英: Chlamydophila pneumoniae、C. pneumoniae、(Chlamydia pneumoniae)
同: 肺炎クラミジア。クラミジア・ニューモニエ、クラミドフィラ・ニューモニエ、クラミドフィラ・ニューモニアエ
関: クラミジア感染症、TWAR株、クラミドフィラ・ニューモニエ肺炎 Chlamydophila pneumoniae肺炎

WordNet

respiratory disease characterized by inflammation of the lung parenchyma (excluding the bronchi) with congestion caused by viruses or bacteria or irritants

PrepTutorEJDIC

肺炎

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/12/06 04:48:49」(JST)

wiki en

Chlamydophila pneumoniae is a species of Chlamydophila, an obligate intracellular bacterium^[2] that infects humans and is a major cause of pneumonia. It was known as the Taiwan acute respiratory agent (TWAR) from the names of the two original isolates – Taiwan (TW-183) and an acute respiratory isolate designated AR-39.^[3] Until recently, it was known as Chlamydia pneumoniae, and that name is used as an alternate in some sources.^[4] In some cases, to avoid confusion, both names are given.^[5]

C. pneumoniae has a complex life cycle and must infect another cell to reproduce; thus, it is classified as an obligate intracellular pathogen. The full genome sequence for C. pneumoniae was published in 1999. It also infects and causes disease in koalas, emerald tree boas (Corallus caninus), iguanas, chameleons, frogs, and turtles.

The first known case of infection with C. pneumoniae was a case of sinusitis in Taiwan. This atypical bacterium commonly causes pharyngitis, bronchitis and atypical pneumonia,^[6] mainly in elderly and debilitated patients, but in healthy adults, also.^[7]

Micrograph ofChlamydophila (Chlamydia) pneumoniae in an epithelial cell in acute bronchitis: 1 – infected epitheliocyte, 2 – uninfected epitheliocytes, 3 – chlamydial inclusion bodies in cell, 4 – cell nuclei

Life cycle and method of infection[edit]

Life cycle of Chlamydophila pneumoniae

Chlamydophila pneumoniae is a small gram negative bacterium (0.2 to 1 μm) that undergoes several transformations during its life cycle. It exists as an elementary body (EB) between hosts. The EB is not biologically active, but is resistant to environmental stresses and can survive outside a host for a limited time. The EB travels from an infected person to the lungs of an uninfected person in small droplets and is responsible for infection. Once in the lungs, the EB is taken up by cells in a pouch called an endosome by a process called phagocytosis. However, the EB is not destroyed by fusion with lysosomes, as is typical for phagocytosed material. Instead, it transforms into a reticulate body (RB) and begins to replicate within the endosome. The reticulate bodies must use some of the host's cellular metabolism to complete its replication. The reticulate bodies then convert back to elementary bodies and are released back into the lung, often after causing the death of the host cell. The EBs are thereafter able to infect new cells, either in the same organism or in a new host. Thus, the life cycle of C. pneumoniae is divided between the elementary body, which is able to infect new hosts but can not replicate, and the reticulate body, which replicates but is not able to cause new infection.

Diseases[edit]

C. pneumoniae is a common cause of pneumonia around the world; it is typically acquired by otherwise healthy people and is a form of community-acquired pneumonia. Because its treatment and diagnosis are different from historically recognized causes, such as Streptococcus pneumoniae, pneumonia caused by C. pneumoniae is categorized as an "atypical pneumonia" .^[8]

In addition to pneumonia, C. pneumoniae less commonly causes several other illnesses. Among these are meningoencephalitis (infection and inflammation of the brain and meninges), arthritis, myocarditis (inflammation of the heart), and Guillain-Barré syndrome.^[who?]^{[citation needed]}

Multiple studies have evaluated prior C. pneumoniae infection and a possible connection to lung cancer. One meta-analysis of serological data comparing prior C. pneumoniae infection in patients with and without lung cancer found results suggesting prior infection was associated with a slightly increased risk of developing lung cancer.^[9]

In research into the association between C. pneumoniae infection and atherosclerosis and coronary artery disease, serological testing, direct pathologic analysis of plaques and in vitro testing suggest chronic infection with C. pneumoniae may be a risk factor for development of atherosclerotic plaques. C. pneumoniae infection increases adherence of macrophages to endothelial cells in vitro and aortas ex vivo.^[10] However, the current data do not define how often C. pneumoniae is found in atherosclerotic or normal vascular tissue, nor does it allow for determining whether C. pneumoniae infection has a causative effect on atheroma formation or is merely an "innocent passenger" in these plaques. The largest trials that studied the use of antibiotics as a prevention for diseases associated with atherosclerosis, such as heart attacks and strokes, did not show any significant difference between antibiotics and placebo.^[11]

C. pneumoniae has been found in the cerebrospinal fluid of some patients diagnosed with multiple sclerosis.^[12]

Serological evidence for possible chronic C. pneumoniae infection was first associated with wheezing, asthmatic bronchitis and adult-onset asthma in 1991.^[13] Subsequent studies of bronchoalveolar lavage fluid from pediatric patients with severe chronic respiratory illnesses including asthma have demonstrated that over half had evidence of C. pneumoniae by direct organism identification.^[14]^[15] The only prospective study of new-onset adult asthma carried out in a primary care clinic diagnosed acute C. pneumoniae infection serologically in 5/5 patients with acute wheezing that became chronic and that was later diagnosed as asthma, and in another patient who developed new-onset chronic bronchitis who had the organism cultured from his sputum 6 months after illness onset.^[16] These observations suggest that acute C. pneumoniae infection is capable of causing protean manifestations of chronic respiratory illness, some of which is diagnosed as asthma.

That these associations are clinically relevant in the primary care setting is suggested by the results of two observational trials^[17]^[18] and two randomized controlled trials^[19]^[20] of azithromycin treatment for asthma. One of these RCTs^[20] and another macrolide trial^[21] suggest that the treatment effect may be greatest in patients with severe, refractory asthma. These clinical results correlate with epidemiological evidence that C. pneumoniae is positively associated with asthma severity^[22] and laboratory evidence that C. pneumoniae infection creates steroid-resistance.^[23] Currently available asthma guidelines do not address this evidence.

Vaccine research[edit]

There is no vaccine to protect against Chlamydophila pneumoniae. Research is on-going. Identification of highly immunogenic antigens is critical for the construction of an efficacious subunit vaccine against C. pneumoniae infections.

References[edit]

^ Everett, K. D. E.; Bush, R. M.; Andersen, A. A. (1999). "Emended description of the order Chlamydiales, proposal of Parachlamydiaceae fam. nov. and Simkaniaceae fam. nov., each containing one monotypic genus, revised taxonomy of the family Chlamydiaceae, including a new genus and five new species, and standards for the identification of organisms". International Journal of Systematic Bacteriology 49 (2): 415–440. doi:10.1099/00207713-49-2-415. ISSN 0020-7713. PMID 10319462.
^ Chlamydophila pneumoniae at the US National Library of Medicine Medical Subject Headings (MeSH)
^ http://pathmicro.med.sc.edu/mayer/chlamyd.htm
^ "www.ncbi.nlm.nih.gov". Retrieved 2009-01-27.
^ Appelt DM, Roupas MR, Way DS, et al. (2008). "Inhibition of apoptosis in neuronal cells infected with Chlamydophila (Chlamydia) pneumoniae". BMC Neurosci 9: 13. doi:10.1186/1471-2202-9-13. PMC 2266938. PMID 18218130.
^ Lang, B. R., Chlamydia pneumonia as a differential diagnosis? Follow-up to a case report on progressive pneumonitis in an adolescent, Patient Care, Sept. 15, 1991
^ Little, Linda, Elusive pneumonia strain frustrates many clinicians, Medical Tribune, p. 6, September 19, 1991
^ Pignanelli S, Shurdhi A, Delucca F, et al. (2009). "Simultaneous use of direct and indirect diagnostic techniques in atypical respiratory infections from Chlamydophila pneumoniae and Mycoplasma pneumoniae.". J Clin Lab Anal. 23 (4): 206–9. doi:10.1002/jcla.20332. PMID 19623657.
^ Zhan P, Suo LJ, Qian Q, et al. (March 2011). "Chlamydia pneumoniae infection and lung cancer risk: A meta-analysis". Eur. J. Cancer 47 (5): 742–7. doi:10.1016/j.ejca.2010.11.003. PMID 21194924.
^ Takaoka N, Campbell LA, Lee A, Rosenfeld ME, Kuo CC (February 2008). "Chlamydia pneumoniae infection increases adherence of mouse macrophages to mouse endothelial cells in vitro and to aortas ex vivo.". Infection and Immunity 76 (2): 510–4. doi:10.1128/IAI.01267-07. PMID 18070891.
^ Mussa FF, Chai H, Wang X, Yao Q, Lumsden AB, Chen C (June 2006). "Chlamydia pneumoniae and vascular disease: an update". J. Vasc. Surg. 43 (6): 1301–7. doi:10.1016/j.jvs.2006.02.050. PMID 16765261.
^ Sriram S, Stratton CW, Yao S, et al. (1999). "Chlamydia pneumoniae infection of the central nervous system in multiple sclerosis". Annals of Neurology 46 (1): 6–14. doi:10.1002/1531-8249(199907)46:1<6::AID-ANA4>3.0.CO;2-M. PMID 10401775.
^ Hahn DL, Dodge R, Golubjatnikov R (1991). "Association of Chlamydia pneumoniae (strain TWAR) infection with wheezing, asthmatic bronchitis and adult-onset asthma". JAMA. 266: 225–230. doi:10.1001/jama.266.2.225. PMID 2056624.
^ Schmidt SM, Muller CE, Bruns R, et al. (2001). "Bronchial Chlamydia pneumoniae infection, markers of allergic inflammation and lung function in children". Pediatr Allergy Immunol. 12 (5): 257–265. PMID 11737672.
^ Webley WC, Salva PS, Andrzejewski C, et al. (2005). "The bronchial lavage of pediatric patients with asthma contains infectious Chlamydia". Am J Respir Crit Care Med. 171: 1083–1088. doi:10.1164/rccm.200407-917OC. PMID 15735056.
^ Hahn DL, McDonald R (1998). "Can acute Chlamydia pneumoniae infection initiate chronic asthma?". Ann Allergy Asthma Immunol. 81: 339–344. doi:10.1016/S1081-1206(10)63126-2. PMID 9809498.
^ Hahn DL (1995). "Treatment of Chlamydia pneumoniae infection in adult asthma: a before-after trial". J Fam Pract. 41 (4): 345–351. PMID 7561707.
^ Hahn DL, Schure A, Patel K, et al. (2012). "Chlamydia pneumoniae-specific IgE is prevalent in asthma and is associated with disease severity". PLOS ONE 7: e35945. doi:10.1371/journal.pone.0035945. PMC 3335830. PMID 22545149.
^ Hahn DL, Plane MB, Mahdi OS, et al. (2006). "Secondary outcomes of a pilot randomized trial of azithromycin treatment for asthma". PLoS Clin Trials. 1: e11. doi:10.1371/journal.pctr.0010011. PMC 1488900. PMID 16871333.
^ ^a ^b Hahn DL, Grasmick M, Hetzel S, et al. (2012). "Azithromycin for bronchial asthma in adults: An effectiveness trial". J Am Bd Fam Med. 25: 442–459. doi:10.3122/jabfm.2012.04.110309. PMID 22773713.
^ Simpson JL, Powell H, Boyle MJ, et al. (2008). "Clarithromycin targets neutrophilic airway inflammation in refractory asthma". Am J Respir Crit Care Med. 177: 148–155. doi:10.1164/rccm.200707-1134OC. PMID 17947611.
^ von Hertzen L, Vasankari T, Liippo K, et al. (2002). "Chlamydia pneumoniae and severity of asthma". Scand J Infect Dis. 34 (1): 22–27. PMID 11874160.
^ Cho YS, Kim TB, Lee TH, et al. (2005). "Chlamydia pneumoniae infection enhances cellular proliferation and reduces steroid responsiveness of human peripheral blood mononuclear cells via a tumor necrosis factor-alpha-dependent pathway". Clinical & Experimental Allergy. 35: 1625–1631. doi:10.1111/j.1365-2222.2005.02391.x. PMID 16393329.

External links[edit]

Chlamydia Pneumoniae cpnhelp.org

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 成人における肺炎クラミジアによる肺炎 pneumonia caused by chlamydia pneumoniae in adults
2. 小児における肺炎クラミジアによる肺炎 pneumonia caused by chlamydia species in children
3. アテローム性動脈硬化症の潜在的な病原因子としての肺炎クラミジア感染 chlamydia pneumoniae infection as a potential etiologic factor in atherosclerosis
4. 小児における市中肺炎：外来治療 community acquired pneumonia in children outpatient treatment
5. 下肢末梢動脈疾患の症状を治療するための試験的治療 investigational therapies for treating symptoms of lower extremity peripheral artery disease

English Journal

Detection of DNA of Chlamydophila psittaci in psoriatic subjects: a casual or a causal link?

Stinco G, Fabris M, Pasini E, Pontarini E, Patriarca MM, Piccirillo F, De Vita S, Dolcetti R.SourceInstitute of Dermatology, Department of Experimental and Clinical Medicine, DISM, University of Udine, Udine, Italy Clinic of Rheumatology and Institute of Clinical Pathology, Department of Medical and Biological Sciences, University of Udine, Udine, Italy Cancer Bio-Immunotherapy Unit, Department of Medical Oncology, Centro di Riferimento Oncologico, IRCCS- National Cancer Institute, Aviano, Italy.
The British journal of dermatology.Br J Dermatol.2012 May 7. doi: 10.1111/j.1365-2133.2012.11043.x. [Epub ahead of print]
Objective: Recent evidence indicates that subclinical infection by Chlamydophila psittaci occurs in a significant percentage of patients with chronic inflammatory polyarthritis, including psoriatic arthritis. Methods: The presence of a subclinical C. psittaci infection was investigated in 64 p
PMID 22564212

Aetiology of community-acquired pneumonia among adults in an H1N1 pandemic year: the role of respiratory viruses.

Sangil A, Calbo E, Robles A, Benet S, Viladot ME, Pascual V, Cuchí E, Pérez J, Barreiro B, Sánchez B, Torres J, Canales L, De Marcos JA, Garau J.SourceService of Internal Medicine, Hospital Universitari Mútua Terrassa, Barcelona, Spain, annasangil@yahoo.com.
European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology.Eur J Clin Microbiol Infect Dis.2012 May 2. [Epub ahead of print]
This study aimed to determine the aetiology of community-acquired pneumonia (CAP) by adding polymerase chain reaction (PCR) to conventional methods and to describe the clinical and laboratory features between patients with bacterial pneumonia (BP) and viral pneumonia (VP). Adults with CAP admitted f
PMID 22549730

Japanese Journal

Effect of the steroid receptor antagonist RU486 (mifepristone) on an IFNγ-induced persistent Chlamydophila pneumoniae infection model in epithelial HEp-2 cells

Ishida Kasumi,Yamazaki Tomohiro,Motohashi Kazuki,Kobayashi Miho,Matsuo Junji,Osaki Takako,Hanawa Tomoko,Kamiya Shigeru,Yamamoto Yoshimasa,Yamaguchi Hiroyuki
Journal of Infection and Chemotherapy 18(1), 22-29, 2012-02
… We have previously demonstrated that the steroid receptor antagonist mifepristone (RU486) causes growth inhibition of Chlamydophila pneumoniae by binding to and subsequently destroying the bacteria during their normal developmental cycle in epithelial HEp-2 cells. … pneumoniae infection in interferon (IFN)γ-treated HEp-2 cells. …
NAID 120003783328

Chlamydophila pneumoniae attachment and infection in low proteoglycan expressing human lymphoid Jurkat cells

Kobayashi Miho,Ishida Kasumi,Matsuo Junji,Nakamura Shinji,Nagasawa Ayumi,Motohashi Kazuki,Yao Takashi,Hirai Itaru,Yamamoto Yoshimasa,Suzuki Haruki,Shimizu Chikara,Matsuno Kazuhiko,Yamaguchi Hiroyuki
Microbial Pathogenesis 51(3), 209-216, 2011-09
… This study investigated the proteoglycan (PG)-dependent mechanism of Chlamydophila pneumoniae attachment to lymphocytic cells. … pneumoniae (TW183). … pneumoniae was statically infected to human CD4(+) peripheral blood lymphocytes known not expressing detectable level of heparin, the bacteria attached to and formed inclusion bodies in the cells. …
NAID 120003295071

Related Pictures

★リンクテーブル★

国試過去問	「105A051」
リンク元	「特殊な細菌」「クラミドフィラ・ニューモニエ肺炎」「急性咽頭炎」「クラミドフィラ属」「C. pneumoniae」
拡張検索	「Chlamydophila pneumoniae肺炎」
関連記事	「pneumoniae」

「105A051」

Chlamydophila pneumoniae
Scientific classification
Kingdom:	Bacteria
Phylum:	Chlamydiae
Order:	Chlamydiales
Family:	Chlamydiaceae
Genus:	Chlamydophila
Species:	C. pneumoniae

　　[★]

56歳の男性。発熱と膿性痰とを主訴に来院した。 3日前から38℃台の発熱と膿性痰とを認めている。既往歴と家族歴とに特記すべきことはない。胸部エックス線写真にて右下肺野に浸潤影を認める。喀痰のGram染色で好中球と菌体とを多数認める。
考えられる起炎菌はどれか。2つ選べ。

a　Chlamydophila pneumoniae Chlamydia pneumoniae
b　Haemophilus influenzae
c　Klebsiella pneumoniae
d　Mycoplasma pneumoniae
e　Streptococcus pneumoniae

[正答]

※国試ナビ4※　［105A050］←［国試_105］→［105A052］

「特殊な細菌」

　　[★]

関: 細菌

マイコプラズマ・リケッチア・クラミジア

科	寄生性	大きさ	グラム染色性	細胞壁	LPS	ペプチドグリカン	封入体	免疫原性	感染経路	無効抗菌薬
マイコプラズマ科		直径0.3μm		なし	なし	なし	なし		飛沫感染	βラクタム薬
リケッチア科	偏性細胞寄生性	(0.3-0.5)x(0.8-2.0)μm	陰性	あり	あり	あり	なし		媒介動物	βラクタム薬
クラミジア科	偏性細胞寄生性		陰性	あり	あり	なし	あり	なし	飛沫感染/接触感染/性行為	βラクタム薬、アミノ配糖体系

マイコプラズマ・リケッチア・クラミジアと疾患

科	属	病原体名		疾患名	潜伏期	感染経路	診断	症状	治療
マイコプラズマ科	マイコプラズマ属	Mycoplasma pneumoniae	肺炎マイコプラズマ	マイコプラズマ肺炎		飛沫感染			マクロライド系・テトラサイクリン系
リケッチア科	オリエンチア属	Orientia tsutsugamushi		ツツガムシ病	4-18日	ツツガムシ	Weil-Felix反応/蛍光抗体法/免疫ペルオキシダーゼ法/ペア血清		テトラサイクリン系ニューロキノロン系
リケッチア科	リケッチア属	Rickettsia japonica		日本紅斑熱	2-8日	マダニ	Weil-Felix反応
リケッチア科	エールリキア属	Ehrlichia sennetsu		腺熱	10-17日	不明
リケッチア科	コクシエラ属	Coxiella burnetii		Q熱	14-26日	経気道的、経口的、経皮的。人獣共通感染症			テトラサイクリン系・ニューキノロン系・リファンピシン併用
リケッチア科	バルトネラ属	Bartonella henselae		Bartonella henselae感染症 (ネコひっかき病/細菌性血管腫症)					マクロライド系・テトラサイクリン系
クラミジア科	クラミジア属	Chlamydia psittaci	オウム病クラミジア		7-10日				テトラサイクリン系、マクロライド系。 βラクタム、アミノ配糖体無効。基本小体に作用しない
クラミジア科	クラミジア属	Chlamydia trachomatis	トラコーマクラミジア		1-5週	性行為
クラミジア科	クラミドフィラ属	Chlamydophila pneumoniae	肺炎クラミジア		3-4週

「クラミドフィラ・ニューモニエ肺炎」

　　[★]

英: Chlamydia pneumoniae pneumonia
同: Chlamydophila pneumoniae肺炎
関: Chlamydophila pneumoniae。クラミジア肺炎

Chlamydophila pneumoniaeによる肺炎である。
Chlamydophila pneumoniaeの血清学的有病率は50-85%とされており、世界中に存在する生物である。
抗体保有率は年齢と共に増加する傾向があり、10歳未満の子供で10%未満、10代で30-40%、中年の成年で50%の抗体が検出される。
日本で肺炎の5-6%を占め軽症例が多い。
若年者よりも高齢者で発症が多いとされる。
感染様式は飛沫感染である。
Chlamydophila pneumoniaeは偏性細胞内寄生菌である。
グラム陰性菌と同様に内膜、外膜、およびLPSを有するが、ペプチドグリカンがほとんど無いため、ペニシリンに対する感受性が乏しいとされている。
Chlamydophila pneumoniaeはトリプトファン生合成経路を欠いているので、インターフェロンγを介する免疫系に脆弱であり、またST合剤に耐性がある。
宿主の外では固い壁を有する基本小体 EBとなり、短時間生存可能となる。
感染者からの飛沫を吸入するなどして呼吸粘膜上皮に付着するとエンドサイトーシスにより細胞内に侵入、ファゴソーム内で網様体 RBとなり、細胞内で複製される。
複製のさなかにクラミドフィラの抗原が宿主細胞の表面に提示され、宿主の免疫応答を誘導する。
肺炎の症状は発熱、咳嗽、呼吸困難であるが、肺炎は軽症であることが多い。
他の病原体による肺炎と異なり、咽頭炎、喉頭炎、副鼻腔炎などの上気道炎症状を呈しやすい。また、中耳炎、気管支炎を起こしうる。
血液検査：WBCは正常から軽度上昇。
胸部レントゲン：小葉の透過性低下

「急性咽頭炎」

　　[★]

英: acute pharyngitis
同: カタル性咽頭炎 catarrhal pharyngitis
関: 咽頭炎、急性扁桃炎

病因の鑑別

IRE.475改変

1. 非感染性

全身性エリテマトーデス
黄色ブドウ球菌毒素性ショック症候群
溶連菌毒素性ショック症候群
川崎病
天疱瘡
薬剤熱

2. 感染性

ウイルス

細菌

真菌

Candida

化膿性連鎖球菌 Streptococcus pyogenes A群β溶連菌による急性咽頭炎

治療

ペニシリン系抗菌薬：ペニシリンアレルギーがある場合には使えない。また病原体が不明であるときに投与すると、疾患が伝染単核球症の場合皮疹を生じさせてしまうので、これを否定できるまで投与しない。(IRE.999)
マクロライド系抗菌薬：クラリスロマイシンやアジスロマイシン。日本ではマクロライド耐性溶連菌が多いらしい。(IRE.999)