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Chlamydial pneumonia and human sexuality.

The cover of this issue of the Journal records the beautiful photographic capture by Embil, Ozere and MacDonald (see their article on page 1199) of an iodine-stained intracellular inclusion characteristic of infection due to Chiamydia trachomatis. It reminds us that we are living in an exciting period of discovery in microbiology and infectious disease a time when almost each month brings new information of practical importance to the clinician. The traditional concept of syphilis and gonorrhea as the principal sexually transmitted diseases is about as passe as the mustard plaster. Other important infections, some much more prevalent than the classic duo, are quietly passed between sexual partners. Among the sexually transmitted pathogens are herpesviruses, cytomegaloviruses and chlamydiae, all of which are also transmissible from mother to fetus and can cause important disease in early infancy. For some, the name Chiamydia trachomatis may still conjure up images of photophobic sheiks in amber sunglasses and blind beggars in the Casbah. This antique fantasy must also be discarded. Chlamydial infections are widespread throughout the world, affecting young and old at all socioeconomic levels. These infections are due to types of C. trachomatis that are distinguishable serologically from those responsible for hyperendemic blinding trachoma of the sort found in North Africa and the Middle East. They are clinically important for several reasons: first, because the diseases they cause are often misdiagnosed and, second, because the infections are amenable to treatment and can become chronic or transmissible from mother to fetus. Persons who care for newborn infants should recognize that conjunctivitis appearing in infants between 5 and 14 days of age is almost certainly not due to the chemical irritation of silver nitrate prophylaxis, but is probably inclusion blennorrhea caused by C. trachomatis an infection not prevented by silver nitrate. Chlamydial infection should also be considered in any young infant in whom pneumonia develops between 4 weeks and 3 months of age, with or without antecedent conjunctivitis, and in those of the same age group in whom pertussis is suspected. Several clinical clues should heighten the suspicion. The cough is often distinctive: unlike the typical uninterrupted expiratory paroxysm of pertussis, "chlamydial spasms" occur in a series of closely spaced, interrupted, staccato coughs. Sometimes the roentgenographic changes seem disproportionately severe when compared with the degree of clinical illness. Finally, as the patients described by Embil and colleagues illustrate, significant elevations in the serum concentrations of IgG and 1gM may offer another clue. The principal message is that C. trachomatis infection is no rarity it is a common cause of pneumonia in young infants and is probably responsible for some pneumonias previously labelled as "viral". Hammerschlag1 recently estimated that C. trachomatis may cause pneumonia in 15 000 to 30 000 infants per year in the United States. It has also been suggested that 2% to 13% of women in city hospitals in the United States are infected with C. trachomatis. In infants born to such mothers there is a 50% chance of conjunctivitis developing and a 10% to 20% risk of pneumonia.2 Other serotypes of the intracellular bacteria-like parasite C. trachomatis are responsible for many cases of nongonococcal urethritis and epididymitis in men, cervicitis and acute salpingitis in women and lymphogranuloma venereum. The other species of Chiamydia, C. psittaci, is the causative agent of psittacosis. Just as this organism may be excreted by healthy-looking birds, silent C. trachomatis infections also occur in humans. Persons wishing to familiarize themselves with all aspects of the current knowledge about chlamydial infections should consult the excellent recent review by Schachter.2 Unless physicians learn to suspect chlamydial infections by becoming familiar with the characteristic clinical features, they are unlikely to recognize the infection because the organisms do not grow on usual bacteriologic culture media. Cell scrapings may be stained for inclusions. The organism can be isolated by tissue culture methods and stained with iodine or by immunofluorescent techniques. Confirmation can be obtained by demonstrating serum antibodies by microimmunofluorescence. Refinements of these methods have made the diagnosis of chlamydial infections much more accessible. Many new microbial actors are currently enlivening the theatre of human infectious disease. Some of the newer stars' names, such as the organism causing Legionnaires' disease, are already household words. Others, such as Yersinia enterocolitica, Campylobacter and Chiamydia,