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Communications to the Editor |

Community-Acquired Chlamydia pneumoniae pneumonia FREE TO VIEW

Naoyuki Miyashita, MD, PhD; Yoshihito Niki, MD, PhD, FCCP; Toshiharu Matsushima, MD, PhD, FCCP; Niro Okimoto, MD, PhD, FCCP
Author and Funding Information

Affiliations: Kawasaki Medical School Kawasaki Medical School Kawasaki Hospital Okayama, Japan;Correspondence to: Naoyuki Miyashita, MD, PhD, Division of Respiratory Diseases, Department of Medicine, Kawasaki Medical School, Matsushima 577, Kurashiki City, Okayama 701-0192, Japan; e-mail: nao@med.kawasaki-m.ac.jpKurashiki Central Hospital Kurashiki, Japan



Chest. 2000;117(2):615-616. doi:10.1378/chest.117.2.615
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To the Editor:

We read with great interest the article by Ishida et al (December 1998)1regarding their investigation of the etiology of community-acquired pneumonia (CAP) among the Japanese population for the first time and their finding that Chlamydia pneumoniae was identified in 3.4% of episodes by using the enzyme-linked immunosorbent assay (ELISA). Of these patients, two (18.1%) had dual infections. In several recent CAP studies, however, C pneumoniae has been found to account for up to 10% of CAP cases in Western countries.3 Furthermore, C pneumoniae has been reported to cause pneumonia frequently in association with other microorganisms, mainly Streptococcus pneumoniae.,34 We would like to expand these observations with our findings, using the traditional diagnostic methods for detection of C pneumoniae.

We undertook a study to determine the etiology of CAP in Japan between April 1998 and July 1999. Traditional diagnostic methods, including paired serum samples for the microimmunofluorescence test to detect C pneumoniae, were used in combination with cell cultures for isolation of C pneumoniae. Culture for C pneumoniae was performed in cycloheximide-treated HEp-2 cells.

Nine out of 112 patients (8.0%) received diagnoses of C pneumoniae by this method. Serologic criteria established the diagnosis in nine cases and isolated the bacteria in two. Culture-positive specimens were also found to be positive by serology. Of these patients, five had polymicrobial infections, which were associated with S pneumoniae in two cases, Legionella pneumophila in one, Haemophilus influenzae in one, and S pneumoniae and Staphylococcus aureus in one. One of these patients died. The mean length of hospitalization of these five patients with mixed C pneumoniae pneumonia was significantly longer than that of patients with C pneumoniae monoinfection or those with non-C pneumoniae pneumonia (45.2 days vs 16.9 days). It has been noted that mixed infection with C pneumoniae and other microorganisms often increases symptoms and even mortality.34 This was also observed in our study, especially in the patients infected with C pneumoniae and S pneumoniae.

We found C pneumoniae in 8.0% of the CAP cases using specific methods, and the clinical results were comparable with those of recent reports in Western countries.34 Therefore, we believe that, in addition to S pneumoniae, C pneumoniae is also an important pathogen among the Japanese population, and we believe that diagnostic tests must be readily available for early recognition of C pneumoniae infections.

References

Ishida, T, Hashimoto, T, Arita, M, et al (1998) Etiology of community-acquired pneumonia in hospitalized patients: A 3-year prospective study in Japan.Chest114,1588-1593. [PubMed] [CrossRef]
 
Woodhead, M Community-acquired pneumonia guidelines: an international comparison.Chest1998;113(suppl),S183-S187
 
Liberman, D, Ben-Yaakov, M, Lazarovich, Z, et al Chlamydia pneumoniae: a review of community-acquired pneumonia of 62 hospitalized adult patients.Infection1996;24,109-114. [PubMed]
 
Kauppinen, MT, Saikku, P, Kujala, P, et al Clinical picture of community-acquiredChlamydia pneumoniaepneumonia requiring hospital treatment: a comparison between chlamydial and pneumococcal pneumonia.Thorax1996;51,185-189. [PubMed]
 
To the Editor:

We thank Dr. Miyashita and colleagues for their interest in our article (December 1998).1 In our study, screening for Chlamydia pneumoniae was chiefly conducted using enzyme-linked immunosorbent assay (ELISA). However, because it often takes several weeks to recognize the significant elevation of antibody titer, there may have been patients with conditions that could not be diagnosed using ELISA while hospitalized and who were not followed after discharge. It is therefore possible that the actual incidence of C pneumoniae pneumonia was slightly higher among all community-acquired pneumonia (CAP) cases. The incidence of C pneumoniae pneumonia may also have differed because of the year in which the survey was conducted.

We conducted a separate prospective multicenter study of the etiology of CAP at three hospitals in Japan2 and diagnosed C pneumoniae pneumonia in 7.9% of all cases. Statistics kept independently by our hospital over the past 5 years show that C pneumoniae pneumonia accounted for 33 (6.0%) of all 552 CAP cases, and was the fourth leading causative organism after Streptococcus pneumoniae, Haemophilus influenzae, and Mycoplasma pneumoniae. Of the 33 C pneumoniae pneumonia patients, 10 had dual infections involving another pathogenic organism. As also pointed out by Dr. Miyashita and colleagues, C pneumoniae appears to be an important cause of CAP in Japan as it is in Western countries. However, we often find difficulty in diagnosing C pneumoniae pneumonia, so the widespread availability of a simple and rapid diagnostic method is needed.

References
Ishida, T, Hashimoto, T, Arita, M, et al Etiology of community-acquired pneumonia in hospitalized patients: a 3-year prospective study in Japan.Chest1998;114,1588-1593. [PubMed] [CrossRef]
 
Ishida, T, Hashimoto, T, Arita, M, et al Multicenter screening ofChlamydia pneumoniaepneumonia by ELISA method (In Japanese).Kansenshogaku Zasshi1999;73,70-75. [PubMed]
 

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References

Ishida, T, Hashimoto, T, Arita, M, et al (1998) Etiology of community-acquired pneumonia in hospitalized patients: A 3-year prospective study in Japan.Chest114,1588-1593. [PubMed] [CrossRef]
 
Woodhead, M Community-acquired pneumonia guidelines: an international comparison.Chest1998;113(suppl),S183-S187
 
Liberman, D, Ben-Yaakov, M, Lazarovich, Z, et al Chlamydia pneumoniae: a review of community-acquired pneumonia of 62 hospitalized adult patients.Infection1996;24,109-114. [PubMed]
 
Kauppinen, MT, Saikku, P, Kujala, P, et al Clinical picture of community-acquiredChlamydia pneumoniaepneumonia requiring hospital treatment: a comparison between chlamydial and pneumococcal pneumonia.Thorax1996;51,185-189. [PubMed]
 
Ishida, T, Hashimoto, T, Arita, M, et al Etiology of community-acquired pneumonia in hospitalized patients: a 3-year prospective study in Japan.Chest1998;114,1588-1593. [PubMed] [CrossRef]
 
Ishida, T, Hashimoto, T, Arita, M, et al Multicenter screening ofChlamydia pneumoniaepneumonia by ELISA method (In Japanese).Kansenshogaku Zasshi1999;73,70-75. [PubMed]
 
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