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Archive 1

Typical and atypical[edit]

The article contains the following statement:

"Infective agents were historically divided into "typical" and "atypical" based on their presumed presentations, but the evidence has not supported this distinction, thus it is no longer emphasized.[18]."

Reference 18 is listed as "Murray and Nadel (2010). Chapter 32." I do not have access to this particular source, but my understanding was that this differentiation was based on the causative pathogen. Atypical bacteria such as Legionella, Chlamydophilia and Mycoplama differ from S. pneumoniae and the various Gram-(-) pathogens not simply in "presentation", but in the mode of treatment. Atypical bacteria lack a cell wall, and thus are not susceptible to beta lactam antibiotics (whose mode of action is interference with cell wall synthesis). It is the potential involvment of these atypical bacteria that requires that a macrolide, tetracycline, or quinolone be included in empiric therapy. Is anyone aware of any reason that I should not correct this passage per the above discussion and identification of an appropriate source? Formerly 98 (talk) 14:07, 5 January 2015 (UTC)

I have access to that text and that is what it says. Can pull up the direct quote if you want. These terms are following out of favor in the clinical context. Doc James (talk · contribs · email) 14:12, 5 January 2015 (UTC)

"The division of CAP into typical and atypical syndromes has been used to predict the likely pathogens and select appropriate empirical therapy. 4 5 6 7 The clinical picture of “typical” CAP is that of disease characteristically caused by bacteria such as S. pneumoniae , H. influenzae , and K. pneumoniae . The initial presentation is frequently acute, with an intense and unique chill. Productive cough is present, and the expectoration is purulent or bloody. Pleuritic pain may be present and it is a very specific finding of S. pneumoniae . Physical examination reveals typical findings of pulmonary consolidation. There is leukocytosis with neutrophilia and the presence of band forms. Chest radiography shows lobar condensation with air bronchograms. In contrast, the syndrome of gradual onset of fever, nonproductive cough, and a relatively normal white blood cell count in a patient without a demonstrable bacterial pathogen has been called “atypical pneumonia.” Frequently, systemic complaints are more prominent than the respiratory ones. The atypical syndrome is characteristic of infections by pathogens such as M. pneumoniae ,Chlamydophila spp., C. burnetii , and viruses. Unfortunately, several studies, including one that included patients with mild CAP treated on an outpatient basis,39 have found that neither the clinical symptoms nor the radiographic manifestations are sufficiently sensitive or specific to reliably guide pathogen-directed antibiotic treatment against “typical” versus “atypical” microorganisms.39 Therefore, current guidelines do not emphasize the use of the typical versus atypical classification to determine initial empirical antibiotic treatment for CAP."

Atypical versus typical is not about the organism but the presenting symptoms. Have adjusted the wording i question and moved it. Doc James (talk · contribs · email) 14:31, 5 January 2015 (UTC)

Thanks. Agree that treatment guidelines point to empiric therapy covering all likely pathogens. Should we have a second sentence for most common pathogens in HAP? Much larger contribution from MRSA and Pseudomonas, though its complicated by the fact that most HAP is really VAP. Formerly 98 (talk) 14:59, 5 January 2015 (UTC)
Do we have data on hospital acquired but not ventilator assciated? Doc James (talk · contribs · email) 15:17, 5 January 2015 (UTC)
I'm not sure I've seen them split out explicitly, but I'll have a look. Formerly 98 (talk) 15:19, 5 January 2015 (UTC)
I think its most commonly VAP. I found one source for non-VAP HAP pathogens. Technically its secondary, but I don't know if you'll like it. It mainly emphasizes S. aureus and the frequency of polymicrobial infections.
Some good data here, not sure its a secondary ref. (talk) 15:26, 5 January 2015 (UTC)

Wrong phonetic notation[edit]

The phonetic notation at the very beginning of the article is wrong, or at least written in some system that is unknown to me (especially the position of the stress mark). Either way, it should be replaced or accompanied by the standard IPA notation, which is /njuːˈməʊ.ni.ə/ (UK) and /nuːˈmoʊ.njə/ (US). [1] Maybe someone with a confirmed account wants to do that. MrArsGravis (talk) 15:38, 19 May 2015 (UTC)

Yes check.svg Done Stickee (talk) 23:09, 19 May 2015 (UTC)

No mention of it being "caused" by cold temperatures?[edit]

It's widely believed that pneumonia is caused or exacerbated by cold, and especially wet, weather or low ambient temperatures. Whether true or not, this ought to be mentioned in the article. (And preferably written by someone with more medical expertise than me.) -ProhibitOnions (T) 06:52, 24 August 2015 (UTC)

The discussion is more around if the common cold is caused by cold weather and that is here Common_cold#Weather Doc James (talk · contribs · email) 06:59, 24 August 2015 (UTC)