Infectious Diseases Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
Expert Rev Anti Infect Ther. 2010 Jul;8(7):775-90. doi: 10.1586/eri.10.52.
Intracellular bacteria are common causes of community-acquired pneumonia that grow poorly or not at all on standard culture media and do not respond to beta-lactam antibiotic therapy. Apart from well-established agents of pneumonia such as Legionella pneumophila, Mycoplasma pneumoniae, Chlamydia pneumoniae, Chlamydia psittaci and Coxiella burnetii, some new emerging pathogens have recently been recognized, mainly Parachlamydia acanthamoebae and Simkania negevensis, two Chlamydia-related bacteria. Most of them are causes of benign and self-limited infections. However, they may cause severe pneumonia in some cases (i.e., Legionnaires' disease) and they may cause outbreaks representing a public health problem deserving prompt recognition and appropriate therapy. Although extrapulmonary manifestations are often present, no clinical features allow them to be distinguished from classical bacterial agents of pneumonia such as Streptococcus pneumoniae. Thus, specific molecular diagnostic tools are very helpful for early recognition of the offending bacteria, whereas serology often only allows retrospective or late diagnosis. Macrolides remain the best empirical treatment of intracellular respiratory pathogens, although some observational studies suggest that quinolones may be superior for the treatment of legionellosis.
细胞内细菌是社区获得性肺炎的常见病因，它们在标准培养基上生长不良或根本不生长，并且对β-内酰胺类抗生素治疗无反应。除了已确立的肺炎病原体，如嗜肺军团菌、肺炎支原体、肺炎衣原体、鹦鹉热衣原体和伯氏考克斯体外，最近还认识到一些新出现的病原体，主要是 Parachlamydia acanthamoebae 和 Simkania negevensis，这两种与衣原体相关的细菌。它们大多数是良性和自限性感染的原因。然而，在某些情况下，它们可能会导致严重的肺炎（即军团病），并且它们可能会导致爆发，这是一个需要及时识别和适当治疗的公共卫生问题。尽管常伴有肺外表现，但没有临床特征可将其与肺炎的经典细菌病原体（如肺炎链球菌）区分开来。因此，特定的分子诊断工具对于早期识别病原体非常有帮助，而血清学检测通常仅允许回顾性或晚期诊断。大环内酯类药物仍然是治疗细胞内呼吸道病原体的最佳经验性治疗方法，尽管一些观察性研究表明，喹诺酮类药物可能更适合治疗军团菌病。
