Correspondence
Chlamydia Pneumonia and Meningoencephalitis
N Engl J Med 1994; 331:406August 11, 1994
- Article
To the Editor:
Chlamydia pneumoniae causes respiratory1 and nonrespiratory2,3 clinical syndromes. We describe a case of pneumonia caused by C. pneumoniae and associated with meningoencephalitis.
An 18-year-old man who had been in good health had malaise, a high temperature, and a nonproductive cough. Ten days later, he had a headache, double vision, and paresthesias of the right side of the body, predominantly in the upper and the lower limbs. On admission to the hospital, he was somnolent and febrile, with a rigid neck. The next day, patellar reflexes became asymmetric, with an extensor left plantar reflex. The patient became unconscious and required ventilatory support.
The erythrocyte sedimentation rate was 24 mm per hour. The white-cell count was 15.1 × 109 per liter with a normal differential count. The level of C-reactive protein was 119 mg per liter. The cerebrospinal fluid was clear, and the total protein and glucose concentrations were normal. There were 26 × 106 white cells per liter, with a lymphocyte predominance (25 × 106 per liter). The results of routine biochemistry studies were normal. A chest film showed a pneumonia involving the inferior lobe of the left lung. A computed tomographic scan of the brain was normal, but an electroencephalogram showed abnormal diffuse slow-wave activity. Serum samples obtained on admission had a high IgG antibody titer to C. pneumoniae (1:512). The IgM antibody titer was 1:32 (microimmunofluorescence assay, Institute of Ophthalmology, London). The cerebrospinal fluid showed no IgG or IgM antibody titer to C. pneumoniae. The cerebrospinal fluid and a throat washing were positive, however, on a direct-immunofluorescence test4 with C. pneumoniae-specific monoclonal antibodies (Cellabs, Australia).
Four months after the onset of illness, the serum IgG antibody titer declined to 1:64, the serum IgM antibody titer was negative, and no elementary bodies were found in a throat washing. Specific IgM and IgG antibody titers to C. psittaci and C. trachomatis were below 1:16 (microimmunofluorescence test). Paired serum specimens obtained approximately five weeks apart were tested for complement-fixing antibody to Mycoplasma pneumoniae, Coxiella burnetii, adenovirus, influenza viruses A and B, and parainfluenza viruses 1, 2, and 3. No elevated titers were observed. Indirect-immunofluorescence tests for specific IgM and IgG antibodies to Legionella pneumophila, Epstein-Barr virus, and Borrelia burgdorferi were negative. No IgM antibodies to cytomegalovirus and herpes simplex virus were found with an enzyme-linked immunosorbent assay. Serologic tests were negative for the presence of antibodies in the cerebrospinal fluid against C. psittaci, C. trachomatis, M. pneumoniae, L. pneumophila, B. burgdorferi, and herpes simplex virus.
The patient was treated with intravenous acyclovir (750 mg three times daily), cefotaxime (2 g three times daily), and erythromycin (600 mg four times daily) for 14 days. He regained consciousness and started to breathe spontaneously in four days. He had a complete recovery.
Patients with central nervous system infections and negative studies for common etiologic agents should be examined for chlamydial infection. This is a rare, yet possible, cause of meningoencephalitis.
4 ReferencesMaja Socan, M.D.
Bojana Beovic, M.D.
University Medical CenterDarja Kese
Institute of Microbiology, 61000 Ljubljana, Slovenia1
Grayston JT ,Aldous MB ,Easton A , et al. Evidence that Chlamydia pneumoniae causes pneumonia and bronchitis. J Infect Dis 1993;168:1231-1235
CrossRef | Web of Science | Medline2
Haidl S ,Ivarsson S ,Bjerre I ,Persson K . Guillain-Barre syndrome after Chlamydia pneumoniae infection. N Engl J Med 1992;326:576-577
Web of Science | Medline3
Michel D ,Antoine JC ,Pozzetto B ,Gaudin OG ,Lucht F . Lumbosacral meningoradiculitis associated with Chlamydia pneumoniae infection. J Neurol Neurosurg Psychiatry 1992;55:511-511
CrossRef | Web of Science | Medline4
Sillis M ,White P ,Caul EO ,Paul ID ,Treharne JD . The differentiation of Chlamydia species by antigen detection in sputum specimens from patients with community-acquired acute respiratory infections. J Infect 1992;25:Suppl 1:77-86
CrossRef | Web of Science | Medline
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I. Steiner, H. Budka, A. Chaudhuri, M. Koskiniemi, K. Sainio, O. Salonen, P. G. E Kennedy. (2010) Viral meningoencephalitis: a review of diagnostic methods and guidelines for management. European Journal of Neurology 17:8, 999-e57
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Charles W Stratton, Subramaniam Sriram. (2003) Association of Chlamydia pneumoniae with central nervous system disease. Microbes and Infection 5:13, 1249-1253
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A. Heick, E. Skriver. (2000) Chlamydia pneumoniae -associated ADEM. European Journal of Neurology 7:4, 435-438
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J. Guglielminotti, N. Lellouche, E. Maury, M. Alzieu, B. Guidet, G. Offenstadt. (2000) Severe Meningoencephalitis: An Unusual Manifestation of Chlamydia pneumoniae Infection. Clinical Infectious Diseases 30:1, 209-210
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F. Blasi, P. Tarsia, C. Arosio, L. Fagetti, L. Allegra. (1998) Epidemiology of Chlamydia pneumoniae. Clinical Microbiology and Infection 4, 4S1-4S6
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Rosa Monno, Emilia Leone, Paolo Maggi, Giovanni Buccoliero, Maria A. Valenza, Gioacchino Angarano. (1997) Chlamydia pneumoniae: a new opportunistic infectious agent in AIDS?. Clinical Microbiology and Infection 3:2, 187-191
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J Gaillat. (1996) Manifestations cliniques des infections à Chlamydia pneumoniae. La Revue de Médecine Interne 17:12, 987-991
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J Gaillat. (1996) Manifestations cliniques des infections à Chlamydia pneumoniae. La Revue de Médecine Interne 17, s41-s44
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Francesco Blasi. (1996) Clinical features of Chlamydia pneumoniae acute respiratory infection. Clinical Microbiology and Infection 1, S14-S18
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(1995) More on Chlamydia Pneumonia and Meningoencephalitis. New England Journal of Medicine 332:1, 62-63
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