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Overview Of Pneumonia Health Article

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Clinical Manifestations

The possibility of pneumonia should be considered in any patient who has new respiratory symptoms including cough, sputum, or dyspnea, particularly when these symptoms are accompanied by fever or abnormalities on physical examination of the chest, such as rhonchi and rales. The initial presentation can be more subtle in patients who are elderly or have an altered immunologic status; in such patients, nonspecific symptoms, including loss of appetite, confusion, dehydration, worsening of symptoms or signs of other chronic illnesses, or failure to thrive may be the initial manifestation of pneumonia. Pneumonia also is increasingly prevalent in patients with specific comorbid diseases, including smoking, chronic obstructive pulmonary disease (COPD), diabetes mellitus, malignancy, heart failure, neurologic diseases, narcotic and alcohol use, and chronic liver disease.

The presenting symptoms and signs are often variable from patient to patient and cannot be reliably used to establish a specific (microbiologic) diagnosis. Classic physical findings of lobar pneumonia include evidence of consolidation with altered transmission of breath sounds, egophony, crackles, and changes in tactile fremitus. However, in many patients, the physical findings are more subtle and may be limited to scattered rhonchi. A thorough physical examination, posteroanterior and lateral chest radiographs, and blood leukocyte count with differential cell count should be performed when pneumonia is suspected. An assessment of gas exchange (oximetry or arterial blood gas determination) should be obtained for all patients who are admitted to the hospital. The clinician needs to be mindful of competing diagnoses that can mimic the presentation of pneumonia such as pulmonary embolism, bronchogenic and bronchoalveolar carcinoma, drug-induced lung diseases, and idiopathic interstitial lung diseases.