COVID-19 pandemic
During the pandemic, consider any patient with cough, fever, or any other suggestive symptoms to have COVID-19 until proven otherwise.
- This topic does not cover pneumonia due to COVID-19. See our topic Coronavirus disease 2019 (COVID-19).
The National Institute for Health and Care Excellence (NICE) in the UK has issued a rapid guideline on management of suspected or confirmed CAP during the COVID-19 pandemic.1 It has temporarily withdrawn its pre-COVID-19 guideline on diagnosis and management of pneumonia in adults.2
References
- National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing COVID-19. Dec 2021 [internet publication].
Full text - National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Sep 2019 [internet publication]. WITHDRAWN during COVID-19 pandemic.
Full text
Summary
Definition
History and exam
Key diagnostic factors
- cough with increasing sputum production
- dyspnoea
- pleuritic chest pain
- rigors or night sweats
- fever
- abnormal auscultatory findings
- confusion
- presence of risk factors
Other diagnostic factors
- myalgia
- malaise
- anorexia
- lethargy
- worsening of pre-existing conditions
- sore throat
- headache
- nausea
- abdominal pain
- diarrhoea
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
- use of opioids
Diagnostic investigations
1st investigations to order
- chest x-ray
- pulse oximetry
- arterial blood gas (ABG)
- urea and electrolytes
- full blood count
- C-reactive protein (CRP)
- liver function tests
Investigations to consider
- blood culture
- sputum culture (± Gram stain)
- urinary antigen testing for legionella and pneumococcus
- polymerase chain reaction (PCR) and/or serological tests
- CT scan of chest
- chest ultrasound
- thoracocentesis and pleural fluid culture
- computer tomographic pulmonary angiography (CTPA)
- bronchoscopy
Treatment algorithm
suspected CAP: presenting in hospital with life-threatening illness
suspected CAP: presenting in hospital without life-threatening illness
suspected CAP: presenting in the community
confirmed CAP on chest x-ray: presenting in hospital
confirmed CAP on chest x-ray: presenting in the community
Contributors
Expert advisers
Jonathan Bennett, MD
Honorary Professor of Respiratory Sciences
University of Leicester
Respiratory Consultant
Glenfield Hospital
Leicester
UK
Biography
JB is Chair of the British Thoracic Society.
Disclosures
JB declares that he has no competing interests.
Acknowledgements,
BMJ Best Practice would like to gratefully acknowledge the previous team of expert contributors, whose work has been retained in parts of the content:
Catia Cilloniz MSc, PhD
Post-doctoral Research
Pneumology Department
Hospital Clinic of Barcelona
CIBERES
IDIBAPS
Barcelona
Spain
Antoni Torres MD, PhD
Professor of Medicine
Director
Pulmonary Intensive Care Unit
Respiratory Institute
Hospital Clinic of Barcelona
Barcelona
Spain
Disclosures
CC and AT are each authors of a number of references cited in this topic.
Peer reviewers
Wei Shen Lim,
Consultant Respiratory Physician and Honorary Professor of Medicine
Nottingham University Hospitals NHS Trust
Nottingham
UK
Disclosures
WSL was chairman of the British Thoracic Society community-acquired pneumonia guidelines committee and a member of the guideline development group for the National Institute for Health and Care Excellence pneumonia guidelines. His institution has received unrestricted investigator-initiated research funding from Pfizer for a multicentre study of pneumococcal pneumonia in which he was the chief investigator, and research funding from the National Institute for Health Research for studies in pneumonia in which he was the principal investigator. He is also an author of at least one reference cited in the topic.
Editors
Helena Delgado-Cohen,
Section Editor, BMJ Best Practice
Disclosures
HDC declares that she has no competing interests.
Rachel Wheeler,
Lead Section Editor, BMJ Best Practice
Disclosures
RW declares that she has no competing interests.
Julie Costello,
Comorbidities Editor, BMJ Best Practice
Disclosures
JC declares that she has no competing interests.
Adam Mitchell,
Drug Editor, BMJ Best Practice
Disclosures
AM declares that he has no competing interests.
Differentials
- Coronavirus disease 2019 (COVID-19)
- Acute bronchitis
- Congestive heart failure
More DifferentialsGuidelines
- Pneumonia in adults: diagnosis and management (withdrawn during COVID-19 pandemic)
- Pneumonia (community-acquired): antimicrobial prescribing
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