Last reviewed: June 2019
Last updated: May  2018



History and exam

Key diagnostic factors

  • presence of risk factors
  • age <50 years
  • persistent cough
  • dry cough
  • long duration of symptoms

Other diagnostic factors

  • recent community exposure
  • throat involvement
  • fever
  • headache
  • diarrhoea
  • bullous myringitis
  • lung rales/crepitations
  • rash

Risk factors

  • close community settings
  • immunosuppression
  • cigarette smoking
  • chronic lung disease
  • travel
  • male sex
  • immunomodulating drugs

Diagnostic investigations

1st investigations to order

  • CXR
  • WBC count
  • haemoglobin
  • LFTs
  • oxygen saturation in air
  • urea
Full details

Investigations to consider

  • urinary Legionella antigen
  • sputum culture for Legionella
  • molecular diagnosis of M pneumoniae or C pneumoniae
  • serology for atypical pathogens
  • nasopharyngeal viral cultures
Full details

Treatment algorithm


Authors VIEW ALL

Ran Nir-Paz

Associate Professor in Medicine

Department of Clinical Microbiology and Infectious Diseases

Hadassah Hebrew University Medical Center




RNP is chairman of the International Research Program on Comparative Mycoplasmology group Clinical Aspects of Human Mycoplasmas, and chairman of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma Infections (ESGMI).

Peer reviewers VIEW ALL

Honorary Senior Lecturer (University of Manchester)

Consultant in General & Respiratory Medicine

Department of Respiratory Medicine

Manchester Royal Infirmary




MW is an author of a reference cited in this monograph.

H.E. Sellers Research Chair in Infectious Diseases


Section of Adult Infectious Diseases

Department of Internal Medicine

Department of Medical Microbiology

University of Manitoba




At the time of the peer review, Professor Rubinstein declared no competing interests. We were made aware that Professor Rubinstein is now deceased.

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