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Snapshot
  • A 26-year-old woman presents to her primary care physician for a nonproductive cough of 1-week duration. She reports that the cough started quite suddenly, along with subjective fevers. She denies having any headaches, any upper respiratory symptoms, chest pain, or shortness of breath. She has a past medical history of polycystic ovarian syndrome and anxiety. She lives at home with her parents and a 10-year-old parrot. A chest radiograph shows left lower lobe consolidation and bilateral small pleural effusions. Given her risk factors, she is started on doxycycline for suspected atypical pneumonia. (Chlamydophila psittaci infection)
Introduction
  • Classification
    • Chlamydiae
      • obligate intracellular bacteria
      • Chlamydophila pneumoniae
        • atypical (interstitial) pneumonia
      • Chlamydophila psittaci
        • psittacosis, which presents as an atypical (interstitial) pneumonia or fever of unknown origin
      • Chlamydia trachomatis
        • sexually transmitted disease, trachoma, or lymphogranuloma venereum
  • Pathogenesis
    • cannot make own ATP and are obligate intracellular (Chlamys = cloak, as in cloaked inside a cell!)
    • the bacteria has 2 forms: elementary body and reticulate body
      • the elementary body (the infectious form) attaches to the outer membrane of host cells and enters through endocytosis to become intracellular
        • they produce cytoplasmic inclusions (reticulate bodies)
      • the reticulate body replicates inside the cell using fission and reorganizes into elementary bodies, which then goes on to infect more cells
  • Studies
    • detection of DNA via polymerase chain reaction (PCR) or nucleic acid amplification test (NAAT)
    • detection of immunoglobulin using microimmunofluorescence
    • Giemsa stain
      • reticulate bodies seen in cytoplasm
    • diagnosis is made via serologic testing and clinical findings
Chlamydophila pneumoniae
  • Introduction
    • clinical syndrome
      • atypical pneumonia
      • transmission via aerosols
    • demographics
      • adolescents and young adults
    • risk factors
      • smoking
  • Presentation
    • upper respiratory symptoms (initial)
      • nasal congestion
      • sore throat
      • sinus pressure
    • pneumonia (after 1-4 weeks)
      • fever and malaise
      • cough with minimal sputum
      • hoarse voice
      • headache
      • sinus percussion tenderness
  • Imaging
    • chest radiography
      • findings
        • diffuse patchy infiltrates in interstitial areas
        • generally involves more than 1 lobe
  • Treatment
    • azithromycin
      • first-line
    • doxycycline
      • avoid in children and pregnant women
  • Complications
    • erythema nodosum
    • Guillain-Barré syndrome
Chlamydophila psittaci
  • Introduction
    • clinical syndrome
      • presents as an atypical (interstitial) pneumonia or fever of unknown origin 
      • transmission via aerosols
      • reservoir is birds (parrots)
    • risk factors
      • exposure to birds, especially pet birds that are sick
      • pet shop employees
      • occupational exposure to poultry
  • Presentation
    • acute onset of symptoms
    • high fever
    • nonproductive cough
    • may have splenomegaly
  • Imaging
    • chest radiography
      • findings
        • unilateral single lower lobe consolidation
        • can have small pleural effusions
  • Treatment
    • doxycycline or tetracycline 
      • first-line
    • azithromycin
  • Complications
    • endocarditis
    • myocarditis
    • multi-organ failure
 

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Questions (1)
Lab Values
Blood, Plasma, Serum Reference Range
ALT 8-20 U/L
Amylase, serum 25-125 U/L
AST 8-20 U/L
Bilirubin, serum (adult) Total // Direct 0.1-1.0 mg/dL // 0.0-0.3 mg/dL
Calcium, serum (Ca2+) 8.4-10.2 mg/dL
Cholesterol, serum Rec: < 200 mg/dL
Cortisol, serum 0800 h: 5-23 μg/dL //1600 h:
3-15 μg/dL
2000 h: ≤ 50% of 0800 h
Creatine kinase, serum Male: 25-90 U/L
Female: 10-70 U/L
Creatinine, serum 0.6-1.2 mg/dL
Electrolytes, serum  
Sodium (Na+) 136-145 mEq/L
Chloride (Cl-) 95-105 mEq/L
Potassium (K+) 3.5-5.0 mEq/L
Bicarbonate (HCO3-) 22-28 mEq/L
Magnesium (Mg2+) 1.5-2.0 mEq/L
Estriol, total, serum (in pregnancy)  
24-28 wks // 32-36 wks 30-170 ng/mL // 60-280 ng/mL
28-32 wk // 36-40 wks 40-220 ng/mL // 80-350 ng/mL
Ferritin, serum Male: 15-200 ng/mL
Female: 12-150 ng/mL
Follicle-stimulating hormone, serum/plasma Male: 4-25 mIU/mL
Female: premenopause: 4-30 mIU/mL
midcycle peak: 10-90 mIU/mL
postmenopause: 40-250
pH 7.35-7.45
PCO2 33-45 mmHg
PO2 75-105 mmHg
Glucose, serum Fasting: 70-110 mg/dL
2-h postprandial:<120 mg/dL
Growth hormone - arginine stimulation Fasting: <5 ng/mL
Provocative stimuli: > 7ng/mL
Immunoglobulins, serum  
IgA 76-390 mg/dL
IgE 0-380 IU/mL
IgG 650-1500 mg/dL
IgM 40-345 mg/dL
Iron 50-170 μg/dL
Lactate dehydrogenase, serum 45-90 U/L
Luteinizing hormone, serum/plasma Male: 6-23 mIU/mL
Female: follicular phase: 5-30 mIU/mL
midcycle: 75-150 mIU/mL
postmenopause 30-200 mIU/mL
Osmolality, serum 275-295 mOsmol/kd H2O
Parathyroid hormone, serume, N-terminal 230-630 pg/mL
Phosphatase (alkaline), serum (p-NPP at 30° C) 20-70 U/L
Phosphorus (inorganic), serum 3.0-4.5 mg/dL
Prolactin, serum (hPRL) < 20 ng/mL
Proteins, serum  
Total (recumbent) 6.0-7.8 g/dL
Albumin 3.5-5.5 g/dL
Globulin 2.3-3.5 g/dL
Thyroid-stimulating hormone, serum or plasma .5-5.0 μU/mL
Thyroidal iodine (123I) uptake 8%-30% of administered dose/24h
Thyroxine (T4), serum 5-12 μg/dL
Triglycerides, serum 35-160 mg/dL
Triiodothyronine (T3), serum (RIA) 115-190 ng/dL
Triiodothyronine (T3) resin uptake 25%-35%
Urea nitrogen, serum 7-18 mg/dL
Uric acid, serum 3.0-8.2 mg/dL
Hematologic Reference Range
Bleeding time 2-7 minutes
Erythrocyte count Male: 4.3-5.9 million/mm3
Female: 3.5-5.5 million mm3
Erythrocyte sedimentation rate (Westergren) Male: 0-15 mm/h
Female: 0-20 mm/h
Hematocrit Male: 41%-53%
Female: 36%-46%
Hemoglobin A1c ≤ 6 %
Hemoglobin, blood Male: 13.5-17.5 g/dL
Female: 12.0-16.0 g/dL
Hemoglobin, plasma 1-4 mg/dL
Leukocyte count and differential  
Leukocyte count 4,500-11,000/mm3
Segmented neutrophils 54%-62%
Bands 3%-5%
Eosinophils 1%-3%
Basophils 0%-0.75%
Lymphocytes 25%-33%
Monocytes 3%-7%
Mean corpuscular hemoglobin 25.4-34.6 pg/cell
Mean corpuscular hemoglobin concentration 31%-36% Hb/cell
Mean corpuscular volume 80-100 μm3
Partial thromboplastin time (activated) 25-40 seconds
Platelet count 150,000-400,000/mm3
Prothrombin time 11-15 seconds
Reticulocyte count 0.5%-1.5% of red cells
Thrombin time < 2 seconds deviation from control
Volume  
Plasma Male: 25-43 mL/kg
Female: 28-45 mL/kg
Red cell Male: 20-36 mL/kg
Female: 19-31 mL/kg
Cerebrospinal Fluid Reference Range
Cell count 0-5/mm3
Chloride 118-132 mEq/L
Gamma globulin 3%-12% total proteins
Glucose 40-70 mg/dL
Pressure 70-180 mm H2O
Proteins, total < 40 mg/dL
Sweat Reference Range
Chloride 0-35 mmol/L
Urine  
Calcium 100-300 mg/24 h
Chloride Varies with intake
Creatinine clearance Male: 97-137 mL/min
Female: 88-128 mL/min
Estriol, total (in pregnancy)  
30 wks 6-18 mg/24 h
35 wks 9-28 mg/24 h
40 wks 13-42 mg/24 h
17-Hydroxycorticosteroids Male: 3.0-10.0 mg/24 h
Female: 2.0-8.0 mg/24 h
17-Ketosteroids, total Male: 8-20 mg/24 h
Female: 6-15 mg/24 h
Osmolality 50-1400 mOsmol/kg H2O
Oxalate 8-40 μg/mL
Potassium Varies with diet
Proteins, total < 150 mg/24 h
Sodium Varies with diet
Uric acid Varies with diet
Body Mass Index (BMI) Adult: 19-25 kg/m2
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