Last reviewed: 25 Jun 2021
Last updated: 22 Jun 2021

Summary

Definition

History and exam

Key diagnostic factors

  • cough with increasing sputum production
  • fever or chills
  • dyspnea
  • pleuritic pain
  • abnormal auscultatory findings

Other diagnostic factors

  • dullness to percussion
  • myalgia
  • arthralgia
  • confusion

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, inhaled corticosteroids, antipsychotics, antidiabetic drugs
  • contact with children
  • HIV infection
  • diabetes mellitus
  • chronic renal disease
  • chronic liver disease
  • use of opioids

Diagnostic investigations

1st investigations to order

  • chest x-ray
  • CBC
  • serum electrolytes/blood urea nitrogen
  • liver function tests
  • blood glucose
  • arterial blood gases/oximetry
  • blood culture
  • sputum culture

Investigations to consider

  • lung ultrasound
  • CT chest
  • urinary antigen testing for Legionella and pneumococcus
  • serum C-reactive protein
  • serum procalcitonin
  • thoracocentesis and pleural fluid culture
  • bronchoscopy
  • tests for respiratory viruses
  • molecular microbiological techniques

Treatment algorithm

Contributors

Authors

Catia Cilloniz, MSc, PhD

Post-doctoral Research

Pneumology Department

Hospital Clinic of Barcelona

CIBERES

IDIBAPS

Barcelona

Spain

Disclosures

CC is an author of a number of references cited in this topic.

Antoni Torres, MD, PhD

Professor of Medicine

Director

Pulmonary Intensive Care Unit

Respiratory Institute

Hospital Clinic of Barcelona

Barcelona

Spain

Disclosures

AT is an author of a number of references cited in this topic.

Acknowledgements

Dr Catia Cilloniz and Professor Antoni Torres would like to gratefully acknowledge Dr M. Nawal Lutfiyya, Dr Linda Chang, and Dr Robert Bales, previous contributors to this topic.

Disclosures

MNL is an author of a reference cited in this topic. LC and RB declare that they have no competing interests.

Peer reviewers

Barbara Jones, MD, MSc

Assistant Professor

Division of Pulmonary and Critical Care Medicine

University of Utah

Salt Lake City

UT

Disclosures

BJ declares that she has no competing interests.

Denise Nassisi, MD

Associate Professor

Departments of Emergency Medicine and Medicine

Icahn School of Medicine at Mount Sinai

New York

NY

Disclosures

DN declares that she has no competing interests.

Grant Waterer, MBBS, PhD, MBA, FRACP, FCCP

Professor of Medicine

Royal Perth Hospital

Perth

Australia

Disclosures

GW declares that he has no competing interests.

Jeremy Brown, MBBS, FRCP, PhD

Professor of Respiratory Infection/Honorary Consultant

University College London

London

UK

Disclosures

JB was a member of the NICE pneumonia guidelines committee.

Nathan Dean, MD

Professor (clinical) of Medicine

Section Chief Pulmonary Critical Care Medicine

University of Utah

Intermountain Medical Center

Murray

UT

Disclosures

ND declares that he has no competing interests.

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