PURPOSE:Cpn is the second most commonly diagnosed atypical pathogen in the United States. We report several cases of chronic cough, lasting more than 8 weeks, that were resistant to all prior therapy, but were improved after being diagnosed with Cpn, and treated with a regimen of antibiotics and symptomatic drug therapy.
METHODS:Between November, 2006 and May 2008 (18 months), 195 patients were evaluated at The Cough Center having chronic cough. Twenty two patients (11.3%) were diagnosed as having had Cpn with at least a four fold increase in IgG levels, as determined by microimmunofluorescence antibody assay, (Focus Diagnostics, Inc., Cypress, CA). Gender incidence was identical (11 male, 11 female). Cough, prior to evaluation, persisted between 2 and 18 months. Nineteen patients (86%) had severe rhinitis, 7 of whom had sinusitis documented on CT exam. Nineteen patients (86%) on history and/or exam, revealed bronchospasm, with only 7 of whom having an FEV1, less than 80% predicted. Fifteen of the patients (68%) experienced severe fatigue. Only 4 patients had pneumonia, documented by chest x-ray. Nine patients (41%) gave an allergic history. On serologic evaluations, 8 patients had IgG titers > 1:1024, 6 patients > 1:512, 7 patients > 1:256, and 1 patient > 1:128. Eight patients also had elevated IgA levels and none had elevated IgM levels.
RESULTS:Antibiotic treatment consisted of either Doxycycline or Clarithromycin, and occasional combination with Flagyl. The duration, until successful treatment resulted, was between 4 and 12 weeks. Treatment success was demonstrated by a statistically significant improvement in the Leicester Quality of Life scale, and at least a 90% reduction in cough episode frequency. All 22 patients were determined to be successfully treated by the above criteria.
CONCLUSION:Cpn appears to be a more common cause of chronic cough than previously appreciated. Delays in diagnosis, difficulties in treatment modalities and multi-system inflammatory sequelae all can contribute to the chronicity of the cough.
CLINICAL IMPLICATIONS:Recognition of Cpn as a cause of chronic cough.
DISCLOSURE:Brian Levine, No Financial Disclosure Information; No Product/Research Disclosure Information