WordNet

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

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）』「2015/08/28 04:10:36」(JST)

wiki en

Atypical pneumonia, also known as walking pneumonia, is the type of pneumonia not caused by one of the more traditional pathogens. 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, however, is 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 still were not 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.

Chlamydia 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 etiology^{[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.
^ ^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. doi:10.1111/j.1469-0691.2006.01393.x. PMID 16669925.
^ "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. doi:10.1196/annals.1374.104. PMID 17114771.
^ Hindiyeh M, Carroll KC (June 2000). "Laboratory diagnosis of atypical pneumonia". Semin Respir Infect 15 (2): 101–13. doi:10.1053/srin.2000.9592. PMID 10983928.
^ p714, Robbins and Cotran Pathologic Basis of Disease 8th edition, Kumar et al, Philadelphia 2010
^ 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.
^ "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. doi:10.1197/j.aem.2006.08.022. PMID 17242382.
^ 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. doi:10.1097/PEC.0b013e318191dab2. PMID 19116501.
^ 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. doi:10.1080/00365540410020127. PMID 15198183.
^ ^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. 成人における肺炎マイコプラズマ感染症 mycoplasma pneumoniae infection in adults
2. 成人における市中肺炎に対する診断的アプローチ diagnostic approach to community acquired pneumonia in adults
3. 小児における肺炎：入院治療 pneumonia in children inpatient treatment
4. 小児における市中肺炎：臨床的特徴および診断 community acquired pneumonia in children clinical features and diagnosis
5. 成人における肺炎クラミジアによる肺炎 pneumonia caused by chlamydia pneumoniae in adults

English Journal

Antipsychotic use in elderly patients and the risk of pneumonia.

Gambassi G1, Sultana J, Trifirò G.
Expert opinion on drug safety.Expert Opin Drug Saf.2015 Jan;14(1):1-6. doi: 10.1517/14740338.2015.984684. Epub 2014 Nov 28.
Antipsychotics are frequently and increasingly prescribed off-label for the treatment of behavioral and psychological symptoms associated with dementia, despite their modest efficacy. Instead, the safety profile of antipsychotics has been questioned repeatedly in recent years with various concerns,
PMID 25431005

Automated Classification of Usual Interstitial Pneumonia Using Regional Volumetric Texture Analysis in High-Resolution Computed Tomography.

Depeursinge A1, Chin AS, Leung AN, Terrone D, Bristow M, Rosen G, Rubin DL.
Investigative radiology.Invest Radiol.2014 Dec 30. [Epub ahead of print]
OBJECTIVES: We propose a novel computational approach for the automated classification of classic versus atypical usual interstitial pneumonia (UIP).MATERIALS AND METHODS: Thirty-three patients with UIP were enrolled in this study. They were classified as classic versus atypical UIP by a consensus o
PMID 25551822

Organizing pneumonia with atypical computed tomography findings in Sjögren's syndrome.

Lee W1, Choi K.
International journal of rheumatic diseases.Int J Rheum Dis.2014 Dec 25. doi: 10.1111/1756-185X.12523. [Epub ahead of print]
PMID 25545763

Japanese Journal

Efficacy and safety of garenoxacin tablets on clinically diagnosed atypical pneumonia: Postmarketing surveillance in Japan

Izumikawa Koichi,Watanabe Akira,Miyashita Naoyuki,Ishida Tadashi,Hosono Hiroaki,Kushimoto Satoru,Kohno Shigeru
Journal of Infection and Chemotherapy 20(9), 541-548, 2014-09
… We performed a postmarketing surveillance study to determine the efficacy and safety of the oral quinolone antibacterial agent garenoxacin (Geninax ® Tablets 200 mg) against atypical pneumonia. … Between October 2009 and July 2011, patients with community-acquired pneumonia visited 26 facilities in Japan; …
NAID 120005477081

Invasive Mucinous Adenocarcinoma Mimicking Organizing Pneumonia Associated with Mycobacterium fortuitum Infection

Morichika Daisuke,Miyahara Nobuaki,Hotta Katsuyuki,Okamoto Yoshiko,Minami Daisuke,Irie Masahiro,Tanimoto Yasushi,Kanehiro Arihiko,Tanimoto Mitsune,Kiura Katsuyuki
Internal Medicine 53(24), 2795-2799, 2014
… however, repeated bronchoscopy showed no atypical cells, thus suggesting a diagnosis of organizing pneumonia associated with M. … Invasive mucinous adenocarcinoma should not be excluded in the differential diagnosis of patients with clinical features of organizing pneumonia and nontuberculous mycobacterium infection, even if a transbronchial biopsy confirms the absence of malignancy. …
NAID 130004713290

早期肺癌の画像診断

久保武
肺癌 54(6), 854-861, 2014
早期肺癌は，日本の取扱い規約上，中枢型扁平上皮癌に対して定義されているが，頻度の高い末梢型腺癌には定義されていない．野口らにより，小型肺癌の予後良好群として組織学的にlocalized bronchioloalveolar carcinomaを示すものがあり，特に活動性線維芽細胞増生のないものは極めて予後良好であることが示され，早期肺癌に相当するものと考えられる．これらは画像的に経時的変化の乏しい …
NAID 130004705043