Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cough with increasing sputum production
  • fever or chills
  • dyspnoea
  • pleuritic pain
  • abnormal auscultatory findings

Other diagnostic factors

  • dullness to percussion
  • myalgia
  • arthralgia
  • confusion

Risk factors

  • age >65 years
  • residence in a healthcare setting
  • COPD
  • exposure to cigarette smoke
  • alcohol abuse
  • poor oral hygiene
  • use of acid-reducing drugs
  • contact with children
  • diabetes mellitus
  • chronic renal disease
  • chronic liver disease

Diagnostic investigations

1st investigations to order

  • CXR
  • FBC
  • serum electrolytes, urea
  • blood glucose
  • arterial blood gases/oximetry
Full details

Investigations to consider

  • blood culture
  • sputum culture
  • urinary antigen testing for Legionella and pneumococcus
  • liver function tests
  • thoracocentesis and pleural fluid culture
  • bronchoscopy
  • C-reactive protein
  • procalcitonin
  • acute and convalescent-phase serological testing
  • tests for respiratory viruses
  • molecular microbiological techniques
  • CT scan of chest
  • ultrasound of the lungs
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Post-doctoral Research

Pneumology Department

Hospital Clinic of Barcelona

CIBERES

IDIBAPS

Barcelona

Spain

Disclosures

CC is an author of a number of references cited in this topic.

Professor of Medicine

Director

Pulmonary Intensive Care Unit

Respiratory Institute

Hospital Clinic of Barcelona

Barcelona

Spain

Disclosures

AT has received honoraria or consultation fees from Arsanis, Aridis, Bayer, Roche, Polyphor, GSK, and Pfizer. AT is an author of a number of references cited in this topic.

Dr Catia Cilloniz and Professor Antoni Torres would like to gratefully acknowledge Dr M. Nawal Lutfiyya, Dr Linda Chang, and Dr Robert Bales, previous contributors to this monograph. MNL is an author of a reference cited in this monograph. LC and RB declare that they have no competing interests.

Peer reviewers VIEW ALL

Assistant Professor

Division of Pulmonary and Critical Care Medicine

University of Utah

Salt Lake City

UT

Disclosures

BJ declares that she has no competing interests.

Associate Professor

Departments of Emergency Medicine and Medicine

Icahn School of Medicine at Mount Sinai

New York

NY

Disclosures

DN declares that she has no competing interests.

Professor of Medicine

Royal Perth Hospital

Perth

Australia

Disclosures

GW declares that he has no competing interests.

Professor of Respiratory Infection/Honorary Consultant

University College London

London

UK

Disclosures

JB was a member of the NICE pneumonia guidelines committee.

Professor (clinical) of Medicine

Section Chief Pulmonary Critical Care Medicine

University of Utah

Intermountain Medical Center

Murray

UT

Disclosures

ND declares that he has no competing interests.

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