| Abstract: |
Summary and conclusionThis study was conducted on infants admitted to Zagazig University Hospital with afebrile pneumonia during the period from October 2003 to October 2004.Forty infants below six months of age manifested by afebrile chronic chest troubles (cough, tachypnea or wheezes for at least 3 weeks ) were included in our study. Patients with definite lung pathology as lobar pneumonia, effusion or pneumothorax were excluded from the study. Patients with underlying pathology like congenital heart disease, gastro-esophageal reflux, tracheo-esophageal fistula and neuro-muscular disorders proved clinically or radiologically were excluded from the study. Twenty healthy infants in the same age group were included as a control group.The aim of our study was to detect the prevalence of C. trachomatis as a causative agent among infants presenting with the clinical picture of afebrile pneumonia to Zagazig University Hospital during the period of the study.Full history taking, careful clinical examination was done for all studied subjects. In addition, chest X-ray, complete blood picture and erythrocyte sedimentation rate were done. Also, specific tests for Chlamydia trachomatis as throat swab for detection of the organsm by Giemsa stain and serologic tests by ELISA for detection of anti-Chlamydia trachomatis IgM , IgG and reevaluation of IgG after two weeks to detect it’s rising level.We further subdevided the 40 pateints into two subgroups; either infected or notinfected by Chlamydia trachomatis according to the results of serologic tests.* The study revealed that:1. High value of history of prematurity , LBW, PROM, Chorioamnionitis and vaginal infections in patients with C. trachomatis pneumonia.2. High value of current or past history of conjunctivitis in patients with C. trachomatis pneumonia.3. C. trachomatis pneumonia has a very characteristic presentation. Onset usually appears between 1-3 months of age, and is often insidious with persistent cough, tachypnea and absence of fever. Auscultation reveals crepitations, wheezing is uncommon.4. 45% of the patient group was IgM positive. 75% of the patient group was IgG positive. 25% of the patient group was Giemsa positive. 30% of the control group was IgG positive.5. No one of the control group was IgM positive or having positive results in Giemsa stain .6. Detection of IgM antibodies againest C. trachomatis by ELISA is enough for diagnosis.7. Single value of IgG denote nothing except past infection in the mother and diagnosis needs rising level after at least two weeks.8. Detection of inclusion bodies by Giemsa stain is specific in diagnosis of Chlamydia trachomatis (100%), but not sensitive enough to be a screening test ( 55.6%).9. All cases with positive IgM values had also IgG rising level10. All positive cases of Giemsa stain was IgM positive and having rising level of IgG titer.11. CBC in cases of C. trachomatis pneumonia show no or mild leukocytosis, with increase mainly in lymphocytes and eosinophiles not the neutrophils.12. X-ray finding differs among patients, but the most common among IgM positive group was hyperinflation with infiltrates.
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