eMedicine Specialties > Pulmonology > Infectious Lung Diseases

Chlamydial Pneumonias: Follow-up

Author: Yuji Oba, MD, FCCP, Associate Professor of Clinical Medicine, Division of Pulmonary, Critical Care, and Environmental Medicine, University of Missouri Health Care
Coauthor(s): Vamsi P Guntur, MD, MSc, Assistant Professor of Clinical Medicine, Division of Pulmonary, Critical Care and Environmental Medicine, University of Missouri
Contributor Information and Disclosures

Updated: Oct 15, 2008

Follow-up

Further Inpatient Care

  • C psittaci: Valve replacement and prolonged antibiotic treatment may be necessary for patients with endocarditis.
  • C pneumoniae: Treat mixed infections with other organisms (eg, pneumococci, mycoplasmata, legionellae) when present. The frequency of mixed infection can be as high as 60%.2

Further Outpatient Care

  • C psittaci: A full recovery usually takes 6-8 weeks, and relapse may occur.
  • C pneumoniae: Treatment failure may occur more often with erythromycin.16 Re-treatment is often successful, especially with tetracyclines. Complete recovery is slow. Cough and malaise may persist for weeks to months despite appropriate treatment.
  • C trachomatis: A higher-than-normal incidence of obstructive airway disease or asthma occurs in children who had chlamydial pneumonia before age 6 months.

Transfer

  • Severely ill hypoxemic patients require ventilatory support in an ICU.

Deterrence/Prevention

  • C psittaci
    • Avoid dust from bird feathers and cage contents. Do not handle sick birds.
    • Imported psittacine birds must be treated for 45 days with a balanced feed containing chlortetracycline with 0.7% calcium.
    • Refer infected birds or suspected sources to veterinarians.
    • Past infection with C psittaci does not confer immunity to the disease.
  • C pneumoniae: The incidence of infection among military recruits during basic training is high, and weekly azithromycin prophylaxis was 58% effective in preventing the disease in this setting.
  • C trachomatis
    • Evaluate mothers of infected children and their sexual partners, and treat them appropriately.
    • Repeated parental screening may be warranted in high-risk populations.

Complications

  • C psittaci: Complications include endocarditis, thrombophlebitis, myocarditis, thyroiditis, pancreatitis, hepatitis, renal failure, disseminated intravascular coagulation, and fetal death in infected pregnant women.
  • C pneumoniae
    • Complications include otitis, erythema nodosum, exacerbations of asthma, endocarditis, Guillain-Barré syndrome, and encephalitis.
    • New-onset asthma has been observed after C pneumoniae infection.
    • While some studies clearly associate C pneumoniae organisms with atheromatous plaques or sarcoidosis, the role of C pneumoniae in the pathogenesis of these syndromes remains to be established. Antibiotic trials for coronary artery disease are not supportive of their role.17
  • C trachomatis: Complications include neonatal inclusion conjunctivitis, meningoencephalitis, myocarditis, and endocarditis.

Prognosis

  • C psittaci infection is usually curable in 7-14 days with early diagnosis and treatment.
  • Most cases of infection with C pneumoniae are mild and usually respond to treatment in an outpatient setting. Patients with underlying disease or with concurrent infection (eg, pneumococcal bacteremia) can develop severe illness.
  • Most patients with C trachomatis infection are moderately ill and respond to appropriate antibiotics. The clinical course may be protracted if untreated.

Patient Education

  • C psittaci: Educate patients about transmission of the disease. Suspected birds should be isolated until a veterinarian can examine them.
  • C pneumoniae: Educate patients about the possible protracted course of illness and about the need for re-treatment if symptoms recur or worsen.
  • C trachomatis: Educate the parents of infected children about sexually transmitted diseases and safe sex. Screening of high-risk populations for asymptomatic infections and partner notification and treatment are also important.
  • For excellent patient education resources, visit eMedicine's Sexually Transmitted Diseases Center. Also, see eMedicine's patient education article Chlamydia.

Miscellaneous

Medicolegal Pitfalls

  • C psittaci
    • Failure to consider the diagnosis in patients with community-acquired pneumonia, especially those with bird exposure or fever of unknown origin, who are not responding to treatment
    • Failure to report cases to an appropriate health authority
    • Failure to investigate the possible source of infection
    • Failure to ask a veterinarian for evaluation and treatment of birds that are suspected sources of human infection
  • C pneumoniae - Failure to consider the diagnosis in patients with bronchitis or community-acquired pneumonia and failure to treat with an appropriate antibiotic
  • C trachomatis - Failure to evaluate mothers of infected infants and their sexual partners and treat them appropriately

Special Concerns

  • Pregnancy: Avoid tetracyclines.
  • Pediatric patients
    • Avoid tetracyclines in children younger than 9 years.
    • In younger children, C trachomatis infection can be acquired through sexual abuse.
  • Geriatric patients: Infection with C pneumoniae or C psittaci can be fatal, especially in elderly patients with an underlying disease.
 
Acknowledgments

The primary author thanks Dr. Makoto Aoki for his valuable comments on an earlier version of this article.



More on Chlamydial Pneumonias

Overview: Chlamydial Pneumonias
Differential Diagnoses & Workup: Chlamydial Pneumonias
Treatment & Medication: Chlamydial Pneumonias
Follow-up: Chlamydial Pneumonias
References
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References

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Further Reading

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Keywords

chlamydial pneumonia, psittacosis , ornithosis, Chlamydophila pneumoniae, Chlamydia pneumoniae, C pneumoniae, Chlamydophila psittaci, Chlamydia psittaci, C psittaci, Chlamydophila trachomatis, Chlamydia trachomatis, C trachomatis, Chlamydophila pneumoniae pneumonia, Chlamydophila trachomatis pneumonia, Taiwan acute respiratory pneumonia, TWAR pneumonia, parrot fever, avian chlamydiosis

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Contributor Information and Disclosures

Author

Yuji Oba, MD, FCCP, Associate Professor of Clinical Medicine, Division of Pulmonary, Critical Care, and Environmental Medicine, University of Missouri Health Care
Yuji Oba, MD, FCCP is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Nothing to disclose.

Coauthor(s)

Vamsi P Guntur, MD, MSc, Assistant Professor of Clinical Medicine, Division of Pulmonary, Critical Care and Environmental Medicine, University of Missouri
Vamsi P Guntur, MD, MSc is a member of the following medical societies: American Association for Cancer Research, American College of Chest Physicians, American College of Physicians, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Helen M Hollingsworth, MD, Director, Adult Asthma and Allergy Services, Associate Professor, Department of Internal Medicine, Division of Pulmonary and Critical Care, Boston Medical Center
Helen M Hollingsworth, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American Thoracic Society, and Massachusetts Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H, Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine
Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine
Disclosure: Keck School of Medicine, USC None None

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Zab Mosenifar, MD, Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center; Professor of Medicine, David Geffen School of Medicine at UCLA
Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society
Disclosure: Nothing to disclose.

 
 
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