Pneumonia

A- Legionella pneumonia:

* Around 5% of community bacterial pneumonia

* Outbreaks exist; the germ grows in contact with water, tanks (air conditioners, earthworks)

* It is often sporadic forms

* The beginning is rapidly progressive with high fever, chills; dry cough

* Clinical examination often found suggestive extra-respiratory signs: digestive disorders; neurological (confusion, agitation, headache); kidney (oliguria); myalgia.

* Rx: fuzzy opacities alveolar, confluent, rounded, poorly limited, sometimes bilateral; not systematized

* Biology: lymphopenia; hyponatremia; discrete elevated liver enzymes; hematuria; proteinuria; rhabdomyolysis with elevated muscle enzymes (CPK, aldolase).

* Direct immunofluorescence: specified> 90% but poor sensitivity (50%): Direct sputum … (unattractive)

* The sensitive enough urinary Ag (70%) and specific permit rapid diagnostic certainty

* Serology provides certainty of retrospective diagnosis

* The macrolides (erythromycin) are the treatment of choice (duration: 3 weeks). Other (in association with erythromycin) = rifampicin, fluoroquinolones.

B- A MYCOPLASMA PNEUMONIA:

* About 10 to 20% of community bacterial pneumonia

* Key willingly healthy young subjects without pathological past; often by family or community outbreaks

* The onset is gradual. The fever is low (38 ° C); nasopharyngitis;persistent dry cough; asthenia; headache; myalgia.

* Bilateral interstitial Images often; sometimes poorly systematized alveolar pictures.

* The NFS is often normal (sometimes leukocytosis PNN moderate); VS is very high. Hemolytic anemia can

* The presence of cold hemagglutinin is highly suggestive of Mycoplasma, but not specific; present in over 50% of cases. It is anti-erythrocyte IgM.

* The direct Coombs test is positive

* The diagnosis is based on serology

* The evolution is favorable in 1 to 2 weeks; radiological healing is delayed; residual bronchial hyperresponsiveness is possible

C- PNEUMONIA CHLAMYDIAL:

* The onset is gradual with high fever> 39 ° C; cough

* Extra-respiratory signs: skin rash, myalgia, splenomegaly

* Chlamydia psitacci => ornithosis psittacosis

* Signs

* Rarely ADP evocative bilateral mediastinal

* The diagnosis is based on serology

D- excavated PNEUMONIA:

* Three groups of germs predominated: anaerobic; Klebsiella; Staphylococcus aureus

* Elements in anaerobic favors: fetid breath; marked impairment of the general condition

* Inhalation pneumonitis (anaerobic): poor dental condition; alcoholism; neurological events with wrong; swallowing disorders by obstacle.

* Sloping Territories (anaerobic): Nelson, post segment of an upper lobe

* Treatment (anaerobic): Peni G; clindamycin if you are allergic

* The Klebsiella pneumonia always gives a manager a harsh picture; purulent expectoration abundant.