Clinical presentations of Chlamydia pneumoniae in children hospitalized for acute respiratory infections: a comparison to Mycoplasma pneumonia

Jae Jin Sung; Eun Jin Kim; Yong Han Sun; In Sang Jeon; Hann Tchah; Eell Ryoo; Dong Woo Son; Hye Kyung Cho; Hye Jung Cho; Na Yeon Kim

doi:10.4168/aard.2015.3.5.346

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Sung, Kim, Sun, Jeon, Tchah, Ryoo, Son, Cho, Cho, and Kim: Clinical presentations of Chlamydia pneumoniae in children hospitalized for acute respiratory infections: a comparison to Mycoplasma pneumonia

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(5): 346-351.

Published online: 30 September 2015

DOI: https://doi.org/10.4168/aard.2015.3.5.346

Clinical presentations of Chlamydia pneumoniae in children hospitalized for acute respiratory infections: a comparison to Mycoplasma pneumonia

Jae Jin Sung, Eun Jin Kim, Yong Han Sun

, In Sang Jeon, Hann Tchah, Eell Ryoo, Dong Woo Son, Hye Kyung Cho, Hye Jung Cho, Na Yeon Kim

Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.

Correspondence to: Yong Han Sun. Department of Pediatrics, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel: +82-32-460-2689, Fax: +82-32-460-3224, chdsyh@gilhospital.com

Received 27 May 2015 Revised 27 July 2015 Accepted 6 August 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

Chlamydia pneumoniae is a common intracellular bacterial pathogen and plays an important role in acute respiratory infections. The purpose of this study was to investigate clinical presentations of C. pneumoniae in children with acute respiratory infections.

Methods

We examined the medical records of pediatric patients (age<18 years) admitted with acute respiratory infections of C. pneumoniae to Gachon University Gil Medical Center between March 1, 2011 and August 31, 2014. We compared the clinical features of C. pneumoniae infection with that of Mycoplasma pneumoniae infection.

Results

We confirmed acute respiratory infections of C. pneumoniae in 110 patients out of 2,156 patients (5.1%) admitted with acute respiratory infections. The mean age was 37.2±30.1 months. More than half of them (54.5%) had coinfection. C. pneumoniae infection had mild and subacute courses. The mean duration of symptoms prior to admission was 8.5±13.8 days. There were remarkable seasonal variations and prevalence was higher in December and April (P=0.03 and P=0.02, respectively). Although rhinorrhea and pharyngeal injection were more common in C. pneumoniae infection (P<0.05), clinical signs and symptoms were similar between C. pneumoniae and M. pneumoniae. Extrapulmonary manifestations such as skin lesion, Gastrointestinal symptoms, hepatitis, and neurologic symptoms were common (41.0%) in C. pneumoniae infection and, had similar incidence in M. pneumoniae infection.

Conclusion

C. pneumoniae is an important infectious agent of acute respiratory infections in children. Clinical pictures of C. pneumoniae are similar to M. pneumoniae, even in extrapulmonary manifestations. C. pneumoniae should be taken into consideration in differential diagnosis of acute respiratory infection in children.

Keywords: Chlamydia pneumoniae, Respiratory infections, Mycoplasma pneumoniae

Figures and Tables

Fig. 1

Frequencies of infections caused by Chlamydia pneumoniae among children hospitalized in individual months of the year.

Table 1

Demographics of pediatric patients hospitalized with Chlamydia pneumoniae and Mycoplasma pneumoniae infections

Variable	C. pneumoniae (n = 50)	M.pneumoniae (n = 94)	P-value
Male sex	22 (44.0)	46 (48.9)	0.572
Age (mo)	24 (17.8-55.5)	50 (37.8-69.3)	0.000
Underlying disease	9 (18.0)	15 (16.0)	0.938
Obesity^*	2 (4.0)	8 (8.5)	0.494
Asthma	1 (2.0)	4 (6.4)	0.659
Preterm baby^†	4 (8.0)	2 (2.1)	0.183
Neurologic disease^‡	1 (2.0)	1 (1.1)	1.000
Congential heart disease	1 (2.0)	0 (0.0)	0.347
Allergic rhinitis	2 (4.0)	4 (4.3)	0.942

Values are presented as number (%) or median (interquartile range).

^*Obesity is defined as >95th percentile body mass index (kg/m²) for age in patients 2 years of age or over. ^†Preterm is defined as <37 weeks. ^‡Neurologic disease included seizure disorder, cerebral palsy, mental retardation.

Table 2

Clinical characteristics of hospitalized pediatric patients with Chlamydia pneumoniae and Mycoplasma pneumoniae infections

Variable	C. pneumoniae (n = 50)	M.pneumoniae (n = 94)	P-value
Fever	45 (90.0)	83 (88.3)	0.975
Cough	47 (94.0)	93 (98.9)	0.236
Rhinorrhea	38 (76.0)	44 (46.8)	0.001
Sputum	30 (60.0)	53 (56.4)	0.810
Vomiting	4 (8.0)	9 (9.6)	0.993
Diarrhea	0 (0)	6 (6.4)	0.166
Pharyngeal injection	30 (60.0)	37 (39.4)	0.029
Chest retraction	2 (4.0)	2 (2.2)	0.375
Wheezing	4 (8.0)	11 (11.7)	0.685
Crackle	23 (46.0)	52 (55.3)	0.373

Values are presented as number (%).

Table 3

Clinical courses of hospitalized pediatric patients with Chlamydia pneumoniae and Mycoplasma pneumoniae infections

Variable	C. pneumoniae (n = 50)	M.pneumoniae (n = 94)	P-value
Total fever duration (day)	3.7 ± 2.3	5.2 ± 3.2	0.019
Fever duration after admission (day)	1.7 ± 1.3	2.6 ± 2.0	0.007
Duration of symptom before admission (day)	4 (2.0-7.8)	7 (4.8-7.0)	0.011
Duration of hospitalization (day)	5.8 ± 2.2	6.0 ± 2.2	0.989
X-ray confirmed pneumonia	34 (68)	77 (81.9)	0.092
Bronchopneumonia	27 (54.0)	47 (50.0)	0.648
Lobar pneumonia	7 (14.0)	24 (25.5)	0.116
Parapneumonic effusion	0 (0)	6 (6.4)	0.167

Values are presented as mean±standard deviation, median (interquartile range), or number (%).

Table 4

Laboratory findings of hospitalized pediatric patients with Chlamydia pneumoniae and Mycoplasma pneumoniae infections

Variable	C. pneumoniae (n = 50)	M.pneumoniae (n = 94)	P-value
WBC ( × 10³ cells/µL)	12.5 ± 6.2	10 ± 4.2	0.006
Neutrophil (%)	48.2 ± 16.9	55.6 ± 14.8	0.013
Lymphocyte (%)	39.1 ± 15.8	33.4 ± 13.3	0.037
Platelet ( × 10³ cells/µL)	331 ± 158.5	319.6 ± 95.9	0.572
CRP (mg/dL)	2.3 ± 2.6	2.7 ± 3.7	0.496

Values are presented as mean±standard deviation.

WBC, white blood cell; CRP, C-reactive protein.

Table 5

Extrapulmonary manifestations of hospitalized pediatric patients with Chlamydia pneumoniae and Mycoplasma pneumoniae infections

Variable	C. pneumoniae (n = 50)	M.pneumoniae (n = 94)	P-value
Total	21 (42.0)	37 (39.4)	0.898
Hepatitis^*	11 (22.0)	16 (17.0)	0.448
Skin lesion	8 (16.0)	13 (13.8)	0.614
GI abnormality^†	4 (8.0)	13 (13.8)	0.918
Neurologic abnormality^‡	1 (2.0)	2 (2.1)	1.000

Values are presented as number (%).

^*Hepatitis included aspartate aminotransferase or alanine aminotransferase elevated above 40 U/L. ^†Gastrointestinal (GI) abnormality included vomting or diarrhea. ^‡Neurologic abnormality included seizure or headache.

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ORCID iDs: Yong Han Sun
https://orcid.org/http://orcid.org/0000-0003-1527-6782
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