History and exam
Key diagnostic factors
Symptoms of a lower respiratory tract infection such as cough are frequently seen in people with CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
[64]National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Sep 2019 [internet publication]. WITHDRAWN during COVID-19 pandemic.
https://www.nice.org.uk/guidance/cg191
Cough is one of the most common symptoms present in patients with CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Cough is usually productive with mucopurulent sputum.
The presence of mucopurulent sputum is associated with bacterial pneumonia.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Scant or watery sputum is associated with an atypical pathogen.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Older patients may not present with cough and are more likely to have non-specific symptoms (e.g., confusion) and may be afebrile.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Dyspnoea is frequently seen in people with CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
[64]National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Sep 2019 [internet publication]. WITHDRAWN during COVID-19 pandemic.
https://www.nice.org.uk/guidance/cg191
Dyspnoea is one of the most useful predictive symptoms of CAP in the community (together with fever, tachypnoea, pleuritic chest pain, and new/focalising signs on physical examination of chest) when compared with the gold standard of radiological diagnosis of CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Pleuritic chest pain is frequently reported in people with CAP,[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
[64]National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Sep 2019 [internet publication]. WITHDRAWN during COVID-19 pandemic.
https://www.nice.org.uk/guidance/cg191
occuring in 30% of patients.[99]Marrie TJ. Community-acquired pneumonia. Clin Infect Dis. 1994 Apr;18(4):501-13.
http://www.ncbi.nlm.nih.gov/pubmed/8038304?tool=bestpractice.com
Pleuritic chest pain is one of the most useful predictive symptoms of CAP in the community (together with fever, dyspnoea/tachypnoea, and new/focalising signs on physical examination of chest) when compared with the gold standard of radiological diagnosis of CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Rigors or night sweats are usually present in people with CAP, but are less common in older patients.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
[64]National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Sep 2019 [internet publication]. WITHDRAWN during COVID-19 pandemic.
https://www.nice.org.uk/guidance/cg191
Fever is commonly seen in people with CAP, although older people may be afebrile.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
[64]National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Sep 2019 [internet publication]. WITHDRAWN during COVID-19 pandemic.
https://www.nice.org.uk/guidance/cg191
A fever (>38ºC [>100ºF]) is one of the most useful predictive symptoms of CAP in the community (together with dyspnoea/tachypnoea, pleuritic chest pain, and new/focalising signs on physical examination of chest) when compared with the gold standard of radiological diagnosis of CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Older people may be afebrile.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
New focal chest signs are frequently present on examination in people with CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
[64]National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Sep 2019 [internet publication]. WITHDRAWN during COVID-19 pandemic.
https://www.nice.org.uk/guidance/cg191
You may hear crackles, decreased breath sounds, dullness to percussion, and wheeze.
Tachypnoea is one of the most useful predictive symptoms of CAP in the community (together with fever, dyspnoea, pleuritic chest pain, and new/focalising signs on physical examination of chest) when compared with the gold standard of radiological diagnosis of CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Confusion is frequently seen in older people presenting with CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
[64]National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Sep 2019 [internet publication]. WITHDRAWN during COVID-19 pandemic.
https://www.nice.org.uk/guidance/cg191
Older people with CAP often present with non-specific symptoms such as confusion or worsening of underlying diseases, and may be afebrile.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
[64]National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Sep 2019 [internet publication]. WITHDRAWN during COVID-19 pandemic.
https://www.nice.org.uk/guidance/cg191
[65]Hoare Z, Lim WS. Pneumonia: update on diagnosis and management. BMJ. 2006 May 6;332(7549):1077-9.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1458569/
http://www.ncbi.nlm.nih.gov/pubmed/16675815?tool=bestpractice.com
Atypical presentations (without obvious chest signs) of CAP may include confusion, such as in the case of legionella pneumonia, which may present as constitutional upset, diarrhoea, and confusion.[73]Stein PD, Afzal A, Henry JW, et al. Fever in acute pulmonary embolism. Chest. 2000 Jan;117(1):39-42.
http://www.ncbi.nlm.nih.gov/pubmed/10631196?tool=bestpractice.com
Your history should cover the following risk factors to help assess the likelihood of CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
[64]National Institute for Health and Care Excellence. Pneumonia in adults: diagnosis and management. Sep 2019 [internet publication]. WITHDRAWN during COVID-19 pandemic.
https://www.nice.org.uk/guidance/cg191
(*denotes a strong risk factor for CAP)
Age ≥65 years*
Incidence of CAP increases significantly with age. Advanced age is associated with a higher mortality from CAP.[10]Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax. 2012 Jan;67(1):71-9.
http://www.ncbi.nlm.nih.gov/pubmed/20729232?tool=bestpractice.com
Residence in a nursing home*
Mortality rates due to pneumonia in nursing home residents have been reported to reach 55%.[78]Mehr DR, Zweig SC, Kruse RL, et al. Mortality from lower respiratory infection in nursing home residents: a pilot prospective community-based study. J Fam Pract. 1998 Oct;47(4):298-304.
http://www.ncbi.nlm.nih.gov/pubmed/9789516?tool=bestpractice.com
[79]Norman DC. Pneumonia in the elderly: empiric antimicrobial therapy. Geriatrics. 1991 Dec;46(12):26-32.
http://www.ncbi.nlm.nih.gov/pubmed/1743528?tool=bestpractice.com
Nursing home residents also have an increased risk of aspiration pneumonia.[80]Vergis EN, Brennen C, Wagener M, et al. Pneumonia in long-term care: a prospective case-control study of risk factors and impact on survival. Arch Intern Med. 2001 Oct 22;161(19):2378-81.
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/649245
http://www.ncbi.nlm.nih.gov/pubmed/11606155?tool=bestpractice.com
Contact with children*
Regular contact with children is associated with an increased risk of CAP.[50]Almirall J, Bolíbar I, Serra-Prat M, et al. New evidence of risk factors for community-acquired pneumonia: a population-based study. Eur Respir J. 2008 Jun;31(6):1274-84.
http://erj.ersjournals.com/content/31/6/1274.long
http://www.ncbi.nlm.nih.gov/pubmed/18216057?tool=bestpractice.com
Respiratory chronic diseases
COPD*, asthma, and bronchitis are associated with a 2-fold to 4-fold increased risk of CAP.[6]Torres A, Peetermans WE, Viegi G, et al. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax. 2013 Nov;68(11):1057-65.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812874/
http://www.ncbi.nlm.nih.gov/pubmed/24130229?tool=bestpractice.com
COPD is an independent risk factor for mortality in patients with CAP.[39]Molinos L, Clemente MG, Miranda B, et al. Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease. J Infect. 2009 Jun;58(6):417-24.
http://www.ncbi.nlm.nih.gov/pubmed/19329187?tool=bestpractice.com
Other chronic comorbidities
Chronic heart disease.[6]Torres A, Peetermans WE, Viegi G, et al. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax. 2013 Nov;68(11):1057-65.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812874/
http://www.ncbi.nlm.nih.gov/pubmed/24130229?tool=bestpractice.com
[39]Molinos L, Clemente MG, Miranda B, et al. Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease. J Infect. 2009 Jun;58(6):417-24.
http://www.ncbi.nlm.nih.gov/pubmed/19329187?tool=bestpractice.com
Diabetes[6]Torres A, Peetermans WE, Viegi G, et al. Risk factors for community-acquired pneumonia in adults in Europe: a literature review. Thorax. 2013 Nov;68(11):1057-65.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3812874/
http://www.ncbi.nlm.nih.gov/pubmed/24130229?tool=bestpractice.com
[39]Molinos L, Clemente MG, Miranda B, et al. Community-acquired pneumonia in patients with and without chronic obstructive pulmonary disease. J Infect. 2009 Jun;58(6):417-24.
http://www.ncbi.nlm.nih.gov/pubmed/19329187?tool=bestpractice.com
– the risk of severe pneumococcal bacteraemia is higher in people with diabetes.[55]Kang CI, Song JH, Kim SH, et al. Risk factors and pathogenic significance of bacteremic pneumonia in adult patients with community-acquired pneumococcal pneumonia. J Infect. 2013 Jan;66(1):34-40.
http://www.ncbi.nlm.nih.gov/pubmed/22922634?tool=bestpractice.com
Alcohol use/misuse*
People who consume alcohol at all or in higher amounts have an 83% higher risk of CAP compared with people who consume no alcohol or lower amounts (relative risk of 1.83).[44]Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of pneumonia: a systematic review and meta-analysis. BMJ Open. 2018 Aug 22;8(8):e022344.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112384/
http://www.ncbi.nlm.nih.gov/pubmed/30135186?tool=bestpractice.com
For every 10-20 g higher alcohol intake per day, there is an 8% increase in the risk of CAP.[44]Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of pneumonia: a systematic review and meta-analysis. BMJ Open. 2018 Aug 22;8(8):e022344.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6112384/
http://www.ncbi.nlm.nih.gov/pubmed/30135186?tool=bestpractice.com
Smoking*
Smoking is an independent risk factor for developing CAP.[81]Baskaran V, Murray RL, Hunter A, et al. Effect of tobacco smoking on the risk of developing community acquired pneumonia: a systematic review and meta-analysis. PLoS One. 2019 Jul 18;14(7):e0220204.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6638981/
http://www.ncbi.nlm.nih.gov/pubmed/31318967?tool=bestpractice.com
Passive smoking at home is also a risk factor for CAP in people aged 65 years or older.[43]Almirall J, Serra-Prat M, Bolíbar I, et al. Passive smoking at home is a risk factor for community-acquired pneumonia in older adults: a population-based case-control study. BMJ Open. 2014 Jun 13;4(6):e005133.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067857/
http://www.ncbi.nlm.nih.gov/pubmed/24928592?tool=bestpractice.com
[81]Baskaran V, Murray RL, Hunter A, et al. Effect of tobacco smoking on the risk of developing community acquired pneumonia: a systematic review and meta-analysis. PLoS One. 2019 Jul 18;14(7):e0220204.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6638981/
http://www.ncbi.nlm.nih.gov/pubmed/31318967?tool=bestpractice.com
Poor oral hygiene
Poor oral hygiene (particularly dental dysaesthesia and wearing dental prosthesis) may contribute to a higher risk of CAP in adults.[82]Rodriguez F, Bolíbar I, Serra-Prat M, et al. Poor oral health as risk factor for community-acquired pneumonia. J Pulm Respir Med. 2014 Sep 26;4(5):1000203.
https://www.omicsonline.org/open-access/poor-oral-health-as-risk-factor-for-communityacquired-pneumonia-2161-105X.1000203.pdf
Proton pump inhibitors
Associated with the occurrence of CAP.[47]Abramowitz J, Thakkar P, Isa A, et al. Adverse event reporting for proton pump inhibitor therapy: an overview of systematic reviews. Otolaryngol Head Neck Surg. 2016 Oct;155(4):547-54.
http://www.ncbi.nlm.nih.gov/pubmed/27188706?tool=bestpractice.com
H2 antagonists
Associated with the occurrence of CAP.[49]Eom CS, Jeon CY, Lim JW, et al. Use of acid-suppressive drugs and risk of pneumonia: a systematic review and meta-analysis. CMAJ. 2011 Feb 22;183(3):310-9.
http://www.cmaj.ca/content/183/3/310.long
http://www.ncbi.nlm.nih.gov/pubmed/21173070?tool=bestpractice.com
Prescribed opioids
In particular, immunosuppressive opioids are associated with CAP.[60]Edelman EJ, Gordon KS, Crothers K, et al. Association of prescribed opioids with increased risk of community-acquired pneumonia among patients with and without HIV. JAMA Intern Med. 2019 Mar 1;179(3):297-304.
http://www.ncbi.nlm.nih.gov/pubmed/30615036?tool=bestpractice.com
Other diagnostic factors
Non-specific symptoms such as myalgia have been reported by people with CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Older people with CAP frequently present with non-specific symptoms and worsening of pre-existing conditions.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Non-specific symptoms such as malaise have been reported by people with CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Older people with CAP frequently present with non-specific symptoms and worsening of pre-existing conditions.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Non-specific symptoms such as anorexia have been reported by people with CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Older people with CAP frequently present with non-specific symptoms and worsening of pre-existing conditions.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Non-specific symptoms such as lethargy have been reported by people with CAP.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Older people with CAP frequently present with non-specific symptoms and worsening of pre-existing conditions.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Older people frequently present with non-specific symptoms and worsening of pre-existing conditions.[1]Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64(suppl 3):iii1-55.
https://thorax.bmj.com/content/64/Suppl_3/iii1.long
http://www.ncbi.nlm.nih.gov/pubmed/19783532?tool=bestpractice.com
Atypical presentations (without obvious chest signs) of CAP may include sore throat.
Mycoplasma pneumonia in young adults may present as sore throat, headache, nausea, abdominal pain, and diarrhoea.[73]Stein PD, Afzal A, Henry JW, et al. Fever in acute pulmonary embolism. Chest. 2000 Jan;117(1):39-42.
http://www.ncbi.nlm.nih.gov/pubmed/10631196?tool=bestpractice.com
Atypical presentations (without obvious chest signs) of CAP may include headache.
Mycoplasma pneumonia in young adults may present as sore throat, headache, nausea, abdominal pain, and diarrhoea.[73]Stein PD, Afzal A, Henry JW, et al. Fever in acute pulmonary embolism. Chest. 2000 Jan;117(1):39-42.
http://www.ncbi.nlm.nih.gov/pubmed/10631196?tool=bestpractice.com
Atypical presentations (without obvious chest signs) of CAP may include nausea.
Mycoplasma pneumonia in young adults may present as sore throat, headache, nausea, abdominal pain, and diarrhoea.[73]Stein PD, Afzal A, Henry JW, et al. Fever in acute pulmonary embolism. Chest. 2000 Jan;117(1):39-42.
http://www.ncbi.nlm.nih.gov/pubmed/10631196?tool=bestpractice.com
Atypical presentations (without obvious chest signs) of CAP may include abdominal pain.
Mycoplasma pneumonia in young adults may present as sore throat, headache, nausea, abdominal pain, and diarrhoea.[73]Stein PD, Afzal A, Henry JW, et al. Fever in acute pulmonary embolism. Chest. 2000 Jan;117(1):39-42.
http://www.ncbi.nlm.nih.gov/pubmed/10631196?tool=bestpractice.com
Atypical presentations (without obvious chest signs) of CAP may include diarrhoea.
Mycoplasma pneumonia in young adults may present as sore throat, headache, nausea, abdominal pain, and diarrhoea.[73]Stein PD, Afzal A, Henry JW, et al. Fever in acute pulmonary embolism. Chest. 2000 Jan;117(1):39-42.
http://www.ncbi.nlm.nih.gov/pubmed/10631196?tool=bestpractice.com
Legionella pneumonia may present as constitutional upset, diarrhoea, and confusion.[73]Stein PD, Afzal A, Henry JW, et al. Fever in acute pulmonary embolism. Chest. 2000 Jan;117(1):39-42.
http://www.ncbi.nlm.nih.gov/pubmed/10631196?tool=bestpractice.com