Atypical pneumonia is a lung infection caused by a group of 3 bacteria. Children with atypical pneumonia often have milder symptoms than typical pneumonia, even parents find it difficult to recognize that the child is suffering from the disease.
1. Atypical pneumonia overview
The term atypical pneumonia first appeared in 1938 and tends to be increasing. Atypical pneumonia rates account for about 15-25% of the total cases of pneumonia in general.
This is a bacterial infection that any age can get. However, the most common subjects are children from 2 to 10 years old or adults under 40 years old, of which pre-school age accounts for 75-80%.
People who live and work in crowded concentrations such as schools, homeless or prison accommodation, are more likely to get sick. The course of infection occurs when a person comes into contact with a patient's saliva or nasal water during coughing or sneezing.
It is important when treating atypical pneumonia in children to use enough doses of antibiotics for one course. If antibiotics are discontinued too early, the risk of recurrence of infection is very high. Without timely treatment, atypical pneumonia also risks leading to dangerous complications.
2. Causes of atypical pneumonia
There are 3 types of bacteria that cause atypical pneumonia:
- Mycoplasma pneumoniae: Accounts for 55-70% of cases, mainly affecting people under the age of 40;
- Chlamydia pneumoniae: Accounts for 10-15% of cases, the most common in school-age children and usually manifests only mild symptoms ;
- Legionella pneumoniae: Accounts for 5-7% of cases, but may be more severe than other forms.
The most common form of atypical pneumonia is caused by the bacterium Mycoplasma. The percentage of healer carrying atypical bacteria in the community accounts for about 30-35%.
3. Clinical symptoms of atypical pneumonia
The majority of atypical cases of pneumonia begin with symptoms of respiratory inflammation, sometimes a sudden onset of rapid onset. In addition, children with atypical pneumonia also have the following suggested clinical characteristics:
- High fevers of > 39 – 40°C are common and continuous. For babies, young children or the elderly can also have fever-free pneumonia, even hypothermia;
- Coughing multiple times or initial dry cough, later with phlegm;
- Hoarseness due to coughing a lot;
- Older children may have chest pain;
- Symptoms of muscle function (children feel) are often rampant;
- Physical symptoms (clinical manifestations) are often poor, less clearly manifested;
- Breathing faster than age;
- Older children may not have lungs (rale), young children are humid and bronchial but appear quite late;
- There is usually a combination of extrapulmonary lesions such as pleura, liver, spleen or myocardium …
4. Diagnosis of atypical pneumonia
For a definitive diagnosis, in addition to considering the age of the pediatric patient, epidemiological factors and clinical manifestations, the doctor will also rely on subclinical values that suggest atypical pneumonia as follows:
4.1. Hematological tests
Blood glucose index in blood formula tests in children with atypical pneumonia shows:
- Normal or slightly increased white blood cells;
- The rate of neupino-polycythemia may not increase;
- C-re reacting proteins (CRPs) are often high.
- Little transformation;
- There are cases of severe breathing failure;
- Blood gas measurement: pH can be reduced, arterial co2 pressure (PaCO2), PaO2 and oxygen saturation (SaO2) are all reduced.
Microbial testing helps to analyze images of microorganisms, which have diagnostic value to determine the causes of pathogenic bacteria. For atypical pneumonia in children,the doctor can find evidence of atypical bacterial DNA genes from respiratory secretion products by:
- Direct bacterial culture method;
- PCR molecular biology test: Mycoplasma pneumoniae / Chlamydia pneumoniae / Legionella pneumoniae mesentery, ins tram or pleural (+);
- Real-time PCR synthesis reaction.
4.4. Lung X-ray
Lung images on X-rays show:
- Mainly lesions in the skin of the skin, spread, mesh shape, uneven blurring, scattered all 2 types of interstitial pneumonia;
- Sometimes there is concentrated pneumonia, dark cloud lesions, necrotic focus;
- In some cases there is a 1- or 2-party pleural effusion but not much volume.
Doctors need to make clinical examinations and perform subclinical tests to diagnose pneumonia. In which symptoms such as fever, cough, rapid breathing, chest concave withdrawal are the most important for clinical diagnosis and determination of the degree of severeness of the disease. Subclinical tests prescribed by doctors after parents take children with suspected pneumonia to visit
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5. Treatment of atypical pneumonia
5.1. Anti-respiratory failure
In case of atypical pneumonia in children with respiratory failure, it is necessary to:
- Use oxygen therapy;
- Closely monitor breathing, SaO2, blood gases and airway ventilation;
- Infusion to provide enough water and electrolys for pediatric patients.
5.2. Supportive treatment
Supportive treatment principles include reducing fever, while providing adequate nutrition and calories according to the needs of the child.
5.3. Antibiotic therapy
For atypical pneumonia, the first option is macrolid group antibiotic Azithromycin at a dosage of 10 mg / kg on the first day, followed by 5 mg / kg / day, once a day within 2-7 days.
Oral alternatives for 10-14 days include:
- Clarithromycin: 15 mg / kg / day divided 2 times;
- Erythromycin: 40 – 50 mg / kg / day divided 4 times;
- Doxycycline: 2 – 4 mg / kg / day divided 2 times between > 7 years old.
If the child is allergic to Macrolid, then replaced with the next group of antibiotics, which is also highly effective with the atypical pneumonia-causing bacteria Quinolone. Specifically:
- Levofloxacin: 20 mg / kg / day or 500 mg once daily for children > 15 years old;
- Or moxifloxacin: 400 mg once daily for children over 15 years old.
Oral use with non-severe pneumonia (without respiratory failure). If the child has atypical pneumonia accompanied by breathing failure, the antibiotic Azithromycin or Lactobionate erythromycin / levofloxacin should be given intravenously.
The duration of treatment with antibiotic therapy usually lasts from 5-14 days. For children with immunosmmunity, severe illness and L.pneumophila pneumonia, treatment will last about 14-21 days.
6. Follow-up treatment and handling
During the healing process there is a possibility of co-infection, drug resistance or extrapulmonary complications that cause the treatment to fail with the signs of:
- Fever lasts more than 48 hours;
- Increased respiratory failure;
- Increased peridoted lesions on 2 pulmonary lobes;
- Extrapulmonary manifestations.
At that time, the doctor can conduct a number of tests over time and depending on the course of the disease as well as extrapulmonary manifestations, such as blood cultures, insyment, chest CT, pleural ultrasound, electrolysis,…
If resistance occurs, consider replacing Macrolid antibiotics with Quinolon, or taking antibiotics according to antibiotics in case of co-infection. For pediatric patients with severe M.pneumoniae may consider corticoids.
However, in general, cases of atypical pneumonia can be fully recovered during a full course of antibiotic therapy. There is currently no specific vaccine to prevent atypical pneumonia in children caused by group 3 bacteria. Parents can prevent children from pneumonia primarily by taking adequate nutritional care, vaccinating on schedule, and limiting the impact of contaminated environments.
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