非典型肺炎

胸腔/肺炎旁积液是因相邻的肺部感染或病原体侵犯胸膜腔导致的液体和炎症细胞在胸膜腔中积聚。[69]Light RW. Parapneumonic effusions and empyema. Proc Am Thorac Soc. 2006;3:75-80.http://www.ncbi.nlm.nih.gov/pubmed/16493154?tool=bestpractice.com高达30%的嗜肺性军团菌肺炎患者和少数肺炎支原体肺炎患者可出现胸腔积液。[6]Klement E, Talkington DF, Wasserzug O, et al. Identification of risk factors for infection in an outbreak of Mycoplasma pneumoniae respiratory tract disease. Clin Infect Dis. 2006;43:1239-1245.http://www.ncbi.nlm.nih.gov/pubmed/17051486?tool=bestpractice.com[70]Shuvy M, Rav-Acha M, Izhar U, et al. Massive empyema caused by Mycoplasma pneumoniae in an adult: a case report. BMC Infect Dis. 2006;6:18.http://www.ncbi.nlm.nih.gov/pubmed/16451727?tool=bestpractice.com

合适的抗生素治疗是必须的。胸腔积液积聚或不能吸收可能是胸腔穿刺引流的指征。严重、不能消退的病例可能需要胸膜剥脱术。

胸腔积液

高达25%的肺炎支原体感染患者可出现皮疹，主要是自限性的斑丘疹或水泡疹。[4]Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev. 2004;17:697-728.http://www.ncbi.nlm.nih.gov/pubmed/15489344?tool=bestpractice.com严重的病例可能包括 Stevens-Johnson 综合征和溃疡性口腔炎。

由于皮疹的主要原因可能是病原体全身播散至皮肤，因此应选择合适的抗生素治疗。

高达 7% 的肺炎支原体感染的住院患者会出现神经系统并发症。感染发生长达2周后，可能发生多种神经系统并发症，包括脑炎、脑膜炎、小脑综合征、颅神经麻痹和Guillain-Barre 综合征。[4]Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev. 2004;17:697-728.http://www.ncbi.nlm.nih.gov/pubmed/15489344?tool=bestpractice.com

因为这些并发症具有自身免疫特征，应依据特异性神经系统综合征，针对个体患者调整治疗方法。

心包炎是液体在心包腔中蓄积，主要发生于肺炎支原体和嗜肺军团菌感染。[4]Waites KB, Talkington DF. Mycoplasma pneumoniae and its role as a human pathogen. Clin Microbiol Rev. 2004;17:697-728.http://www.ncbi.nlm.nih.gov/pubmed/15489344?tool=bestpractice.com[71]Scerpella EG, Whimbey EE, Champlin RE, et al. Pericarditis associated with Legionnaires' disease in a bone marrow transplant recipient. Clin Infect Dis. 1994;19:1168-1170.http://www.ncbi.nlm.nih.gov/pubmed/7888562?tool=bestpractice.com如果使用抗生素治疗不能缓解病情，那么患者可能需要进行心包穿刺术和引流。

心包炎

十多年来，研究提示非典型病原体（主要是肺炎衣原体）可能在动脉粥样硬化的进展中起到的作用。但仍需进一步研究。[72]Ieven MM, Hoymans VY. Involvement of Chlamydia pneumoniae in atherosclerosis: more evidence for lack of evidence. J Clin Microbiol. 2005;43:19-24.http://jcm.asm.org/cgi/content/full/43/1/19?view=long&pmid=15634945http://www.ncbi.nlm.nih.gov/pubmed/15634945?tool=bestpractice.com[73]Grayston JT. Chlamydia pneumoniae and atherosclerosis. Clin Infect Dis. 2005;40:1131-1132.http://www.ncbi.nlm.nih.gov/pubmed/15791512?tool=bestpractice.com[74]Arcari CM, Gaydos CA, Nieto FJ, et al. Association between Chlamydia pneumoniae and acute myocardial infarction in young men in the United States military: the importance of timing of exposure measurement. Clin Infect Dis. 2005;40:1123-1130.http://www.ncbi.nlm.nih.gov/pubmed/15791511?tool=bestpractice.com