Summary
Definition
History and exam
Key diagnostic factors
- age <50 years
- persistent cough
- dry cough
- long duration of symptoms
Other diagnostic factors
- recent community exposure
- throat involvement
- fever
- headache
- diarrhea
- bullous myringitis
- lung rales/crepitations
- rash
Risk factors
- close community settings
- immunosuppression
- cigarette smoking
- chronic lung disease
- travel
- male sex
- immunomodulating drugs
Diagnostic tests
1st tests to order
- oxygen saturation in air
- WBC count
- hemoglobin
- Liver function tests (LFTs)
- BUN level
- real-time reverse transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2
- chest x-ray
Tests to consider
- urinary Legionella antigen
- sputum culture
- molecular diagnosis of Mycoplasma pneumoniae or Chlamydophila pneumoniae
- nasopharyngeal PCR
Treatment algorithm
presumed atypical bacterial pneumonia: nonpregnant adult
presumed atypical bacterial pneumonia: pregnant or child
Contributors
Authors
Lorenzo Di Francesco, MD, SFHM, FACP
Professor of Medicine
Department of Medicine
Division of General Internal Medicine
Emory University School of Medicine
GA
Disclosures
LDF is a Gen Medicine/Point of Care Editorial Board Member for ClinicalKey.
Peer reviewers
Mark Woodhead, BSc, DM, FRCP
Honorary Senior Lecturer (University of Manchester)
Consultant in General & Respiratory Medicine
Department of Respiratory Medicine
Manchester Royal Infirmary
Manchester
UK
Disclosures
MW is an author of a reference cited in this topic.
Ethan Rubinstein, MD
H.E. Sellers Research Chair in Infectious Diseases
Head
Section of Adult Infectious Diseases
Department of Internal Medicine
Department of Medical Microbiology
University of Manitoba
Winnipeg
Canada
Disclosures
At the time of the peer review, Professor Rubinstein declared no competing interests. We were made aware that Professor Rubinstein is now deceased.
George L. Anesi, MD, MSCE, MBE
Assistant Professor
Medicine, Division of Pulmonary, Allergy, and Critical Care
Perelman School of Medicine
University of Pennsylvania
PA
Disclosures
GLA receives research funding from the National Institutes of Health (K23HL161353), the CDC Foundation, the Society of Critical Care Medicine (SCCM), and the University of Pennsylvania Perelman School of Medicine Thomas B. McCabe and Jeannette E. Laws McCabe Fund. GLA reports payments for authoring chapters for UpToDate and for expert witness consulting, including involving COVID-19, and reports that his spouse is employed by the U.S. Food and Drug Administration (FDA).
References
Key articles
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-67.Full text Abstract
Lim WS, Baudouin SV, George RC, et al; Pneumonia Guidelines Committee of the BTS Standards of Care Committee. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64 Suppl 3:iii1-55.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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