II. Epidemiology

  1. Incidence: 12,000 cases per year in United States
  2. Occurs in <10% of vaginal deliveries from mothers with active genitourinary Chlamydia

III. Pathophysiology

  1. Chlamydia trachomatis infection in the newborn
  2. Acquired via vertical transmission during delivery from a mother with chlamydia Vaginitis
  3. Not the same as the Atypical Pneumonia of Chlamydia pneumoniae (TWAR)
    1. TWAR in contrast is seen in the elderly and to a lesser extent in young adults

IV. Findings

  1. Onset of symptoms 1-3 months after delivery (2 to 19 weeks of age)
  2. Tachypnea
  3. Staccato Cough (coughing in short bursts)
  4. No fever
  5. Rhinorrhea
  6. Rales

V. Imaging: Chest XRay

  1. Hyperinflation
  2. Bilateral diffuse infiltrates

VI. Labs

  1. Complete Blood Count
    1. Eosinophilia >400 cells/mm3
  2. Chlamydia trachomatis testing
    1. Nasal Swab for Chlamydia Direct Fluorescence Antibody (low Test Sensitivity) OR
    2. Chlamydia DNA Probe or NAAT (not FDA approved for nasopharyngeal swab, but better Test Sensitivity)

VII. Differential Diagnosis

VIII. Management

  1. Start antibiotics while awaiting test results
  2. Erythromycin Base or EES 50 mg/kg divided four times daily for 14 days
  3. Second course may be required
  4. Close interval follow-up

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