Atypical pneumonia

Definition

Atypical pneumonia refers to pneumonia caused by certain bacteria, including Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.

This article provides a general overview of atypical pneumonia.

See also:

• Legionella pneumonia (Legionnaire's disease)
• Mycoplasma pneumonia

Alternative Names

Walking pneumonia; Chlamydophila pneumoniae

Causes, incidence, and risk factors

Atypical pneumonia due to mycoplasma and chlamydophila bacteria usually cause mild forms of pneumonia, unlike other types of the disease that can come on more quickly with more severe early symptoms.

Mycoplasma pneumonia often affects younger people and may be associated with anemia, certain types of rashes, and neurological conditions such as meningitis, myelitis, and encephalitis. For more information on this type of pneumonia, see: Mycoplasma pneumonia

Pneumonia due to chlamydia-related bacteria occurs year round and accounts for 5 - 15% of all pneumonias. It is usually mild with a low death rate.

Atypical pneumonia due to Legionella accounts for 2 - 6% of pneumonias and has a higher death rate. Older adults, smokers, and those with chronic illnesses and weakened immune systems are at higher risk for this type of pneumonia. Breathing in contaminated air (such as that from infected air conditioning systems) has also been linked to pneumonia due to Legionella. For more information on this type of pneumonia, see: Legionnaire's disease

Symptoms

• Chills
• Confusion (especially with Legionella pneumonia)
• Cough
• Diarrhea (especially with Legionella pneumonia)
• Fever
• General ill feeling
• Headache
• Loss of appetite
• Muscle stiffness and aching
• Rapid breathing
• Rash (especially with mycoplasma pneumonia)
• Shortness of breath

Signs and tests

Persons with suspected pneumonia should have a complete medical evaluation, including a thorough physical exam and a chest x-ray -- especially since the physical exam may not always distinguish pneumonia from acute bronchitis or other respiratory infections.

Depending on the severity of illness, additional studies may be done, include:

• Complete blood count (CBC)
• Blood cultures
• Blood tests for antibodies to specific bacteria
• Bronchoscopy
• Open lung biopsy (only done in very serious illnesses when the diagnosis cannot be made from other sources)
• Sputum culture

Urine tests or a throat swab may also be done.

Treatment

Antibiotics are used to treat atypical pneumonia. If you have a mild case, you may be able to take antibiotics by mouth. If you have severe atypical pneumonia, you will likely be admitted to a hospital where you will be given antibiotics through a vein (intravenously), as well as oxygen.

Antibiotics used to treat atypical pneumonia include:

• Azithromycin
• Clarithromycin
• Erythromycin
• Fluoroquinolones and their derivatives (such as levofloxacin)
• Tetracyclines (such as doxycycline)

Expectations (prognosis)

Most patients with pneumonia due to mycoplasma or chlamydophila do well with appropriate antibiotic therapy, although there is a small chance that the infection will return if antibiotics are used for fewer than 2 weeks.

While atypical pneumonias are commonly associated with milder forms of pneumonia, pneumonia due to Legionella, in particular, can be quite severe, especially among the elderly and those with chronic diseases and weakened immune systems. It is associated with a higher death rate.

Complications

• Hemolytic anemia (especially with mycoplasma pneumonia)
• Lung failure

Calling your health care provider

Contact your health care provider if you develop fever, cough, or shortness of breath. There are numerous causes for these symptoms. The doctor will need to rule out pneumonia.

Prevention

There is no known prevention for atypical pneumonia. No vaccine is available at this time for atypical pneumonia.

References

Limper AH. Overview of pneumonia. In: Goldman L, Ausiello D. Cecil Medicine. Philadelphia, Pa: Saunders; 2007:chap 97.

Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27-S72.