Last reviewed: November 2017
Last updated: June  2016

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • cough with purulent sputum
  • fever

Other diagnostic factors

  • male sex
  • headache
  • nausea and vomiting
  • confusion
  • depressed consciousness
  • cutaneous ulcers or abscesses

Risk factors

  • solid organ and haematopoietic stem cell transplant recipients
  • HIV-positive and low CD4 T-cell count (<100 cells/mm^3)
  • immunosuppression
  • structural pulmonary disease
  • malignancy and chemotherapy
  • male sex
  • agricultural work

Diagnostic investigations

1st investigations to order

  • Gram and acid-fast stains
  • culture
  • CXR
Full details

Investigations to consider

  • biochemical species typing
  • thoracic CT scan
  • CT head
  • MRI head
Full details

Emerging tests

  • 16S rRNA sequencing
  • identification and typing according to gyrB and rpoB genes
  • matrix-assisted laser desorption ionisation-time-of-flight mass spectrometry (MALDI-TOF MS)
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Division of Infectious Disease

Geneva University Hospital

Geneva

Switzerland

Disclosures

JG declares that he has no competing interests.

Division of Infectious Diseases

Hospital Clinic-IDIBAPS

Barcelona

Spain

Disclosures

JA declares that he has no competing interests.

Peer reviewers VIEW ALL

Infectious Disease Specialist

Alabama Infectious Diseases Center

Huntsville

AL

Disclosures

AH declares that he has no competing interests.

Associate Professor of Medicine

Division of Pulmonary and Critical Care

Harborview Medical Center

University of Washington

Seattle

WA

Disclosures

MN declares that he has no competing interests.

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