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Afebrile Pneumonia Syndrome

Background

Afebrile pneumonia syndrome (APS) is a relatively uncommon disease of neonates and infants younger than 6 months. A correlation has been noted between low birthweight, prematurity, and low socioeconomic status and the incidence of APS.

APS was first described as a vertically transmitted infection of newborns and young infants by the female genital tract pathogens Chlamydia trachomatis, cytomegalovirus (CMV), and Ureaplasma urealyticum. Other potential causes of the syndrome have since been recognized, including respiratory syncytial virus (RSV), parainfluenza virus, adenovirus, human metapneumovirus,
human bocavirus,
Pneumocystis jiroveci,
and, perhaps, Simkania negevensis.

For more information on specific pathogens, see Chlamydial Infections, Cytomegalovirus Infection, Parainfluenza Virus Infections, Pneumocystis Carinii Pneumonia, and Respiratory Syncytial Virus Infection.

APS is typified by chlamydial pneumonitis,
with acute or subacute onset of a chronic, afebrile or minimally febrile, diffuse pulmonary process associated with mild peripheral eosinophilia and elevated serum immunoglobulin levels. Symptoms are usually nonspecific and include cough, tachypnea, irritability, poor feeding, and low-grade fever or lack of fever, making differentiating among the above etiologies of APS and among APS and other pulmonary processes difficult. (See Clinical Presentation.)

Acutely, APS is generally a benign and self-limiting disease. In such cases, infants often have viral illness, which does not respond to antibiotic therapy, but differentiating bacterial from viral illness is often difficult. Consider empiric antibiotic therapy if the potential benefits of early intervention outweigh the risks of unnecessary treatment. (See Medication, as well as Treatment and Management.)

Knowledge of the likely pathogens can help determine the tests needed to confirm diagnosis. (See Workup.)

Long-term prognosis for significant morbidity is high. Affected individuals have a high rate of obstructive airway disease later in life. (See Prognosis.)

Go to Pneumonia, Pediatric for more complete information on this topic.

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