title: Fatal hemorrhagic pneumonia concomitant with Chlamydia pneumoniae and parainfluenza virus 4 infection.
abstract: BACKGROUND
  Cases of fatal hemorrhagic pneumonia need to be investigated for highly contagious viral causes. While not all hemorrhagic pneumonias are caused by very contagious agents, the etiology must be correctly determined in order to administer appropriate patient care.
  
  
  OBJECTIVE
  To determine whether chlamydia, paramyxovirus, or mycoplasma was the causative agent in a case of fatal hemorrhagic pneumonia, and to evaluate the possibility that this was the first case of hantavirus pulmonary syndrome in Illinois.
  
  
  METHODS
  Nonroutine virological and molecular analyses were performed on lung tissue taken during an unrestricted autopsy of a patient who died in 2002. SETTING AND PATIENT: An elderly, male, Chicago-area resident with a 3-week history of nonspecific, mild upper respiratory tract infection was admitted for hospital treatment of the respiratory infection and viral myositis without cardiac involvement. The patient became febrile, hypoxic, developed hemorrhagic pneumonia, and died. Because he had proven exposure to mice and had developed hemorrhagic pneumonia, hantavirus pulmonary syndrome was suspected as the cause of death. Mice known to carry hantaviruses live in Illinois, including the Chicago area.
  
  
  METHODS
  Gatifloxacin and heparin anticoagulation were initiated because community-acquired pneumonia and pulmonary embolism were considered likely etiologies for an acute exacerbation of hypoxemia.
  
  
  RESULTS
  Two respiratory pathogens were isolated and identified: Chlamydia pneumoniae and human parainfluenza virus 4a.
  
  
  CONCLUSIONS
  A mixed (polymicrobial) infection contributed to the patient's death. Hemorrhage was likely a result of anticoagulation therapy superimposed on lung tissues damaged by pneumonia. The uncommon nature of this case and the pathogens involved underscore the challenges in infection control and clinical evaluation that hospitals will face when confronted with possibly new and potentially deadly communicable diseases.
authors.affiliation: Department of Pathology, Loyola University Medical Center, Maywood, Ill 60153, USA.
authors.forename: Tara C
authors.initials: TC
authors.lastname: Rubinas
authors.forename: Roberta B
authors.initials: RB
authors.lastname: Carey
authors.forename: Mitchell C
authors.initials: MC
authors.lastname: Kampert
authors.forename: Serhan
authors.initials: S
authors.lastname: Alkan
authors.forename: John A
authors.initials: JA
authors.lastname: Lednicky
mesh_terms: D000368:Aged; D000595:Amino Acid Sequence; D001483:Base Sequence; D023521:Chlamydophila Infections / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D016993:Chlamydophila pneumoniae / Q000302:isolation & purification*; D004279:DNA, Viral / Q000737:chemistry; D017809:Fatal Outcome; D018804:Hantavirus Pulmonary Syndrome / Q000175:diagnosis; D006470:Hemorrhage / Q000382:microbiology / Q000821:virology; D006801:Humans; D008297:Male; D008969:Molecular Sequence Data; D029482:Parainfluenza Virus 4, Human / Q000235:genetics / Q000302:isolation & purification*; D011014:Pneumonia; D018410:Pneumonia, Bacterial / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D011024:Pneumonia, Viral / Q000150:complications / Q000175:diagnosis / Q000821:virology*; D019351:Rubulavirus Infections / Q000150:complications / Q000175:diagnosis / Q000821:virology*
chemical_list: D004279:DNA, Viral