Chlamydophila Species - Chlamydia pneumoniae Infection

Chlamydophila is a genus of bacteria in the Chlamydiaceae family that causes atypical pneumonias, which may become life threatening. According to the CDC, the varied clinical presentation and lack of standardization for diagnostic methods available present unique challenges for accurately identifying C. pneumoniae cases and appropriately treating patients. Diagnostic laboratory tests include culture, serology, and molecular methods.

Tabs Content

Clinical Overview

Diagnosis

Indications for Testing

Chlamydophila pneumoniae – atypical pneumonia presentation
Chlamydophila psittaci – atypical pneumonia and history of bird exposure

Laboratory Testing

Chlamydophila pneumoniae infection (CDC, 2016)
Psittacosis (CDC, 2016)
Initial testing – CBC with differential
Polymerase chain reaction (PCR) – much more sensitive than culture and serology
Serology – atypical pneumonia presentation
- Order C. pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila concurrently; routine diagnostic tests to identify etiologic agent of outpatient pneumonia in adults are optional (Mandell, Infectious Disease Society of America/American Thoracic Society, 2007)
- Confirmed by paired serology for C. pneumoniae (four-fold elevation)
Culture
- Difficult to grow atypical agents; positive culture confirms diagnosis
- Suspicion for C. psittaci
  - Order antibody panel
  - Performed using complement fixation, microimmunofluorescence, enzyme immunoassay

Imaging Studies

Chest x-ray – no distinctive chest x-ray pattern

Differential Diagnosis

Respiratory tract infections
- M. pneumoniae
- L. pneumophila
- Coxiella burnetii (Q-fever)
- Influenza virus
- Parainfluenza 1, 2, 3, 4
- Hantavirus
- Respiratory syncytial virus (RSV)
- Bordetella pertussis (whooping cough)
- Adenovirus
Hepatitis – viral
Myocarditis
Myocardial infarction
Connective tissue disease
- Polymyositis
Erythema nodosum/erythema multiforme

Background

Epidemiology

Incidence
- Chlamydophila pneumophilia
  - Overall incidence unknown (CDC, 2015)
  - ~7-10% of community-acquired pneumonias in adults
- Chlamydophila psittaci – rare in U.S.; zoonotic disease
Age
- Chlamydophila pneumoniae – peak incidence is late childhood to young adulthood
  - ~50% of young adults in the U.S. will have evidence of past infection by age 20
  - Reinfection throughout life is common
Transmission
- C. pneumoniae – respiratory secretions
  - May produce epidemics in close-quarter settings such as military barracks, prisons
- C. psittaci – respiratory inhalation of dried secretions during exposure to infected birds
  - Does not require prolonged contact with infected bird
  - May be an occupation-related disease

Organism

C. pneumoniae and C. psittaci are obligate, intracellular, gram-negative bacteria

Clinical Presentation

C. pneumoniae
- Incubation – 7-10 days
- Constitutional – leukocytosis and fever are often lacking; may resemble Mycoplasma pneumoniae infections
- Pulmonary – cough, bronchitis, pneumonia, exacerbations of chronic bronchitis and asthma
- Upper respiratory tract – laryngitis, otitis media, sinusitis, pharyngitis
- Dermatologic – erythema nodosum
- Neurologic – meningitis (uncommon)
- Cardiac – endocarditis, myocarditis (uncommon)
C. psittaci
- Incubation – 5-19 days
- Constitutional – fever, chills, headache, myalgias
- Pulmonary – dry cough, pleural rub, rales, dyspnea, pneumonia
- Gastrointestinal – diarrhea, nausea, anorexia, abdominal pain
- Hepatitic – hepatitis
- Dermatologic – faint macular rash may occur (Horder spots), erythema multiforme, erythema nodosum
- Neurologic – cranial nerve palsies, cerebellar involvement, transverse myelitis, meningitis
- Cardiac – endocarditis, myocarditis, pericarditis

ARUP Lab Tests

Primary Tests

Detect Chlamydia pneumoniae in bronchoalveolar lavage (BAL), nasal wash, nasopharyngeal swab, or pleural fluid

Chlamydia pneumoniae by PCR 0060715

Method: Qualitative Polymerase Chain Reaction

Differentiate between Chlamydophila species (C. psittaci, C. pneumoniae)

Differentiate early IgM response to infection from persistent low-level titer

Because of cross-reactivity, a C. pneumoniae-specific reaction will exhibit titers two-fold or greater than C. trachomatis or C. psittaci serology

Limited value in the diagnosis of most oculogenital (eg, eyes, genitalia) chlamydial infections

Chlamydia Antibody Panel, IgG & IgM by IFA 0065100

Method: Semi-Quantitative Indirect Fluorescent Antibody

Panel includes C. pneumoniae, C. trachomatis, and C. psittaci IgM titers; C. pneumoniae, C. trachomatis, and C. psittaci IgG titers

May aid in the diagnosis of Mycoplasma pneumoniae in patient with persistent pneumonia that is outside of the expected acute phase

Mycoplasma pneumoniae Antibodies, IgG & IgM 0050399

Method: Semi-Quantitative Enzyme-Linked Immunosorbent Assay

Provide retrospective evidence of suspected Legionella pneumophila infection

Legionella pneumophila Antigen, Urine 0070322

Method: Qualitative Enzyme-Linked Immunosorbent Assay

Detect respiratory pathogens in patients with pneumonia

Explify Respiratory Pathogens by Next Generation Sequencing (INACTIVE as of 11/18/19: Refer to 3002026 in the November Hotline) 2013694

Method: Massively Parallel Sequencing

Method: Automated Cell Count/Differential

A combined IgG and IgM antibody panel is available

Differentiate between Chlamydophila species (C. psittaci, C. pneumoniae)

Because of cross-reactivity, a C. pneumoniae-specific reaction will exhibit titers 2-fold or greater than C. trachomatisor C. psittaci serology

Limited value in the diagnosis of most oculogenital (eg, eyes, genitalia) chlamydial infections

Chlamydia Antibody Panel, IgG by IFA 0065139

Method: Semi-Quantitative Indirect Fluorescent Antibody

Panel includes C. pneumoniae, C. trachomatis, and C. psittaci IgG titers

A combined IgG and IgM antibody panel is available

Differentiate between Chlamydophila species (C. psittaci, C. pneumoniae)

Differentiate early IgM response to infection from persistent low-level titer

Because of cross-reactivity, a C. pneumoniae-specific reaction will exhibit titers 2-fold or greater than C. trachomatisor C. psittaci serology

Limited value in the diagnosis of most oculogenital (eg, eyes, genitalia) chlamydial infections

Chlamydia Antibody Panel, IgM by IFA 0065105

Method: Semi-Quantitative Indirect Fluorescent Antibody

Panel includes C. pneumoniae, C. trachomatis, and C. psittaci IgM titers, and chlamydia IgM panel interpretation

Detect Mycoplasma pneumoniae bacteria

Mycoplasma pneumoniae by PCR 0060256

Method: Qualitative Polymerase Chain Reaction

Detect Legionella species

Legionella Species by Qualitative PCR 2010125

Method: Qualitative Polymerase Chain Reaction

Medical Experts

Couturier, Marc Roger, PhD, D(ABMM), Medical Director, Microbial Immunology, Parasitology and Fecal Testing, and Infectious Disease Antigen Testing at ARUP Laboratories; Associate Professor of Clinical Pathology, University of Utah

Hillyard, David R., MD, Medical Director, Molecular Infectious Diseases at ARUP Laboratories; Professor of Clinical Pathology, Adjunct Professor of Biology, University of Utah

References

Guidelines

Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell D, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG, Infectious Diseases Society of America, American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 Suppl 2: S27-72. PubMed

General References

Blasi F, Tarsia P, Aliberti S. Chlamydophila pneumoniae. Clin Microbiol Infect. 2009; 15(1): 29-35. PubMed

Burillo A, Bouza E. Chlamydophila pneumoniae. Infect Dis Clin North Am. 2010; 24(1): 61-71. PubMed

Cunha BA. The atypical pneumonias: clinical diagnosis and importance. Clin Microbiol Infect. 2006; 12 Suppl 3: 12-24. PubMed

Forgie S, Marrie TJ. Healthcare-associated atypical pneumonia. Semin Respir Crit Care Med. 2009; 30(1): 67-85. PubMed

Johansson N, Kalin M, Tiveljung-Lindell A, Giske CG, Hedlund J. Etiology of community-acquired pneumonia: increased microbiological yield with new diagnostic methods. Clin Infect Dis. 2010; 50(2): 202-9. PubMed

Kumar S, Hammerschlag MR. Acute respiratory infection due to Chlamydia pneumoniae: current status of diagnostic methods. Clin Infect Dis. 2007; 44(4): 568-76. PubMed

Villegas E, Sorlózano A, Gutiérrez J. Serological diagnosis of Chlamydia pneumoniae infection: limitations and perspectives. J Med Microbiol. 2010; 59(Pt 11): 1267-74. PubMed

Wolf J, Daley AJ. Microbiological aspects of bacterial lower respiratory tract illness in children: atypical pathogens. Paediatr Respir Rev. 2007; 8(3): 212-9, quiz 219-20. PubMed

Resources from the ARUP Institute for Clinical and Experimental Pathology®

Kendall BA, Tardif KD, Schlaberg R. Chlamydia trachomatis L serovars and dominance of novel L2b ompA variants, U.S.A. Sex Transm Infect. 2014; 90(4): 336. PubMed

Content Review:

January 2018

Last Update: October 2019

Chlamydophila Species - Chlamydia pneumoniae Infection

Diagnosis

Indications for Testing

Laboratory Testing

Imaging Studies

Differential Diagnosis

Background

Epidemiology

Organism

Clinical Presentation

ARUP Lab Tests

Medical Experts

References

Guidelines

General References

Resources from the ARUP Institute for Clinical and Experimental Pathology®

ARUP Laboratories

ARUP Websites

ARUP Consult


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	Chlamydophila Species - Chlamydia pneumoniae Infection. ARUP Consult^©. Retrieved October 18, 2019, from: https://arupconsult.com/content/chlamydophila-species

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Chlamydophila Species - Chlamydia pneumoniae Infection

Diagnosis

Indications for Testing

Laboratory Testing

Imaging Studies

Differential Diagnosis

Background

Epidemiology

Organism

Clinical Presentation

ARUP Lab Tests

Medical Experts

References

Guidelines

General References

Resources from the ARUP Institute for Clinical and Experimental Pathology®

ARUP Laboratories

ARUP Websites

ARUP Consult