Community-acquired pneumonia related to intracellular pathogens.
Catia Cillóniz, Antoni Torres, Michael Niederman, Menno van der Eerden, James Chalmers, Tobias Welte, Francesco Blasi
Author Information
Catia Cillóniz: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)-SGR 911-Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain.
Antoni Torres: Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB)-SGR 911-Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain. atorres@clinic.ub.es.
Michael Niederman: Division of Pulmonary and Critical Care Medicine, Weill Cornell Medicine, New York, NY, USA.
Menno van der Eerden: Department of Pulmonary diseases, Erasmus Medical Centre, Rotterdam, The Netherlands.
James Chalmers: Scottish Centre for Respiratory Research, University of Dundee, Dundee, DD1 9SY, UK.
Tobias Welte: Department of Pulmonary Medicine, Hannover Medical School and Member of the German Center of Lung Research (DZL), Hannover, Germany.
Francesco Blasi: Department of Pathophysiology and Transplantation, Università degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà Granda, Milan, Italy.
Community-acquired pneumonia (CAP) is associated with high rates of morbidity and mortality worldwide; the annual incidence of CAP among adults in Europe has ranged from 1.5 to 1.7 per 1000 population. Intracellular bacteria are common causes of CAP. However, there is considerable variation in the reported incidence between countries and change over time. The intracellular pathogens that are well established as causes of pneumonia are Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydophila psittaci, and Coxiella burnetii. Since it is known that antibiotic treatment for severe CAP is empiric and includes coverage of typical and atypical pathogens, microbiological diagnosis bears an important relationship to prognosis of pneumonia. Factors such as adequacy of initial antibiotic or early de-escalation of therapy are important variables associated with outcomes, especially in severe cases. Intracellular pathogens sometimes appear to cause more severe disease with respiratory failure and multisystem dysfunction associated with fatal outcomes. The clinical relevance of intracellular pathogens in severe CAP has not been specifically investigated. We review the prevalence, general characteristics, and outcomes of severe CAP cases caused by intracellular pathogens.
