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 tests
1st tests to order
- chest x-ray
- CBC
- serum electrolytes/blood urea nitrogen
- liver function tests
- blood glucose
- arterial blood gases/oximetry
- blood culture
- sputum culture
Tests to consider
- point-of-care 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
outpatient
inpatient
Contributors
Expert advisers
Catia Cilloniz, MD, PhD, FERS
Applied Research in Respiratory Diseases
Hospital Clinic of Barcelona
CIBERES
IDIBAPS
Associate Professor
University of Barcelona
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.
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.
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.
Grant Waterer, MBBS, PhD, MBA, FRACP, FCCP
Professor of Medicine
Royal Perth Hospital
Perth
Australia
Disclosures
GW declares that he has no competing interests.
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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