Mycoplasma pneumonia and Chlamydia pneumonia infection in patients admitted to Beheshti Hospital in Kashan with community-acquired pneumonia

Document Type : Original Article

Authors

1 Infectious Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran

2 Autoimmune Diseases Research Center, Kashan University of Medical Sciences, Kashan, Iran

Abstract

Objectives: The objective of this study was to investigate the prevalence of Mycoplasma pneumoniae and Chlamydophila pneumoniae infections in patients with community-acquired pneumonia (CAP) admitted to Beheshti hospital in Kashan.
Methods: A descriptive cross-sectional study was conducted on 160 CAP patients admitted to Beheshti hospital in Kashan. Serological tests were performed using the ELISA method to evaluate IgG and IgM antibodies for Mycoplasma and Chlamydia pneumoniae. A questionnaire was also completed, which included demographic data, hospitalization time, and clinical and paraclinical findings. The data were analyzed using SPSS software (version 20).
Results: The study found that 19 (11.9%) cases tested positive for M. pneumoniae IgM antibodies, while 132 (82.5%) cases tested positive for M. pneumoniae IgG antibodies. For C. pneumoniae, 16 (10%) cases tested positive for IgM antibodies, and 151 (94.4%) cases tested positive for IgG antibodies. There was no significant association between M. pneumoniae and Chlamydia pneumoniae infections with sex, underlying illness, pneumonia severity, ICU admission, hospital death, hospitalization time, CRP, hematocrit, and platelet count. However, a significant relationship was observed between M. pneumoniae and chief complaint (p<0.001), as well as age (p = 0.122). Additionally, a significant relationship was found between C. pneumoniae and white blood cell count (p = 0.001), as well as changes in chest radiography (p = 0.001).
Conclusion: Given the significant incidence of atypical infections in CAP patients and the difficulties in laboratory detection, effective antibiotics targeting Mycoplasma pneumoniae and Chlamydophila pneumoniae are strongly suggested in the empirical therapy of CAP.

Keywords

Main Subjects


  1. Torres A, Cilloniz C, Niederman MS, Menéndez R, Chalmers JD, Wunderink RG, et al. Pneumonia. Nat Rev Dis Primers. 2021;7 (1):25 doi:10.1038/s41572-021-00259-0 PMid:33833230
  2. Sharma L, Losier A, Tolbert T, Dela Cruz C, Marion C. Atypical Pneumonia: Updates on Legionella, Chlamydophila, and Mycoplasma Pneumonia. Clin Chest Med. 2017; 38(1): 45-58 doi:10.1016/j.ccm.2016.11.011 PMid:28159161 PMCid:PMC5679202
  3. Marchello C, Dale AP, Thai TN, Han DS, Ebell MH. Prevalence of Atypical Pathogens in Patients With Cough and Community-Acquired Pneumonia: A Meta-Analysis. Ann Fam Med. 2016; 14 (6):552-566 doi:10.1370/afm.1993 PMid:28376442 PMCid:PMC5389400
  4. Yu Y, Fei A. Atypical pathogen infection in community-acquired pneumonia. Biosci Trends. 2016;10(1):7-13. doi:10.5582/bst.2016.01021 PMid:26961211
  5. He J, Liu M, Ye Z, Tan T, Liu X, You X, et al. Insights into the pathogenesis of Mycoplasma pneumoniae (Review). Mol Med Rep. 2016;14(5):4030-4036. doi:10.3892/mmr.2016.5765 PMid:27667580 PMCid:PMC5101875
  6. Defilippi A, Silvestri M, Tacchella A, Giacchino R, Melioli G. Epidemiology and clinical features of Mycoplasmapneumoniae infection in children. Respir Med 2008;102(12):1762-8 doi:10.1016/j.rmed.2008.06.022 PMid:18703327
  7. Kashyap S, Sarkar M. Mycoplasma pneumonia: Clinical features and management. Lung India. 2010; 27(2):75-85 doi:10.4103/0970-2113.63611 PMid:20616940 PMCid:PMC2893430
  8. Holzman R, Simberkoff M, Leaf H. Mycoplasma pneumoniae and Atypical Pneumonia In: Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of Infectious Diseases. 9th ed. USA: Elsevier; 2019. P2332-38.
  9. Cosentini R, Tarsia P, Blasi F, Roma E, Allegra L. Community-acquired pneumonia: role of atypical organisms. Monaldi Arch Chest Dis. 2001; 56(6): 527-34.
  10. Hammerschlag M, Kohlhoff S, Gaydos CH. Chlamydia pneumonia. In: Mandell GL, Bennett JE, Dolin R, editors. Principles and Practice of Infectious Diseases. 9th ed. USA: Elsevier; 2019. P2323-31
  11. Bozzoni M, Radice L, Frosi A, Vezzoli S, Cuboni A, Vezzoli F. Prevalence of pneumonia due to Legionella pneumophila and Mycoplasma pneumoniae in a population admitted to a department of internal medicine. Respiration. 1995;62(6):331-5 doi:10.1159/000196475 PMid:8552864
  12. Bansal S, Kashyap S, Pal LS, Goel A. clinical and bacteriological profile of community-acquired pneumonia in Shimla, Himachal Pradesh. Indian J Chest Dis Allied Sci. 2004; 46:17-22.
  13. Shenoy VD, Upadhyaya SA, Rao SP, Shobha KL. Mycoplasma pneumoniae infection in children with an acute respiratory infection. J Trop Pediatr. 2005; 51:232-5 doi:10.1093/tropej/fmi008 PMid:15980029
  14. Chaudhry R, Nazima N, Dhawan B, Kabra SK. Prevalence of Mycoplasma pneumoniae and chlamydia pneumoniae in children with community-acquired pneumonia. Indian J Pediatr. 1998; 65: 717-21 doi:10.1007/BF02731050 PMid:10773927
  15. Meloni F, Paschetto E, Mangiarotti P. Acute chlamydia pneumonia and Mycoplasma pneamonia infections in Community-acquired pneumonia and exacerbations of COPD or asthma: therapeutic considerations. J Chemather. 2004; 16(1): 70-76 doi:10.1179/joc.2004.16.1.70 PMid:15078002
  16. Chambers ST, Town GI, Neill AM. Legionella, Chlamydia pneumonia, and Mycoplasma infection in patients admitted to Christchurch Hospital With pneumonia. N Z Med J. 1999; 112 (10): 222-224.
  17. Nagalingam NA, Adesiyun AA, Swanston WH. Prevalence of Mycoplasma pneumonia and Chlamydia pneumonia in pneumonia patients in four major hospitals in Trinidad. New Microbio. 2004; 27(4): 345-351.
  18. Al-Hajaya TS, Al-Zereini WA, Al-Younes HM. Chlamydia pneumoniae infection in patients hospitalised for community-acquired pneumonia in Southern Jordan. Indian J Med Microbiol. 2020; 38(3 & 4): 338-343 doi:10.4103/ijmm.IJMM_20_63 PMid:33154244
  19. Wellinghausen N, Straube E, Freidank H, von Baum H, Marre R, Essig A. Low prevalence of Chlamydia pneumoniae in adults with community-acquired pneumonia. Int J Med Microbiol. 2006; 296(7): 485-91 doi:10.1016/j.ijmm.2006.05.003 PMid:16890487
  20. Donalisio MR, Arca CH, Madureira PR. Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia at a general hospital in the Sumare microregion of Brazil. J Bras Pneumol. 2011; 37(2): 200-8.
  21. Behbehani N, Mahmood A, Mokaddas EM, Bittar Z, Jayakrishnan B, Khadadah M, et al. Significance of atypical pathogens among community-acquired pneumonia adult patients admitted to hospital in Kuwait. Med Princ Pract. 2005; 14(4): 235-40 doi:10.1159/000085741 PMid:15961932
  22. Honarman HR, Taghizadeh S, Rahbar Taromsari M, Mirzajani E. Prevalence of Mycoplasma pneumoniae-specific IgG antibody in the adult population of Rasht. J Health Care. 2009; 11 (4): 56-50
  23. Ghasemi A, Habibzadeh S, Bakhshpoori P. Frequency of Mycoplasmal Pneumonia in Hospitalized patients with diagnosis of Community Acquired Pneumonia in Infectious Diseases Ward of Immam Khomeini Hospital, Ardebil, Iran.J Ardabil Univ Med Sci 2010;9(4) :307-314
  24. Sharifi S, Qootasloo R, Akhi MT, Soroush MH, Ansarin Kh, Shabanpour J, et al. Detection of respiratory infections caused by Mycoplasma pneumoniae in patients of Tabriz educational and medical centers by three methods of culture, ELISA and PCR polymerase chain reaction. Med J Tabriz Univ Med Sci 2011;33 (3):36-41
  25. Shah Hosseini MH, Mardani M, Hosseini Z, Khorram Khorshid HR, Rahimi AA, Wendyusfi J. Comparison of culture and PCR tests for the diagnosis of Mycoplasma pneumoniae respiratory infections. Adv Med Biomed Res. 2006 ;14(56):12-23
  26. Noori Goodarzi N, Pourmand MR, Rajabpour M, Arfaatabar M, Mosadegh M, Syed Mohamad SA. Frequency of Mycoplasma pneumoniae, Legionella pneumophila and Chlamydia spp. among patients with atypical pneumonia in Tehran. New Microbes New Infect. 2020;37:100744 doi:10.1016/j.nmni.2020.100744 PMid:32953125 PMCid:PMC7482018
  27. Sohn JW, Park SC, Choi YH, Woo HJ, Cho YK, Lee JS, et al. Atypical pathogens as etiologic agents in hospitalized patients with community-acquired pneumonia in Korea: a prospective multi-center study. J Korean Med Sci. 2006;21(4):602-7 doi:10.3346/jkms.2006.21.4.602 PMid:16891800 PMCid:PMC2729878
  28. Okazaki N, Ohya H, Sasaki T. Mycoplasma pneumoniae isolated from patients with respiratory infection in Kanagawa Prefecture in 1976-2006: emergence of macrolide-resistant strains. Jpn J Infect Dis. 2007;60(5):325-6.
  29. Al-Ghizawi GJ, Al-Sulami AA, Al-Taher SS. Profile of community- and hospital-acquired pneumonia cases admitted to Basra General Hospital, Iraq. East Mediterr Health J. 2007; 13(2): 230-42.
  30. Sidal M, Kilic A, Unuvar E, Oguz F, Onel M, Agacfidan A, et al. Frequency of Chlamydia pneumoniae and Mycoplasma pneumoniae infections in children. J Trop Pediatr. 2007;53 (4):225-31. doi:10.1093/tropej/fmm003 PMid:17517817
  31. Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev. 2004 Oct;17(4):697-728, table of contents. doi:10.1128/CMR.17.4.697-728.2004 PMid:15489344 PMCid:PMC523564
  32. Donalisio MR, Arca CH, Madureira PR. Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia at a general hospital in the Sumare microregion of Brazil. J Bras Pneumol. 2011; 37(2): 200-8.
  33. Al-Hajaya TS, Al-Zereini WA, Al-Younes HM. Chlamydia pneumoniae infection in patients hospitalised for community-acquired pneumonia in Southern Jordan. Indian J Med Microbiol. 2020; 38(3 & 4): 338-343 doi:10.4103/ijmm.IJMM_20_63 PMid:33154244
  34. Wellinghausen N, Straube E, Freidank H, von Baum H, Marre R, Essig A. Low prevalence of Chlamydia pneumoniae in adults with community-acquired pneumonia. Int J Med Microbiol. 2006; 296(7): 485-91 doi:10.1016/j.ijmm.2006.05.003 PMid:16890487
  35. Song JH, Huh K, Chung DR. Community-Acquired pneumonia in the Asia-Pacific region. Semin Respir Crit Care Med. 2016; 37 (6):839-854 doi:10.1055/s-0036-1592075 PMid:27960208 PMCid:PMC7171710
  36. Lui G, Ip M, Lee N, Rainer TH, Man SY, Cockram CS, et al. Role of 'atypical pathogens' among adult hospitalized patients with community-acquired pneumonia. Respirology. 2009;14(8):1098-105 doi:10.1111/j.1440-1843.2009.01637.x PMid:19818051