clinical features , diagnosis , treatment , complication , mycoplasma & chlamydia pneumonia

1. Atypical pneumonia
NELSON TEXTBOOK OF PEDIATRICS 20TH EDITION
BY
DR. MAZIN MALIK KADHIM

3. Mycoplasma pneumoniae
M. pneumoniae is distinguished by the complete absence
of a cell wall that results
(1) in their dependence to host cells for obtaining
essential nutrients,
(2) the intrinsic resistance to β-lactam agents,
(3) their pleomorphic shape and lack of visibility on Gram
staining.

4. Clinical presentation
Tracheobronchitis and pneumonia are the most commonly
recognized clinical syndromes associated with M. pneumoniae
infection.
This agent is responsible for up to 20% of all cases of pneumonia.
Although the onset of illness may be abrupt, it is usually
characterized by gradual onset of headache, malaise, fever, and
sore throat, followed by progression of lower respiratory
symptoms, including hoarseness and nonproductive cough.

5. cough, the clinical hallmark of M. pneumoniae infection, usually
worsens during the 1st wk of illness, and symptoms generally
resolve within 2 wk. Cough can last up to 4 wk and may be
accompanied by wheezing.
Clinical findings are often less severe than suggested by the
patient chest radiograph, explaining why the term “walking
pneumonia” is often used to describe CAP caused by M.
pneumoniae.

6. Extrapulmonary Disease
A. CNS
B. Dermatological
C. Hematological
D. Arthritis
E. Others

7. Treatment options
Azithromycin 10 mg / kg 1st day followed by 5mg/ kg
day for 4 days.
Clarithromycin 15 mg / kg / day in 2 divided doses
for 10 days
Doxycycline 100mg x 2 for 7-14 days
Levofluxacine 500 mg x 1 for 7- 14 days

8. For macrolides resistant M. pneumonia
Tosufluxacine < 8 yr
Minocycline >8 yr
Indication of steroid in M. pneumonia
1) Severe lung diz.
2) CNS diz.
3) SJS
4) Hemolytic anemia

9. Indication of prophylactic AB.
Sickle cell diz.
Immunodeficiency
Down syndrome
Chronic cardiopulmonary diz.

10. Chlamydia trachomatis
pneumonia

11. C. trachomatis is the most prevalent sexually
transmitted disease, causing
*urethritis in men
*cervicitis and salpingitis in women
*conjunctivitis and pneumonia in infants.

12. Chlamydia trachomatis conjunctivitis

13. Pneumonia in Newborns
EPIDEMIOLOGY
Chlamydial genital infection is reported in 5-30% of
pregnant women,with a risk for vertical transmission at
parturition to newborn infants of approximately 50%. The
infant may become infected at 1 or more sites, including
the conjunctivae, nasopharynx, rectum, and vagina.
Transmission is rare following cesarean section with intact
membranes.

14. Pneumonia caused by C. trachomatis can
develop in 10-20% of infants born to women
with active, untreated chlamydial infection.
Only approximately 25% of infants with
nasopharyngeal chlamydial infection
develop pneumonia.

15. Clinical presentation
Onset usually occurs between 1 and 3 mo of age and is often insidious,
Sign & symptoms persistent cough
tachypnea,
absence of fever.
Auscultation reveals rales
wheezing is uncommon
The absence of fever and wheezing helps to distinguish C. trachomatis pneumonia from respiratory syncytial
virus pneumonia.
A distinctive laboratory finding is the presence of peripheral eosinophilia (>400 cells/μL).
The most consistent finding on chest radiograph is hyperinflation accompanied by minimal interstitial or
alveolar infiltrates

16. CxR

17. Diagnosis
*Definitive diagnosis is achieved by isolation of C. trachomatis in cultures of
specimens obtained from the conjunctiva or nasopharynx.
*direct fluorescent antibody
*NAATs
*PCR

18. Treatment
Erythromycin 50 mg / kg / day
divided by 4
for 14 days
Azithromycin 20 mg / kg / day
single dose
for 3 days

19. *The failure rate with oral erythromycin remains 10-20%, and some
infants require a second course of treatment.
*Mothers (and their sexual contacts) of infants with C. trachomatis
infections should be empirically treated for genital infection.

20. An association between treatment with oral
erythromycin and infantile hypertrophic pyloric
stenosis has been reported in infants younger than 6
wk of age who were given the drug for prophylaxis
after nursery exposure to pertussis.

21. prevention
The most effective method of controlling perinatal chlamydial infection is
screening and treatment of pregnant women.
For treatment of C. trachomatis infection in pregnant women, the CDC currently
recommends either azithromycin (1 g PO as a single dose) or amoxicillin (500 mg PO 3
times a day for 7 days) as first-line regimens. Erythromycin base (250 mg PO 4 times a
day for 14 days) and erythromycin ethylsuccinate (800 mg 4 times a day for 7 days, or
400 mg PO 4 times a day for 14 days) are listed as alternative regimens. Reasons for
failure of maternal treatment to prevent infantile chlamydial infection include poor
compliance and reinfection from an untreated sexual partner.

22. Thank you