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Atypical Pneumonia


Presentation

  • The distinction was historically considered important, as it differentiated those more likely to present with "typical" respiratory symptoms and lobar pneumonia from those more likely to present with "atypical" generalized symptoms (such as fever, headache[en.wikipedia.org]
  • We need to return to the original meaning of atypical pneumonia and restrict its use to describe pneumonia that is truly unusual in clinical presentation, epidemiology, or both.[ncbi.nlm.nih.gov]
  • It is an uncommon presentation of shigellosis in an immunocompetent person without underlying severe predisposing conditions.[ncbi.nlm.nih.gov]
  • PURPOSE OF REVIEW: We present the key advances in the infections that clinicians conventionally associate with atypical pneumonia: legionellosis, Mycoplasma pneumonia, Chlamydophila species pneumonia and Q fever.[ncbi.nlm.nih.gov]
  • This paper aims to present a case of MP with sars, ARDS, pneumonia and pleural effusion during the MERS epidemics, and review the incidence and mortality of severe AP with MP.[ncbi.nlm.nih.gov]
Fever
  • His fever subsided soon and clinical symptoms improved after minocycline was administrated on Day 12. The psittacosis case was confirmed by history of psittacine bird contact, clinical symptoms, treatment response, and positive IgM titer.[ncbi.nlm.nih.gov]
  • During the later stages of the illness, symptoms may worsen, the fever may become higher, and coughing may yield discolored phlegm (sputum).[my.clevelandclinic.org]
  • Coxiella burnetii Causes Q fever. Francisella tularensis Causes tularemia. Legionella pneumophila Causes a severe form of pneumonia with a relatively high mortality rate, known as legionellosis or Legionnaires' disease.[en.wikipedia.org]
  • All are marked by extensive but short-lived pulmonary infiltration, fever, malaise, muscle pains, sore throat, and coughing. Copyright 2007. An Elsevier publication. All rights reserved.[web.archive.org]
  • Clinical findings Incubation 3 weeks; insidious onset of fever, malaise, headache, myalgia, low-grade fever, cough, chest pain and respiratory disease, from asymptomatic to rhinitis, pharyngitis, tracheobronchitis and pneumonia.[medical-dictionary.thefreedictionary.com]
Malaise
  • All are marked by extensive but short-lived pulmonary infiltration, fever, malaise, muscle pains, sore throat, and coughing. Copyright 2007. An Elsevier publication. All rights reserved.[web.archive.org]
  • None had received the seasonal influenza vaccine; they had cough (92%), fever (86.8%), and malaise (73.7%). The median time from disease onset to hospital admission was 6 days (range 0-8 days).[ncbi.nlm.nih.gov]
  • Atypical bacterial pneumonia generally is characterised by a symptom complex that includes headache, low-grade fever, cough, and malaise. Constitutional symptoms often predominate over respiratory findings.[bestpractice.bmj.com]
  • Clinical findings Incubation 3 weeks; insidious onset of fever, malaise, headache, myalgia, low-grade fever, cough, chest pain and respiratory disease, from asymptomatic to rhinitis, pharyngitis, tracheobronchitis and pneumonia.[medical-dictionary.thefreedictionary.com]
Coronary Artery Disease
  • Because of the potential role of C. pneumoniae in coronary artery disease and multiple sclerosis (MS), and the role of M. pneumoniae and C. pneumoniae in causing or exacerbating asthma, atypical CAPs also have public health importance.[ncbi.nlm.nih.gov]
  • Coronary Artery Disease or Peripheral Vascular Disease No change in standard management. E. Diabetes or other Endocrine issues No change in standard management. F. Malignancy No change in standard management. G.[clinicaladvisor.com]
Vietnamese
  • Younger age and co-infection with typical bacteria or viruses were the most significant risk factors, while respiratory/cardiac system malformation and neonatal pneumonia were additional potential risk factors, associated with severe-ApCAP in Vietnamese[ncbi.nlm.nih.gov]
Intermittent Fever
  • Herein we report a 44-year-old male patient displaying atypical pneumonia symptoms of intermittent fever, dry cough, chest pain, dyspnea, headache, hepatitis, and hyponatremia. He had two sick cockatiels, one of which had died a month previously.[ncbi.nlm.nih.gov]
Cough
  • During the later stages of the illness, symptoms may worsen, the fever may become higher, and coughing may yield discolored phlegm (sputum).[my.clevelandclinic.org]
  • Cough is prominent; chest radiographic findings are varied. Many organisms are associated with this syndrome. Mycoplasma pneumoniae, Chlamydia psittaci, Chlamydia pneumoniae, Coxiella burnetii, and Francisella tularensis are reviewed in this article.[ncbi.nlm.nih.gov]
  • It develops gradually with a dry cough and low-grade fever as opposed to sudden fever and coughing up mucus in bacterial pneumonia [1] .[ehealthstar.com]
  • All are marked by extensive but short-lived pulmonary infiltration, fever, malaise, muscle pains, sore throat, and coughing. Copyright 2007. An Elsevier publication. All rights reserved.[web.archive.org]
  • The clinical picture was remarkable as the patient presented with cough and purulent sputum production, but otherwise no classical signs of pneumonia. Furthermore, there was no diarrhoeal episode in the recent history.[ncbi.nlm.nih.gov]
Pertussis
  • ., Bordetella pertussis, and Coxiella bumetii, the most common agents associated with atypical pneumonia.[ncbi.nlm.nih.gov]
  • Specificity The Chlamydophila pneumoniae PCR assay was tested for cross reactivity against Bordetella pertussis , Bordetella parapertussis , Bordetella bronchiseptica , all relevant non- C. pneumoniae species of Chlamydophila , all relevant strains of[viracoribt.com]
  • There may also be dyspnea and, in some cases, the cough may take on a pertussis-like character. Some children may develop inflammation of the throat, cervical adenopathy, conjunctivitis, and myringitis.[phac-aspc.gc.ca]
  • Bordetella pertussis: B pertussis is the agent responsible for pertussis or whooping cough. Anaerobic organisms Pneumonia due to anaerobes typically results from aspiration of oropharyngeal contents, as previously mentioned.[emedicine.com]
Rales
  • As pneumonia progresses, rales appear in the chest, C. penumoniae is known to be associated with hyper-reactive airway. Infec-tion with C. pneumoniae can trigger acute epidosde of wheezing in children with asthma.[indianpediatrics.net]
  • […] hypothermia ( 35 C) Tachypnea ( 18 respirations/min) Use of accessory respiratory muscles Tachycardia ( 100 bpm) or bradycardia ( 60 bpm) Central cyanosis Altered mental status Physical findings may include the following: Adventitious breath sounds, such as rales[emedicine.com]
Chest Pain
  • Herein we report a 44-year-old male patient displaying atypical pneumonia symptoms of intermittent fever, dry cough, chest pain, dyspnea, headache, hepatitis, and hyponatremia. He had two sick cockatiels, one of which had died a month previously.[ncbi.nlm.nih.gov]
  • Cough, fever, and substernal chest pain were common presenting complaints, and upper respiratory symptoms were often present. White blood cell counts ranged from 6,500 to 18,300/mm 3 .[annals.org]
  • Minimally to non-productive cough often with chest pain (from cough, not pleuritic) with negative sputum stain. CXR often negative or demonstrating typically unilateral interstitial infiltrate. Mycoplasma is the big one, chlamydia pneumoniae #2.[forums.studentdoctor.net]
  • Clinical findings Incubation 3 weeks; insidious onset of fever, malaise, headache, myalgia, low-grade fever, cough, chest pain and respiratory disease, from asymptomatic to rhinitis, pharyngitis, tracheobronchitis and pneumonia.[medical-dictionary.thefreedictionary.com]
  • Shortness of breath and chest pain during deep breathing (pleuritic pain) are uncommon [4] . The main late symptoms are fatigue and a lingering dry cough or coughing up mucus, which may persist for several weeks or months [4] . Signs.[ehealthstar.com]
Joint Stiffness
  • […] when you exert yourself) Other symptoms include: Chest pain that gets worse when you breathe deeply or cough Confusion, most often in older people or those with legionella pneumonia Headache Loss of appetite, low energy, and fatigue Muscle aches and joint[medlineplus.gov]
  • Shortness of breath occurs when the individual is running, climbing up stairs, or swimming Other symptoms that occur less commonly are: Chest pain, confusion (mostly in elderly individuals), headaches, lack of energy, hunger, joint stiffness, increased[dovemed.com]
Withdrawn
  • Five days after admission, systemic quinolones were withdrawn given the possibility that treatment with beta-lactams might be causing the clinical picture, and intravenous glucocorticoid treatment was started.[archbronconeumol.org]
  • Ketolides: including telithromycin (ketek, recently withdrawn from Food and Drug Administration (FDA) approval) ( Ross 2007 ; Soreth 2007 ). We included other drugs within the antibiotic classes listed above, if identified by our searches.[doi.org]
Headache
  • Despite general symptoms and problems with the upper respiratory tract (such as high fever, headache, a dry irritating cough followed later by a productive cough with radiographs showing consolidation), there are in general few physical signs.[en.wikipedia.org]
  • Herein we report a 44-year-old male patient displaying atypical pneumonia symptoms of intermittent fever, dry cough, chest pain, dyspnea, headache, hepatitis, and hyponatremia. He had two sick cockatiels, one of which had died a month previously.[ncbi.nlm.nih.gov]
  • Atypical bacterial pneumonia generally is characterised by a symptom complex that includes headache, low-grade fever, cough, and malaise. Constitutional symptoms often predominate over respiratory findings.[bestpractice.bmj.com]
  • These might include a prominent headache, a low-grade fever, an earache, and a sore throat.[medicalnewstoday.com]
Neglect
  • PURPOSE OF REVIEW: After decades of neglect, the importance of establishing an aetiological diagnosis for community-acquired and atypical pneumonias has increased dramatically in recent years--driven by the movement towards more rational use of antibiotics[ncbi.nlm.nih.gov]
  • Chronic diseases like malignancy (42%), [1] HIV (40%), tuberculosis (10%), [2] and sarcoidosis (5%) [3] are leading cause of such associations, but an acute condition due to neglected group of organism causing atypical pneumonia like mycoplasma (0.01-[annalsofian.org]

Workup

  • Challenges in Community-Acquired Pneumonia American Family Physician Atypical pneumonia General Practice Notebook Bono MJ, Mycoplasmal pneumonia Emedicine Bono MJ, Mycoplasmal pneumonia, clinical presentation Emedicine Bono MJ, Mycoplasmal pneumonia, workup[ehealthstar.com]
  • Urine assays Sputum, serum, and/or urinary antigen tests Immune serologic tests Histologic examination Histologic inflammatory lung changes vary according to whether the patient has lobar pneumonia, bronchopneumonia, or interstitial pneumonia. [2] See Workup[emedicine.com]
Atelectasis
  • Subsegmental and sometimes segmental atelectasis from small airway obstruction may occur. The radiographic features are often more extensive than what is suggested clinically.[radiopaedia.org]
  • Other findings that suggest the presence of pneumonia include air bronchograms; the silhouette sign; parapneumonic effusions; and complications of pneumonia, such as lung abscesses, and atelectasis.[emedicine.medscape.com]
  • Small areas of segmental or sub-segmental atelectasis are also common. Rarely, enlargement of hilar lymph nodes, segmental consolidation or pleural effusion can be seen in chest radiograph.[indianpediatrics.net]
Coxiella Burnetii
  • Mycoplasma pneumoniae, Chlamydia psittaci, Chlamydia pneumoniae, Coxiella burnetii, and Francisella tularensis are reviewed in this article.[ncbi.nlm.nih.gov]
  • ., Francisella tularensis, and Coxiella burnetii, which are the agents most commonly associated with atypical pneumonia. Because many of these pathogens are intracellular, diagnosis depends upon serological confirmation.[ncbi.nlm.nih.gov]
  • The presence of Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci, Coxiella burnetii, and Legionella pneumophila infection was diagnosed by serological tests.[ncbi.nlm.nih.gov]
  • Bacterial agents include Legionella species, Mycoplasma pneumoniae, Chlamydophila species, and Coxiella burnetii.[ncbi.nlm.nih.gov]
  • The most common atypical pneumonias are caused by three zoonotic pathogens, Chlamydia psittaci (psittacosis), Francisella tularensis (tularemia), and Coxiella burnetii (Q fever), and three nonzoonotic pathogens, Chlamydia pneumoniae, Mycoplasma pneumoniae[ncbi.nlm.nih.gov]
Francisella Tularensis
  • Mycoplasma pneumoniae, Chlamydia psittaci, Chlamydia pneumoniae, Coxiella burnetii, and Francisella tularensis are reviewed in this article.[ncbi.nlm.nih.gov]
  • ., Francisella tularensis, and Coxiella burnetii, which are the agents most commonly associated with atypical pneumonia. Because many of these pathogens are intracellular, diagnosis depends upon serological confirmation.[ncbi.nlm.nih.gov]
  • The most common atypical pneumonias are caused by three zoonotic pathogens, Chlamydia psittaci (psittacosis), Francisella tularensis (tularemia), and Coxiella burnetii (Q fever), and three nonzoonotic pathogens, Chlamydia pneumoniae, Mycoplasma pneumoniae[ncbi.nlm.nih.gov]
  • Other organisms include Chlamydia psittaci ( Psittacosis ), Francisella tularensis ( tularemia ), and Coxiella burnetii ( Q Fever ).[histopathology-india.net]
  • Francisella tularensis Causes tularemia. Legionella pneumophila Causes a severe form of pneumonia with a relatively high mortality rate, known as legionellosis or Legionnaires' disease.[en.wikipedia.org]
Complement Fixing Antibody
  • Eight patients did not respond to treatment: 5 had significant complement fixing antibody titers to adenovirus and in 3 the etiology was unknown. The success rate in Group 2 was 88% (36 patients).[ncbi.nlm.nih.gov]

Treatment

  • In the azithromycin treatment group, Mycoplasma pneumoniae was identified in 65, Chlamydia spp. in 9 and Coxiella burnetti in 1 patient.[ncbi.nlm.nih.gov]
  • Azithromycin is equally effective as treatment of atypical pneumonia in adult patients if given for 3 or 5 days at the same total dose.[ncbi.nlm.nih.gov]
  • Treatment failure: as defined in study, with and without treatment modifications. 21. Mechanical ventilation. 22. Adverse events: life‐threatening events, events necessitating specific medical treatment, events requiring cessation of treatment.[doi.org]
  • Control clinical examinations were performed 72 h, 10-12 days and 4 weeks after treatment initiation.[ncbi.nlm.nih.gov]
  • OBJECTIVE: To probe into the mechanism on TCM treatment of infectious atypical pneumonia (severe acute respiratory syndrome, SARS) and evaluate its feasibility and effectiveness.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSION: This analysis of pneumonia in the Al-Qassim area indicates the pattern and prognosis of acute bacterial and atypical pneumonia that requires admission to hospital in the central region of Saudi Arabia.[ncbi.nlm.nih.gov]
  • Prognosis. Chlamydia pneumoniae infection is usually mild, but may last for several weeks or months; in older individuals, it may be life-threatening; mortality among individuals treated with antibiotics is 5% [9,11] .[ehealthstar.com]
  • Outlook (Prognosis) Most people with pneumonia due to mycoplasma or chlamydophila get better with the right antibiotics. Legionella pneumonia can be severe.[ufhealth.org]

Etiology

  • M. pneumoniae was an important microorganism in the etiology of atypical pneumonia of childhood in our community.[ncbi.nlm.nih.gov]
  • Physicians at the time were unclear as to the precise etiology of these infections.[ncbi.nlm.nih.gov]
  • The current serological tests used to identify these agents in the etiologic diagnosis of atypical pneumonia are described. Recently, however, it has become possible to make a diagnosis directly in these cases using DNA or protein microarrays.[ncbi.nlm.nih.gov]
  • We report an unusual identification of S. sonnei as the only identified pathogen from respiratory specimens, which we therefore consider the most likely etiology of this subacute atypical pneumonia.[ncbi.nlm.nih.gov]
  • In reality, differentiation as to etiology of pneumonia cannot be distinguished on the basis of clinical presentation.[ncbi.nlm.nih.gov]

Epidemiology

  • SUMMARY: There are few advances in our knowledge of the epidemiology of atypical pathogens or the effectiveness of antimicrobial therapy--empirical or pathogen specific.[ncbi.nlm.nih.gov]
  • Pleuritic symptoms, positive epidemiology and eosinophilia led to suspicion of the diagnosis, which was further supported by serology.[ncbi.nlm.nih.gov]
  • We need to return to the original meaning of atypical pneumonia and restrict its use to describe pneumonia that is truly unusual in clinical presentation, epidemiology, or both.[ncbi.nlm.nih.gov]
  • This article will discuss the epidemiology, clinical manifestations, and laboratory diagnoses of Mycoplasma pneumoniae, Chlamydia sp., Legionella sp., Francisella tularensis, and Coxiella burnetii, which are the agents most commonly associated with atypical[ncbi.nlm.nih.gov]
  • This review will discuss the epidemiology, clinical manifestations, and laboratory diagnosis of Mycoplasma pneumoniae, Chlamydia sp., Legionella sp., Bordetella pertussis, and Coxiella bumetii, the most common agents associated with atypical pneumonia[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • References Cheng AC, BartJC (2005) Melioidosis: Epidemiology, Pathophysiology, andManagement, Clinical Microbiology Review 12: 383-416.[omicsonline.org]
  • Pathophysiology The organism responsible for mycoplasmal pneumonia, M pneumoniae, is a pleomorphic organism that, unlike bacteria, lacks a cell wall, and unlike viruses, does not need a host cell for replication.[emedicine.com]
  • Pathophysiology The organism responsible for mycoplasmal pneumonia, M pneumoniae , is a pleomorphic organism that, unlike bacteria, lacks a cell wall, and unlike viruses, does not need a host cell for replication.[emedicine.medscape.com]
  • Mycoplasma pneumoniae disease: clinical spectrum, pathophysiology, epidemiology, and control. J Infect Dis 1971;123:74-92. [PubMed] 1 1. Dorigo-Zetsma JW, Zaat SA, Wertheim-van Dillen PM,Spanjaard L, Rijntjes J, van Waveren G, et al.[antimicrobe.org]

Prevention

  • CONCLUSION: TCM intervention could effectively control and alleviate the symptoms and prevent the disease from exacerbation.[ncbi.nlm.nih.gov]
  • Centers of Disease Control and Prevention[ehealthstar.com]
  • In order to prevent loss of time with beta-lactamase antibiotics, which are usually started in severe pneumonia, serologic tests and PCR must be done during the initial evaluation of the patient for the reliable diagnosis of M. pneumoniae, which will[ncbi.nlm.nih.gov]
  • What can be done to prevent the spread of mycoplasma? At this time, there are no vaccines for the prevention of mycoplasma infection and there are no reliably effective measures for control.[health.ny.gov]
  • Some forms of pneumonia may be prevented with vaccination. However, there are many different causes for pneumonia. These can be broadly classified under bacterial, viral and fungal infections.[news-medical.net]

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