Intensive Care Medicine

, Volume 42, Issue 9, pp 1374–1386 | Cite as

Community-acquired pneumonia related to intracellular pathogens

  • Catia Cillóniz
  • Antoni Torres
  • Michael Niederman
  • Menno van der Eerden
  • James Chalmers
  • Tobias Welte
  • Francesco Blasi


Community-acquired pneumonia (CAP) is associated with high rates of morbidity and mortality worldwide; the annual incidence of CAP among adults in Europe has ranged from 1.5 to 1.7 per 1000 population. Intracellular bacteria are common causes of CAP. However, there is considerable variation in the reported incidence between countries and change over time. The intracellular pathogens that are well established as causes of pneumonia are Legionella pneumophila, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Chlamydophila psittaci, and Coxiella burnetii. Since it is known that antibiotic treatment for severe CAP is empiric and includes coverage of typical and atypical pathogens, microbiological diagnosis bears an important relationship to prognosis of pneumonia. Factors such as adequacy of initial antibiotic or early de-escalation of therapy are important variables associated with outcomes, especially in severe cases. Intracellular pathogens sometimes appear to cause more severe disease with respiratory failure and multisystem dysfunction associated with fatal outcomes. The clinical relevance of intracellular pathogens in severe CAP has not been specifically investigated. We review the prevalence, general characteristics, and outcomes of severe CAP cases caused by intracellular pathogens.


Community-acquired pneumonia Pneumonia Intracellular pathogens Etiology 


Compliance with ethical standards

Conflicts of interest

The authors have no potential conflict of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2016

Authors and Affiliations

  • Catia Cillóniz
    • 1
  • Antoni Torres
    • 1
  • Michael Niederman
    • 2
  • Menno van der Eerden
    • 3
  • James Chalmers
    • 4
    • 5
  • Tobias Welte
    • 6
  • Francesco Blasi
    • 7
  1. 1.Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)University of Barcelona (UB)—SGR 911—Ciber de Enfermedades Respiratorias (Ciberes)BarcelonaSpain
  2. 2.Division of Pulmonary and Critical Care MedicineWeill Cornell MedicineNew YorkUSA
  3. 3.Department of Pulmonary diseasesErasmus Medical CentreRotterdamThe Netherlands
  4. 4.Scottish Centre for Respiratory ResearchUniversity of DundeeDundeeUK
  5. 5.Ninewells Hospital and Medical SchoolDundeeUK
  6. 6.Department of Pulmonary MedicineHannover Medical School and Member of the German Center of Lung Research (DZL)HannoverGermany
  7. 7.Department of Pathophysiology and TransplantationUniversità degli Studi di Milano, IRCCS Fondazione Ospedale Maggiore Policlinico Cà GrandaMilanItaly

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