Diagnostic Considerations

Some organisms acquired perinatally may not cause illness until later in infancy, including Chlamydophila pneumoniae,Ureaplasma urealyticum,Mycoplasma hominis, cytomegalovirus, and Pneumocystis jiroveci. Infants infected with these organisms present between age 4-11 weeks with an afebrile pneumonia characterized by a staccato cough, tachypnea, and, occasionally, hypoxia.

Infants with bacterial pneumonia often are febrile, but those with viral pneumonia or pneumonia caused by atypical organisms may have a low-grade fever or may be afebrile. The child's caretakers may complain that the child is wheezing or has noisy breathing.

Differential Diagnoses

Atypical Mycobacterial Infection
Chlamydia (Chlamydial Genitourinary Infections)
Congenital Pneumonia
Hypersensitivity Pneumonitis
Parainfluenza Virus Infections
Pediatric Cytomegalovirus Infection
Pediatric Mycoplasma Infections
Pediatric Pneumonia
Respiratory Syncytial Virus Infection
Rhinovirus Infection

Workup

Brewster DR, De Silva LM, Henry RL. Chlamydia trachomatis and respiratory disease in infants. Med J Aust. 1981 Oct 3. 2(7):328-30. [QxMD MEDLINE Link].
Wolf DG, Greenberg D, Shemer-Avni Y, Givon-Lavi N, Bar-Ziv J, Dagan R. Association of human metapneumovirus with radiologically diagnosed community-acquired alveolar pneumonia in young children. J Pediatr. 2010 Jan. 156(1):115-20. [QxMD MEDLINE Link].
Brasfield DM, Stagno S, Whitley RJ, et al. Infant pneumonitis associated with cytomegalovirus, Chlamydia, Pneumocystis, and Ureaplasma: follow-up. Pediatrics. 1987 Jan. 79(1):76-83. [QxMD MEDLINE Link].
Fasoli L, Paldanius M, Don M, et al. Simkania negevensis in community-acquired pneumonia in Italian children. Scand J Infect Dis. 2008. 40(3):269-72. [QxMD MEDLINE Link].
Camlar SA, Babayigit A, Olmez D, Duman M, Makay B, Anal O, et al. Chlamydia pneumonia mimicking miliary tuberculosis. Pediatr Emerg Care. 2009 Sep. 25(9):597-8. [QxMD MEDLINE Link].
Chen CJ, Wu KG, Tang RB, Yuan HC, Soong WJ, Hwang BT. Characteristics of Chlamydia trachomatis infection in hospitalized infants with lower respiratory tract infection. J Microbiol Immunol Infect. 2007 Jun. 40(3):255-9. [QxMD MEDLINE Link].
Beem MO, Saxon E, Tipple MA. Treatment of chlamydial pneumonia of infancy. Pediatrics. 1979 Feb. 63(2):198-203. [QxMD MEDLINE Link].
Radkowski MA, Kranzler JK, Beem MO, et al. Chlamydia pneumonia in infants: radiography in 125 cases. AJR Am J Roentgenol. 1981 Oct. 137(4):703-6. [QxMD MEDLINE Link].
Pientong C, Ekalaksananan T, Teeratakulpisarn J, Tanuwattanachai S, Kongyingyoes B, Limwattananon C. Atypical bacterial pathogen infection in children with acute bronchiolitis in northeast Thailand. J Microbiol Immunol Infect. 2011 Apr. 44(2):95-100. [QxMD MEDLINE Link].
Lienard J, Croxatto A, Aeby S, Jaton K, Posfay-Barbe K, Gervaix A, et al. Development of a new chlamydiales-specific real-time PCR and its application to respiratory clinical samples. J Clin Microbiol. 2011 Jul. 49(7):2637-42. [QxMD MEDLINE Link]. [Full Text].
Robinson JL, Meier K, Lee BE, Larke B. Could urine be useful for the diagnosis of Chlamydia trachomatis pneumonia in infancy?. Diagn Microbiol Infect Dis. 2014 Jul. 79 (3):308-9. [QxMD MEDLINE Link].
Liu Z, Zhang P, Tang S, He X, Zhang R, Wang X, et al. Urine real-time polymerase chain reaction detection for children virus pneumonia with acute human cytomegalovirus infection. BMC Infect Dis. 2014 May 8. 14:245. [QxMD MEDLINE Link]. [Full Text].
Geis T, Schilling S, Segerer H. [A Young Infant with Afebrile Pneumonia Caused by Chlamydia Trachomatis]. Klin Padiatr. 2006 Aug 3. [QxMD MEDLINE Link].
Abzug MJ, Beam AC, Gyorkos EA, Levin MJ. Viral pneumonia in the first month of life. Pediatr Infect Dis J. 1990 Dec. 9(12):881-5. [QxMD MEDLINE Link].
FDA Approves Roche (RHHBY)'s Valcyte(R) to Prevent Cytomegalovirus Disease in Pediatric Patients Who Receive Heart or Kidney Transplants. Available at http://www.biospace.com/news_story.aspx?NewsEntityId=154407. Accessed: November 12, 2010.

Media Gallery

of 0

Author

Dagnachew (Dagne) Assefa, MD, FAAP, FCCP Pediatric Pulmonologist, Sleep Physican

Dagnachew (Dagne) Assefa, MD, FAAP, FCCP is a member of the following medical societies: American Academy of Pediatrics, American Academy of Sleep Medicine, American College of Chest Physicians, American Thoracic Society, European Respiratory Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Girish D Sharma, MD, FCCP, FAAP Professor of Pediatrics, Rush Medical College; Director, Section of Pediatric Pulmonology and Rush Cystic Fibrosis Center, Rush Children's Hospital, Rush University Medical Center

Girish D Sharma, MD, FCCP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, Royal College of Physicians of Ireland

Disclosure: Nothing to disclose.

Additional Contributors

Susanna A McColley, MD Professor of Pediatrics, Northwestern University, The Feinberg School of Medicine; Director of Cystic Fibrosis Center, Head, Division of Pulmonary Medicine, Children's Memorial Medical Center of Chicago

Susanna A McColley, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Sleep Disorders Association, American Thoracic Society

Disclosure: Received honoraria from Genentech for speaking and teaching; Received honoraria from Genentech for consulting; Partner received consulting fee from Boston Scientific for consulting; Received honoraria from Gilead for speaking and teaching; Received consulting fee from Caremark for consulting; Received honoraria from Vertex Pharmaceuticals for speaking and teaching.

Acknowledgements

Heidi Connolly, MD Associate Professor of Pediatrics and Psychiatry, University of Rochester School of Medicine and Dentistry; Director, Pediatric Sleep Medicine Services, Strong Sleep Disorders Center

Heidi Connolly, MD is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Judith R Grisi, PA-C Physician Assistant, Monmouth Ocean Pulmonary Medicine, CentraState Medical Center

Disclosure: Nothing to disclose.