Salome Abbott Atypical pneumonia

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Salome Abbott Atypical pneumonia

AtypicalPneumoniain ChildrenSalome Abbott29-8-2012


Historical background Hobart A. Reimann (1938) Seven cases unusual pneumonia Pulmonary symptoms Radiological featuresReimann HA. An acute infection of the respiratory tract with atypicalpneumonia. Jour. AMA 1938; 111:2377-2384.


―... group of conditions, which unlike a typicalpneumonia are characterized by an insidiousonset, and interstitial inflammation of thelungs, showing patchy infiltrates on chestradiographs.‖Salaria M. Indian Pediatr 2002; 39:259-266.


―... group of conditions, which unlike a typicalpneumonia are characterized by an insidiousonset, and interstitial inflammation of thelungs, showing patchy infiltrates on chestradiographs.‖Salaria M. Indian Pediatr 2002; 39:259-266.


―... group of conditions, which unlike a typicalpneumonia are characterized by an insidiousonset, and interstitial inflammation of thelungs, showing patchy infiltrates on chestradiographs.‖Salaria M. Indian Pediatr 2002; 39:259-266.


―... group of conditions, which unlike a typicalpneumonia are characterized by an insidiousonset, and interstitial inflammation of thelungs, showing patchy infiltrates on chestradiographs.‖Salaria M. Indian Pediatr 2002; 39:259-266.


―... group of conditions, which unlike a typicalpneumonia are characterized by an insidiousonset, and interstitial inflammation of thelungs, showing patchy infiltrates on chestradiographs.‖Salaria M. Indian Pediatr 2002; 39:259-266.


Definition Less virulent course Lower mortality Leukocytosis less common Diagnosis is difficult Routine cultures fail to reveal microbial cause Patchy infiltrates on chest radiographs Do not respond to conventional antibiotics


Epidemiology Geographical distribution Seasonal variation Age The role in Asthma


Geographical distribution 6-40% first world No good statistics in developing worldPrincipi N. et al. Role of Mycoplasma pneumoniae and Chlamydia pneumoniaein Children with Community-Acquired Lower Respiratory Tract Infections. CID2001; 32:1281-1289.


Seasonal variationPrincipi N. et al. Role of Mycoplasma pneumoniae and Chlamydia pneumoniaein Children with Community-Acquired Lower Respiratory Tract Infections. CID2001; 32:1281-1289.


AgeBamba M. Prospective surveillance for atypical pathogens in children withcommunity-acquired pneumonia in Japan. J Infect Chemother 2006; 12:36-41.


The role in asthma New onset wheeze Exacerbation of established asthma a Chronic infection ba. Lieberman D et al. Atypical Pathogen Infection in Adults with acuteexacerbation of Bronchial Asthma. Am Journ Resp. and Crit. Care Med. 2003;167:406-410.b. Martin RJ et al. A link between chronic asthma and chronic infection. Journalof Allergy and Clinical Immunology 2001; 107:595-601.


Clinical presentation No difference between three groups Pneumococcal pneumonia Atypical pneumonia Viral pneumoniaKorppi M et al. The value of clinical features in differentiating between viral,pneumococcal and atypical bacterial pneumonia in children. Acta Paediatrica2008; 97:943-947.


Predictive factors associated withthe aetiology of CAP PCT and age > 5 years a,b White cell count, CRP, Interleukins b Radiological changes aa. Korppi M et al. The value of clinical features in differentiating between viral,pneumococcal and atypical bacterial pneumonia in children. ActaPaediatrica 2008; 97:943-947.b. Moulin F et al. Arch Dis Child 2001; 84:332-336.


Diagnosis Serology Microscopy and Culture Polymerase chain reaction Other diagnostic tests


Serology IgG IgM Limited role in acute infectionDowel S et al. Standardizing Chlamydia pneumoniae Assays:Recommendations from the Centers for Disease Control and Prevention (USA)and the Laboratory Centre for Disease Control (Canada). Clinical InfectiousDiseases 2001; 33:492-503.


Microscopy and Culture Specimen collection important Type of specimen Dacron tip and plastic shaft Calcium alginate Transport medium Transport at 4 degrees CelsiusDowel S et al. Standardizing Chlamydia pneumoniae Assays:Recommendations from the Centers for Disease Control and Prevention (USA)and the Laboratory Centre for Disease Control (Canada). Clinical InfectiousDiseases 2001; 33:492-503.


Microscopy and Culture cont. Unreliable, sensitivity 60% Complex Low yield Contamination Identification and sensitivity testingWolf J et al. Microbiological aspects of bacterial lower respiratory tract illness inchildren: atypical pathogens . Paediatric Respiratory Reviews 2007; 8:212-220.


Polymerase chain reaction Rapid results Limited sensitivity a Can’t distinguish between colonisation andtrue infection b a. Michelow I et al. Diagnostic Utility and Clinical Significance of Naso– andOropharyngeal Samples Used in a PCR Assay to Diagnose Mycoplasmapneumoniae Infection in Children with Community-Acquired Pneumonia.Journal of Clinical Microbiology 2004; 42:3339-3341.b. Dowel S et al. Standardizing Chlamydia pneumoniae Assays:Recommendations from the Centers for Disease Control and Prevention (USA)and the Laboratory Centre for Disease Control (Canada). Clinical InfectiousDiseases 2001; 33:492-503.


Other diagnostic tests Immunofluorescence ImmunohistochemistryDowel S et al. Standardizing Chlamydia pneumoniae Assays:Recommendations from the Centers for Disease Control and Prevention (USA)and the Laboratory Centre for Disease Control (Canada). Clinical InfectiousDiseases 2001; 33:492-503.


Diagnosis continued No gold standard Clinical diagnosis If going to test, use PCR Sputum or BAL best specimenWolf J et al. Microbiological aspects of bacterial lower respiratory tract illness inchildren: atypical pathogens . Paediatric Respiratory Reviews 2007; 8:212-220.


Treatment Erythromycin/Clarithromycin for ten daysequally efficacious as five days Azithromycin More side effects Azithromycin better activity againstH.InfluenzaeManfredi R et al. Clinical comparative study of azithromycin versuserythromycin in the treatment of acute respiratory tract infections in children. JChemother 1992; 4:364-370.


Legionnaire’s disease Rare Water Underlying conditions Hospital acquired High mortality AzithromycinGreenberg D et al. Problem pathogens: paediatric legionellosis—implicationsfor improved diagnosis. Lancet Infect Dis 2006; 6:529-535.


Pneumocystis Jirovecii Pneumoniae Gradual onset of symptoms Minimal chest findings Patchy interstitial infiltrates on chest xray Diagnosis Special staining Immunofluorescence Polymerase Chain Reaction


Pneumocystis Jirovecii Pneumoniae Gradual onset of symptoms Minimal chest findings Patchy interstitial infiltrates on chest xray Diagnosis Special staining Immunofluorescence Polymerase Chain Reaction


Pneumocystis Jirovecii Pneumoniae Gradual onset of symptoms Minimal chest findings Patchy interstitial infiltrates on chest xray Diagnosis Special staining Immunofluorescence Polymerase Chain Reaction


―group of conditions, which unlike a typicalpneumonia are characterized by an insiduousonset, and interstitial inflammation of thelungs, showing patchy infiltrates on chestradiographs‖Salaria M. Indian Pediatr 2002; 39:259-266.


Conclusion Remember atypical pneumonia even in thevery young Not just Mycoplasma and Chlamydophilla Atypical pneumonia remains a diagnosticchallenge Role of macrolides in other childhoodrespiratory conditions


Acknowledgements Robin Green Refiloe Masekela Carla Els Wim Wijnant

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