Atypical pneumonia, also known as walking pneumonia, is an atypical 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).
Distinction between atypical and typical pneumonia, however, is medically insufficient. For the treatment of pneumonia it is important to know the exact causal organism. Moreover, S. pneumoniae has become a relatively less important cause.
"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). 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. At the time that atypical pneumonia was described first, organisms like Mycoplasma, Chlamydophila, and Legionella still were not recognized as bacteria and instead considered as viruses. Hence "atypical pneumonia" was also called "non-bacterial". In literature the term atypical pneumonia (contrasted with bacterial pneumonia) is still in use, though incorrect. Meanwhile, many of 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 signs and symptoms of lobar consolidation, 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.
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.
The most common causative organisms are (often intracellular living) bacteria:
Atypical pneumonia can also have a fungal, protozoan or viral cause. 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.
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 and is contrasted with viral pneumonia.
Chest radiographs (X-ray photographs) often show a pulmonary infection before physical signs of atypical pneumonia are observable at all. 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.
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.
Mycoplasma is found more often in younger than in older people. Older people are more often infected by Legionella.
^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 Care25 (1): 1–7. doi:10.1097/PEC.0b013e318191dab2. PMID19116501.
^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 Diseases36 (4): 269–73. doi:10.1080/00365540410020127. PMID15198183.