Atypical and Typical Bacteria in Children with Community Acquired Pneumonia.

This study seeks to determine the pathogens in respiratory specimens and blood serum obtained from children who present with community acquired pneumonia (CAP) diagnosed on the basis of clinical and radiological evidence. The study group consisted of 46 hospitalized children aged 1-11 years. The material for research consisted of pharyngeal swabs and samples of blood serum. One hundred and thirty eight pharyngeal swabs were examined for the presence of C. pneumoniae antigen, C. pneumoniae DNA, and for typical pathogens. C. pneumoniae DNA was detected in pharyngeal swabs with nested PCR. Classical microbiological culture was used for detection of typical bacteria. ELISA test were used for detection anti-C. pneumoniae and anti-M. pneumoniae antibodies in the serum. C. pneumoniae DNA was identified in 10.9% of children. Positive culture for typical pathogens was observed in 8.7% of children. Specific anti-C. pneumoniae IgM antibodies were found in 8.7% of children, and IgG and IgA antibodies in 1 child each. Specific anti-M. pneumoniae IgG antibodies were found in 13.1% of children and IgM antibodies in 1 child. We conclude that the underlying bacterial etiology of CAP is rather rarely conclusively confirmed in children. Nonetheless, determining the etiology of CAP is essential for the choice of treatment to optimize the use and effectiveness of antimicrobials and to avoid adverse effect. Due to considerable variations in the power of detection of the type of atypical bacteria causing CAP, the search for the optimum diagnostic methods continues.

Pathogens Causing Upper Respiratory Tract Infections in Outpatients.

The aim of the present study was to determine the results of typical and atypical bacteria microbiological tests in patients with symptoms of chronic cough. We investigated 230 outpatients aged from 1 to 83 years (112 female, 72 male, and 46 children) who were free of any respiratory tract infection at the time of study. The material for the investigation consisted of pharyngeal swabs. Two hundred and thirty pharyngeal swabs were examined for Chlamydia pneumoniae antigen and for typical pathogens each. Chlamydia pneumoniae antigen was detected using an indirect immunofluorescence test and classical microbiological culture was used for the detection of typical bacteria. The antigen was found in 44/230 (19.1 %) patients with chronic cough (23 women, 13 men, and 8 children). Positive culture for typical pathogens was observed in 65/230 (28.3 %) patients (37 women, 14 men, and 14 children). Simultaneous occurrence of Chlamydia pneumoniae and typical pathogens such as Staphylococcus aureus, Streptococcus pyogenes, Moraxella catarrhalis, and Haemophilus influenzae, was observed in 11/230 (4.8 %) patients. The results show that in patients with chronic cough Chlamydia pneumoniae is detected less frequently than the typical pathogens are. A search for atypical bacteria in patients with chronic cough is needed to be able to conduct effective and sufficiently long therapy.

Detection of Chlamydophila Pneumoniae and Typical Bacteria in Patients with Chronic Cough.

The aim of research was to analyze the results of microbiological tests for typical and atypical bacteria in patients with symptoms of chronic cough. A total of 214 outpatients aged from 2 to 94 years (110 women, 64 men, and 40 children) with chronic cough were studied. Four hundred twenty eight throat swabs were examined for atypical bacteria antigen (Chlamydophila pneumoniae) (n=214) and typical pathogens (n=214). Chl. pneumoniae detection was performed using indirect immunofluorescence test. Classical microbiological culture was used for typical bacteria detection. Chl. pneumoniae antigen was detected in 55/214 (26.0%) patients with chronic cough (in 31 (28.2%) women, 14 (21.9%) men, and 10 (25.0%) children). Positive culture for typical pathogens was observed in 30 (27.3%) women, 22 (34.4%) men, and 21 (52.5%) children. Simultaneous occurrence of Chl. pneumoniae and typical pathogens (Staphylococcus aureus strain MSSA, Streptococcus pyogenes, or Moraxella catarrhalis) was found in 16 (7.5%) patients. The findings show that in patients with chronic cough Chl. pneumoniae infection, although less than that with typical pathogens, is rather frequent. Further, the performance of test for Chl. pneumoniae in throat swabs from patients with chronic cough is good and provides an efficient way to diagnose the infection and implement appropriate therapy.

[Evaluation of an atypical clinical presentation for pneumonia caused by Mycoplasma pneumoniae and Chlamydia sp in children]. / Ocena obrazu klinicznego atypowych zapalen pluc wywolanych przez Mycoplasma pneumoniae i Chlamydia sp. u dzieci.

Mycoplasma pneumoniae and Chlamydia sp. frequently cause atypical pneumonia in children. The study aim was the analysis of clinical picture of pneumonia caused by Mycoplasma pneumoniae and Chlamydia sp. in 278 children treated in the period of 1985-1998 in the IInd Clinic of Pediatrics and Gastroenterology, Medical Academy of Wroclaw. The influence of etiological factor and age of children for the clinical picture of the disease was estimated. The most characteristic clinical symptom of the atypical pneumonia in children was "staccato" cough observed in 89.9% of children. More severe course of the mycoplasmal pneumonia in comparison with that of Chlamydia origin was demonstrated. The most severe course of pneumonia was observed in infants. The afebrile course of the disease was observed in the group of Chlamydia pneumonia (in 26.3% of infants, 40% of children aged 1-6 years and 54.8% of children aged 7-15 years). None of children with mycoplasmal pneumonia had an afebrile course of the disease. The most characteristic radiological picture in children with atypical pneumonia were diffused, symmetrical interstitial inflammatory changes of the lungs. In the group of children with mycoplasmal pneumonia in over 50% of cases the enlargement of lymph nodes of the lungs hili were observed.

[Screening lab tests of Chlamydia trachomatis. Do they show declining trend of the infections?]. / Badania laboratoryjne w kierunku Chlamydia trachomatis; czy wskazuja one na spadek liczby zakazen?

A study on the frequency of Chlamydia trachomatis (Ct) urogenital infection comprised 2393 patients (1,197 women and 1,196 men), aged 18-69 years. Urethral and cervical specimens were tested using immunofluorescent (DFA) for symptomatic and immunoenzymatic techniques (EIA, IMx, Vidas-ELFA) for asymptomatic patients. Basing on the tests results (1993-1996) chlamydiosis was diagnosed in 323 (13.5%) cases, 169 (14.1%) women and 154 (12.8%) men, aged 20-40 yrs. The percentage of positive results determined by EIA, IMx or Vidas were similar (8.2-4.2%, 3.0-2.0%, 5.4-3.4%, respectively) but lower than that by DFA test (38.9-13.2%). Over the last few years the number of patients screened for Ct, as well as the incidence of Ct infection, has decreased (5.6% in 1996). The data were compared to those from 1986-1992.

[Chlamydia trachomatis in cervical canal and in the pouch of Douglas in infertile women]. / Chlamydia trachomatis w kanale szyjki macicy i w zatoce Douglasa u nieplodnych kobiet.

The results of microbiological examination of samples from cervical canal of the uterus and from pouch of Douglas in 71 women who underwent diagnostic and operative laparoscopy is presented. In 33 cases diagnosed because of infertility Chlamydia trachomatis was present in 2 (6.1%) women and in one woman both in cervical canal and pouch of Douglas. In second woman only in cervical canal Chlamydia trachomatis was present. There was not statistically significant correlation between control and study groups.

[Prevalence of chlamydia trachomatis in the epithelial cells of the urethra in children]. / Wystepowanie Chlamydia trachomatis w komórkach nablonka cewki moczowej u dzieci.

Tests for the presence of Chlamydia trachomatis were performed in 432 children, aged 4 months to 16 years at the Department of Paediatric Nephrology of the Academy of Wroclaw, Poland. The children were hospitalised because of recurrent urinary tract infection. The presence of Chlamydia trachomatis was established in 27.5% of children by tissue culture on McCoy cells, in 22.8% when using the Chlamyset test (Orion Diagnostica) and in 8.9% when using the Chlamydiazyme test (Abbott).

[The evaluation of the applicability of urine samples for the detection of chlamydia trachomatis antigen in children]. / Ocena przydatnosci badania próbek moczu do wykrywania antygenów Chlamydia trachomatis u dzieci.

In 12 out of 66 children (18.2%), hospitalised at the Department of Pediatric Nephrology of the Medical Academy of Wroclaw, Poland, the presence of Chlamydia trachomatis was detected in the urinary sediment. The tests were made using an enzyme-linked-immunoassay, ELISA. These results are in 96.9% agreement with the results obtained by urethra swabs.

[Chlamydia trachomatis during genital tract infection and in imminent abortion]. / Chlamydia trachomatis w stanach zapalnych narzadów plciowych i w poronieniu zagrazajacym.

Chlamydia trachomatis (Ch.t.) is suspected to be a dominant factor in the etiology of genito-urinary tract infectious diseases. The aim of the authors work was the evaluation of the Ch. t. presence in the cervix of women with adnexitis or with the imminent abortion. 300 women were investigated for the Ch.t. detection. The smear taken from the cervical canal was evaluated with 3 methods: direct immunofluorescence assay. Chlamydiazine test and culture. Ch.t. infection was detected in 27% of examined patients. The positive results was observed the more frequently in the patients showing the clinical symptoms of infection (42%) and in the pregnant women with imminent abortion symptoms (26%). The obtained results seem to confirm the pathogenic role of Ch.t. in the genital tract infectious diseases. Authors are postulating them the necessity of the prophylactic Ch.t. detection in the pregnant women.

[The prevalence of C. trachomatis genitourinary tract infection in 1986-1993]. / Ocena czestosci zakazen chlamydiami ukladu moczowoplciowego w latach 1986-1993.

The study comprised 7224 patients from Lower Silesia District, 3576 women and 3648 men, at age 18-69 yrs. Urethral and endocervical specimens were tested for Chlamydia trachomatis using culture method (on McCoy cells treated with cycloheximid), immunofluorescent technique (Chlamyset-Orion Diagnostica) or immunoenzymatic assay (Chlamydiazyme-Abbott). In the examined population chlamydial infection was found in prevalence among 20-40 yrs old patients. Symptomatic infection was observed in 97.3%, asymptomatic in 2.7%. Basing on the laboratory tests results chlamydiosis was diagnosed in 1393 (19.2%) patients, 658 (47.2%) women and 735 (52.7%) men. The highest percentage (25.7%) of the infected people was noticed in 1986, the lowest in 1991 (10.6%). Despite the general declining trend, every second year a small rising in number of C. trachomatis infection was regularly observed.

[Epidemic occurrence of respiratory tract infections due to chlamydia]. / Epidemiczne wystepowanie zakazen ukladu oddechowego wywolanych przez chlamydie.

An analysis included 92 children aged between 3 and 7 years, 88 children aged between 3 months and 17 years and 29 their parents with diagnosed chlamydial respiratory infections. Incidence of respiratory infections in the studies pre-school children was 53.2% while in family environment -87.5% in children, and 68.9% in their parents. Infection with chlamydia was found in all members in 57.8% the examined families. All children in 70.3% families were infected.

[Urinary tract infection caused by Chlamydia trachomatis in children]. / Zakazenia ukladu moczowego u dzieci wywolane przez Chlamydia trachomatis.

In 1988-1989, 131 children aged between 1 and 18 years were examined for urinary infections with C. trachomatis at the Department of Pediatric Urology in Wroclaw. Chlamydia trachomatis was diagnosed with the aid of McCoy's cellular cultures and immunoenzymatic test Chlamydiazyme in 25% of the examined children. A relationship between Chlamydia trachomatis and particular components of the clinical picture has been analysed. Effectiveness of the treatment with erythromycin (Davercin) and doxycycline (Vibramycin) has been also assessed.

[Chlamydia trachomatis infection of the urogenital system in our clinical experience]. / Zakazenie Chlamydia trachomatis ukladu moczoplciowego we wlasnej obserwacji klinicznej.

The increased number of the genitourinary system infection caused by Chlamydia trachomatis (Ch. Tr.), increased number of patients with dysuria or sterile leukocyturia gave stimulus to studies of 615 patients from Department of Nephrology and District Outpatient Nephrological Care Unit with regard to infections with that microbes. Material for investigations derived from urethra. Diagnostic examinations were performed using the Mc Coy cell culture and the immunofluorescence method. The infection was noted in 176 patients (119 women and 57 men) that is in 28.6% of cases studied. The mean age of patients was 42.7 +/- 12 years. Clinical symptoms such as dysuria or frequency were typical for that kind of infection. The most frequent abnormality was leukocyturia or leukocyturia accompanied by erythrocyturia noted in 66% of patients. Isolated erythrocyturia was observed in 24.4% of cases. It has been stated that anamnesis or routine laboratory examinations were not able to the identification of infection. In face of poorly characteristics of clinical picture of infection the infection with Ch.Tr. could be the cause of unsuccessful therapy in patients with signs of genitourinary tract infections.

[Bacterial flora in the urethra of men with Chlamydia trachomatis urethritis before and after treatment with ofloxacin]. / Flora bakteryjna towarzyszaca chlamydialnemu zapaleniu cewki moczowej u mezczyzn przed i po leczeniu ofloksacyna.

From urethra of 40 men with CTU, 190 bacterial strains were isolated, 110 before and 80 after treatment with OFX (400 mg daily for 5 days). Among the strains coexisting with Chlamydia trachomatis, Staphylococcus epidermidis (30.9%), Micrococcus (13.6%), Streptococcus group D (10.9%) and Staphylococcus aureus (10.9%) were isolated more frequently than others. The in vitro susceptibility testing showed that, in comparison to erythromycin, doxycycline, oxytetracycline and co-trimoxazole, OFX was the most active antimicrobial agent against the majority of bacteria (except streptococci) isolated from urethra in CTU cases in men. The OFX treatment was found to reduce the total number of isolated strains, including Staphylococcus aureus and Staphylococcus saprophyticus, without disturbing normal urethral flora.

[Sensitivity and specificity of the Chlamydiazyme test in comparison with tissue culture in the light of our studies]. / Czulosc i swoistosc testu Chlamydiazyme w porównaniu z hodowla w swietle badan wlasnych.

The Chlamydiazyme Test was used in the laboratory examination of 1139 patients (716 women, 368 men, 55 children) hospitalized in the departments of urology, nephrology and gynaecology. Urethral and cervical smears were examined. In comparison with the culture method for C. trachomatis on McCoy cells the Chlamydiazyme test had a 91.6% agreement of the positive and negative results. The disagreeing results, that is only Chlamydiazyme test positive or only culture positive, accounted respectively for 2.1% and 6.2% of the results. The sensitivity of the Chlamydiazyme test was 74.6% and its specificity was 97.2%.

[Results of 5-day ofloxacin (Tarivid) treatment of chlamydial urethritis in men]. / Wyniki 5-dniowego leczenia ofloksacyna (Tarivid) chlamydialnego zapalenia cewki moczowej u mezczyzn.

The examined group of men with urethritis comprises 40 patients at age 20-50 yrs. Diagnosis of Chlamydia trachomatis infection was based on the positive results of two of three techniques: culture on McCoy cells, direct immunofluorescent (Chlamyset) and immunoenzymatic (Chlamydiazyme) methods. The patients with CT-urethritis were treated with Tarivid given orally 2 X 200 mg daily for 5 days. Five days later they were reexamined with the same methods. The results were as follows: 36 out of 40 patients were negative by culture and Chlamydiazyme and were clinically cured. Four were positive by both methods and still had symptoms of urethritis.

[Immunologic status in cattle naturally infected with the microorganisms Chlamydia trachomatis and Chlamydia psittaci]. / Imunologický status u hovädzieho dobytka prirodzene infikovaného mikroorganizmami Chlamydia trachomatis a Chlamydia psittaci.

In the present paper there is a description of immunological reactions in 12 to 14 months old bullocks, naturally infected by the microorganisms Chlamydia (Ch.) psittaci and Chlamydia trachomatis. In the course of infection by the above-mentioned microorganisms (chlamydia isolated from semen) without any clinical symptoms the activity of leucocytes and polymorphonuclear cells (PMN) in the peripheral blood is variable and the concentrations of serum immunoglobulins (IG) decrease. It has been demonstrated that the infection of bullocks by Ch. trachomatis increases the bacteria absorbing capacity of PMN cells (from 14.2 to 20.1), percent of phagocytic cells in the peripheral blood (from 13.0 to 26.5%). NBT reduction activity both in a spontaneous test (from 3 to 6) and in a stimulated test (from 8 to 12), and also myeloperoxidase activity (from 0.29 to 0.42). In these animals there were also recorded decreases (although not statistically significant) in the concentrations of serum IgG1, IgG2, IgA by about 10% and by about 30% in IgM. In Ch. psittaci-infected bulls leucocyte migration in the peripheral blood decreased (from 4.5 to 2.7 mm). PMN cell adherence (from 50 to 32), lysosome amount (from 0.63 to 0.35 mg per l) also decreased. In these bullocks decreases in the concentrations of serum Ig from 12.2 to 8.2 g per l in IgG1 and from 3.8 to 1.7 g per l in IgM were also proved.

[Correlation of detection of Chlamydia infection of the urethra sperm]. / Korelacja czestosci wykrywania zakazen chlamydiami cewki moczowej i spermy.

In the group of 150 men with urological diseases simultaneous examinations of urethra swabs and sperm specimens were done. By culture method on McCoy cells Chlamydia trachomatis was found more frequently in semen (46.7%) than in urethra (35.3%); in 103 patients with urethritis the results were 43.6% and 33.0% respectively. Consistently positive results were obtained in 33 (26.0%) and consistently negative ones in 66 (44.05) of all examined men. In 31 (20.7%) patients, 22 with urethritis including Chlamydia trachomatis was cultured from semen alone and in 14 (9.3%) from urethra alone. The above findings suggest that human semen constitutes a valuable diagnostic material in cases suspected of infection due to Chlamydia trachomatis.

[Chlamydia-induced pneumonia in children]. / Die durch Chlamydien verursachte Lungenentzündung bei Kindern.

Three cases of pneumonia caused by Chlamydia were observed. The disease ran a protracted course and was refractory to treatment. Erythromycin was given initially intravenously and then orally, with improvement of the general condition of children and regression of inflammatory changes in the lungs. Such cases are worth of reporting in view of only isolated reports on respiratory infections caused by these organisms.