191.4 📌 章末速蚘

  • C. pneumoniae + C. psittaci — both obligate intracellular, no cell wall, β-lactam useless
  • C. pneumoniae: ubiquitous, p2p, atypical CAP 5-10% adults; atherosclerosis 關聯 negative trials
  • C. psittaci: bird-borne aerosol, severe pneumonia + severe headache + Faget sign + hepatosplenomegaly (mimics typhoid)
  • Treatment: doxycycline 100 bid × 14d (both); 14-21d for C. psittaci
  • Azithromycin / FQ alternatives
  • β-lactam NOT effective
  • Empirical CAP: cover atypicals with macrolide / doxy / FQ
  • Bird exposure history KEY for psittacosis — ask explicitly
  • 通報 (Taiwan): C. psittaci occupational
  • Atypical CAP family: M. pneumoniae, Legionella, C. pneumoniae, C. psittaci, Coxiella