Chlamydophila (Chlamydia) pneumoniae as a Cause of Community-Acquired Pneumonia in Thailand
WUDTHICHAI SUTTITHAWIL, M.D.*, PlYA DA WANGROONGSARB, M.Sc.**,
PIMJAI NAIGOWIT, B.Sc., M.T.**, PONGPUN NUNTHAPISUD, M.Sc.***,
NONGLAK CHANTADISAI, M.D.****, YONGYUDH PLOYSONGSANG, M.D., D.Sc., FCCP.*****
Affiliation : * Division of Allergy and Immunology, Pramongkutklao College of Medicine, Rajvithi Rd., Bangkok 10400,
** NIH, Department of Medical Sciences, Ministry of Public Health, Nonthaburi 11000,
*** Department of Microbiology, Faculty of Medicine, King Chulalongkom Memorial Hospital, Bangkok 10330,
**** Division of Pulmonary Medicine, Pramongkutklao College of Medicine, Rajvithi Rd., Bangkok 10400,
***** Pulmonary and Critical Care Medicine, Bumrungrad Hospital, Bangkok 10400, Thailand.
t Presented in part at the 1997 Annual Conference of the Royal College of Physicians of Thailand, April 22-25,
Chiang Mai, Thailand.
AbstractChlamydophila (Chlamydia) pneumoniae infection is increasingly reported worldwide
nowadays. We studied twelve Thai adults presenting with the clinical symptoms and signs of
community-acquired pneumonia (CAP) due to C. pneumoniae (TWA R) at Pramongkutklao
Hospital in Bangkok, Thailand. Their mean age was 38 (range 21-73) years. Six patients lived in
Bangkok. Seven patients had comorbid diseases (four cases with allergic asthma, one each with
diabetes mellitus, chronic obstructive pulmonary disease and coronary artery disease).
C. pneumoniae pneumonia presented as subacute pneumonia in 6 patients. The clinical mani
festations were mild (IDSA risk class I-III) except in 4 patients who had preexisting allergic
asthma, COPD and coronary heart disease. The diagnosis of C. pneumoniae pneumonia was based
on microimmunofluorescence (MIF) antibody technique (IgM titer 2:. 1: 16, IgG 2:. 1:512, IgA 2:.
1:256 with or without fourfold rises). The clinical conditions were consistent with the primary
infection (IgM titer of 1:16 or higher) in 6 patients and reinfection (IgG titer of 1:512, IgA titer of
1:256 or higher without rises of IgM titer) in the other 6 patients. Minimal bilateral pleural effusion
was detected in only one patient. Coinfection was demonstrated in 2 patients (one each with
S. pneumoniae and K. pneumoniae). All patients markedly improved after a 2-week course of
macrolide, doxycycline or newest fluoroquinolone therapy. All patients had done well at one year
of follow-up. C. pneumoniae infection has been recently recognized and a high seroprevalence (37%)
in Thai school children and 100 per cent in young male Thai military conscripts has been reported.
This report suggests that this infection, C. pneumoniae, may be a common pathogen of CAP in
Thailand.
Keywords : Chlamydophila Pneumoniae, Chlamydia Pneumoniae, Chlamydophila, Chlamydia, TWA R, Community-Acquired Pneumonia, CAP, Atypical Pneumonia, Atypical Pathogen, Respiratory Tract Infection, Sinusitis, Microimmunofluorescence, MIF, Fluoroquinolone, Thailand.
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