Chlamydial pneumonia – the infectious and inflammatory process in lungs caused by obligate intracellular bacteria of the sort Chlamydia and Chlamydophila. Respiratory manifestations (rhinitis, trakheobronkhit), unproductive cough, subfebrilny and febrilny temperature, extra pulmonary symptoms (an artralgiya, a mialgiya) are characteristic of chlamydial pneumonia. At diagnosis auskultativny and radiological data are considered, however the crucial role belongs to laboratory diagnostics (IFA, MIF, PTsR, etc.). Antimicrobic means (macroleads, tetratsiklina, ftorkhinolona), immunomodulators, physiotherapy are applied to therapy of chlamydial pneumonia.
Chlamydial pneumonia – the etiologichesky kind of atypical pneumonia arising at infection of airways with different types of hlamidiya - Ch. pneumoniae, Ch. psittaci and Ch. trachomatis. It is considered that annually among extra hospital pneumonia from 5 to 15% of cases are caused by hlamidiya; during epidemic flashes this indicator can make 25%. Most often adults get sick, cases of chlamydial pneumonia at newborns are connected with infection from mothers sick with urogenital clamidiosis. The asymptomatic carriage of hlamidiya in a nasopharynx is defined more than at a half of adults and 5-7% of children therefore the probability of transmission of infection with respiratory secrets is very high. The intra family outbreaks of chlamydial pneumonia, and also cases of mass incidence in the isolated collectives are described.
Reasons of chlamydial pneumonia
From all variety of representatives of the Chlamydiaceae family in the etiologichesky relation three types of hlamidiya are of practical interest to pulmonology: Chlamydophila pneumoniae, Chlamydia trachomatis and Chlamydophila psittaci. As the most frequent causative agent of respiratory clamidioses (including chlamydial pharyngitis, sinusitis, bronchitis, pneumonia) at patients of all age serves Ch. pneumoniae. With Ch. trachomatis is connected incidence of trachoma, urinogenital clamidiosis, venereal limfogranulemy, and also chlamydial pneumonia among newborns and babies up to 6 months. Also pneumonia at immunokomprometirovanny persons and the staff of laboratories is associated with this type of hlamidiya. Ch. psittaci is considered as the causative agent of ornithosis (ornithosis) which is often proceeding in the form of heavy interstitsialny pneumonia.
Ways of infection with each kind of hlamidiya differ, however all types can extend in the hematogenic way. Ch broadcast. pneumoniae from the person to the person is carried out mainly airborne and contact and household in the ways. Infection with Ch strain. psittaci occurs in the air and dust or fecal and oral way at inhalation of dust or the use of the food containing biological secrets of birds carriers of an infection (parrots, canaries, hens, ducks, pigeons, sparrows, etc.). Infection of newborns of Ch. trachomatis happens in the course of childbirth from mothers to an urogenital chlamydial infection. At intranatalny infection 15-25% of babies have chlamydial nazofaringit also conjunctivitis which often are complicated by pneumonia.
All hlamidiya are the obligate gramotritsatelny microorganisms parasitizing in cells of the owner. In a macroorganism of a hlamidiya can exist in an infectious form (elementary little bodies) and a vegetative form (retikulyarny little bodies). Elementary little bodies get in a cage by stimulation of an endotsitoz where will be transformed to retikulyarny little bodies. The last have high metabolic activity and ability to intracellular binary division. The cycle of reproduction lasts about 48 hours then retikulyarny little bodies turn into elementary again, there is a rupture of a cell membrane of the owner to an exit of elementary little bodies of new generation on extracellular Wednesday. Further the cycle of infection of new cages is repeated.
Symptoms of chlamydial pneumonia
The pneumonia caused by Chlamydophila pneumoniae
The chlamydial pneumonia caused by Ch. to pneumoniae, a thicket children and young people aged from 5 up to 35 years are ill. Among the reasons of extra hospital pneumonia concede in this age group of a hlamidiya only Mycoplasma pneumoniae.
Onset of the illness sharp or gradual. In the first case symptoms of intoxication and damage of airways reach the maximum expressiveness for the 3rd days. At a subsharp current chlamydial pneumonia demonstrates from a respiratory syndrome (rhinitis, a nazofaringit, laryngitis), a poznablivaniye, a subfebriliteta in this connection in the first week of a disease ORZ is mistakenly diagnosed for patients. Mainly, patients are disturbed by a nose congestion, violation of nasal breath, moderate mucous allocations from a nose, a voice osiplost.
Actually pneumonia can develop in terms from 1 to 4 weeks after emergence of respiratory symptoms. Body temperature increases to 38-39 °C, weakness increases, the mialgiya, a headache disturbs. In all cases along with fever dry or damp pristupoobrazny cough, breast pain develops. Course of chlamydial pneumonia long; painful cough and an indisposition can remain up to several months. From complications otitises, sinusitis, jet arthritises are most frequent.
The pneumonia caused by Chlamydia trachomatis
Beginning often gradual; at children of chlamydial pneumonia conjunctivitis, sharp average otitis or bronchitis of the same etiology quite often precedes. Dry cough which, amplifying, gains pristupoobrazny character becomes an early sign. Against the background of kashlevy attacks at the child arises , cyanosis and vomiting, however reprises are absent. Aggravation of short wind is gradually noted, increase in ChD till 50-70 in a minute, breath becomes groaning. At the same time, the general state usually remains satisfactory, symptoms of intoxication and respiratory insufficiency are expressed poorly.
The Auskultativny and radiological picture of bilateral chlamydial pneumonia is developed by the outcome of the first – at the beginning of the second week. At the height of a disease symptoms of an enterokolit, a gepatosplenomegaliya can appear. Recovery often drags on for many weeks and months. At severe forms of chlamydial pneumonia there can be pheumothorax, pleurisy, an abstsedirovaniye. From extra pulmonary complications myocardites, endocarditises, meningoentsefalita meet. The children who had the chlamydial pneumonia caused by Ch. trachomatis, in further have bronchial asthma and other chronic obstructive diseases of lungs more often.
Pneumonia, the caused Chlamydophila psittaci (Ornithosis)
Options of a clinical course of ornithosis are various – from asymptomatic to heavy. The body temperature which is followed by oznoba and the most severe intoxication (sharp weakness, a headache, artralgiya, mialgiya) acts as the brightest symptom high (to 39,5-40 °C and above). For lack of other symptoms this state is quite often regarded as fever of not clear genesis.
Further more than in half of cases there is unproductive cough, breast pain, increase in a liver and spleen. As the characteristic signs indicating a chlamydial etiology of pneumonia serve symptoms of neurotoxicosis, spotty rash on skin, nasal bleedings. Often there are disorders of digestion: nausea, vomiting, abdominal pains, ponosa or locks.
Kliniko-rentgenologichesky changes can remain within 4-6 weeks. Hepatitis, the DVS-syndrome, venous thromboses, hemolytic anemia, polyneuropathies, myocarditis act as typical complications of ornithosis.
Diagnosis of chlamydial pneumonia
Difficulties at establishment of the etiologichesky diagnosis are connected with the fact that unlike bacterial pneumonia, at chlamydial pneumonia there are no distinct fizikalny and radiological signs, and also characteristic changes in peripheral blood. In these conditions therapists and pulmonologists should be guided, mainly, by indications of the anamnesis, feature of a clinical picture and to confirm the suspicions with laboratory methods (IFA, PTsR, etc.).
Auskultativny data are variable: breath can be rigid, bronchial or weakened vesicular; rattles at the height of a disease are more often damp or krepitiruyushchy. The Perkutorny sound is usually dulled. At a X-ray analysis of lungs focal, segmentary or share infiltration or interstitsialny changes comes to light.
Laboratory methods are applied to confirmation of chlamydial pneumonia. The most specific and sensitive of them is the cultural method allocation of the activator, however because of duration and labor input of diagnostics in practice are usually limited to a serotipirovaniye. As the standard of detection of chlamydial pneumonia serve IFA and MYTH (reaction of a microimmunofluorescence) today. When carrying out IFA will point out increase in a caption of specific IGM, IgG and IGA more than 1:16 activity of a chlamydial infection, 1:512 and 1:256 respectively; The MYTH - increase in a caption of IgG/IgA in pair serums of blood in 4 and more times. The PTsR-analysis allows to identifitsirvoat quickly and unmistakably activator DNA, however does not allow to distinguish a persistiruyushchy infection from active.
Treatment and forecast of chlamydial pneumonia
Complexity of effective treatment of chlamydial pneumonia is accompanied by the fact that hlamidiya are present at an organism at the same time as in extracellular, and intracellular forms therefore it is necessary to influence both of these links. Besides, activization of an infection, as a rule, happens against the background of immunity oppression that also demands correction of the immune answer.
Antimicrobic medicines from groups of macroleads, ftorkhinolon and tetratsiklin are recognized as cure of eradikatsionny therapy for chlamydial pneumonia. Macroleads since they can be applied to therapy of newborns, children and pregnant women are most preferable among them. From medicines of this group have the greatest activity concerning hlamidiya , , erythromycin, . Also successfully cope with a chlamydial infection of a ftorkhinolona (ciprofloxacin, , ) and tetratsiklina (doxycycline, ), however reception of the last is excluded at pregnancy and a liver failure. Duration of a course of antimicrobic treatment of chlamydial pneumonia makes not less than 2-3 weeks.
For the purpose of correction of immunological frustration, and also preventions of a recurrence of an infection, besides antimicrobic means, are appointed immunomodulators, vitamins, a probiotics. In the period of a convalescence much attention is paid to physical therapy, respiratory gymnastics.
At patients of young age with absence of the accompanying pathology chlamydial pneumonia usually terminates in recovery. Among elderly lethal outcomes arise in 6-10% of cases. Observations of experts indicate a possible etiologichesky role of Ch. pneumoniae in development of atherosclerosis, a sarkoidoz of lungs, an ischemic stroke, Alzheimer's disease therefore the postponed chlamydial pneumonia can have far-reaching consequences. It is proved negative influence of respiratory clamidiosis on the course of bronchial asthma and frequency of its aggravations definitively.