Fitting, Jean-William

Greub, Gilbert

Jaton, Katia

Senn, Laurence

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Does Respiratory InfectionDue to Chlamydiapneumoniae Still Exist?To the Editor—Since the late 1980s,Chlamydia pneumoniae has been con-sidered an agent of community-acquiredpneumonia and of other respiratorytract infections affecting all ages [1]. Thecommon occurrence of C. pneumoniaeinfection is suggested by the high sero-prevalence ($70%) observed in adults[2]. However, in recent studies [3–5],the prevalence of respiratory infectionsdue to C. pneumoniae was reported to bemuch lower (,1.5%) than previously(6%–22%) [6]. This apparent decreasein the prevalence of C. pneumoniae in-fection could be due to changes inthe epidemiological characteristics ofC. pneumoniae over time, to increasedspecificity of new diagnostic methods, orto the difficulty for clinicians to targetthe infected population.In our university hospital, we routinelyuse a multiplex real-time polymerasechain reaction (PCR) for the detection ofC. pneumoniae and Mycoplasma pneu-moniae DNA [7]. From October 2001through June 2010, a total of 2244 re-spiratory specimens retrieved from 1583patients were sent to the laboratory forC. pneumoniae and/or M. pneumoniaePCR, including 884 bronchoalveolar la-vage samples, 843 nasopharyngeal swabsamples, 354 bronchial aspirate samples,111 sputum samples, and 52 other sam-ples. Only 4 samples (0.2%) taken from2 patients were positive for C. pneumo-niae, whereas 76 samples (3.4%) werepositive forM. pneumoniae in 65 patients.In both cases, the diagnosis of C. pneu-moniae infection was not suspected by theclinician and the test was performedthanks to the multiplex format of ourmolecular test.The first patient with C. pneumoniaeinfection was a 48-year-old man re-ceiving immunosuppressive therapy forinflammatory bowel disease. He pre-sented with a chronic cough initiallysuspected to be asthma and a febrileepisode. PCRs performed on sputumsamples obtained on day 0 and day 4 hadhighly positive results, with 2,285,300copies/mL (Ct 5 24.6) and 2,389,200copies/mL (Ct 5 25). The amount ofDNA decreased to 465 copies/mL (Ct 537.2) in 17 days. In the presence ofa persistent dry cough despite the fallingbacterial load, clarithromycin 500 mgper day was administered for 2 weeks.Clinical evolution was favorable underantimicrobial therapy with rapid de-crease of cough. Follow-up PCRs at days34 and 48 had negative results.The second patient with C. pneumo-niae infection was a healthy 13-year-oldgirl presenting with a third episode ofpneumonia over a 5-month period. PCRperformed on a nasopharyngeal swabsample yielded positive results, with 153copies/mL (Ct 5 36.5). The patient’scondition improved with clarithromycintherapy.This study confirms that C. pneumo-niae is rarely detected, at least in oursetting, because only 2 of 1583 patientswere identified with C. pneumoniae in-fection during a 10-year period. Thismay reflect a low prevalence of the dis-ease and/or suggests that clinicians donot target the right population. Thesecond hypothesis is supported by thefact that both cases were not suspectedby the physician in charge and the eti-ological diagnosis was made thanks tothe duplex approach of our moleculartest. Because C. pneumoniae infectionmay be associated with persistent coughin adults [8, 9], it should be included inthe differential diagnosis of chroniccough and asthma.NotesFinancial support. G. G. is supported by theLeenards Foundation through a career awardentitled ‘‘Bourse Leenards pour la rele`ve aca-de´mique en me´decine clinique a` Lausanne.’’Potential 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 relevant tothe content of the manuscript have been dis-closed.Laurence Senn,1,2 Katia Jaton,3Jean-William Fitting,4 and Gilbert Greub2,31Division of Hospital Preventive Medicine,2Department of Internal Medicine, InfectiousDiseases Service, 3Department of Pathologyand Laboratory Medicine, Institute of Microbiology,and 4Department of Internal Medicine,Pneumology Service, Centre HospitalierUniversitaire Vaudois and University ofLausanne, Lausanne, SwitzerlandReferences1. Grayston JT, Campbell LA, Kuo CC, et al.A new respiratory tract pathogen: Chlamydiapneumoniae strain TWAR. J Infect Dis 1990;161:618–25.2. Hermann C, Gueinzius K, Oehme A, VonAS, Straube E, Hartung T. Comparison ofquantitative and semiquantitative enzyme-linked immunosorbent assays for imm-unoglobulin G against Chlamydophilapneumoniae to a microimmunofluorescencetest for use with patients with respiratorytract infections. J Clin Microbiol 2004;42:2476–9.3. Deng J, Zheng Y, Zhao R, Wright PF, Strat-ton CW, Tang YW. Culture versus poly-merase chain reaction for the etiologicdiagnosis of community-acquired pneumoniain antibiotic-pretreated pediatric patients.Pediatr Infect Dis J 2009; 28:53–5.4. Stralin K, Tornqvist E, Kaltoft MS, Olcen P,Holmberg H. Etiologic diagnosis of adultbacterial pneumonia by culture and PCRapplied to respiratory tract samples. J ClinMicrobiol 2006; 44:643–5.5. Weigl JA, Puppe W, Meyer CU, et al. Tenyears’ experience with year-round activesurveillance of up to 19 respiratory patho-gens in children. Eur J Pediatr 2007;166:957–66.6. Kumar S, Hammerschlag MR. Acute re-spiratory infection due to Chlamydia pneu-moniae: current status of diagnostic methods.Clin Infect Dis 2007; 44:568–76.7. Welti M, Jaton K, Altwegg M, Sahli R,Wenger A, Bille J. Development of a multi-plex real-time quantitative PCR assay to de-tect Chlamydia pneumoniae, Legionellapneumophila and Mycoplasma pneumoniae inrespiratory tract secretions. Diagn MicrobiolInfect Dis 2003; 45:85–95.8. Miyashita N, Fukano H, Yoshida K, Niki Y,Matsushima T. Chlamydia pneumoniaeinfection in adult patients with persistentcough. J Med Microbiol 2003; 52:265–9.9. Kauppinen MT, Saikku P, Kujala P, Herva E,Syrjala H. Clinical picture of community-acquired Chlamydia pneumoniae pneumoniarequiring hospital treatment: a comparisonbetween chlamydial and pneumococcalpneumonia. Thorax 1996; 51:185–9.CORRESPONDENCE d CID 2011:53 (15 October) d 847Correspondence: Gilbert Greub, MD, PhD, Center forResearch on Intracellular Bacteria (CRIB), Institute ofMicrobiology, University of Lausanne, Lausanne, Switzerland(gilbert.greub@chuv.ch).Clinical Infectious Diseases 2011;53(8):847–848 The Author 2011. Published by Oxford University Press onbehalf of the Infectious Diseases Society of America. Allrights reserved. For Permissions, please e-mail: journals.permissions@oup.com.1058-4838/2011/538-0017$14.00DOI: 10.1093/cid/cir515848 d CID 2011:53 (15 October) d CORRESPONDENCE

Does Respiratory Infection Due to Chlamydia pneumoniae Still Exist?

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