Symptoms of chlamydia pneumonia in children

Common types

Chlamydial pneumonia, caused by the bacterium Chlamydophila pneumoniae, is diagnosed in 7–25% of cases of community-acquired disease in both children and adolescents. Despite the fact that this disease is diagnosed annually, the cyclicity of outbreaks of such pneumonia is recorded every 3–4 years.

According to statistics, this disease most often affects men in 65–85% of all diagnosed cases, and most often this prevalence among the male population is associated with smoking.

The disease is also quite widespread among children and adolescents, but infection in older people cannot be ruled out. Serological marking of a previous disease is observed in approximately 45% of the adult and 70% of the elderly population.

In approximately 5–22%, cervical infection is diagnosed in women during pregnancy.

According to statistics, infection of an infant with chlamydia during its passage through the birth canal is observed in 35–55% of cases. Among infants infected during childbirth, 20–55% develop conjunctivitis, and 12–20% develop pneumonia within up to two months due to active chlamydia bacteria acquired from the mother.

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Causes of chlamydia pneumonia infection

All three potentially dangerous types of chlamydia enter the human body in different ways. However, each of these species is capable of causing systemic infection through the blood. Chlamydophila pneumoniae infection occurs through close contact with an infected person when they cough or sneeze.

It is important to remember that pets can also be carriers of chlamydia and transmit the disease to the owner. In order to avoid infection, it is necessary to systematically take your pet to a specialist, especially this activity should be carried out after suspected contact with parasitic organisms.

Chlamydophila trachomatis is transmitted through unprotected sexual intercourse through contact with physiological secretions.

Chlamydophila psittaci infects the human body through penetration through the respiratory tract, inhalation of air containing particles of excrement or secretions of infected birds. Most often, infection occurs from birds with which humans have frequent contact (parrots, pigeons and others).

Development of pneumonia

Pathological microorganisms live in the human body in two varieties:

• elementary bodies;
• reticular bodies.

Elementary particles are considered the most dangerous to human health, since in this variety bacteria are able to survive for a long period outside the human cell, minimizing their metabolic processes. After their transformation, reproduction occurs by fission, and chlamydia returns to the form of elementary bodies, reducing its activity.

This cycle of microbial activity lasts approximately two days, after which the cell membrane is destroyed and parasitism spreads to other healthy cells. Chlamydia pneumonia can remain in this form for quite a long time without the symptoms characteristic of the disease, especially when the human body is exposed to antibiotics and cytokines. The ability of bacteria to provoke prolonged and asymptomatic infection is considered the main distinguishing feature of chlamydia.

It is very important to remember that it is regular examination that can preserve a person’s health, since due to the ability of these microorganisms not only to hide the manifestation for a long time, but also to imitate the symptoms of respiratory tract diseases, they pose a serious danger

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Causes of chlamydial pneumonia

Of the variety of representatives of the Chlamydiaceae family, three types of chlamydia are of practical interest for pulmonology in etiological terms: Chlamydophila pneumoniae, Chlamydia trachomatis and Chlamydophila psittaci.

The most common causative agent of respiratory chlamydia (including chlamydial pharyngitis, sinusitis, bronchitis, pneumonia) in patients of all ages is Ch. pneumoniae With Ch. trachomatis is associated with the incidence of trachoma, genitourinary chlamydia, lymphogranuloma venereum, as well as chlamydial pneumonia among newborns and infants up to 6 months.

Pneumonia in immunocompromised individuals and laboratory workers is also associated with this type of chlamydia. Ch. psittaci is considered to be the causative agent of ornithosis (psittacosis), often occurring in the form of severe interstitial pneumonia. The routes of infection for each type of chlamydia are different, but all types can spread hematogenously. Transfer Ch. pneumoniae from person to person is carried out mainly by airborne droplets and contact-household routes.

Infection with Ch. psittaci occurs through the airborne dust or fecal-oral route when inhaling dust or eating food containing biological secretions of birds that carry the infection (parrots, canaries, chickens, ducks, pigeons, sparrows, etc.). Infection of newborns with Ch. trachomatis occurs during childbirth from mothers with urogenital chlamydial infection.

With intranatal infection, 15-25% of infants develop chlamydial nasopharyngitis and conjunctivitis, which are often complicated by pneumonia. With intranatal infection, 15-25% of infants develop chlamydial nasopharyngitis and conjunctivitis, which are often complicated with pneumonia

All chlamydia are obligate gram-negative microorganisms that parasitize inside host cells. In the macroorganism, chlamydia can exist in an infectious form (elementary bodies) and a vegetative form (reticular bodies). Elementary bodies penetrate into the cell by stimulating endocytosis, where they are converted into reticular bodies.

The latter have high metabolic activity and the ability for intracellular binary fission. The reproduction cycle lasts about 48 hours, after which the reticular bodies again turn into elementary ones, the host cell membrane ruptures with the release of elementary bodies of a new generation into the extracellular environment. Then the cycle of infection of new cells is repeated.

C. trachomatis infection of the cervix occurs in approximately 5-22% of pregnant women.

During childbirth, the child becomes infected in 30-50% of cases. Among infected newborns, 25-50% develop symptoms of conjunctivitis, which is accompanied by nasopharyngitis in at least half of the cases. 11-20% of infants born to mothers with active chlamydia develop pneumonia before 8 weeks of age. C. trachomatis infection of the cervix occurs in approximately 5-22% of pregnant women

In children with symptoms of chlamydial nasopharyngitis, pneumonia develops in approximately 25% of cases. Pneumonia caused by C. trachomatis has been reported in immunocompromised adults.

Cases of ornithosis pneumonia are currently rare, but their frequency is quite stable - 1-3%. Children get sick much less often than adults, which is most likely due to the limited close contacts of children with birds, so psittacosis will not be considered in this article.

Symptoms of invasion

The disease caused by Chlamydophila pneumoniae can occur in the body without showing any characteristic symptoms, but often a small percentage of children and adolescents may be mistakenly diagnosed with ordinary pneumonia or mild bronchitis. In the elderly population, the disease most often occurs in a more severe form, and there is a high risk of recurrence of the disease.

The incubation period for chlamydial pneumonia most often lasts 3–4 weeks. After this, characteristic symptoms of diseases associated with nasopharyngeal disease, such as pharyngitis, sinusitis, laryngitis and rhinitis, begin to appear. After 2–4 weeks, in some patients the pathological process affects the lung parenchyma, causing pneumonia with characteristic symptoms:

• slight hoarseness;
• frequent shortness of breath;
• runny nose;
• malaise of varying strength;
• in the initial stages of disease development, the general temperature rises;
• headache of varying strength;
• cough, which can be not only dry, but also accompanied by a small amount of sputum. Often the cough persists for from a week to several months even with the use of antibiotics;
• not only dry, but also wet rales are heard

Symptoms of chlamydial pneumonia, provoked by Chlamydophila trachomatis, are characterized by a dry and hacking cough, before the attack of which a short breath is taken. When listening, clear and fine rales are observed; most often, dry rales are not diagnosed. More than 55% of children are diagnosed with conjunctivitis and inflammation of the middle ear accompanying the disease.

Pneumonia caused by Chlamydophila psittaci in more than 55% of cases causes not only changes in the lung parenchyma and symptoms of respiratory tract disease, but also a significant enlargement of the liver and spleen.

In addition, characteristic symptoms of central nervous system lesions may appear, such as noticeable slowness, meningeal symptoms and delirium.

Treatment

β-lactam antibiotics are ineffective against chlamydia. These microorganisms develop and live intracellularly, so drugs are used whose mechanism of action is to penetrate into diseased cells and accumulate in them. Medicines must have the ability to block the processes of protein synthesis occurring inside the cell.

Most often used:

• Tetracyclines;
• Macrolides;
• Fluoroquinolones.

The most optimal means include macrolides. Their use poses almost no danger when treating infants or pregnant women. They act by disrupting protein production in the cells of harmful organisms.

Typically, drugs of this type provoke lifelong changes in the ribosomes of cells. The effect increases with constant treatment, so it lasts for a time sufficient for the duration of the new production or combination of proteins, which are blocked by the given antibiotics.

In addition to the listed advantages, macrolides act as immunomodulators and can have an anti-inflammatory effect. There is an effect on the work of neutrophils: phagocytosis, chemotaxis, and killing occur. With the participation of macrolides, oxidative processes are inhibited, which can cause harm not only to harmful microorganisms, but also to the tissues of the body itself.

Through interaction with the immune system, these drugs can worsen or stop the production and combination of cytokines involved in inflammatory processes; on the contrary, they increase the production of interleukins, which prevent the onset and development of inflammatory processes. They are able to have an effect aimed at preventing the adhesion of harmful microorganisms to the cells of the human body, and also slow down the development of resistance to antimicrobial agents of some microbes.

Fluoroquinolones are also active in the fight against chlamydia - ofloxacin, ciprofloxacin. These antibiotics are usually an alternative to macrolides. Among the new drugs, levofloxacin and moxifloxacin have proven themselves well.

Tetracyclines can also suppress the disease, but have many side effects, so they are not currently used in the treatment of pregnant women or patients with liver failure. Doxycycline and monocycline fight against atypical microorganisms, which include chlamydia.

Therapy for uncomplicated forms of the disease usually lasts up to 3 weeks. Shorter periods of taking antibiotics may cause a recurrence of the infection. If the course of the disease is not severe, then the drugs are prescribed in medium doses.

If pneumonia is severe, drugs should usually be given intravenously. Erythromycin phosphate, spiramycin, and clarithromycin are often prescribed. To dilute the last two substances, a glucose solution is used.

There is a huge list of antimicrobial drugs that can quickly remove the infection from the body, however, when curing pneumonia caused by chlamydia, difficulties usually arise. The development of this disease usually occurs due to a decrease in anti-infective resistance, which is provoked by suppressed immunity.

Chlamydia can be located in the body both inside cells and on their surface. For their complete destruction (elimination), the correct functioning of both the humoral and cellular immune systems is necessary.

Most antibiotics affect the extracellular form of pathogens, which provokes the persistence of infection in the body, the occurrence of relapses of the disease or complications. Therapy aimed at a complete cure for pneumonia necessarily contains not only antibiotics, but also means to strengthen the immune system.

Antibiotics together with immunomodulators can achieve a good effect. In most cases, provided that suitable drugs are selected, a complete cure for the disease occurs. If all instructions are followed, patients have minimal risk of the process becoming chronic and complications developing.

Diagnosis of the disease

To correctly identify the bacterium chlamydial pneumonia, a number of not only general, but also specific examinations are carried out:

• examination by a specialist, including anamnesis, palpation, percussion and auscultation;
• laboratory tests, including urine, feces and blood analysis, blood biochemistry, as well as serological analysis of sputum;
• instrumental diagnostics - chest X-ray, MIF, PCR and isolation of chlamydia culture in smears taken from the nasopharynx.

Diagnostics

So, the symptoms are erased, dim, the disease resembles a regular ARVI. This makes it very difficult to determine the cause of the disease.

The situation is also clouded by the fact that an x-ray, characteristic of all types of pneumonia, does not work in this case - the image shows practically no signs of infection.

The signs that a doctor can observe during examination are practically indistinguishable from the symptoms of other viral diseases.

Nevertheless, x-rays are necessarily prescribed to all patients who apply, and at the very beginning of the examination. It reveals infiltrates of lung tissue.

At the same time, material from the nasopharynx is taken for examination. The purpose of this is to identify the causative agent of the disease and immediately test it for sensitivity to various antibiotics. Blood is also taken for biochemical testing.

Test systems are used to search for antibodies that destroy chlamydia.

There is such a term as pulmonary titers. It is used to interpret test results to find the causative agent of the disease. It is with its help that antibodies are detected.

If lgg is positive, then the body has been in contact with the virus, which means it is easier to make a diagnosis - there is information about the presence of chlamydia in the blood and cells of the respiratory tract.

Treatment of the disease

For the treatment of chlamydial pneumonia, antibiotics of the tetracycline, macrolide and fluoroquinol groups are prescribed. For treatment in pregnant women and children, antibiotics of the macrolide group are used exclusively, and for the treatment of newborns and babies up to two months, only Erythromycin is approved for use. The duration of antibiotic use is 10–21 days, and for faster treatment it is important to follow the following recommendations:

• compliance with bed rest;
• warm drinks are preferably in large quantities;
• performing breathing exercises.

If the need arises, symptomatic therapy is prescribed with parallel treatment of diseases associated with pneumonia and complications that arise.

Prevention

To prevent chlamydial pneumonia in children, you need to know the following rules:

• The child must be provided with adequate nutrition so that he does not develop a deficiency of vitamins and minerals. Do not give a lot of fast food, soda and other junk food.
• It is necessary to limit his contact with infected people: isolation from the patient is important, since the infection is transmitted even through hugs.
• You should also avoid places where wild birds gather, as their droppings may contain chlamydia, and small children often fall and get their hands dirty.
• Inhalation of tobacco smoke is often a provoking factor. For this reason, adults should not smoke near children.
• During pregnancy, the expectant mother needs to monitor her health and prevent the occurrence of pneumonia. Otherwise, the pathology can be transmitted to the child, and then the baby’s health will be undermined.

Fast food
To protect your child from pneumonia, you need to follow the doctor’s recommendations and not treat the disease yourself. An initiative of this kind usually leads to chronic disease and complications.

Timely treatment of chlamydial pneumonia can reduce the risk of concomitant diseases. When treating young children, adults must strictly follow all the doctor’s instructions and do not forget about regular examinations with a pediatrician. Prevention also plays an important role: it is easier to prevent a disease than to treat it.