Chlamydia trachomatis-associated respiratory disease in the very early neonatal period

Neonatal Chlamydia muridarum respiratory infection causes neuroinflammation within the brainstem during the early postnatal period

Respiratory infections are one of the most common causes of illness and morbidity in neonates worldwide. In the acute phase infections are known to cause wide-spread peripheral inflammation. However, the inflammatory consequences to the critical neural control centres for respiration have not been explored. Utilising a well characterised model of neonatal respiratory infection, we investigated acute responses within the medulla oblongata which contains key respiratory regions. Neonatal mice were intranasally inoculated within 24 h of birth, with either Chlamydia muridarum or sham-infected, and tissue collected on postnatal day 15, the peak of peripheral inflammation. A key finding of this study is that, while the periphery appeared to show no sex-specific effects of a neonatal respiratory infection, sex had a significant impact on the inflammatory response of the medulla oblongata. There was a distinct sex-specific response in the medulla coincident with peak of peripheral inflammation, with females demonstrating an upregulation of anti-inflammatory cytokines and males showing very few changes. Microglia also demonstrated sex-specificity with the morphology of females and males differing based upon the nuclei. Astrocytes showed limited changes during the acute response to neonatal infection. These data highlight the strong sex-specific impact of a respiratory infection can have on the medulla in the acute inflammatory phase.

Acute Chlamydia trachomatis respiratory infection in infants

Objectives:

This designed was designed to estimate the prevalence of Chlamydia trachomatis infection in infants of up to 6 months of age and to assess clinical and laboratory indicators as predictors of Chlamydia etiology.

Materials and Methods:

A hospital-based study was conducted in Department of Pediatrics, Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India, where infants up to 6 months of age (n=50) with features of lower respiratory tract infection of at least 1 week duration and fulfilling the inclusion criteria were assessed clinically and underwent laboratory investigations using hemogram, Chest X-ray, and IgM ELISA.

Results:

Out of 50 infants, 12 (24%) were tested positive by IgM ELISA test for C. trachomatis infection. In age group of up to 2 months 25% positivity was seen whereas it was found to be 31.81% in age group of 2–4 months and 15% in age group 4–6 months. With the ‘P’ value less than 0.05, it was found that there may be an association of seropositivity of C. trachomatis with duration of cough and absolute eosinophil count.

Conclusion:

Chlamydia trachomatis is an important cause of lower respiratory tract infection in infants below six months of age. The prolonged duration of cough and increased absolute eosinophil count may be good indicator of its etiology.

Neonatal chlamydial infections: prevention and treatment

Neonatal chlamydial infection, which manifests principally as ophthalmia neonatorum (ON) or pneumonia, is a significant cause of neonatal morbidity. Widespread use of silver nitrate drops resulted in a dramatic decline in the incidence of gonococcal ophthalmia but had much less impact on the incidence of neonatal chlamydial infection. Chlamydia trachomatis has become the most common infectious cause of ON in developed countries.A number of prophylactic antibiotic or antiseptic agents have been used to prevent ON. Prophylaxis with 1% silver nitrate ophthalmic drops, 0.5% erythromycin ophthalmic ointment, or 1% tetracycline ointment has comparable efficacy for the prevention of chlamydial ophthalmia but does not offer protection against nasopharyngeal colonization or the development of pneumonia. Erythromycin or tetracycline topically have been used as prophylactic agents because of their allegedly superior activity for the prevention of ON and because they produced less chemical conjunctivitis compared with silver nitrate. However, the relative efficacy of these agents for chlamydial infection and the emergence of beta-lactamase-producing Neisseria gonorrheae has raised questions regarding their effectiveness when applied topically for prophylaxis of ON. Compared with these agents, a 2.5% povidone-iodine ophthalmic solution has been found to have greater efficacy for the prevention of ON generally, and chlamydial ophthalmia specifically. In countries where the incidence of ON is very low, an alternative strategy is to institute prenatal screening and treatment of infected mothers, forgo routine neonatal prophylaxis, and follow-up infants after birth for the possible development of infection. For the treatment of chlamydial ophthalmia or pneumonia, oral erythromycin for 2 weeks is recommended; additional topical therapy is unnecessary. However, in approximately 20-30% of infants, therapy will not eradicate the organism and the infant may require a repeat oral course of antibiotics. The few published studies on the use of the new oral macrolide antibiotics, such as azithromycin, roxithromycin, or clarithromycin for chlamydial infections in neonates suggest that these agents may be effective; however, more data on their tolerability and efficacy in this patient group are warranted.

[Respiratory infection due to Chlamydia trachomatis in infants. Clinical presentation and outcome in 18 patients]

BACKGROUND

Among other diseases, Chlamydia trachomatis causes epididymitis and prostatitis in men and urethritis, cervicitis and pelvic inflammatory disease in women. In children, it most usually causes conjunctivitis and is also responsible for lower respiratory tract disease, occasionally requiring hospital admission.

OBJECTIVE

To draw attention to this disease, which is usually overlooked and which can be potentially serious.

METHODS

We retrospectively reviewed the medical records of infants aged less than 6 months with symptoms of lower respiratory tract disease in whom C. trachomatis antigen was detected by enzyme immunoassay.

RESULTS

We identified 18 patients with C. trachomatis between 1993 and 2002. Of these, 17 patients required hospital admission and five required monitoring in the pediatric intensive care unit. The mean length of hospital stay was 9.6 days. Three patients were immigrants. The mean age at admission was 6.6 weeks. Apnea occurred in five infants. Chest x-ray showed interstitial infiltrates in five infants. Sixteen patients were treated with erythromycin and all made a complete recovery.

CONCLUSIONS

Although lower respiratory tract disease caused by C. trachomatis is usually managed on an outpatient basis, it sometimes requires hospital admission or even management in the intensive care unit. Therefore, C. trachomatis infection should be ruled out in infants aged less than 6 months with clinical symptoms of lower respiratory tract disease for which no other pathogen can be found.

Chlamydia trachomatis lower respiratory tract infection in infants

Chlamydia trachomatis may be an important cause of lower respiratory tract infection (LRTI) in infants born to mothers amongst whom there is a high prevalence of sexually transmitted disease. A study of 100 ambulatory infants with signs of LRTI in South Africa showed that 6% had C. trachomatis infection. The majority of the infected infants had received chloramphenicol eye ointment as prophylaxis. Half had previously visited a health facility for the same illness but the infection has been misdiagnosed. Infants with C. trachomatis infection were According to the Centers for Disease Control (CDC) guidelines, 85% were younger than uninfected infants (mean (SD) age of 3.8 weeks (3.2) vs 8.7 weeks (5.4); p=0.03). Clinical signs significantly associated with chlamydial infection were the presence of eye discharge (p = 0.02) or conjunctivitis (p = 0.01). There was a greater rate of rhinorrhoea (p = 0.06) and wheeze (p = 0.03) amongst patients without chlamydial infection. H. influenzae, M. catarrhalis, S. pneumoniae, S. aureus and N. gonorrhoeae were cultured from five different patients infected with chlamydia. The majority of infants with chlamydial infection had mild disease requiring only outpatient anti- biotic therapy.

Ureaplasma urealyticum and pulmonary outcome in a neonatal intensive care population

OBJECTIVE

To determine whether the presence of Ureaplasma urealyticum in the respiratory tracts of very low birth weight infants is associated with increased risk of pneumonia, radiographic evidence of severe bronchopulmonary dysplasia during the second or third week of life (precocious) and oxygen dependency at 36 weeks of corrected postnatal gestational age.

METHODS

From October, 1993, to January, 1996, all infants who met the following entry criteria were enrolled in the study: birth weights < or = 1500 g; admission to the NICU within 24 h after birth; evidence on admission of respiratory distress; and no prior antibiotic treatment. Infants were cultured for mycoplasmas, viruses, chlamydiae and aerobic and anaeroic bacteria.

RESULTS

Ninety-four critically ill newborns constituted our study cohort. Within 7 days of birth more infants with U. urealyticum infection showed radiographic features of pneumonia (53.1%, 25 of 47) than infants without U. urealyticum infection (21.2%, 10 of 47). Infants with U. urealyticum were more likely to have radiographic evidence of precocious bronchopulmonary dysplasia than those without this isolate (22.5%, 9 of 40 vs. 2.3%, 1 of 42). The relative risk of oxygen dependency at 36 weeks of corrected age in U. urealyticum-positive infants was 11.0 times that in U. urealyticum-negative infants (95% confidence interval, 1.6 to 75.5). Association of U. urealyticum and chronic lung disease at this age was not weakened after adjustments were made in a multivariate analysis for other significant risk factors including gestational age and presence of a patent ductus arteriosus.

CONCLUSIONS

Isolation of U. urealyticum from respiratory tracts is associated with radiographic changes compatible with pneumonia within 7 days of birth, precocious bronchopulmonary dysplasia and severe pulmonary outcome.