High rates of Chlamydia trachomatis infections in young Papua New Guinean infants

Objective. Determine the importance of Chlamydia trachomatis in the etiolog y of severe infection in young Papua New Guinean infants. Methods. Between March, 1991, and April, 1993, children <3 months old were recruited as outpatients at Goroka Base Hospital, Papua New Guinea, as part of a multicenter study in four developing countries. Children with! predef ined inclusion criteria were enrolled. C. trachomatis was identified by dir ect fluorescent antibody staining in nasopharyngeal aspirates (NPAs) collec ted from children with and without signs of severe disease and eye swabs fr om children with and without conjunctivitis. Two to three radiologists read chest radiographs without knowledge of clinical and laboratory findings. Results. Of 3280 outpatients seen 2168 enrolled, 955 NPAs were tested for C . trachomatis and 549 chest radiographs were read. of 210 eye swabs from ch ildren with conjunctivitis 57% were positive for C. trachomatis compared wi th 8% from 167 children with no conjunctivitis. The prevalence of C. tracho matis in NPAs was 9% in asymptomatic children and 18 and 33% in children wi th nonsevere or severe pneumonia, respectively. C. trachomatis in NPAs was strongly associated with clinically severe pneumonia [odds ratio (OR), 2.91 ], reduced arterial oxygen saturation (OR 2.58) and radiographic evidence o f pneumonia (OR 5.84) and was also-associated with pneumococcal bacteremia (OR 3.48). Conclusions. In Papua New Guinea Chlamydia must be considered as a cause wh en treating pneumonia in infants, and effective treatment and prevention of sexually transmitted diseases are urgently needed for a number of reasons, including the need to curb high rates of chlamydial infection in women and infants.