By Lance Chilton For the Journal
YOUR CHILD'S HEALTH: Q: My teen-age daughter was recently diagnosed with "chlamydia pneumonia." I have been unable to find much information on this infection. Can you please address this health issue and discuss how it is spread, what are its symptoms and long-term effects, and what are effective forms of treatment?
A: Pneumonia is a timely subject; thank you for your question. As with almost all infections of the lungs, the nose and everything in between, pneumonia is much more common in winter than any other time of year, both in children and adults. The microbe Chlamydia pneumoniae causes about one of every six cases of infection of the lung (pneumonia) — less in younger children, more in older children.
Now you may think of Chlamydia as the cause of a very common sexually transmitted disease (STD), and you are right. However, one form of Chlamydia causes STDs and occasional lung infections in infants, and another causes older children's pneumonia. Chlamydia pneumonia in teen-agers is caused by being coughed on or sneezed on by someone else with the germ. But, as with many other infections, not everyone who has the germ within them is sick.
I suspect that your daughter's doctor was making an educated guess about what was causing her infection. There's nothing wrong with that! In fact, much of the time children's infections are treated without knowing which germ is causing them; it's just too painful for the child or there's too much of a delay to find out for sure which germ is the culprit. For ear or sinus infections, we would have to puncture the ear drum or the sinus. For lung infections, we would either have to pierce the chest and draw fluid from the infected area or wait several weeks to see an increase in antibodies (chemicals the body makes to fight the infection).
The most common form of pneumonia is that caused by a bacterium called Streptococcus pneumoniae (the pneumococcus), a relative of the strep that causes sore throats. Until recently, this infection always responded to penicillin and many other drugs. The bad news is that an increasing number of the pneumococci are resistant to commonly used drugs. The good news is that we have a new vaccine that prevents infection with the most common pneumococci.
There isn't any vaccine yet against Chlamydia, though one effective in rabbits may eventually get to us. Chlamydia is probably the third leading cause of pneumonia in children beyond infancy, behind the pneumococcus and something called Mycoplasma pneumoniae. In infants, Chlamydia is much less common, while the pneumococcus and respiratory syncytial virus are seen much more often.
This information comes from strenuous studies where very sensitive and expensive tests are taken from children's noses and throats, and from a study of antibodies at the time of infection and several weeks later. Your doctor used that information, I suspect, to decide what the most likely germ was in your daughter's case. He or she then chose an antibiotic that would kill Chlamydia — there are several — while also covering the other common possibilities.
Chlamydia pneumonia, like most forms of pneumonia, causes little or nothing in the way of long-term effects. Some studies show a link with childhood asthma, showing that more children with asthma have evidence of previous infection with Chlamydia (83 percent) than children without asthma (60 percent). I can't tell from the studies whether children with asthma are more likely to get Chlamydia infection, or whether Chlamydia infection causes asthma in some kids. Chickens or eggs — which comes first?
By the time this column sees the pages of the Journal, your child will probably be fine and happy (?) to be back in school. If she's not fine, she should probably go back to her doctor.
Lance Chilton is a pediatrician who has practiced in Albuquerque for the past 26 years. He is president of the New Mexico Pediatric Society. Send your questions about children's health to Chilton by mail, Lovelace Pediatrics, 5400 Gibson SE, Albuquerque, NM 87108, or by e-mail to lancekathy@yahoo.com.
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