WordNet

of first rank or importance or value; direct and immediate rather than secondary; "primary goals"; "a primary effect"; "primary sources"; "a primary interest"
a preliminary election where delegates or nominees are chosen (同)primary_election
one of the main flight feathers projecting along the outer edge of a birds wing (同)primary feather, primary quill
(astronomy) a celestial body (especially a star) relative to other objects in orbit around it
not derived from or reducible to something else; basic; "a primary instinct"
not representative of a group, class, or type; "a group that is atypical of the target audience"; "a class of atypical mosses"; "atypical behavior is not the accepted type of response that we expect from children" (同)untypical
deviating from normal expectations; somewhat odd, strange, or abnormal; "these days large families are atypical"; "atypical clinical findings"; "atypical pneumonia"; "highly irregular behavior" (同)irregular
respiratory disease characterized by inflammation of the lung parenchyma (excluding the bronchi) with congestion caused by viruses or bacteria or irritants

PrepTutorEJDIC

『第一の』,『主要な』 / 『初期の』,『初等の』,初級の / 『根本的な』,基本的な,本来の,直接的な / 《名詞の前にのみ用いて》(回路・コイル・巻き・電流などが)一次の / 原色(三原色の一つ) / 《米》=primary election
型にはまらない,異常な
肺炎

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/06/10 01:19:43」(JST)

wiki en

Atypical pneumonia, also known as walking pneumonia^{[citation needed]}, is the type of pneumonia not caused by one of the pathogens most commonly associated with the disease. Its clinical presentation contrasts to that of "typical" pneumonia. A variety of microorganisms can cause it. When it develops independently from another disease it is called primary atypical pneumonia (PAP). The term was introduced in the 1930s^[1]^[2] and was contrasted with the bacterial pneumonia caused by Streptococcus pneumoniae, at that time the best known and most commonly occurring form of pneumonia. 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, sweating and myalgia) and bronchopneumonia. ^[3]

Distinction between atypical and typical pneumonia is, however, medically insufficient. For the treatment of pneumonia, it is important to know the exact causal organism.

Terminology

"Primary atypical pneumonia" is called primary because it develops independently of other diseases.

"Atypical pneumonia" is atypical in that it is caused by atypical organisms (other than Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis).^[4] These atypical organisms include special bacteria, viruses, fungi, and protozoa. In addition, this form of pneumonia is atypical in presentation with only moderate amounts of sputum, no consolidation, only small increases in white cell counts, and no alveolar exudate.^[5]^[6] At the time that atypical pneumonia was first described, organisms like Mycoplasma, Chlamydophila, and Legionella were not yet recognized as bacteria and instead considered viruses. Hence "atypical pneumonia" was also called "non-bacterial".^[7] In literature the term atypical pneumonia (contrasted with bacterial pneumonia) is still in use, though incorrect. Meanwhile, many such organisms are identified as bacteria, albeit unusual types (Mycoplasma is a type of bacteria without a cell wall and Chlamydias are intracellular parasites). As the conditions caused by these agents have different courses and respond to different treatments, the identification of the specific causative pathogen is important.

Signs and symptoms

Usually the atypical causes also involve atypical symptoms:

No response to common antibiotics such as sulfonamide^[8] and beta-lactams like penicillin.
No signs and symptoms of lobar consolidation,^[9]^[10] meaning that the infection is restricted to small areas, rather than involving a whole lobe. As the disease progresses, however, the look can tend to lobar pneumonia.
Absence of leukocytosis.
Extrapulmonary symptoms, related to the causing organism.^[6]
Moderate amount of sputum, or no sputum at all (i.e. non-productive).
Lack of alveolar exudate.^[11]
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. The patient looks better than the symptoms suggest.^[1]^[8]

Cause

The most common causative organisms are (often intracellular living) bacteria:^[6]

Chlamydophila pneumoniae: Mild form of pneumonia with relatively mild symptoms.
Chlamydophila psittaci: Causes psittacosis.
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.
Mycoplasma pneumoniae: ^[12] Usually occurs in younger age groups and may be associated with neurological and systemic (e.g. rashes) symptoms.

Atypical pneumonia can also have a fungal, protozoan or viral cause.^[13]^[14]
In the past, most organisms were difficult to culture. However, newer techniques aid in the definitive identification of the pathogen, which may lead to more individualized treatment plans.

Viral

When comparing the bacterial-caused atypical pneumonias with these caused by real viruses (excluding bacteria that were wrongly considered as viruses), the term "atypical pneumonia" almost always implies a bacterial cause^{[citation needed]} and is contrasted with viral pneumonia.

Known viral causes of atypical pneumonia include respiratory syncytial virus (RSV), influenza A and B, parainfluenza, adenovirus, severe acute respiratory syndrome (SARS)^[15] and measles.^[5]

Diagnosis

Chest radiographs (X-ray photographs) often show a pulmonary infection before physical signs of atypical pneumonia are observable at all.^[8] This is called occult pneumonia. In general, occult pneumonia is rather often present in patients with pneumonia and can also be caused by Streptococcus pneumoniae, as the decrease of occult pneumonia after vaccination of children with a pneumococcal vaccine suggests.^[16]^[17]

Infiltration commonly begins in the perihilar region (where the bronchus begins) and spreads in a wedge- or fan-shaped fashion toward the periphery of the lung field. The process most often involves the lower lobe, but may affect any lobe or combination of lobes.^[8]

Epidemiology

Mycoplasma is found more often in younger than in older people.^[18]^[19] Older people are more often infected by Legionella.^[19]

References

^ ^a ^b Walter C, McCoy MD (1946). "Primary atypical pneumonia: A report of 420 cases with one fatality during twenty-seven month at Station Hospital, Camp Rucker, Alabama". Southern Medical Journal. 39 (9): 696. doi:10.1097/00007611-194609000-00005.
^ Pneumonia, Atypical Bacterial at eMedicine
^ Pneumonia, Typical Bacterial at eMedicine
^ Memish ZA, Ahmed QA, Arabi YM, Shibl AM, Niederman MS (October 2007). "Microbiology of community-acquired pneumonia in the Gulf Corporation Council states". Journal of Chemotherapy. 19 (Suppl 1): 17–23. PMID 18073166. ^{[permanent dead link]}
^ ^a ^b Diseases Database Causes of atypical pneumonia
^ ^a ^b ^c Cunha BA (May 2006). "The atypical pneumonias: clinical diagnosis and importance". Clin. Microbiol. Infect. 12 (Suppl 3): 12–24. PMID 16669925. doi:10.1111/j.1469-0691.2006.01393.x.
^ "Primary atypical pneumonia" at Dorland's Medical Dictionary
^ ^a ^b ^c ^d Commission on Acute Respiratory Diseases, Fort Bragg, North Carolina (April 1944). "Primary Atypical Pneumonia" (PDF). American Journal of Public Health and the Nations Health. 34 (4): 347–357. doi:10.2105/AJPH.34.4.347.
^ Gouriet F, Drancourt M, Raoult D (October 2006). "Multiplexed serology in atypical bacterial pneumonia". Ann. N. Y. Acad. Sci. 1078: 530–40. PMID 17114771. doi:10.1196/annals.1374.104.
^ Hindiyeh M, Carroll KC (June 2000). "Laboratory diagnosis of atypical pneumonia". Semin Respir Infect. 15 (2): 101–13. PMID 10983928. doi:10.1053/srin.2000.9592.
^ Robbins and Cotran Pathologic Basis of Disease, 8th edition, Kumar et al., Philadelphia, 2010, p. 714
^ MYCOPLASMA PNEUMONIAE at the US National Library of Medicine Medical Subject Headings (MeSH)
^ Diseases Database
^ Tang YW (December 2003). "Molecular diagnostics of atypical pneumonia" (PDF). Acta Pharmacol. Sin. 24 (12): 1308–13. PMID 14653964. Archived from the original (PDF) on 2011-07-08.
^ "Severe Acute Respiratory Syndrome (SARS) — multi-country outbreak". Archived from the original on 7 December 2008. Retrieved 2008-12-21.
^ Murphy CG, van de Pol AC, Harper MB, Bachur RG (March 2007). "Clinical predictors of occult pneumonia in the febrile child". Acad Emerg Med. 14 (3): 243–9. PMID 17242382. doi:10.1197/j.aem.2006.08.022.
^ Rutman MS, Bachur R, Harper MB (January 2009). "Radiographic pneumonia in young, highly febrile children with leukocytosis before and after universal conjugate pneumococcal vaccination". Pediatric Emergency Care. 25 (1): 1–7. PMID 19116501. doi:10.1097/PEC.0b013e318191dab2.
^ Schneeberger PM, Dorigo-Zetsma JW, van der Zee A, van Bon M, van Opstal JL (2004). "Diagnosis of atypical pathogens in patients hospitalized with community-acquired respiratory infection". Scandinavian Journal of Infectious Diseases. 36 (4): 269–73. PMID 15198183. doi:10.1080/00365540410020127.
^ ^a ^b National Heart, Lung, and Blood Institute, U.S.A. What Causes Pneumonia?

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 小児における肺炎：疫学、病因、および原因 pneumonia in children epidemiology pathogenesis and etiology
2. 小児における肺炎：入院治療 pneumonia in children inpatient treatment
3. 成人における肺炎マイコプラズマ感染症 mycoplasma pneumoniae infection in adults
4. Community-acquired pneumonia in children: Outpatient treatment
5. 難治性肺炎 nonresolving pneumonia

English Journal

Quantitative assessment of bronchiolar smooth muscle in healthy and diseased porcine lungs.

Marruchella G, Bernabò N, Valbonetti L.SourceUniversity of Teramo, Faculty of Veterinary Medicine, Department of Comparative Biomedical Sciences, Piazza A. Moro 45, 64100 Teramo, Italy. Electronic address: gmarruchella@unite.it.
Research in veterinary science.Res Vet Sci.2013 Jun;94(3):641-3. doi: 10.1016/j.rvsc.2012.10.019. Epub 2012 Nov 11.
Smooth muscle cells are major components of bronchiolar wall. Bronchiolar smooth muscle is reported to increase in some veterinary pulmonary disorders, but such assumption is not supported by detailed morphometric analyses. The present investigation aimed at quantitatively evaluating bronchiolar smo
PMID 23151463

Therapeutic Efficacy of Macrolides, Minocycline, and Tosufloxacin against Macrolide-Resistant Mycoplasma pneumoniae Pneumonia in Pediatric Patients.

Kawai Y, Miyashita N, Kubo M, Akaike H, Kato A, Nishizawa Y, Saito A, Kondo E, Teranishi H, Ogita S, Tanaka T, Kawasaki K, Nakano T, Terada K, Ouchi K.SourceDepartment of Pediatrics.
Antimicrobial agents and chemotherapy.Antimicrob Agents Chemother.2013 May;57(5):2252-8. doi: 10.1128/AAC.00048-13. Epub 2013 Mar 4.
The importance of macrolide-resistant (MR) Mycoplasma pneumoniae has become much more apparent in the past decade. We investigated differences in the therapeutic efficacies of macrolides, minocycline, and tosufloxacin against MR M. pneumoniae. A total of 188 children with M. pneumoniae pneumonia con
PMID 23459497

Manganese deficiency associated with bone deformities in calves.

[No authors listed]AbstractManganese deficiency identified in cows with a history of long bone deformities in calves Paramphistomosis suspected as a cause of illthrift in beef youngstock Mycoplasma bovis associated with mastitis and pneumonia in a dairy herd Fatal verminous pneumonia in a goat herd Respiratory syncytial virus suspected in pneumonic changes in a fattening lamb Mulberry heart disease diagnosed in two-week-old suckling piglets These are among matters discussed in the disease surveillance report for January from SAC Consulting: Veterinary Services (SAC C VS).
The Veterinary record.Vet Rec.2013 Apr 13;172(15):389-92. doi: 10.1136/vr.f2024.
Manganese deficiency identified in cows with a history of long bone deformities in calves Paramphistomosis suspected as a cause of illthrift in beef youngstock Mycoplasma bovis associated with mastitis and pneumonia in a dairy herd Fatal verminous pneumonia in a goat herd Respiratory syncytial virus
PMID 23585113

Japanese Journal

マイコプラズマ肺炎に伴う感音難聴例

春野尊,蓑田涼生,湯本英二
耳鼻咽喉科臨床 102(4), 253-257, 2009-04-01
… Mycoplasma pneumoniae infection leading to the development of primary atypical pneumonia causes diverse complications involving other organs and the nervous systems. …
NAID 10024762790

猫の肺の管内性血管肉腫(短報)(病理学)

山上哲史,野村耕二,藤田道郎,尾崎清和,織間博光,奈良間功
The journal of veterinary medical science 68(7), 731-733, 2006-07-25
9歳,去勢雄の日本猫が努力性呼吸困難を主訴に上診した.胸部X線所見より,右中葉の吸飲性肺炎あるいは原発性び漫性腫瘍が疑われた.組織学的には,異型細胞で構成された肺胞壁のびまん性肥厚が右中葉病変部に認められた.これらの異型細胞は,ファクターVIII関連抗原陽性を示した.以上より,本症例を管内性血管肉腫と診断した.
NAID 110004763183

Related Pictures

★リンクテーブル★

リンク元	「非定型肺炎」「PAP」「異型肺炎」「原発性非定型性肺炎」「原発性異型肺炎」
関連記事	「primary」「atypical」「atypical pneumonia」

「非定型肺炎」

Atypical pneumonia
Classification and external resources
Specialty	Infectious disease, pulmonology
ICD-10	J18.9
ICD-9-CM	483
DiseasesDB	1132
MedlinePlus	000079
	[edit on Wikidata]

　　[★]

英: atypical pneumonia　PAP
同: 原発性異型肺炎 primary atypical pneumonia

定義

細菌が検出できない肺炎の総称

特徴

胸部X線画像で、陰影が淡く、両側性、skip lesionなどが非定型的であり、βラクタム薬が無効であることが特徴

病因

マイコプラズマ、クラミジア、リケッチア、ウイルス(RSウイルス、パラインフルエンザウイルス、インフルエンザウイルス、アデノウイルス)による肺炎
レジオネラも含める？

症状

乾性咳嗽、発熱

検査所見

胸部X線画像：間質性陰影　→普通の肺炎では影は見られない

診断

細菌性肺炎と非定型肺炎の鑑別

1. 年齢60歳未満
2. 基礎疾患がない、あるいは軽微
3. 頑固な咳がある
4. 胸部聴診所見が乏しい
5. 痰がない、あるいは、迅速診断法で原因菌が証明されない
6. 末梢血白血球数が10,000/uL未満である

上記6項目を使用した場合

4項目以上合致：非定型肺炎疑い
3項目以下：細菌性肺炎疑い

(感度：77.9%、特異度：93.0%)

上記の1.-5.までの5項目を使用した場合

3項目以上合致：非定型肺炎疑い
2項目以下：細菌性肺炎疑い

(感度：83.9%、特異度：87.0%)

「PAP」

　　[★]

「異型肺炎」

　　[★]

英: atypical pneumonia
関: 非定型肺炎
英: primary atypical pneumonia
同: PAP

「原発性非定型性肺炎」

　　[★]

英: primary atypical pneumonia
関: マイコプラズマ肺炎、原発性異型肺炎

「原発性異型肺炎」

　　[★]

英: primary atypical pneumonia
関: 原発性非定型性肺炎、非定型肺炎

「primary」

　　[★]

adj.

一次の、第一次の、主要な、(化学)第一級の、一級の、初生の、(病名)原発性の、原発の、プライマリーの

関: cardinal、chief、first-order、foremost、main、mainly、major、master、primarily、principal、principally

「atypical」

　　[★]

adj.

非定型の, 非定型的な, 非定型性の, 異型の

関: atypia、atypically、atypism、meta、nonclassic、off-type、variant

「atypical pneumonia」

　　[★]

非定型肺炎、異型肺炎

[Walter-1] Walter C, McCoy MD (1946). "Primary atypical pneumonia: A report of 420 cases with one fatality during twenty-seven month at Station Hospital, Camp Rucker, Alabama". Southern Medical Journal. 39 (9): 696. doi:10.1097/00007611-194609000-00005.

[2] Pneumonia, Atypical Bacterial at eMedicine

[3] Pneumonia, Typical Bacterial at eMedicine

[4] Memish ZA, Ahmed QA, Arabi YM, Shibl AM, Niederman MS (October 2007). "Microbiology of community-acquired pneumonia in the Gulf Corporation Council states". Journal of Chemotherapy. 19 (Suppl 1): 17–23. PMID 18073166. ^{[permanent dead link]}

[ddb-5] Diseases Database Causes of atypical pneumonia

[Cunha06-6] Cunha BA (May 2006). "The atypical pneumonias: clinical diagnosis and importance". Clin. Microbiol. Infect. 12 (Suppl 3): 12–24. PMID 16669925. doi:10.1111/j.1469-0691.2006.01393.x.

[7] "Primary atypical pneumonia" at Dorland's Medical Dictionary

[bragg-8] Commission on Acute Respiratory Diseases, Fort Bragg, North Carolina (April 1944). "Primary Atypical Pneumonia" (PDF). American Journal of Public Health and the Nations Health. 34 (4): 347–357. doi:10.2105/AJPH.34.4.347.

[pmid17114771-9] Gouriet F, Drancourt M, Raoult D (October 2006). "Multiplexed serology in atypical bacterial pneumonia". Ann. N. Y. Acad. Sci. 1078: 530–40. PMID 17114771. doi:10.1196/annals.1374.104.

[pmid10983928-10] Hindiyeh M, Carroll KC (June 2000). "Laboratory diagnosis of atypical pneumonia". Semin Respir Infect. 15 (2): 101–13. PMID 10983928. doi:10.1053/srin.2000.9592.

[11] Robbins and Cotran Pathologic Basis of Disease, 8th edition, Kumar et al., Philadelphia, 2010, p. 714

[12] MYCOPLASMA PNEUMONIAE at the US National Library of Medicine Medical Subject Headings (MeSH)

[13] Diseases Database

[pmid14653964-14] Tang YW (December 2003). "Molecular diagnostics of atypical pneumonia" (PDF). Acta Pharmacol. Sin. 24 (12): 1308–13. PMID 14653964. Archived from the original (PDF) on 2011-07-08.

[15] "Severe Acute Respiratory Syndrome (SARS) — multi-country outbreak". Archived from the original on 7 December 2008. Retrieved 2008-12-21.

[16] Murphy CG, van de Pol AC, Harper MB, Bachur RG (March 2007). "Clinical predictors of occult pneumonia in the febrile child". Acad Emerg Med. 14 (3): 243–9. PMID 17242382. doi:10.1197/j.aem.2006.08.022.

[17] Rutman MS, Bachur R, Harper MB (January 2009). "Radiographic pneumonia in young, highly febrile children with leukocytosis before and after universal conjugate pneumococcal vaccination". Pediatric Emergency Care. 25 (1): 1–7. PMID 19116501. doi:10.1097/PEC.0b013e318191dab2.

[18] Schneeberger PM, Dorigo-Zetsma JW, van der Zee A, van Bon M, van Opstal JL (2004). "Diagnosis of atypical pathogens in patients hospitalized with community-acquired respiratory infection". Scandinavian Journal of Infectious Diseases. 36 (4): 269–73. PMID 15198183. doi:10.1080/00365540410020127.

[nhlbi-19] National Heart, Lung, and Blood Institute, U.S.A. What Causes Pneumonia?

v t e Pneumonia
Infectious pneumonias	Bacterial pneumonia Viral pneumonia Fungal pneumonia Parasitic pneumonia Atypical pneumonia Community-acquired pneumonia Healthcare-associated pneumonia Hospital-acquired pneumonia Ventilator-associated pneumonia Severe acute respiratory syndrome
Pneumonias caused by infectious or noninfectious agents	Aspiration pneumonia Lipid pneumonia Eosinophilic pneumonia Bronchiolitis obliterans organizing pneumonia
Noninfectious pneumonia	Chemical pneumonitis

匿名

検索

案内

案内

primary atypical pneumonia