Atypical pathogens in community-acquired pneumonia.

The atypical pathogens are an important and significant cause of CAP. The clinical and radiologic manifestations of CAP caused by these pathogens are modulated by the immunologic and physiologic status of the host, and therefore are not pathogen-specific. The range of frequencies found in various studies for the atypical pathogens among the causes of CAP is broad. These frequencies are affected by very important factors that should be recognized. In a significant percentage of patients, an atypical pathogen can be identified together with an additional cause. The significance of multiple causes has not been clarified sufficiently. The principal diagnostic techniques in use today for the causative diagnosis of CAP are serologic tests. Different serologic methods have been used in various studies and diagnostic criteria are not standardized. In the future it is likely that diagnostic testing will be based on the PCR technique on serum samples. The effectiveness and importance of antimicrobial therapy in some patients with atypical pathogen CAP are unclear. The accepted therapy today for atypical pathogen CAP, which is based on erythromycin, will probably be changed in the near future in favor of the new generations of fluoroquinolone or the new macrolide preparations.