Chapter: Pneumonia Caused by Other Pathogens
McMaster Section Editor(s): Mark Loeb
Section Editor(s) in Interna Szczeklika: Ewa Niżankowska-Mogilnicka, Filip Mejza
McMaster Author(s): Mark Loeb
Author(s) in Interna Szczeklika: Jan Kuś, Miłosz Jankowski
How to Cite This Chapter: Loeb M, Kuś J, Jankowski M. Pneumonia Caused by Other Pathogens. McMaster Textbook of Internal Medicine. Kraków: Medycyna Praktyczna. https://empendium.com/mcmtextbook/chapter/B31.II.220.127.116.11 Accessed April 23, 2019.
Last Updated: February 20, 2016
Last Reviewed: March 1, 2017
Main Documents Taken Into Account:
National Clinical Guideline Centre (UK). Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults.
London: National Institute for Health and Care Excellence (UK); 2014 Dec. PubMed PMID: 25520986.
Woodhead M, Blasi F, Ewig S, et al; Joint Taskforce of the European Respiratory Society and European Society for Clinical Microbiology and Infectious Diseases. Guidelines for the management of adult lower respiratory tract infections--summary.
Clin Microbiol Infect. 2011 Nov;17 Suppl 6:1-24. doi: 10.1111/j.1469-0691.2011.03602.x. PubMed PMID: 21951384.
Limper AH, Knox KS, Sarosi GA, et al; American Thoracic Society Fungal Working Group. An official American Thoracic Society statement: Treatment of fungal infections in adult pulmonary and critical care patients.
Am J Respir Crit Care Med. 2011 Jan 1;183(1):96-128. doi: 10.1164/rccm.2008-740ST. PubMed PMID: 21193785.
Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009.
Thorax. 2009 Oct;64 Suppl 3:iii1-55. doi: 10.1136/thx.2009.121434. PubMed PMID: 19783532.
Torres A, Ewig S, Lode H, Carlet J; European HAP working group. Defining, treating and preventing hospital acquired pneumonia: European perspective.
Intensive Care Med. 2009 Jan;35(1):9-29. doi: 10.1007/s00134-008-1336-9. PubMed PMID: 18989656.
Mandell LA, Wunderink RG, Anzueto A, et al; Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults.
Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72. PubMed PMID: 17278083.
American Thoracic Society; Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.
Am J Respir Crit Care Med. 2005 Feb 15;171(4):388-416. PubMed PMID: 15699079.
Treatment: Table 2 in Community-Acquired Pneumonia.
1. Streptococcus pneumoniae: The most common etiologic agent of community-acquired pneumonia (CAP). Sputum cultures are recommended in hospitalized patients, although they may be of limited use. Other methods of confirming the diagnosis include blood cultures (positive results in <25% of cases) and detection of the Streptococcus pneumoniae antigen in urine.
2. Haemophilus influenza and Moraxella catarrhalis may be a cause pneumonia, especially in patients with chronic lung disease.
3. Staphylococcus aureus causes <5% of CAP cases and ~30% of hospital-acquired pneumonia (HAP) cases; the disease usually has a severe course. The diagnosis is confirmed by microscopic examination of sputum samples, sputum cultures, and blood cultures. Patients with methicillin-resistant Staphylococcus aureus (MRSA) infection should be isolated. Infection with Panton-Valentine leukocidin-producing strain (PVL-SA) may lead to the formation of cavities in the lungs (necrotizing pneumonia) and multiple organ failure. Start targeted treatment as soon as results of microbiological studies are available.
4. Klebsiella pneumoniae and other gram-negative intestinal bacilli (Escherichia coli, Proteus spp): Radiologic features: See Community-Acquired Pneumonia. The diagnosis is confirmed by blood or sputum cultures.
5. Acinetobacter baumannii usually causes HAP that is often severe and associated with leukopenia. Pleural effusions develop in 50% of patients.
6. Anaerobic bacteria are not a frequent cause of CAP and an uncommon cause of ventilator-associated pneumonia (VAP). They are of prime importance in patients with aspiration and may be associated with abscess formation. Detection can be difficult. Microscopic examination of sputum may be helpful.
7. Atypical pathogens:
1) Mycoplasma pneumoniae: The incubation period lasts 2 to 3 weeks. Patients rarely develop leukocytosis or lobar infiltrates. Occasionally hilar lymphadenopathy is observed. Features of hemolytic anemia may be present.
2) Chlamydophila (Chlamydia) pneumoniae typically causes pharyngitis that precedes CAP by ~2 weeks.
3) Legionella pneumophila: Air conditioning systems, air humidifiers, and tap water are potential sources of infection, which may cause headaches and disorientation. Diarrhea may also be observed. The infection may cause elevated serum levels of alanine aminotransferase, aspartate aminotransferase, creatine kinase; hyponatremia; albuminuria; and microscopic hematuria. The diagnosis is confirmed by detection of the L pneumophila antigen in urine.