Acute Pneumonia and Importance of Atypical Bacteria

  • I. Boyadjiev
  • M. Léone
  • C. Martin
Conference paper


The term and concept of atypical pneumonia appeared in the 1940s following observations of penicillin-resistant pneumonia [1]. Despite the identification of a large number of microorganisms, the challenge of isolating so-called ‘atypical’ bacteria is the principal cause of failure of the etiologic diagnosis of pneumonia. These pathogenic agents in the tracheobronchial tree include a large variety of bacteria, viruses and even protozoa. Among atypical bacteria, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella pneumoniae, Bordetella pertussis, and Coxiella burnetii are the most widespread. Numerous other bacteria are emerging pathogenic species whose virulence is currently being evaluated. Clinical examination only provides a diagnostic orientation in a restricted number of cases. The availability of rapid and specific microbiologic examination improves the diagnostic performance for this type of pneumonia (Table 1) [2]. Since most of these bacteria are intracellular, diagnosis is based principally on serology.


Mycoplasma Pneumoniae Elementary Body Atypical Pneumonia Urinary Antigen Acute Disseminate Encephalomyelitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Eaton M, Meikeljohn G, Van Herick W (1944) Studies on the etiology of primary atypical pneumonia: A filtrable agent transmissible to cotton rats, hamsters and chick embryos. J Exp Med 79:649–661CrossRefPubMedGoogle Scholar
  2. 2.
    Raoult D, Fournier P, Drancourt M (2004) What does the future hold for clinical microbiology? Nat Rev Microbiol 2:151–159PubMedCrossRefGoogle Scholar
  3. 3.
    Aubas S, Aubas P, Capdevila X, Darbas H, Roustan J, du Cailar J (1994) Bronchoalveolar lavage for diagnosing bacterial pneumonia in mechanically ventilated patients. Am J Respir Crit Care Med 149:860–866PubMedGoogle Scholar
  4. 4.
    Rosenstraus M, Wang Z, Chang S, DeBonville D, Spadoro J (1998) An internal control for routine diagnostic PCR: design, properties, and effect on clinical performance. J Clin Microbiol 36:191–197PubMedGoogle Scholar
  5. 5.
    Edelstein P (1993) Legionnaires’ disease. Clin Infect Dis 16:741–749PubMedGoogle Scholar
  6. 6.
    Harrison T, Uldum S, Alexiou-Daniel S, et al (1998) A multicenter evaluation of the Biotest legionella urinary antigen EIA. Clin Microbiol Infect 4:359–365PubMedGoogle Scholar
  7. 7.
    Birtles R, Harrison T, Samuel D, Taylor A (1990) Evaluation of urinary antigen ELISA for diagnosing Legionella pneumophila serogroup 1 infection. J Clin Pathol: 685–690Google Scholar
  8. 8.
    Bornstein N, Fleurette J (1994) Legionella. In: Freney J, Renaud F, Hansen D, Bollet C (eds) Manuel de Bactériologie Clinique. Elsevier, Paris, pp 1327–1354Google Scholar
  9. 9.
    Hammerschlag M (2001) Mycoplasma pneumoniae infections. Curr Opin Infect Dis 14:181–186PubMedCrossRefGoogle Scholar
  10. 10.
    Reimann H (1984) Landmark article Dec 24,1938: An acute infection of the respiratory tract with atypical pneumonia. A disease entity probably caused by a filtrable virus. By Hobart A. Reimann. JAMA 251:936–944PubMedCrossRefGoogle Scholar
  11. 11.
    Parides G, Bloom J, Ampel N, Ray C (1988) Mycoplasma and ureaplasma in bronchoalveolar lavage fluids from immunocompromised hosts. Diagn Microbiol Infect Dis 9:55–57PubMedCrossRefGoogle Scholar
  12. 12.
    Sasaki T, Bonissol C, Stoiljkovic B (1987) Cross-reactive antibodies to mycoplasmas found in human sera by the enzyme-linked immunosorbent assay (ELISA). Microbiol Immunol 31:521–530PubMedGoogle Scholar
  13. 13.
    Bredt W, Kleinmann B, Jacobs E (1987) Antibodies in the sera of Mycoplasma pneumoniae-infected patients against proteins of Mycoplasma genitalium and other mycoplasmas of man. Zentralbl Bakteriol Mikrobiol Hyg 266:32–42Google Scholar
  14. 14.
    Watkins-Riedel T, Stanek G, Daxboeck F (2001) Comparison of SeroMP IgA with four other commercial assays for serodiagnosis of Mycoplasma pneumoniae pneumonia. Diagn Microbiol Infect Dis 40:21–25PubMedCrossRefGoogle Scholar
  15. 15.
    Grayston J, Wang S, Kuo C, Campbell L (1989) Current knowledge on Chlamydia pneumoniae, strain TWAR, an important cause of pneumonia and other acute respiratory diseases. Eur J Clin Microbiol Infect Dis 8:191–202PubMedCrossRefGoogle Scholar
  16. 16.
    Danesh J (2005) Antibiotics in the prevention of heart attacks. Lancet 365:365–367PubMedGoogle Scholar
  17. 17.
    Ramirez J, Ahkee S, Tolentino A, Miller R, Summersgill J (1996) Diagnosis of Legionella pneumophila, Mycoplasma pneumoniae, or Chlamydia pneumoniae lower respiratory infection using the polymerase chain reaction on a single throat swab specimen. Diagn Microbiol Infect Dis 24:7–14PubMedCrossRefGoogle Scholar
  18. 18.
    Laudenbach V, Mantz J, Desmonts J (1999) Understanding of molecular biology. Ann Fr Anesth Reanim 18:725–747PubMedGoogle Scholar
  19. 19.
    Orfila J, Chaigneau C, Gommeux A, Sueur J, Fey T (1995) Epidémiologie des infections respiratoires à Chlamydia Pneumoniae dans le département de la Somme. Bull Epidemiol Hebd 42:186–187Google Scholar
  20. 20.
    Marston B, Plouffe J, File T, et al (1997) Incidence of community-acquired pneumonia requiring hospitalization. Results of a population-based active surveillance Study in Ohio. The Community-Based Pneumonia Incidence Study Group. Arch Intern Med 157:1709–1718PubMedCrossRefGoogle Scholar
  21. 21.
    Tissot Dupont H, Raoult D, Brouqui P, et al (1992) Epidemiologie features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases. Am J Med 93:427–434PubMedCrossRefGoogle Scholar
  22. 22.
    Mege J, Maurin M, Capo C, Raoult D (1997) Coxiella burnetii: the ‘query’ fever bacterium. A model of immune subversion by a strictly intracellular microorganism. FEMS Microbiol Rev 19:209–217PubMedCrossRefGoogle Scholar
  23. 23.
    Raoult D (1996) Q fever: still a query after all these years. J Med Microbiol 44:77–78PubMedCrossRefGoogle Scholar
  24. 24.
    Dupuis G, Petite J, Peter O, Vouilloz M (1987) An important outbreak of human Q fever in a Swiss Alpine valley. Int J Epidemiol 16:282–287PubMedCrossRefGoogle Scholar
  25. 25.
    Dupuis G, Peter O, Pedroni D, Petite J (1985) Clinical aspects observed during an epidemic of 415 cases of Q fever. Schweiz Med Wochenschr 115:814–818PubMedGoogle Scholar
  26. 26.
    Maurin M, Raoult D (1999) Q fever. Clin Microbiol Rev 12:518–553PubMedGoogle Scholar
  27. 27.
    Leone M, Honstettre A, Lepidi H, et al (2004) Effect of sex on Coxiella burnetii infection: protective role of 17beta-estradiol. J Infect Dis 189:339–345PubMedCrossRefGoogle Scholar
  28. 28.
    Derrick E (1937) Q fever, a new fever entity: clinical features, diagnosis and laboratory investigation. Med J Aust 2:281–299Google Scholar
  29. 29.
    Marrie T (1995) Coxiella burnetii (Q fever) pneumonia. Clin Infect Dis Suppl 3:S253–S264Google Scholar
  30. 30.
    Fournier P (1999) Fièvre Q In: Bricaire F (ed) Encycl Med Chir, Maladies Infectieuses, Elsevier, Paris, 8-037-1-10Google Scholar
  31. 31.
    Raoult D, Brouqui P (1993) Intracellular location of microorganisms. In: Raoult D (ed) Antimicrobial Agents and Intracellular Pathogens. CRC Press, Boca Raton, pp 39–62Google Scholar
  32. 32.
    Hackstadt T, Williams J (1981) Biochemical stratagem for obligate parasitism of eukaryotic cells by Coxiella burnetii. Proc Natl Acad Sci USA 78:3240–3244PubMedCrossRefGoogle Scholar
  33. 33.
    Subramanya N, Wright J, Khan M (1982) Failure of rifampicin and co-trimoxazole in Q fever endocarditis. BMJ 285:343–344PubMedGoogle Scholar
  34. 34.
    Raoult D (1993) Treatment of Q fever. Antimicrob Agents Chemother 37:1733–1736PubMedGoogle Scholar
  35. 35.
    Marrie T, Raoult D (2002) Update on Q fever, including Q fever endocarditis. Curr Clin Top Infect Dis 22:97–124PubMedGoogle Scholar
  36. 36.
    Maurin M, Benoliel A, Bongrand P, Raoult D (1992) Phagolysosomal alkalinization and the bactericidal effect of antibiotics: the Coxiella burnetii paradigm. J Infect Dis 166:1097–1102PubMedGoogle Scholar
  37. 37.
    Raoult D, Drancourt M, Vestris G (1990) Bactericidal effect of doxycycline associated with lysosomotropic agents on Coxiella burnetii in P388D1 cells. Antimicrob Agents Chemother 34:1512–1514PubMedGoogle Scholar
  38. 38.
    Brundrett G (1992) Legionella and Building Services. Butterworth Heinemann, Oxford.Google Scholar
  39. 39.
    Greub G, Boyadjiev I, La Scola B, Raoult D, Martin C (2003) Serological hint suggesting that Parachlamydiaceae are agents of pneumonia in polytraumatized intensive care patients. Ann NY Acad Sci 990:311–319PubMedGoogle Scholar
  40. 40.
    Rowbotham TJ (1980) Preliminary report on the pathogenicity of Legionella pneumophila for freshwater and soil amoebae. J Clin Pathol 33:1179–1183PubMedCrossRefGoogle Scholar
  41. 41.
    Kwait Y, Gao L, Stone B, Venkataraman C, Harb O (1998) Invasion of Protozoa by Legionella pneumophila and its role in bacterial ecology and pathogenesis. Appl Environ Microbiol 64:3127–3133Google Scholar
  42. 42.
    Joshi A, Swanson M (1999) Comparative analysis of Legionella pneumophila and Legionella micdadei virulence traits. Infect Immun 67:4134–4142PubMedGoogle Scholar
  43. 43.
    Woo A, Goetz A, Yu V (1992) Transmission of Legionella by respiratory equipment and aerosol generating devices. Chest 102:1586–1590PubMedCrossRefGoogle Scholar
  44. 44.
    Tokuda H, Yahagi N, Kasai S, Kitamura S, Otsuka Y (1997) A case of fatal pneumonia caused by Legionella pneumophila serogroup 6 developed after drowning in a public bath. Kansenshogaku Zasshi 71:169–174PubMedGoogle Scholar
  45. 45.
    Mitchell D, Hicks L, Chiew R, Montanaro J, Chen S (1997) Pseudoepidemic of Legionella pneumophila serogroup 6 associated with contaminated bronchoscopes. J Hosp Infect 37:19–23PubMedCrossRefGoogle Scholar
  46. 46.
    Rello J, Bodi M, Mariscal D, Navarro M, Diaz E, Gallego M, Valles J (2003) Microbiological testing and outcome of patients with severe community-acquired pneumonia. Chest 123:174–180PubMedCrossRefGoogle Scholar
  47. 47.
    Hutchinton O (1990) Nosocomial legionellosis. Rev Med Microbiol 1:108–115Google Scholar
  48. 48.
    Spieker S, Petersen D, Rolfs A, Fehrenbach F, Kuntz R, Seuffe R (1998) Acute disseminated encephalomyelitis following Pontiac fever. Eur Neurol 40:169–172PubMedCrossRefGoogle Scholar
  49. 49.
    Brouqui P, Raoult D (2001) Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev 14:177–207PubMedCrossRefGoogle Scholar
  50. 50.
    Stout J, Yu V (1997) Legionellosis. N Engl J Med 337:682–687PubMedCrossRefGoogle Scholar
  51. 51.
    Vandenesch F, Surgot M, Bornstein N, Paucod J, Marmet D, Isoard P (1990) Relationship between free Amoeba and Legionella: studies in vitro and in vivo. Zentralbl Bakteriol 272:265–275PubMedGoogle Scholar
  52. 52.
    Sile S, Straub T, Christmann B (1994) Manifestations extra-pulmonaires des légionelloses. Med Mal Infect 24:874–880CrossRefGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2006

Authors and Affiliations

  • I. Boyadjiev
    • 1
  • M. Léone
    • 2
  • C. Martin
    • 1
  1. 1.Department of Anesthesiology and Intensive Care MedicineCHU NordMarseilleFrance
  2. 2.Unit for RickettsiasCNRS UMR 6020 Faculty of MedicineMarseilleFrance

Personalised recommendations