Atypical: Pneumonia or the Organism

A 33 year old female patient presented with a fever followed by a dry cough leading to hoarseness of voice, with a history of similar symptoms in her son a week earlier. Routine laboratory parameters and chest X-ray were normal. High-resolution computed tomography thorax showed small areas of consolidation involving the middle lobe of the right lung. These features of prominent systemic symptoms, relatively few findings on clinical examination, and lack of a well-defined lobar consolidation have been referred to as “atypical pneumonia” produced by certain organisms. It is now clear that this differentiation is imprecise. The current concept is certain organisms, which are normally absent in the respiratory tract, such as Mycoplasma, Chlamydia, and Legionella, and a number of viruses are associated with this atypical pneumonia syndrome. On the Sputum BIOFIRE pneumonia plus panel, Mycoplasma pneumoniae, along with Enterobacter cloacae and Klebsiella pneumoniae with low bin value (104) were detected. Of these, Mycoplasma was considered the causative organism for this syndrome. Mycoplasma are very small self-replicating bacteria and do not have a cell wall. For this reason, they do not take up gram stain and are not susceptible to beta-lactams. Treatment options for Mycoplasma include macrolides, tetracyclines, and quinolones. However, macrolide resistance is a growing issue worldwide. Hence, the patient was treated with doxycycline for 14 days. Complications such as hemolytic anemia, cardiac arrhythmias, and meningoencephalitis were watched for but, fortunately, did not develop in this patient, who had an uneventful recovery. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.