Infectious Disease Division, Winthrop-University Hospital, Mineola, New York 11501, USA.
Heart Lung. 2009 Nov-Dec;38(6):530-3. doi: 10.1016/j.hrtlng.2009.01.003. Epub 2009 Jul 10.
Chlamydophila (Chlamydia) pneumoniae is a common, non-zoonotic cause of community-acquired pneumonia (CAP) in ambulatory young adults. C. pneumoniae clinically presents as a mycoplasma-like illness frequently accompanied by laryngitis. C. pneumoniae CAP may also cause nursing home outbreaks in the elderly. Similar to Mycoplasma pneumoniae in immunocompetent hosts, C. pneumoniae CAP usually manifests as a mild/moderately severe CAP. In contrast with Legionnaire's disease, central nervous system involvement is usually not a feature of C. pneumoniae CAP. M. pneumoniae may rarely present with meningoencephalitis accompanied by high cold agglutinin titers. We present the case of a young man who presented with M. pneumoniae-like illness and was hospitalized for severe CAP that was accompanied by a pertussis-like cough and severe headache. Although his chest x-ray showed a right upper lobe infiltrate, a lumbar puncture was performed to rule out meningitis, but his cerebrospinal fluid profile was unremarkable. Titers for non-zoonotic atypical pneumonia pathogens were negative except for a highly elevated C. pneumoniae immunoglobulin-M titer (1:320). Testing for legionella and pertussis was negative. Q fever and adenoviral titers were also negative. Cold agglutinin titers were repeatedly negative. The patient was successfully treated with moxifloxacin but developed permanent asthma after C. pneumoniae CAP. This case is unusual in several aspects. First, C. pneumoniae usually presents as a mild to moderate CAP, but in this case it was severe. Second, hoarseness was absent, which would have suggested C. pneumoniae. Third, wheezing was an important clue to the diagnosis of C. pneumoniae, which is not a clinical finding with other causes of CAP. Fourth, permanent asthma may follow C. pneumoniae, as well as M. pneumoniae CAP. Fifth, severe headache mimicking M. pneumoniae meningoencephalitis may rarely accompany C. pneumoniae CAP.
肺炎衣原体（衣原体）是一种常见的非动物源社区获得性肺炎（CAP）病原体，常见于门诊年轻成年人。肺炎衣原体临床上表现为类似支原体的疾病，常伴有喉炎。肺炎衣原体 CAP 也可能导致老年人疗养院爆发。与免疫功能正常宿主中的肺炎支原体相似，肺炎衣原体 CAP 通常表现为轻度/中度严重的 CAP。与军团病不同，中枢神经系统受累通常不是肺炎衣原体 CAP 的特征。肺炎支原体可能很少表现为伴高冷凝集素滴度的脑膜炎。我们报告了一例年轻男性，表现为肺炎支原体样疾病，并因严重 CAP 住院，伴有百日咳样咳嗽和严重头痛。尽管他的胸部 X 光显示右上叶浸润，但进行了腰椎穿刺以排除脑膜炎，但他的脑脊液特征无明显异常。除肺炎衣原体免疫球蛋白 M 滴度（1:320）高度升高外，非动物源非典型肺炎病原体的滴度均为阴性。军团菌和百日咳检测均为阴性。Q 热和腺病毒滴度也为阴性。冷凝集素滴度反复为阴性。患者用莫西沙星成功治疗，但肺炎衣原体 CAP 后发展为永久性哮喘。这个病例在几个方面都不寻常。首先，肺炎衣原体通常表现为轻度至中度 CAP，但在这种情况下它是严重的。其次，声音嘶哑缺失，这将提示肺炎衣原体。第三，喘息是肺炎衣原体诊断的重要线索，这不是其他 CAP 病因的临床发现。第四，永久性哮喘可能继肺炎衣原体，以及肺炎支原体 CAP 之后。第五，严重头痛可能类似于肺炎支原体脑膜炎，可能很少伴随肺炎衣原体 CAP。
