S, Colby T, Clayton F. Open lung biopsy in Mycoplasma pneumoniae pneumonia.  Arch Pathol Lab Med. 1986;  110 34-41
  PubMedGoogle Scholar
• 18 Grayston J T, Kuo C C, Campbell L A, Wang S P. Chlamydia pneumoniae sp. nov. for Chlamydia sp. strain TWAR.  Int J Sys Bacteriol. 1989;  39 88-90
  PubMedGoogle Scholar
• 19 Ruiz-Gonzalez A, Falguera M, Nogues A, Rubio-Caballero M. Is Streptococcus pneumoniae the leading cause of pneumonia of unknown etiology? A microbiologic study of lung aspirates in consecutive patients with community-acquired pneumonia.  Am J Med. 1999;  106 385-390
  CrossrefPubMedGoogle Scholar
• 20 Marrie T J, Peeling R W, Reid T, De Carolis E D. and the Canadian Community-Acquired Pneumonia Investigators . Chlamydia species as a cause of community-acquired pneumonia in Canada.  Eur Respir J. 2003;  21 779-784
  CrossrefPubMedGoogle Scholar
• 21 Grayston J T. Chlamydia pneumoniae strain TWAR.  Chest. 1989;  95 664-669
  PubMedGoogle Scholar
• 22 Grayston J T, Campbell L A, Kuo C C et al.. A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR.  J Infect Dis. 1990;  161 618-625
  PubMedGoogle Scholar
• 23 Hirai Y, Shiode J, Masayoshi T, Kanemasa Y. Application of an indirect immunofluorescence test for the detection of Mycoplasma pneumoniae in respiratory exudates.  J Clin Microbiol. 1991;  29 2007-2012
  PubMedGoogle Scholar
• 24 Kleemola M, Rati R, Karjalainen J et al.. Evaluation of an antigen-capture enzyme immunoassay for rapid diagnosis of Mycoplasma pneumoniae infection.  Eur J Clin Microbiol Infect Dis. 1993;  12 872-875
  CrossrefPubMedGoogle Scholar
• 25 Madsen R D, Weiner L B, McMillan J A et al.. Direct detection of Mycoplasma pneumoniae antigen in clinical specimens by a monoclonal antibody immunoblot assay.  Am J Clin Pathol. 1988;  89 95-99
  PubMedGoogle Scholar
• 26 Kleemola M, Jokinen C. Outbreak of Mycoplasma pneumoniae infection among hospital personnel studied by a nucleic acid hybridisation test.  J Hosp Infect. 1992;  21 213-221
  CrossrefPubMedGoogle Scholar
• 27 Kai M, Kamiya S, Yabe H et al.. Rapid detection of Mycoplasma pneumoniae in clinical samples by the polymerase chain reaction.  J Med Microbiol. 1993;  38 166-170
  PubMedGoogle Scholar
• 28 Van Kuppelveld F J, Johansson K E, Galama J M et al.. 16S rRNA based polymerase chain reaction compared with culture and serological methods for diagnosis of Mycoplasma pneumoniae infection.  Eur J Clin Microbiol Infect Dis. 1994;  13 401-405
  CrossrefPubMedGoogle Scholar
• 29 Smith T F. Mycoplasma pneumoniae infection: diagnosis based on immunofluorescence titre of IgG and IgM antibodies.  Mayo Clin Proc. 1986;  61 830-831
  PubMedGoogle Scholar
• 30 Tompkins L S, Shachter J, Boman J et al.. Collaborative multidisciplinary workshop report: detection, culture, serology, and antimicrobial susceptibility testing of Chlamydia pneumoniae. .  J Infect Dis. 2000;  181 S460-S461
  CrossrefPubMedGoogle Scholar
• 31 Boman J, Söderberg S, Forsberg J et al.. High prevalence of Chlamydia pneumoniae DNA in peripheral blood mononuclear cells in patients with cardiovascular disease and in middle-aged blood donors.  J Infect Dis. 1998;  178 274-277
  PubMedGoogle Scholar
• 32 Blasi F, Boman J, Esposito G et al.. Chlamydia pneumoniae DNA detection in peripheral blood mononuclear cells is predictive of vascular infection.  J Infect Dis. 1999;  180 2074-2076
  CrossrefPubMedGoogle Scholar
• 33 Lucier T S, Heitzman K, Liu S K, Hu P C. Transition mutations in the 23S rRNA of erythromycin-resistant isolates of Mycoplasma pneumoniae .  Antimicrob Agents Chemother. 1995;  39 2770-2773
  PubMedGoogle Scholar
• 34 Cooper M A, Baldwin D, Matthews R S, Andrews J M, Wise R. In vitro susceptibility of Chlamydia pneumoniae (TWAR) to seven antibiotics.  J Antimicrob Chemother. 1991;  35 407-413
  PubMedGoogle Scholar
• 35 Hjelm E, Hulten K, Nystrom-Rosander C, Gustafsson I, Engstrand L, Cars O. Assay of antibiotic susceptibility of Chlamydia pneumoniae .  Scand J Infect Dis. 1997;  104 (Suppl 104) 13-14
  PubMedGoogle Scholar
• 36 Hammerschlag M R, Qumei K K, Roblin P M. In vitro activities of azithromycin, clarithromycin, l-ofloxacin and other antibiotics against Chlamydia pneumoniae. .  Antimicrob Agents Chemother. 1992;  36 1573-1574
  PubMedGoogle Scholar
• 37 Roblin P M, Montalban G, Hammerschlag M R. Susceptibilities to clarithromycin and erythromycin of isolates of Chlamydia pneumoniae from children with pneumonia.  Antimicrob Agents Chemother. 1994;  36 1573-1574
  PubMedGoogle Scholar
• 38 Roblin P M, Hammerschlag M R. In vitro activity of a new ketolide antibiotic, HMR 3647, against Chlamydia pneumoniae .  Antimicrob Agents Chemother. 1998;  42 1515-1516
  PubMedGoogle Scholar
• 39 Hammerschlag M R, Hyman C L, Roblin P M. In vitro activities of five quinolones against Chlamydia pneumoniae .  Antimicrob Agents Chemother. 1992;  36 682-683
  PubMedGoogle Scholar
• 40 Roblin P M, Montalban G, Hammerschlag M R. In vitro activities of OPC-171 16, a new quinolone, ofloxacin and sparfloxacin against Chlamydia pneumoniae .  Antimicrob Agents Chemother. 1994;  38 1402-1403
  PubMedGoogle Scholar
• 41 Kuo C-C, Grayston J T. In vitro drug susceptibility of Chlamydia SP. strain TWAR.  Antimicrob Agents Chemother. 1988;  32 257-258
  PubMedGoogle Scholar
• 42 Mills G D, Oehley M R, Arrol B. Effectiveness of β-lactam antibiotics compared with antibiotics active against atypical pathogens in non-severe community acquired pneumonia: meta-analysis.  BMJ. 2005;  330 456
  CrossrefPubMedGoogle Scholar
• 43 Kauppinen M T, Saikku P, Kujala P, Herva E, Syrjala H. Clinical picture of community-acquired Chlamydia pneumoniae pneumonia requiring hospital treatment: a comparison between chlamydial and pneumococcal pneumonia.  Thorax. 1996;  51 185-189
  CrossrefPubMedGoogle Scholar
• 44 Mandell L A, Marrie T J, Grossman R F, Chow A W, Hyland R H. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society. The Canadian community-acquired pneumonia working group.  Clin Infect Dis. 2000;  31 383-421
  CrossrefPubMedGoogle Scholar
• 45 Mandell L A, Bartlett J C, Dowell S F, File T M, Musher D M, Whitney C. Update of Practice Guidelines for the Management of Community-Acquired Pneumonia in Immunocompetent Adults.  Clin Infect Dis. 2003;  37 1405-1433
  CrossrefPubMedGoogle Scholar
• 46 Principi N, Esposito S, Blasi F, Allegra L. Role of Mycoplasma pneumoniae and Chlamydia pneumoniae in children with community-acquired lower respiratory tract infections.  Clin Infect Dis. 2001;  32 1281-1289
  CrossrefPubMedGoogle Scholar
• 47 Esposito S, Bosis S, Cavagna R et al.. Characteristics of Streptococcus pneumoniae and atypical bacterial infections in children 2-5 years of age with community-acquired pneumonia.  Clin Infect Dis. 2002;  35 1345-1352
  CrossrefPubMedGoogle Scholar
• 48 Blasi F. Atypical pathogens and respiratory tract infections.  Eur Respir J. 2004;  24 171-181
  CrossrefPubMedGoogle Scholar

Francesco BlasiM.D. 

Institute of Respiratory Diseases, University of Milan, Pad. Sacco, IRCCS Fondazione Ospedale Maggiore di Milano, via F. Sforza 35, I-20122 Milan, Italy

Email: francesco.blasi@unimi.it