0
April 16, 1997, Vol 277, No. 15 >
ARTICLE | April 16, 1997

Chlamydia pneumoniae as a New Source of Infectious Outbreaks in Nursing Homes FREE

Carla J. Troy, MHSc; Rosanna W. Peeling, PhD; Andrea G. Ellis, DVM; James C. Hockin, MD; Deborah A. Bennett, BScN; Monica R. Murphy; John S. Spika, MD
[+] Author Affiliations

Reprints: James C. Hockin, MD, Field Epidemiology Training Program, Laboratory Centre for Disease Control, 0602B Tunney's Pasture, Ottawa, Ontario, Canada K1A 0L2 (e-mail: fetp@hpe.hwc.ca).


JAMA. 1997;277(15):1214-1218. doi:10.1001/jama.1997.03540390044033
Text Size: A A A
Published online
Article
References

Objective.  —To determine the extent and severity of illness and mode of transmission of Chlamydia pneumoniae infection in 3 nursing home outbreaks.

Design and Setting.  —Retrospective cohort study in 3 nursing homes in Ontario from September to November 1994.

Subjects.  —A total of 549 residents and 65 staff members.

Main Outcome Measures.  —Morbidity and mortality were determined by a review of disease surveillance forms, residents' charts, and a self-administered questionnaire to staff. Single and paired serum samples for C pneumoniae serological testing and nasopharyngeal swabs for Cpneumoniae culture were collected, and direct fluorescent antibody assays were performed to confirm C pneumoniae infection.

Results.  —The attack rates for confirmed and suspected cases combined were 68%, 46%, and 44% among residents in nursing homes A, B, and C, respectively, and 34% among nursing home C staff. A total of 16 cases of pneumonia confirmed by chest x-ray and 6 deaths were identified. The spectrum of illness among nursing home C residents included a new cough in 58 (100%), fever in 37 (64%), sore throat in 14 (24%), and hoarseness in 8 (14%). Staff members at nursing home C were more likely to report hoarseness (P<.001) and sore throat (P<.001). Residents who smoked had onset of illness earlier than nonsmokers (P=.007), which perhaps is related to airborne transmission in a designated smoking room.

Conclusions.  —Chlamydia pneumoniae caused serious morbidity and mortality among residents and morbidity among staff; Cpneumoniae is an important cause of respiratory disease outbreaks in nursing homes, and diagnostic tests must be readily available for early recognition of C pneumoniae infections.

REFERENCES

1 +
Nicolle LE, Strausbaugh LJ, Garibald RA.  Infections and antibiotic resistance in nursing homes . Clin Microbiol Rev . 1996;;9:1-17.
2 +
Falsey AR, Cunningham CK, Barker WH, et al.  Respiratory syncytial virus and influenza A infections in the hospitalized elderly . J Infect Dis . 1995;; 172:389-394.
3 +
Grayston JT, Wang S-P, Kuo C-C, Campbell LA.  Current knowledge on Chlamydia pneumoniae, strain TWAR, an important cause of pneumonia and other acute respiratory diseases . Eur J Clin Microbiol Infect Dis . 1989;;8:191-202.
4 +
Grayston JT, Campbell LA, Kuo C-C, et al.  A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR . J Infect Dis . 1990;;161:618-625.
5 +
Grayston JT.  Infections caused by Chlamydia pneumoniae strain TWAR . Clin Infect Dis . 1992;; 15:757-763.
6 +
Grayston JT, Aldous MB, Easton A, et al.  Evidence that Chlamydia pneumoniae causes pneumonia and bronchitis . J Infect Dis . 1993;;168:1231-1235.
7 +
Marrie TJ.  Community-acquired pneumonia . Clin Infect Dis . 1994;;18:501-515.
8 +
Davis C, Barron A, Campbell G, McCracken G, Bates J.  Chlamydia, TWAR strain among older adults with acute pneumonia . Chest . 1989;;95( (suppl) ):206.
9 +
Blasi F, Cosentini R, Denti F, Allegra L.  Two family outbreaks of Chlamydia pneumoniae infection . Eur Respir J . 1994;;7:102-104.
10 +
Yamazaki T, Nakada H, Sakurai N, Kuo C-C, Wang S-P, Grayston JT.  Transmission of Chlamydia pneumoniae in young children in a Japanese family . J Infect Dis . 1990;;162:1390-1392.
11 +
Mordhorst CH, Wang S-P, Grayston JT.  Outbreak of Chlamydia pneumoniae in four farm families . Eur J Clin Microbiol Infect Dis . 1992;;11:617-620.
12 +
Kishimoto T, Kimura M, Kubota Y, Miyashita N, Niki Y, Soejima R.  An outbreak of Chlamydia pneumoniae infection in households and schools . In: Orfila J, Byrne G, Chernesky MA, et al, eds. Chlamydia Infections . Bologna, Italy: Societa Editrice Esculapio; 1994;:465-468.
13 +
Pether JVS, Wang S-P, Grayston JT.  Chlamydia pneumoniae, strain TWAR, as a cause of an outbreak in a boy's school previously called psittacosis . Epidemiol Infect . 1989;;103:395-400.
14 +
Kleemola M, Saikku P, Visakorpi R, Wang S-P, Grayston JT.  Epidemics of pneumonia caused by TWAR, a new Chlamydia organism, in military trainees in Finland . J Infect Dis . 1988;;157:230-236.
15 +
Saikku P, Wang S-P, Kleemola M, Brander E, Rusanen E, Grayston JT.  An epidemic of mild pneumonia due to an unusual stain of Chlamydia psittaci . J Infect Dis . 1985;;151:832-839.
16 +
Ekman MR, Grayston JT, Visakorpi R, Kleemola M, Kuo C-C, Saikku P.  An epidemic of infection due to Chlamydia pneumoniae in military conscripts . Clin Infect Dis . 1993;;17:420-425.
17 +
Casey HL. Adaption of LBCF Method to Microtechnique. Washington, DC: US Government Printing Office; 1965. Public Health Service publication 1228.
18 +
McKinney RM, Thomason BM, Harris PP, et al.  Recognition of a new serogroup of Legionnaire's disease bacterium . J Clin Microbiol . 1979;;9:103-107.
19 +
Schmidt NJ, Emmons RW. Diagnostic Procedures for Viral, Rickettsial and Chlamydia Infections . 6th ed. Washington, DC: American Public Health Association; 1989;.
20 +
Bannatyne RM, Clausen C, McCarthy LR. Cumitech 10 Laboratory Diagnosis of Upper Respiratory Tract Infections . Washington, DC: American Society for Microbiology; 1979;.
21 +
Tang P, Toma S.  Broad-spectrum enzyme-linked immunosorbent assay for detection of Legionella soluble antigens . J Clin Microbiol . 1986;;24:556-558.
22 +
Wang S-P, Grayston JT, Kuo C-C, Alexander ER, Holmes KK.  Serodiagnosis of Chlamydia trachomatis infection with the microimmunofluorescence test . In: Hobson D, Holmes KK, eds. Nongonococcal Urethritis and Related Infections . Washington, DC: American Society for Microbiology; 1997;:237-248.
23 +
Roblin PM, Dumornay W, Hammerschlag MR.  Use of HEp-2 cells for improved isolation and passage of Chlamydia pneumoniae . J Clin Microbiol . 1992;;30:1968-1971.
24 +
Grayston JT, Kuo C-C, Wang S-P, Altman J.  A new Chlamydia psittaci stain, TWAR, isolated in acute respiratory infections . N Engl J Med . 1986;; 315:161-168.
25 +
Ghosh K, Frew CE, Carrington D.  A family outbreak of Chlamydia pneumoniae infection . J Infect Dis . 1992;;25( (suppl 1) ):99-103.
26 +
Theunissen HJH, Lemmens-den Toom NA, Burggraaf A, Stolz E, Michel MF.  Influence of temperature and relative humidity on the survival of Chlamydia pneumoniae in aerosols . Appl Environ Microbiol . 1993;;59:2589-2593
27 +
Falsey AR, Walsh EE.  Transmission of Chlamydia pneumoniae . J Infect Dis . 1993;;168:493-496.
28 +
Mordhorst CH, Wang S-P, Grayston JT.  Transmission of Chlamydia pneumoniae (TWAR) . In: Orfila J, Byrne G, Chernesky MA, et al, eds. Chlamydia Infections . Bologna, Italy: Societa Editrice Esculapio; 1994;:488-491.
29 +
Hyman CL, Augenbraun MH, Roblin PM, Schachter J, Hammerschlag MR.  Asymptomatic respiratory tract infection with Chlamydia pneumoniae TWAR . J Clin Microbiol . 1991;;29:2082-2083.
30 +
Kuo C-C, Grayston JT.  In vitro drug susceptibility of Chlamydia sp. strain TWAR . Antimicrob Agents Chemother . 1988;;32:257-258.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Nicolle LE, Strausbaugh LJ, Garibald RA.  Infections and antibiotic resistance in nursing homes . Clin Microbiol Rev . 1996;;9:1-17.
2 +
Falsey AR, Cunningham CK, Barker WH, et al.  Respiratory syncytial virus and influenza A infections in the hospitalized elderly . J Infect Dis . 1995;; 172:389-394.
3 +
Grayston JT, Wang S-P, Kuo C-C, Campbell LA.  Current knowledge on Chlamydia pneumoniae, strain TWAR, an important cause of pneumonia and other acute respiratory diseases . Eur J Clin Microbiol Infect Dis . 1989;;8:191-202.
4 +
Grayston JT, Campbell LA, Kuo C-C, et al.  A new respiratory tract pathogen: Chlamydia pneumoniae strain TWAR . J Infect Dis . 1990;;161:618-625.
5 +
Grayston JT.  Infections caused by Chlamydia pneumoniae strain TWAR . Clin Infect Dis . 1992;; 15:757-763.
6 +
Grayston JT, Aldous MB, Easton A, et al.  Evidence that Chlamydia pneumoniae causes pneumonia and bronchitis . J Infect Dis . 1993;;168:1231-1235.
7 +
Marrie TJ.  Community-acquired pneumonia . Clin Infect Dis . 1994;;18:501-515.
8 +
Davis C, Barron A, Campbell G, McCracken G, Bates J.  Chlamydia, TWAR strain among older adults with acute pneumonia . Chest . 1989;;95( (suppl) ):206.
9 +
Blasi F, Cosentini R, Denti F, Allegra L.  Two family outbreaks of Chlamydia pneumoniae infection . Eur Respir J . 1994;;7:102-104.
10 +
Yamazaki T, Nakada H, Sakurai N, Kuo C-C, Wang S-P, Grayston JT.  Transmission of Chlamydia pneumoniae in young children in a Japanese family . J Infect Dis . 1990;;162:1390-1392.
11 +
Mordhorst CH, Wang S-P, Grayston JT.  Outbreak of Chlamydia pneumoniae in four farm families . Eur J Clin Microbiol Infect Dis . 1992;;11:617-620.
12 +
Kishimoto T, Kimura M, Kubota Y, Miyashita N, Niki Y, Soejima R.  An outbreak of Chlamydia pneumoniae infection in households and schools . In: Orfila J, Byrne G, Chernesky MA, et al, eds. Chlamydia Infections . Bologna, Italy: Societa Editrice Esculapio; 1994;:465-468.
13 +
Pether JVS, Wang S-P, Grayston JT.  Chlamydia pneumoniae, strain TWAR, as a cause of an outbreak in a boy's school previously called psittacosis . Epidemiol Infect . 1989;;103:395-400.
14 +
Kleemola M, Saikku P, Visakorpi R, Wang S-P, Grayston JT.  Epidemics of pneumonia caused by TWAR, a new Chlamydia organism, in military trainees in Finland . J Infect Dis . 1988;;157:230-236.
15 +
Saikku P, Wang S-P, Kleemola M, Brander E, Rusanen E, Grayston JT.  An epidemic of mild pneumonia due to an unusual stain of Chlamydia psittaci . J Infect Dis . 1985;;151:832-839.
16 +
Ekman MR, Grayston JT, Visakorpi R, Kleemola M, Kuo C-C, Saikku P.  An epidemic of infection due to Chlamydia pneumoniae in military conscripts . Clin Infect Dis . 1993;;17:420-425.
17 +
Casey HL. Adaption of LBCF Method to Microtechnique. Washington, DC: US Government Printing Office; 1965. Public Health Service publication 1228.
18 +
McKinney RM, Thomason BM, Harris PP, et al.  Recognition of a new serogroup of Legionnaire's disease bacterium . J Clin Microbiol . 1979;;9:103-107.
19 +
Schmidt NJ, Emmons RW. Diagnostic Procedures for Viral, Rickettsial and Chlamydia Infections . 6th ed. Washington, DC: American Public Health Association; 1989;.
20 +
Bannatyne RM, Clausen C, McCarthy LR. Cumitech 10 Laboratory Diagnosis of Upper Respiratory Tract Infections . Washington, DC: American Society for Microbiology; 1979;.
21 +
Tang P, Toma S.  Broad-spectrum enzyme-linked immunosorbent assay for detection of Legionella soluble antigens . J Clin Microbiol . 1986;;24:556-558.
22 +
Wang S-P, Grayston JT, Kuo C-C, Alexander ER, Holmes KK.  Serodiagnosis of Chlamydia trachomatis infection with the microimmunofluorescence test . In: Hobson D, Holmes KK, eds. Nongonococcal Urethritis and Related Infections . Washington, DC: American Society for Microbiology; 1997;:237-248.
23 +
Roblin PM, Dumornay W, Hammerschlag MR.  Use of HEp-2 cells for improved isolation and passage of Chlamydia pneumoniae . J Clin Microbiol . 1992;;30:1968-1971.
24 +
Grayston JT, Kuo C-C, Wang S-P, Altman J.  A new Chlamydia psittaci stain, TWAR, isolated in acute respiratory infections . N Engl J Med . 1986;; 315:161-168.
25 +
Ghosh K, Frew CE, Carrington D.  A family outbreak of Chlamydia pneumoniae infection . J Infect Dis . 1992;;25( (suppl 1) ):99-103.
26 +
Theunissen HJH, Lemmens-den Toom NA, Burggraaf A, Stolz E, Michel MF.  Influence of temperature and relative humidity on the survival of Chlamydia pneumoniae in aerosols . Appl Environ Microbiol . 1993;;59:2589-2593
27 +
Falsey AR, Walsh EE.  Transmission of Chlamydia pneumoniae . J Infect Dis . 1993;;168:493-496.
28 +
Mordhorst CH, Wang S-P, Grayston JT.  Transmission of Chlamydia pneumoniae (TWAR) . In: Orfila J, Byrne G, Chernesky MA, et al, eds. Chlamydia Infections . Bologna, Italy: Societa Editrice Esculapio; 1994;:488-491.
29 +
Hyman CL, Augenbraun MH, Roblin PM, Schachter J, Hammerschlag MR.  Asymptomatic respiratory tract infection with Chlamydia pneumoniae TWAR . J Clin Microbiol . 1991;;29:2082-2083.
30 +
Kuo C-C, Grayston JT.  In vitro drug susceptibility of Chlamydia sp. strain TWAR . Antimicrob Agents Chemother . 1988;;32:257-258.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems