The atypical pneumonias

Clinical features

• fever, malaise headache

• minimal respiratory symptoms, non-productive cough

• signs of consolidation absent

• chest X-ray (diffuse infiltration) incompatible with chest signs

Causes

Mycoplasma pneumoniae—the commonest:

• adolescents and young adults

• treat with tetracycline, e.g. doxycycline 100 mg bd for 10 days

Legionella pneumophila (legionnaires' disease):

• related to cooling systems in large buildings

• incubation 2-10 days

Diagnostic criteria include:

• prodromal-like illness

• a dry cough, influenza, confusion or diarrhoea

• lymphopenia with marked leucocytosis

• hyponatraemia

Patients can become very prostrate with complications—treat with erythromycin. Chlamydia psittaci (psittacosis)

• treat with doxycycline 100 mg bd for 10 days Coxiella burnetii (Q fever)

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