Asner, Sandra A.

Greub, Gilbert

Jaton, Katia

Kyprianidou, Sofiaanna

Nowak, Anna-Maria Libudzic

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Chlamydia pneumoniae:Possible Association WithAsthma in ChildrenChlamydia pneumoniae has been recog-nized as a common cause of communi-ty-acquired pneumonia (CAP) andother acute respiratory infections (ARIs)in various age groups [1]. Lately, the prev-alence of Chlamydia-associated ARIs hasdecreased to <1.5% [2], as a result ofchanges in epidemiology of C. pneumo-niae and increased speciﬁcity of new di-agnostic molecular methods. Moreover,C. pneumoniae infection may remain un-detected as clinicians may not screen theinfected population. Indeed, Chlamydiapneumoniae has been recently identiﬁedas an agent of asthma exacerbationand has been associated with its severity[3–5], thus reinforcing the importanceof targeting these patients. In Lausanne,using a duplex real-time polymerasechain reaction (PCR) that detects C.pneumoniae and Mycoplasma pneumo-niae DNA [6], we reported a 0.13% prev-alence of C. pneumoniae–positive PCRs(2/1583) and identiﬁed 1 patient with C.pneumoniae–associated asthma, who re-covered with antibiotics [7]. Below, we re-port a case series of C. pneumoniaerespiratory infections in children.From 10 September to 5 December 2013,C. pneumoniae was detected in upper re-spiratory tract specimens from 8 children(Table 1). Of these, 5 were admitted foreither acute asthma exacerbation or asth-matic bronchitis. All but 2 patients present-ed with chronic cough without fever orsystemic symptoms. These two patients,one with CAP who was coinfected withM. pneumoniae (patient 7) and the otherone with severe asthma exacerbation whowas coinfected with rhinovirus (patient 8),were admitted for severe respiratory distressin the intensive care unit, intubated, andmechanically ventilated. Both patientswith severe clinical presentation were con-ﬁrmed asthmatics. All patients weresuccessfully treated with a macrolide. In-terestingly, C. pneumoniae infection wasdetected by chance in 7 patients as a resultof the dual format of our PCR, because aM. pneumoniae PCR was requested.In conclusion, this report supports therole of C. pneumoniae in asthma exacerba-tion. Whether C. pneumoniae-associatedasthma may be cured with antibiotics orwill also require steroids remains unknownand may vary from patient to patient. Thiscase series underlines the importance ofscreening asthmatic children for C. pneu-moniae. Moreover, our ﬁndings suggestthat C. pneumoniae prevalence is likely un-derestimated and children with chroniccough, even in absence of fever, shouldbe tested for C. pneumoniae.NotePotential conﬂicts of interest. All authors:No reported conﬂicts.All authors have submitted the ICMJE Formfor Disclosure of Potential Conﬂicts of Interest.Conﬂicts that the editors consider relevantto the content of the manuscript have beendisclosed.Sandra A. Asner,1,2 Katia Jaton,3Soﬁaanna Kyprianidou,1Anna-Maria Libudzic Nowak,1 andGilbert Greub2,31Unit of Pediatric Infectious Diseases and Vaccinology,Department of Paediatrics, University Hospital Center;2Service of Infectious Diseases, Department of InternalTable 1. Baseline Characteristics of Children Identiﬁed With C. pneumoniaePatientAge,y SexAsthmaticConditionCoughDuration Fever ICUa SampleCopies/mL Coinfection TreatmentTreatmentDuration1b 7 F Asthma Chronic Yes No Throat 1 743 796 No Clarithromycin 14 d2 7 M Asthma Chronic Yes No Nasal 197 000 No Clarithromycin 10 d3b 7 M None Chronic No No Throat 3100 No Clarithromycin 10 d4 6 M None Chronic No No Nasal 60 No Azithromycin 5 d5b 8 M AsthmaticbronchitisChronic No No NP 78 000 No Clarithromycin 7 d6b 12 F None Chronic No No NP 61 000 No Clarithromycin 7 d7 7 F Asthma Acute Yes Yes NP 170 Mycoplasmapneumoniae(570 copies/mL)Clarithromycin 14 d8 10 M Asthma Acute Yes Yes NP 208 Rhinovirus(13 071 000copies/mL)Erythromycin 14 dAbbreviations: ICU, intensive care unit admission; NP, nasopharyngeal.a Patient 7 was admitted to the ICU for community-acquired pneumonia; patient 8, for a severe asthma exacerbation.b Patient originated from the same eastern region of Vaud canton (nearby Yverdon).1198 • CID 2014:58 (15 April) • CORRESPONDENCEMedicine, University Hospital Center; and 3Institute ofMicrobiology, Department of Laboratory, Universityof Lausanne and University Hospital Center,SwitzerlandReferences1. Grayston JT, Campbell LA, Kuo CC, et al. Anew respiratory tract pathogen: Chlamydiapneumoniae strain TWAR. J Infect Dis 1990;161:618–25.2. Kumar S, Hammerschlag MR. Acute respira-tory infection due to Chlamydia pneumoniae:current status of diagnostic methods. Clin In-fect Dis 2007; 44:568–76.3. Hahn DL, Schure A, Patel K, Childs T, Drizik E,Webley W. Chlamydia pneumoniae-speciﬁcIgE is prevalent in asthma and is associatedwith disease severity. PLoS One 2012; 7:e35945.4. Hahn DL, Peeling RW. Airﬂow limitation,asthma, and Chlamydia pneumoniae-speciﬁcheat shock protein 60. Ann Allergy AsthmaImmunol 2008; 101:614–8.5. Hahn DL, Peeling RW, Dillon E, McDonald R,Saikku P. Serologic markers for Chlamydiapneumoniae in asthma. Ann Allergy AsthmaImmunol 2000; 84:227–33.6. Welti M, Jaton K, Altwegg M, Sahli R, WengerA, Bille J. Development of a multiplex real-time quantitative PCR assay to detect Chla-mydia pneumoniae, Legionella pneumophilaand Mycoplasma pneumoniae in respiratorytract secretions. Diagn Microbiol Infect Dis2003; 45:85–95.7. Senn L, Jaton K, Fitting JW, Greub G. Doesrespiratory infection due to Chlamydia pneu-moniae still exist? Clin Infect Dis 2011; 53:847–8.Correspondence: Gilbert Greub, MD, PhD, Institute of Microbi-ology, Department of Laboratory, Rue du Bugnon 48, 1011 Lau-sanne (Vaud), Switzerland (gilbert.greub@chuv.ch).Clinical Infectious Diseases 2014;58(8):1198–9© The Author 2014. Published by Oxford University Presson behalf of the Infectious Diseases Society of America. Allrights reserved. For Permissions, please e-mail: journals.permissions@oup.com.DOI: 10.1093/cid/ciu034CORRESPONDENCE • CID 2014:58 (15 April) • 1199

Chlamydia pneumoniae: Possible Association With Asthma in Children

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