[Community-acquired pneumonia with atypical (mycoplasmic and chlamydial) infection]

To perfect prehospital diagnosis of community-acquired pneumonia (CAP) of atypical etiology (mycoplastic--Mp and chlamydial--Ch).

Routine clinical examinations, sputum seeding, enzyme immunoassay were made in 214 patients admitted to therapeutic departments of two large Barnaul hospitals.

Mp CAP was diagnosed in 21.5%, Ch CAP--in 12.1%, combination--in 7.0% patients. Sputum seeding was made in 67 patients. Of them 41.8% patients were found to have bacterial infection. Atypical infection combined with bacterial in 44.1% patients. The above combination was more frequent in patients with Ch CAP than with Mp CAP (58.8 and 29.7%, respectively). Bacterial flora was detected in 39.1% CAP patients without atypical infection. A retrospective analysis of case histories in respect of prehospital stage discovered that CAP patients with atypical infection are characterized by more frequent contact with patients with acute respiratory viral infection and workers of services sector. CAP arises primarily in autumn and winter with morbidity correlating with acute respiratory diseases morbidity.

CAP with atypical infection is characterized with prodromal period, late visit to the doctor, late hospitalization, late x-ray verification of the disease especially in Ch CAP. Mp CAP is more prevalent in young patients, Ch CAP occurs most frequently in young, presenile and senile patients. The presence of the prodromal period in CAP patients with atypical infection is the cause of mistakes in outpatient diagnosis. Instead of CAP such patients are often diagnosed to have acute respiratory viral infection (54.5%) or exacerbation of chronic bronchopulmonary disease (15.9%).