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10 - A case of pneumonia caused by chlamydia pneumoniae with a subacute clinical course
Recep Dodurgali, Levent Dalar, Sezai Öztürk, Kerim Küçükler Firdevs Atabey, Cemal Bes, Hanife Can, Füsun Şahin, Çiğdem Y. Ersoy, Arman Poluman
Our case was referred to our clinic with effort dyspnea, dry cough, malaise, and weight loss and joint pain lasting for three months. In the respiratory auscultation of the patient who had a history of avion pet for 20 years (parakeet and parrot), eougli and rales at terminal inspirium not altering with position were heard. In his chest roentgenogram marked appearance in hronchovaseular traces in bilateral lower zones and an appearance of ground glass in high resolution computerized tomography of thorax were determined.
In the bronchoscopy performed, no pathological finding was encountered except increased fragility in the mucosae of the right and left bronchial systems.
No bacteria were found in sputum and gram staining of BAL fluid, neither in the culture. There was a preponderance of lymphocytes and a decrease at the ratio of CD4ICDH in the immunological examination carried out. Due to the fact that the ease was an old woman and that malignancy was suspected, peribronchiolar lymphocyte populations and moderate degree of fibrosis were detected at the open lung biopsy piece obtained by mini thoracotomy and malignancy has been ruled out. As the bacterial culture was negative, serological tests have been performed and Chlamydia IgM was found to be negative, and IgG positive.
By MIF technique performed for the differentiation of species, IgM was found negative, IgG positive at high titration against C. pneumoniae and IgM and IgG negative against C. trachomatis and C. psittaci.
The case was evaluated as C. pneumoniae (possible reinfection) with a subacute course, since IgM was detected to be negative, but IgG positive only at high titration. Treatment with tetracycline at a dose of 2 grand day was intolerated 10 days later: therefore tetracycline treatment has been substituted with Chlarytromycine / gram/day. The patient was followed-up for three months and both clinical and radiological partial regression has been observed.
Keywords: Chlamydia, pneumonia, subacute
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