NICU

Neonatal Chlamydia Pneumonia

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Neonatal Chlamydia Pneumonia

  • See Also
  1. Neonatal Pneumonia
  2. Chlamydia Trachomatis
  3. Chlamydia pneumoniae (TWAR)
  • Epidemiology
  1. Incidence: 12,000 cases per year in United States
  2. Occurs in <10% of vaginal deliveries from mothers with active genitourinary Chlamydia
  • Pathophysiology
  1. Chlamydia Trachomatis infection in the newborn
  2. Acquired via vertical transmission during delivery from a mother with chlamydia Vaginitis
  3. Not the same as the Atypical Pneumonia of Chlamydia pneumoniae (TWAR)
    1. TWAR in contrast is seen in the elderly and to a lesser extent in young adults
  • Findings
  1. Onset of symptoms 1-3 months after delivery
    1. Onset primarily age 4 to 11 weeks (range 2 to 19 weeks of age)
  2. Tachypnea
  3. Staccato Cough (coughing in short bursts)
  4. No fever
  5. Rhinorrhea
  6. Rales
  1. Hyperinflation
  2. Bilateral diffuse infiltrates
  • Labs
  1. Complete Blood Count
    1. Eosinophilia >400 cells/mm3
  2. Chlamydia Trachomatis testing
    1. Nasal Swab for Chlamydia Direct Fluorescence Antibody (low Test Sensitivity) OR
    2. Chlamydia DNA Probe or NAAT (preferred)
      1. Not FDA approved for nasopharyngeal swab (but better Test Sensitivity)
  • Differential Diagnosis
  1. See Neonatal Pneumonia
  2. Bordetella Pertussis (Whooping Cough)
  3. RSV Bronchiolitis
  4. Mycoplama Pneumoniae (rare in infants)
  • Management
  1. Start Antibiotics while awaiting test results (based on clinical diagnosis)
  2. Erythromycin Base or EES 50 mg/kg divided four times daily for 14 days
  3. Second course may be required
  4. Close interval follow-up
  • References
  1. Darville (2005) Semin Pediatr Infect Dis 16(4): 235-44 [PubMed]
  2. Mishori (2012) Am Fam Physician 86(12): 1127-32 [PubMed]
  3. Tipple (1979) Pediatrics 63(2): 192-7 [PubMed]