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GENERAL EVALUATION OF CASES WITH COMMUNITY ACQUIRED PNEUMONIA DUE TO C. PNEUMONIAE

GENERAL EVALUATION OF CASES WITH COMMUNITY ACQUIRED PNEUMONIA DUE TO C. PNEUMONIAE. C. Naz, F. Alatas, G. Durmaz*, G. Ak, H. Yıldırım, M. Metintas, S. Erginel. Eskisehir Osmangazi University Departments of Chest Diseases and *Microbiology, Eskisehir, Turkey. INTRODUCTION and AIM.

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GENERAL EVALUATION OF CASES WITH COMMUNITY ACQUIRED PNEUMONIA DUE TO C. PNEUMONIAE

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  1. GENERALEVALUATION OF CASES WITH COMMUNITY ACQUIRED PNEUMONIA DUE TO C. PNEUMONIAE C. Naz, F. Alatas, G. Durmaz*, G. Ak, H. Yıldırım, M. Metintas, S. Erginel Eskisehir Osmangazi University Departments of Chest Diseases and *Microbiology, Eskisehir, Turkey

  2. INTRODUCTION and AIM Although the prevalence of C.Pneumonia, a mandatory intracellular pathogen, changes from year to year and geographical region, it is responsible from 6-34 % of all CAP. Especially, the frequently seen cause of mix infections

  3. Clinical findings differ from asymptomatic cases to serious pneumonia which threats life and coexisting disease determines the requirement of hospitalization and clinical course of disease.

  4. The first findings are sore throat, head ache and hoarseness. The progression of symptoms is slower than mycoplasma and viral pneumonias. Extrapulmonary findings along with reactive air way disease may be seen.

  5. Leukocyte number increases rarely. In some studies, it was notified that low CRP and high Alkaline Phosphatase levels may be assessed as clue for diagnosis. There is not characteristic radiological specifications. Lesions may involve one or more lobe and usually unilateral. Pleural fluid may develop in 8-30 % of all cases.

  6. Diagnosis; The isolation of C.pneumoniae or its antigen Cell culture EIA, DFA, PCR Serological tests CFT, MIF, EIA

  7. The aim of this study was to evaluate the demographic, clinic, radiologic, laboratory findings and prognosis of patients diagnosed as pneumonia due to C. pneumoniae

  8. MATERIALS and METHODS C. pneumoniae specific Ig M,G, A and M. pneumoniae specific Ig M and G were determined by MIF and ELISA, respectively in sera taken before treatment and twenty first day of treatment of thirty eight CAP patients prediagnosed as atypical pneumonia. The presence of Legionella antigen was investigated in urine samples of the same patients before treatment.

  9. Blood, BAL and/or sputum samples were taken for gram stain and culture before treatment and were assessed by Department of Microbiology. Twenty four cases accepted as acute infection due to C. Pneumoniae by MIF and did not grew any other pathogen in their cultures were evaluated. The statistical evaluation was done by SPSS 10.0 package program.

  10. Diagnostic criteria for C.pneumoniae; - The titration of Ig M antibody ≥1/16 - The titration of Ig M antibody ≥1/16 and the titration of Ig G antibody ≥512 - Four fold increase of Ig M and G antibody titers in blood samples taken in acute and convalescent periods.

  11. RESULTSDemographic results of patients 24 patient: 15 were male, 9 were women Mean age: 58 years (21-79) 10 patient > 65 years old 14 patient < 65 years old 67 %of cases were smoker, 38% of patients were under antibiotic treatment at the time of admission.

  12. Comorbid diseases; n=14 COPD: 6 Asthma: 2 Heart Failure: 3 Malignancy: 2 Cerebrovascular D: 1 57%

  13. Cases PSI CURB 65

  14. Symptoms The duration of symptomatic period was more than one week in 58% of cases.

  15. Physical examination was normal in one patient, rhonchus was observed in three cases which had not obstructive pulmonary disease previously

  16. Laboratuary Findings : p< 0.001 Compared with before therapy levels *: p<0.05 Compared with before therapy levels

  17.  : p<0.001 Compared with before therapy levels *: p<0.05 Compared with before therapy levels

  18. *: p<0.05 Compared with before therapy levels : p<0.01 Compared with before therapy levels

  19. Sterile BAL samples in twelve cases and sputum samples in twenty cases were negative for quantitative culture. The blood culture were negative for 24 cases.

  20. Complications: n=2 • MV was applied to one patient due to respiration insufficiency. • Exitus: n=1 (%4)

  21. CONCLUSIONS We evaluated that C. pneumoniae is an important agent in patients with atypical pneumonia. Redundancy of patients in our serie may be due to comorbid diseases. Since C. pneumoniae is one of the frequent cause in COPD patients and heart disease patients.

  22. The clinical course, laboratory and radiological findings of our cases were compatible with previous studies. Mortality rate was low as declared in literature.

  23. Is C. pneumoniae the unique responsible pathogen in our cases? Otherwise is mix infection in question? Second pathogen was not isolated with culture methods. However, some of the patients were under antibiotic treatment at the time of admittance.

  24. As a result, we should remember C. Pneumoniae as the pathogen of pneumonia especially in patients with atypical pneumonia clinic, smoker and have comorbid diseases like cardio-pulmonary diseases.

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