Last reviewed: 26 Sep 2021
Last updated: 12 May 2021

COVID-19 pandemic

During the pandemic, consider any patient with cough, fever, or any other suggestive symptoms to have COVID-19 until proven otherwise.

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issued a rapid guideline on management of suspected or confirmed CAP during the COVID-19 pandemic.1 It has temporarily withdrawn its pre-COVID-19 guideline on diagnosis and management of pneumonia in adults.2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

  1. National Institute for Health and Care Excellence. COVID-19 rapid guideline: managing COVID-19. April 2021 [internet publication].
    Full text
  2. 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 WITHDRAWN during COVID-19 pandemic.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
  • 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

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.

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