The atypical pneumonias: clinical diagnosis and importance.
The atypical pneumonias: clinical diagnosis and importance.
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DOI：
10.1111/j.1469-0691.2006.01393.x
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发表时间：
2006-05
期刊：
影响因子：
--
通讯作者：
Cunha BA
中科院分区：
文献类型：
--
作者：
Cunha BA
最常见的非典型肺炎是由三种人畜共患病原体，鹦鹉热衣原体（鹦鹉热）、土拉热弗朗西斯菌（土拉菌）和贝氏柯克斯体（Q热），以及三种非人畜共患病原体，肺炎衣原体、肺炎支原体和军团菌引起的。与典型病原体不同，这些非典型病原体常常引起肺外表现。非典型CAP是具有肺部成分的全身性感染性疾病，并且可以通过肺外器官受累的模式在临床上与典型CAP区分，这是每种非典型CAP的特征。有阴性接触史的人畜共患肺炎可从诊断考虑中排除。最常见的临床问题是区分军团病与典型的CAP以及与C。pneumoniae或M.肺炎感染。就严重程度而言，军团菌是最重要的非典型病原体。根据肺外特征的特征性模式，使用综合征诊断的加权评分系统，可在临床上与典型CAP和其他非典型病原体相鉴别。由于军团病通常表现为严重的CAP，因此军团菌的推定诊断应提示特定的检测和经验性抗军团菌治疗，如温斯洛普大学医院传染病科的加权积分系统。大多数非典型病原体难以分离或分离危险，并且明确的实验室诊断通常基于间接的，即，直接荧光抗体（DFA）、间接荧光抗体（IFA）。非典型CAP几乎总是单一微生物; IFA IgG检测增加表明过去的暴露，而不是并发感染。抗军团菌抗生素包括大环内酯类、强力霉素、利福平、喹诺酮类和泰利霉素。抗军团菌活性最高的药物是喹诺酮类和泰利霉素。如果使用强效抗军团菌药物，治疗通常持续2周。成年人，M。pneumoniae和C.肺炎可能会加重或引起哮喘。非典型肺炎的重要性与其发生频率（约占CAP的15%）无关，但与其诊断困难以及对β-内酰胺类药物治疗无反应有关。由于C.肺炎支原体在冠状动脉疾病和多发性硬化（MS）中的作用，以及M. pneumoniae和C.肺炎引起或加剧哮喘，非典型CAP也具有公共卫生重要性。
The most common atypical pneumonias are caused by three zoonotic pathogens, Chlamydia psittaci (psittacosis), Francisella tularensis (tularemia), and Coxiella burnetii (Q fever), and three non-zoonotic pathogens, Chlamydia pneumoniae, Mycoplasma pneumoniae, and Legionella. These atypical agents, unlike the typical pathogens, often cause extrapulmonary manifestations. Atypical CAPs are systemic infectious diseases with a pulmonary component and may be differentiated clinically from typical CAPs by the pattern of extrapulmonary organ involvement which is characteristic for each atypical CAP. Zoonotic pneumonias may be eliminated from diagnostic consideration with a negative contact history. The commonest clinical problem is to differentiate legionnaire's disease from typical CAP as well as from C. pneumoniae or M. pneumonia infection. Legionella is the most important atypical pathogen in terms of severity. It may be clinically differentiated from typical CAP and other atypical pathogens by the use of a weighted point system of syndromic diagnosis based on the characteristic pattern of extrapulmonary features. Because legionnaire's disease often presents as severe CAP, a presumptive diagnosis of Legionella should prompt specific testing and empirical anti-Legionella therapy such as the Winthrop-University Hospital Infectious Disease Division's weighted point score system. Most atypical pathogens are difficult or dangerous to isolate and a definitive laboratory diagnosis is usually based on indirect, i.e., direct flourescent antibody (DFA), indirect flourescent antibody (IFA). Atypical CAP is virtually always monomicrobial; increased IFA IgG tests indicate past exposure and not concurrent infection. Anti-Legionella antibiotics include macrolides, doxycycline, rifampin, quinolones, and telithromycin. The drugs with the highest level of anti-Legionella activity are quinolones and telithromycin. Therapy is usually continued for 2 weeks if potent anti-Legionella drugs are used. In adults, M. pneumoniae and C. pneumoniae my exacerbate or cause asthma. The importance of the atypical pneumonias is not related to their frequency (~15% of CAPs), but to difficulties in their diagnosis, and their nonresponsiveness to β-lactam therapy. 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.
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DOI：
10.1007/s10096-003-0997-0
发表时间：
2003-10-01
影响因子：
4.5
作者：
Beovic, B;Bonac, B;Letonja, S
通讯作者：
Letonja, S
影响因子：
11.5
作者：
Amsden, GW
通讯作者：
Amsden, GW
影响因子：
14.2
作者：
Cunha, BA;Domenico, P;Cunha, CB
通讯作者：
Cunha, CB
影响因子：
5.9
作者：
Castro-Guardiola, A;Viejo-Rodríguez, AL;García-Bragado, F
通讯作者：
García-Bragado, F
影响因子：
1.6
作者：
Bochud, PY;Moser, F;Francioli, P
通讯作者：
Francioli, P