165.4 📌 章末速蚘

  • L. pneumophila (serogroup 1) — atypical CAP 重型
  • Source: water (cooling tower, hot tub, plumbing); aerosol
  • NO person-to-person
  • Clinical: 嚎重 CAP + GI + neuro + hyponatremia (SIADH) + AKI/hepatic/CK ↑
  • Dx: urinary antigen (serogroup 1 only) + culture (BCYE) + PCR
  • Tx: Levofloxacin or azithromycin × 7-14d (21 immunocompromise)
  • NOT β-lactam (intracellular)
  • Pontiac fever: flu-like self-limit, no abx
  • Empirical CAP 必 cover atypicals — Legionella reason
  • Cluster cases → outbreak investigation + water source