Materiały źródłowe

• #1 Chest Infection: Symptoms, Treatment, and Prevention

  https://patient.info/chest-lungs/chest-infection

  A chest infection is an infection that affects your lower large airways (bronchi) and your lungs. Pneumonia and bronchitis are the most common chest infections. […] Pneumonia is usually due to bacterial infection. Pneumonia may be serious and need hospital admission. […] Pneumonia is an inflammation of the lung which is usually caused by an infection. […] There are two main types of chest infection – acute bronchitis and pneumonia. […] Acute bronchitis is common and is often due to a viral infection. […] This is usually a bacterial infection of the lung (bacterial chest infection) and may be serious. Treatment with antibiotics is usually needed. […] A bout of infection of the large airways (bronchi) in the lungs (acute bronchitis) usually gets better on its own within 7-10 days without any medicines.

• #2 Chest infection

  https://www.nhs.uk/conditions/chest-infection/

  A chest infection is an infection of the lungs or large airways. Some chest infections are mild and clear up on their own, but others can be severe and life threatening. […] A pharmacist can recommend cough medicines to loosen the mucus in your lungs. This will make the mucus easier to cough up and help clear the infection from your lungs. […] Treatment for a chest infection will depend on the cause. […] A chest infection will either be caused by: a virus (like viral bronchitis) this usually clears up by itself after a few weeks and antibiotics will not help […] You may need a blood test or a sample of your mucus may need to be tested to see what’s causing your chest infection.

• #3 Pneumonia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pneumonia/diagnosis-treatment/drc-20354210

  This chest X-ray shows an area of lung inflammation indicating the presence of pneumonia. […] Your doctor will start by asking about your medical history and doing a physical exam, including listening to your lungs with a stethoscope to check for abnormal bubbling or crackling sounds that suggest pneumonia. […] If pneumonia is suspected, your doctor may recommend the following tests: […] Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection. However, precise identification isn’t always possible. […] Chest X-ray. This helps your doctor diagnose pneumonia and determine the extent and location of the infection. However, it can’t tell your doctor what kind of germ is causing the pneumonia. […] Pulse oximetry. This measures the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream.

• #4 Chest infection | NHS inform

  https://www.nhsinform.scot/illnesses-and-conditions/infections-and-poisoning/chest-infection/

  Your GP should be able to diagnose you based on your symptoms and by listening to your chest using a stethoscope (a medical instrument used to listen to the heart and lungs). […] In some cases, further tests such as a chest X-ray, breathing tests and testing phlegm or blood samples may be needed.

• #5 Pneumonia Symptoms and Diagnosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/symptoms-and-diagnosis

  How Is Pneumonia Diagnosed? […] To diagnose pneumonia, and to try to identify the germ that is causing the illness, your doctor will ask questions about your medical history, do a physical exam, and run some tests. […] If your doctor suspects you may have pneumonia, they will probably recommend some tests to confirm the diagnosis and learn more about your infection. These may include: […] Blood tests to confirm the infection and to try to identify the germ that is causing your illness. […] Chest X-ray to look for the location and extent of inflammation in your lungs. […] Pulse oximetry to measure the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream. […] Sputum test on a sample of mucus (sputum) taken after a deep cough, to look for the source of the infection.

• #6 Clinical features for diagnosis of pneumonia among adults in primary care setting: A systematic and meta-review | Scientific Reports

  https://www.nature.com/articles/s41598-019-44145-y

  Pneumonia results in significant morbidity and mortality worldwide. However, chest radiography may not be accessible in primary care setting. We aimed to evaluate clinical features and its diagnostic value to identify pneumonia among adults in primary care settings. […] Diagnosis of pneumonia in adults presenting with signs of lower respiratory tract infection is important because it requires specific treatment and follow up. Pneumonia is usually diagnosed by a combination of clinical history, physical examination and/or laboratory tests. According to most clinical guidelines globally, the supposed gold standard tool for diagnosing pneumonia is a chest X-ray (CXR) which can distinguish pneumonia from other respiratory tract infections. […] The findings of this review suggest that individual clinical symptom (cough) and clinical signs (pyrexia, tachycardia, tachypnea, and crackles) are associated to pneumonia but limited as a single predictor for diagnosis of radiographic pneumonia. The combination of these clinical features in decision rule might indeed enhance the overall diagnostic performance of individual symptoms and signs. Future high quality and large-scale case-control studies using the clinical data relevant to the population of interest is necessary to assess the combination with the clinical features identified in this review, and to propose a practical scoring system to aid clinical judgement for ordering of CXR to confirm pneumonia. Moreover, the combination of these clinical features together with molecular biomarkers is likely to further add value to the overall diagnostic accuracy.

• #7 Rapid diagnosis of community-acquired pneumonia for clinicians | The Centre for Evidence-Based Medicine

  https://www.cebm.net/covid-19/rapid-diagnosis-of-community-acquired-pneumonia-for-clinicians/

  VERDICT: Based on the best available evidence, a restricted strategy may be suitable for diagnosing pneumonia in the community. Such a strategy may be particularly suitable during the current Covid-19 pandemic where resources may be stretched. […] A 2019 systematic review of 13 studies including 11,144 adult patients from outpatient clinics, emergency clinics, and primary care practices, presenting with cough, symptoms of respiratory tract infection and clinically suspected pneumonia, assessed the diagnostic accuracy of clinical features for the diagnosis of pneumonia. […] A 2019 systematic review determined the diagnostic accuracy of overall clinical impression (clinical gestalt) in the diagnosis of infection, including community-acquired pneumonia, in primary care. […] Diagnostic accuracy of an overall clinical impression had a +ve LR 7.7 (4.8-11.5) and -ve LR 0.54 (0.42-0.65) for the diagnosis of CAP in adults.

• #8 Pneumonia | Lung inflammation – Diagnosis, Evaluation and Treatment

  https://www.radiologyinfo.org/en/info/pneumonia

  Your doctor may conduct a physical exam and use chest x-ray, chest CT, chest ultrasound, or needle biopsy of the lung to help diagnose your condition. […] If your doctor thinks you may have pneumonia, an imaging test may be performed to confirm the diagnosis. […] One or more of the following tests may be ordered to evaluate for pneumonia: Chest x-ray: An x-ray exam will allow your doctor to see your lungs, heart and blood vessels to help determine if you have pneumonia. […] A CT scan of the chest may be done to see finer details within the lungs and detect pneumonia that may be more difficult to see on a plain x-ray. […] Ultrasound may be used if fluid surrounding the lungs is suspected. […] Your doctor may request a biopsy of your lung(s) to determine the cause of pneumonia. […] Each of these tests will help your doctor further evaluate your lungs and lung function or help determine the type of germ causing your pneumonia.

• #9 Pneumonia: Symptoms, causes, and treatments

  https://www.medicalnewstoday.com/articles/151632

  To diagnose pneumonia, a doctor will usually ask about a persons symptoms and medical history and carry out a physical examination. The physical exam may include listening to the chest through a stethoscope and measuring blood oxygen levels using a pulse oximeter attached to the finger. […] If doctors suspect pneumonia, they may order additional tests, including: […] Chest X-rays: These can confirm a pneumonia diagnosis and show which areas of the lungs are affected. […] A chest CT scan: This scan can provide more detailed images of the lungs. […] White blood cell (WBC) count: A blood test that measures levels of WBCs in the blood. This helps determine how severe the infection is and whether bacteria, virus, or fungus is the likely cause. […] An arterial blood gas test: A blood test that can provide a more accurate reading of the bodys oxygen and carbon dioxide levels and other factors.

• #10 The diagnosis of pneumonia requires a chest radiograph (x-ray)—yes, no or sometimes? | Pneumonia | Full Text

  https://pneumonia.biomedcentral.com/articles/10.15172/pneu.2014.5/464

  Community-acquired pneumonia (CAP) remains a common condition associated with considerable morbidity and mortality. […] A number of international guidelines recommend a chest radiograph (x-ray) is obtained when pneumonia is suspected; the argument forwarded is that chest radiographs are relatively inexpensive and enable pneumonia (lung consolidation) to be confirmed or excluded. […] However, there is considerable debate about the accuracy of symptoms and signs alone in the diagnosis of CAP, with many suggesting that clinical features alone are not accurate enough and that a chest radiograph is an absolute requirement without which pneumonia cannot be adequately diagnosed or excluded. […] The current guideline from North America and the earlier European guideline indicated that if pneumonia was suspected a routine chest radiograph should be performed to confirm the diagnosis.

• #11 Acute Bronchitis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-bronchitis-diagnosis/

  Diagnosis of acute bronchitis is one of exclusion and made on history and physical with additional tests to rule out other causes. […] Acute bronchitis is a clinical diagnosis of exclusion made on history and physical exam. […] Testing for pathogens will not change management and therefore is not recommended unless there is suspicion for COVID-19 or influenza in high-risk patients. […] Chest x-ray may be useful to exclude other diagnoses especially when pneumonia can not be excluded. It may show thickening of bronchial walls in lower lobes but are commonly either normal or have nonspecific findings in the setting of acute bronchitis.

• #12 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Bronchitis-Diagnosis.aspx

  Bronchitis is mainly caused by a chest infection that leads to pathological changes in the narrow airways of the lungs. Diagnosis is based on clinical history, physical examination as well as laboratory, imaging as well as breath analysis tests. […] A chest X ray is performed in patients whose physical examination suggests pneumonia or co-existing heart failure. A chest X ray may also be advised to elderly patients, those with chronic obstructive pulmonary disease, recent episode of pneumonia, cancer, tuberculosis patients and those with debilitated status or lowered immunity. […] Chest X ray may be normal in mild chronic bronchitis. However, occasionally there may be appearance of thickening of bronchial walls and crowding of bronchial structures in the lower part of the lungs on X ray in severe cases.

• #13 Chest X-Ray For Pneumonia: Diagnosis And Interpretation

  https://onestepdiagnostic.com/chest-x-ray-for-pneumonia-diagnosis/

  Yes, chest X-rays are an essential tool in diagnosing pneumonia. They can detect signs of pneumonia on chest X-rays or characteristic abnormalities, such as infiltrates and consolidations in the lungs, which are indicative of pneumonia. […] Chest X-rays play a huge role in diagnosing pneumonia (X-ray of lung pneumonia) by providing evidence of lung abnormalities. […] X-rays reveal infiltrates, consolidation, or opacities in the affected lung segments, indicating inflammatory changes and fluid accumulation. […] X-ray findings help differentiate between bacterial and viral pneumonia based on distinct patterns such as lobar consolidation or diffuse interstitial infiltrates. […] X-ray images assist in assessing the severity of pneumonia by evaluating the extent and distribution of lung abnormalities, guiding clinical management decisions.

• #14 Chest X-Ray For Pneumonia: Diagnosis And Interpretation

  https://onestepdiagnostic.com/chest-x-ray-for-pneumonia-diagnosis/

  Serial chest X-rays track changes in lung pathology over time, assessing the resolution of infiltrates and consolidation following antibiotic therapy. […] X-ray findings may reveal complications such as pleural effusions, abscess formation, or pneumothorax, prompting timely intervention to prevent further morbidity and mortality. […] Understanding how pneumonia manifests on an X-ray is crucial for accurate diagnosis and effective treatment. A chest X-ray serves as a window into the lungs, allowing healthcare professionals to visualize any abnormalities indicative of pneumonia. […] The chest X-ray findings of pneumonia may appear as follows: Dense, patchy infiltrates or areas of opacity within the lung tissue. […] A chest X-ray of aspiration pneumonia typically shows patchy infiltrates scattered throughout the lungs, often with areas of consolidation indicating inflammatory exudate accumulation. […] Chest X-rays play a vital role in diagnosing pneumonia by providing valuable insights into lung abnormalities. Understanding the signs of pneumonia on a chest X-ray, along with prompt medical evaluation, is crucial for timely diagnosis and appropriate management of this respiratory infection.

• #15

  https://journals.lww.com/co-pulmonarymedicine/fulltext/2019/05000/computed_tomography_scan_contribution_to_the.6.aspx

  Pneumonia is a frequent disease mainly affecting older and multimorbid patients. Symptoms and signs lack sensitivity and specificity, and chest X-ray has poor accuracy. Hence, an initial diagnosis of pneumonia has limited predictive value for the presence of pneumonia. Overdiagnosis of pneumonia leads to inappropriate antibiotic use and may delay the appropriate management of mimicking diseases. Alternative imaging strategies including computed tomography (CT)-scan or lung ultrasonography may improve the diagnosis of pneumonia. […] Two studies assessed the diagnostic accuracy of CT-scan in emergency department or hospitalized patients suspected of pneumonia. CT-scan led to a net reclassification improvement of 8 and 18% of patients, and was particularly helpful to rule out the diagnosis, allowing a lowering of the number of inappropriate antibiotic prescriptions.

• #16 Pneumonia – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pneumonia/diagnosis-treatment/drc-20354210

  Sputum test. A sample of fluid from your lungs (sputum) is taken after a deep cough and analyzed to help pinpoint the cause of the infection. […] Your doctor might order additional tests if you’re older than age 65, are in the hospital, or have serious symptoms or health conditions. These may include: […] CT scan. If your pneumonia isn’t clearing as quickly as expected, your doctor may recommend a chest CT scan to obtain a more detailed image of your lungs. […] Pleural fluid culture. A fluid sample is taken by putting a needle between your ribs from the pleural area and analyzed to help determine the type of infection.

• #17 Pneumonia Symptoms and Diagnosis | American Lung Association

  https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/symptoms-and-diagnosis

  If you are considered a high-risk patient because of your age and overall health, or if you are hospitalized, the doctors may want to do some additional tests, including: […] CT scan of the chest to get a better view of the lungs and look for abscesses or other complications. […] Arterial blood gas test, to measure the amount of oxygen in a blood sample taken from an artery, usually in your wrist. This is more accurate than the simpler pulse oximetry. […] Pleural fluid culture, which removes a small amount of fluid from around tissues that surround the lung, to analyze and identify bacteria causing the pneumonia. […] Bronchoscopy, a procedure used to look into the lungs’ airways. If you are hospitalized and your treatment is not working well, doctors may want to see whether something else is affecting your airways, such as a blockage. They may also take fluid samples or a biopsy of lung tissue.

• #18 Pneumonia: Diagnosis, Symptoms, and Treatment

  https://www.healthline.com/health/pneumonia

  Sputum culture […] During a sputum culture, a sample of mucus is collected after youve coughed deeply. Its then sent to a lab to be analyzed to identify the cause of the infection. […] Pulse oximetry […] A pulse oximetry measures the amount of oxygen in your blood. A sensor placed on one of your fingers can indicate whether your lungs are moving enough oxygen through your bloodstream. […] CT scan […] CT scans provide a clearer and more detailed picture of your lungs. […] Fluid sample […] If your doctor suspects theres fluid in the pleural space of your chest, they may take a fluid sample using a needle placed between your ribs. This test can help identify the cause of your infection. […] Bronchoscopy […] A bronchoscopy looks into the airways in your lungs. It does this using a camera on the end of a flexible tube thats gently guided down your throat and into your lungs.

• #19 Pneumonia | Pneumonia Symptoms | Signs of Pneumonia | MedlinePlus

  https://medlineplus.gov/pneumonia.html

  Chest CT scan to see how much of your lungs are affected. It may also show if you have complications such as lung abscesses or pleural effusions (a buildup of fluid in the pleural space). […] Pleural fluid culture, which checks for bacteria in a fluid sample that was taken from the pleural space. […] Pulse oximetry or blood oxygen level test, to check how much oxygen is in your blood. […] Bronchoscopy, a procedure used to look inside your lungs’ airways.

• #20

  https://journals.lww.com/co-pulmonarymedicine/fulltext/2019/05000/computed_tomography_scan_contribution_to_the.6.aspx

  CT-scan reduces overdiagnosis of pneumonia and allows a better identification of alternative diagnoses. The impact on clinical outcomes of a strategy incorporating CT-scan for patients suspected of pneumonia should be evaluated, along with its cost-effectiveness. […] Increasing availability of CT-scan in emergency departments has fuelled the interest in its contribution for the diagnosis of pneumonia. Claessens et al. have reported in 319 patients visiting the emergency department for a suspicion of CAP that early CT-scan changed the probability of the disease for 100 patients (31%). […] These studies also demonstrated the feasibility of using CT scan in emergency department or hospital settings. Low-dose CT scans took 10 min to perform and mean radiation exposure was 1.5 0.47 mSv, to be compared to a mean exposure of 0.05 0.03 mSv for a conventional chest radiograph, and to natural background radiation level of 4 mSv/year.

• #21

  https://journals.lww.com/co-pulmonarymedicine/fulltext/2019/05000/computed_tomography_scan_contribution_to_the.6.aspx

  Recent studies have unveiled a high incidence of misdiagnosis in pneumonia. CT-scan can improve the diagnosis reclassification of 818% of patients. CT-scan is especially useful to rule-out pneumonia, and has a maximal impact in the category of patients with intermediate probability of disease. This diagnostic rectification may lower inappropriate antibiotic prescription, and allow timely identification of an alternative cause of patient’s symptoms. The clinical benefits and cost-effectiveness of a diagnostic strategy incorporating CT-scan for patients suspected of pneumonia should be tested in further studies.

• #22 Current Diagnostic Techniques for Pneumonia: A Scoping Review

  https://www.mdpi.com/1424-8220/24/13/4291

  Accurately diagnosing pneumonia and differentiating it from upper respiratory tract infection and cardiovascular problems are important to rule out the unnecessary prescription of antibiotics. […] The diagnosis of pneumonia is a combined result of correlating symptoms with lab results; however, the chest X-ray is considered the gold standard for diagnosing pneumonia. […] The role of CT scans in diagnosing COVID-19 has increased the development of many CT scan image databases. […] The methods for identifying pneumonia using CXRs, as well as the evaluation techniques and the datasets used by each researcher, are presented in Table A4. […] The key research articles presenting the lung ultrasound technique for diagnosing lower respiratory tract infection compared to CXR or CT scans are summarized in Table A5.

• #23 Pneumonia – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/pneumonia/diagnosis

  Your healthcare provider will diagnose pneumonia based on your medical history, a physical exam, and test results. […] If your provider thinks you have pneumonia, he or she may do one or more of the following tests. […] A chest X-ray looks for inflammation in your lungs. A chest X-ray is often used to diagnose pneumonia. […] Blood tests, such as a complete blood count (CBC) see whether your immune system is fighting an infection. […] Pulse oximetry measures how much oxygen is in your blood. Pneumonia can keep your lungs from getting enough oxygen into your blood. […] A blood gas test may be done if you are very sick. […] A sputum test, using a sample of sputum (spit) or mucus from your cough, may be used to find out what germ is causing your pneumonia. […] A blood culture test can identify the germ causing your pneumonia and also show whether a bacterial infection has spread to your blood.

• #24 Pneumonia – Wikipedia

  https://en.wikipedia.org/wiki/Pneumonia

  Pneumonia is usually caused by infection with viruses or bacteria, and less commonly by other microorganisms. […] Diagnosis is often based on symptoms and physical examination. […] Chest X-rays, blood tests, and culture of the sputum may help confirm the diagnosis. […] The overall impression of a physician appears to be at least as good as decision rules for making or excluding the diagnosis. […] In general, in adults, investigations are not needed in mild cases. […] C-reactive protein (CRP) may help support the diagnosis. […] Procalcitonin may help determine the cause and support decisions about who should receive antibiotics. […] In people requiring hospitalization, pulse oximetry, chest radiography and blood tests including a complete blood count, serum electrolytes, C-reactive protein level, and possibly liver function tests are recommended. […] The diagnosis of influenza-like illness can be made based on the signs and symptoms; however, confirmation of an influenza infection requires testing.

• #25 Pneumonia: Recent Updates on Diagnosis and Treatment

  https://www.mdpi.com/2076-2607/13/3/522

  Pneumonia remains a leading cause of mortality internationally, making it an intense area of study for new tools for diagnosis and treatment. […] The 2019 guidelines recommend the diagnosis of community-acquired pneumonia by infiltrate on imaging, one respiratory symptom, and another finding such as fever or leukocytosis. […] The gold standard for the identification of the microorganisms involved in pneumonia has been with culturing, either via sputum or more invasive testing such as via bronchoalveolar lavage (BAL). […] Syndromic panels are emerging as a newer technique of microorganism identification and are further discussed below. […] There are currently two FDA-approved panels that can be considered true syndromic panels, with the ability to detect a wide array of organisms, including both common and more morbid bacterial pathogens.

• #26 Diagnosis and Management of Community-Acquired Pneumonia in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0601/p1299.html

  A negative sputum culture result from a good-quality sample (i.e., positive for neutrophils, but less than 25 epithelial cells per low-power field) is strong evidence that gram-negative bacilli and Staphylococcus aureus are absent, and can prompt safe de-escalation of antibiotic therapy. […] Blood cultures are not recommended for most hospitalized patients with CAP and should be performed according to the recommendations in Table 3. […] The most common blood isolate in patients with CAP is S. pneumoniae. […] A study comparing 125 patients with CAP caused by pneumococcal bacteremia and 1,847 patients with nonbacteremic CAP found no increase in poor outcomes among those with bacteremia. […] Blood cultures in patients with severe CAP have a higher yield, are more likely to grow pathogens not covered by empiric therapy, and have higher potential to influence antibiotic management.

• #27 Pneumonia – Diagnosis | NHLBI, NIH

  https://www.nhlbi.nih.gov/health/pneumonia/diagnosis

  A polymerase chain reaction (PCR) test quickly checks your blood or sputum sample to find the DNA of germs that cause pneumonia. […] A bronchoscopy looks inside your airways. […] A chest computed tomography (CT) scan can show how much of your lungs are affected by pneumonia. […] A pleural fluid culture can be taken using a procedure called thoracentesis, which is when a doctor uses a needle to take a sample of fluid from the pleural space between your lungs and chest wall.

• #28 Pneumonia: Recent Updates on Diagnosis and Treatment

  https://www.mdpi.com/2076-2607/13/3/522

  The BioFire FilmArray Pneumonia Panel is the most studied and well known of the available syndromic panels. […] BioFire has reported the sensitivity and specificity of their panel as 96.3% and 97.2% on sputum, respectively, with similar accuracy on BAL. […] There have been multiple studies comparing syndromic panels to culture, and it is well documented that they have greater rates of detection as well as sensitivity, specificity, and negative predictive value. […] It is, of course, important to note that the lack of detection of organisms by these syndromic panels does not exclude pneumonia as a diagnosis, since it is based on imaging and symptoms. […] Syndromic panels can identify pathogens much more quickly than sputum cultures. […] Several studies have shown that there is a significant improvement in the time to identification and administration of pathogen-directed treatment.

• #29 Diagnosis and Management of Community-Acquired Pneumonia in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0601/p1299.html

  Community-acquired pneumonia is diagnosed by clinical features (e.g., cough, fever, pleuritic chest pain) and by lung imaging, usually an infiltrate seen on chest radiography. […] In patients with clinically suspected CAP, chest radiography should be obtained to confirm the diagnosis. […] An infiltrate on lung imaging, usually chest radiography, is required for the diagnosis of CAP; therefore, the test should be performed in patients with clinically suspected CAP. […] Routine laboratory testing to establish an etiology in outpatients with CAP is usually unnecessary. However, evaluation for specific pathogens that would alter standard empiric therapy should be performed when the presence of such pathogens is suspected on the basis of clinical and epidemiologic clues. […] Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) guidelines recommend that sputum specimens be obtained before the initiation of antibiotic therapy in inpatients.

• #30 Pneumonia Testing – Testing.com

  https://www.testing.com/pneumonia-testing/

  A chest x-ray is the typical imaging test used to diagnose pneumonia. […] Pneumonia testing may include a range of tests to identify why pneumonia occurred. […] This kind of testing is not routinely performed in patients with mild cases of pneumonia. […] Although many tests are available to look for the underlying cause, in the majority of cases, no single cause can be conclusively identified. […] Blood tests can be used to try to determine the cause of pneumonia. […] A urine sample can be analyzed for the presence of two bacteria that can cause pneumonia, Streptococcus pneumoniae and Legionella pneumophila. […] Pneumonia tests are ordered by a doctor and normally performed in a medical setting like a hospital or doctor’s office.

• #31 Community-acquired pneumonia in adults (non COVID-19) – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/17

  Community-acquired pneumonia (CAP) typically presents with symptoms and signs consistent with a lower respiratory tract infection (i.e., cough, dyspnoea, pleuritic chest pain, mucopurulent sputum, myalgia, fever) and no other explanation for the illness. […] Confirm diagnosis in all patients presenting to hospital with evidence of consolidation (new shadowing that is not due to any other cause) on chest x-ray. A chest x-ray should not be requested routinely for patients managed in the community. […] Use the CURB-65 mortality risk score (hospital setting) or CRB-65 severity score (community setting), together with your clinical judgement, to decide whether to manage the patient in hospital or at home and to determine appropriate therapy. […] Send sputum and blood samples for culture in people with moderate- or high-severity CAP, ideally before antibiotics are started, and consider legionella and pneumococcal urine antigen testing.

• #32 Pneumonia: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/4471-pneumonia

  A sensor measures the amount of oxygen in your blood to give your provider an idea of how well your lungs are working. […] Your provider uses a thin needle to take a sample of fluid from around your lungs. The sample is sent to a lab to help determine whats causing the infection. […] Your provider takes a blood sample from your wrist, arm or groin to measure oxygen levels in your blood to know how well your lungs are working. […] In some cases, your provider may use a thin, lighted tube called a bronchoscope to look at the inside of your lungs. They may also take tissue or fluid samples to be tested in a lab.

• #33 Pneumonia: Symptoms, causes, and treatments

  https://www.medicalnewstoday.com/articles/151632

  Blood cultures: These may reveal whether the microorganism from the lungs has spread into the bloodstream. […] Sputum analysis: Tests the sputum to determine which pathogens are responsible for the pneumonia. […] Bronchoscopy: A procedure that involves passing a bronchoscope into the lungs while a person is under anesthesia. The bronchoscope is a thin, flexible tube with a light and camera attached, which enables the doctor to directly examine infected parts of the airways and lungs. A doctor may recommend this procedure when further investigation is necessary.

• #34 Bacterial Pneumonia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/300157-overview

  Sputum Gram stain and culture should be performed before initiating antibiotic therapy. A single predominant microbe should be noted at Gram staining, although mixed flora may be observed with anaerobic infection caused by aspiration. […] Chest radiography: The criterion standard for establishing the diagnosis of pneumonia. […] Lung tissue can be visually evaluated and bronchial washing specimens can be obtained with the aid of a fiberoptic bronchoscope. […] This is an essential procedure in patients with a parapneumonic pleural effusion. Analysis of the fluid allows differentiation between simple and complicated effusions. […] Histologic inflammatory lung changes vary according to whether the patient has lobar pneumonia, bronchopneumonia, or interstitial pneumonia. […] The mainstay of drug therapy for bacterial pneumonia is antibiotic treatment. First-line antimicrobials for S pneumoniae, the most prevalent cause of bacterial pneumonia, are, for the penicillin-susceptible form of the bacterium, penicillin G and amoxicillin.

• #35 Multifocal Pneumonia: Symptoms, Diagnosis and Treatment | Orlando | UCF Health

  https://ucfhealth.com/our-services/primary-care/multifocal-pneumonia/

  Taking a detailed medical history is essential in diagnosing multifocal pneumonia as it provides valuable clues regarding potential risk factors, exposures and underlying health conditions. […] Integrating imaging modalities such as CT scans and computed tomography enhances the diagnostic workup of multifocal pneumonia by providing detailed images of the lungs. […] Bronchoalveolar lavage (BAL) is a procedure that involves washing the airspaces with fluid and retrieving the fluid for analysis. […] Multifocal pneumonia can manifest at different ages and settings. […] In outpatient settings, symptoms may be subtle and nonspecific, leading to underrecognition or misdiagnosis. […] In emergency department (ED) settings, multifocal pneumonia cases often present with more acute and severe symptoms, necessitating urgent medical attention.

• #36 Clinical evaluation and diagnostic testing for community-acquired pneumonia in adults – UpToDate

  https://www.uptodate.com/contents/clinical-evaluation-and-diagnostic-testing-for-community-acquired-pneumonia-in-adults

  Clinical evaluation and diagnostic testing for community-acquired pneumonia in adults […] Community-acquired pneumonia (CAP) is one of the most commonly diagnosed illnesses worldwide. The clinical presentation of CAP varies, ranging from mild disease characterized by limited shortness of breath and productive cough to severe disease characterized by fever, respiratory distress, and sepsis. Because of the wide spectrum of associated clinical features, CAP is a part of the differential diagnosis of most acute respiratory illnesses. […] In patients with a clinically compatible syndrome, the demonstration of an infiltrate on chest imaging is generally sufficient to establish an initial working diagnosis and start empiric therapy. However, this combination of findings is nonspecific and is shared among many cardiac, pulmonary, and inflammatory disorders. Thus, it is important to remain attentive to the possibility of an alternate diagnosis as a patient’s course evolves.

• #37 Pneumonia – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/pneumonia/

  Pneumonia is classified based on clinical features as either typical or atypical; each type has its own spectrum of commonly associated pathogens. […] Diagnostics include blood tests for inflammatory parameters and pathogen detection in blood, urine, or sputum samples. […] Together with the characteristic clinical features, newly developed pulmonary infiltrate on chest x-ray confirms the diagnosis. […] Pneumonia diagnosis is based on new pulmonary infiltrates on chest imaging in patients with respiratory symptoms and systemic inflammatory response. […] The choice of microbiological studies is guided by a severity assessment for CAP or the presence of HAP or VAP. […] Diagnosis of pneumonia can be challenging due to the lack of a gold-standard test and numerous mimics (e.g., COPD exacerbation, heart failure), especially when diagnostic testing is ambiguous.

• #38 Pneumonia: update on diagnosis and management

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1458569/

  Prompt diagnosis and management of community acquired pneumonia saves lives. This article summarises the latest key recommendations in the management of pneumonia and is intended for junior doctors managing this common condition. […] A chest x ray is crucial to making the diagnosis of pneumonia. New chest signs on examination are helpful but not specific. […] The British Thoracic Society recommends the CURB-65 scoring system. This is a 6 point score (range 0-5) that gives one point each for confusion (abbreviated mental test score 8 or new disorientation in person, place, or time); urea 7 mmol/l; respiratory rate 30/min; low blood pressure (systolic blood pressure 90 mm Hg or diastolic blood pressure 60 mm Hg); and age 65 years or more. […] Measuring C reactive protein (an acute phase protein) concentrations is useful for managing pneumonia. Ninety five percent of patients admitted with community acquired pneumonia have a C reactive protein value 50 mg/l.

• #39 Rapid diagnosis of community-acquired pneumonia for clinicians | The Centre for Evidence-Based Medicine

  https://www.cebm.net/covid-19/rapid-diagnosis-of-community-acquired-pneumonia-for-clinicians/

  In a review of the evidence for the diagnostic accuracy of the physical examination in diagnosing pneumonia, pleural effusion, chronic obstructive pulmonary disease independent predictors of pleural effusion were dullness to percussion (+ve LR 8.7; -ve LR 0.3) and asymmetric chest expansion ( +ve LR 8.1; -ve LR 0.29). […] NICE recommends using the CRB65 score to assess patients at low, intermediate or high risk. […] The CRB65 score is used to assess the severity and mortality risk in patients with CAP. […] A 2010 systematic review of 14 validation studies assessed the validity of CRB-65 to grade the severity of CAP in terms of 30-day mortality and included 397,875 patients. […] The study found that CRB-65 accurately predicts 30-day in hospitalised patients, particularly in those classified as intermediate (RR 0.91, 95% CI, 0.71 to 1.17) or high risk (RR 1.01, 0.87 to 1.16). […] Hypoxemia may influence the prognosis of patients with CAP independently of the CRB-65.

• #40 Bacterial Pneumonia: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/300157-overview

  Bacterial pneumonia is caused by a pathogenic infection of the lungs and may present as a primary disease process or as the final, fatal disorder primarily in an individual who is already debilitated. The most consistent presenting symptom of bacterial pneumonia is cough productive of sputum. Antibiotic treatment is the mainstay of drug therapy for bacterial pneumonia. […] Tools to assess the severity of disease and risk for death include the PSI/PORT (ie, pneumonia severity index/Patient Outcomes Research Team score), the CURB-65 (ie, confusion, urea, respiratory rate, blood pressure, and age 65 years) system, and the APACHE (ie, acute physiology and chronic health evaluation), among others. […] The following laboratory tests are useful for assessing illness severity: Serum chemistry panel, Arterial blood gas (ABG) determination, Venous blood gas determination (central venous oxygen saturation), Complete blood cell (CBC) count with differential, Serum free cortisol value, Serum lactate level.

• #41 Diagnosis and Management of Community-Acquired Pneumonia in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0601/p1299.html

  The initial management of CAP depends on the patient’s severity of illness; underlying medical conditions and risk factors, such as smoking; and ability to adhere to a treatment plan. […] The need for hospitalization is the first decision that needs to be made after CAP is diagnosed or suspected. […] The estimated direct cost of a single CAP hospitalization ranges from $3,000 to $13,000. […] Mortality and severity prediction scores have been designed to identify patients with CAP who can be treated safely as outpatients. […] Because the exact causative organism is not identified in many patients with CAP, treatment is usually empiric. […] Recommendations for antibiotic therapy in these patients are listed in Table 7. […] Drug-resistant S. pneumoniae is a concern in patients with comorbid illness or recent antibiotic therapy (within previous three months) and should be treated with an oral beta-lactam antibiotic combined with a macrolide.

• #42 The diagnosis of pneumonia requires a chest radiograph (x-ray)—yes, no or sometimes? | Pneumonia | Full Text

  https://pneumonia.biomedcentral.com/articles/10.15172/pneu.2014.5/464

  It is also important to recognise that there is considerable interobserver variation in the recording of symptoms and also a high degree of interobserver error in the physical examination of the chest. […] For these reasons it is the authors belief that a chest radiograph should be performed in patients for suspected CAP, if at all possible. […] Despite some studies suggesting that general practitioners may be accurate in diagnosing which patients with cough may have pneumonia and which patients require a chest radiograph, most investigations suggest that clinical judgement alone is relatively inaccurate and that history and clinical examination alone do not provide a high level of certainty with regard to the diagnosis of CAP. […] The authors concluded that physical examination had a modest ability to predict the presence of pneumonia which alone was not sufficient to confirm or exclude the presence of this infection, and that when this diagnosis is suspected a chest radiograph remains the best test.

• #43 The diagnosis of pneumonia requires a chest radiograph (x-ray)—yes, no or sometimes? | Pneumonia | Full Text

  https://pneumonia.biomedcentral.com/articles/10.15172/pneu.2014.5/464

  Not surprisingly many consider that chest radiology, which is a relatively inexpensive test, plays a fundamental and important role in the diagnosis of pneumonia, together with clinical assessment and sometimes appropriate microbiological testing. […] While some guidelines do advocate routine chest radiology for all cases with suspected CAP, even those guidelines that do not recommend routine radiology propose definitive criteria and/or situations in which a chest radiograph should be done. […] Therefore, there will be those patients in whom the diagnosis of CAP will be missed, particularly among those with milder symptoms, who are more likely to be among those treated in the community. […] For these reasons it is widely recommended that routine radiology be performed in any patient suspected on any clinical grounds of having CAP.

• #44 Pneumonia: Recent Updates on Diagnosis and Treatment

  https://www.mdpi.com/2076-2607/13/3/522

  Proponents of syndromic panels often argue that they can aid in antibiotic stewardship by prompting de-escalation more quickly. […] The INHALE trial was a multicenter RCT utilizing syndromic panels in patients with HAP/VAP and demonstrated that, at 24 h, patients tested via syndromic panels were more likely to be receiving pathogen-directed therapy than those tested through standard culturing. […] However, other trials have shown more mixed results. […] Syndromic panels could potentially allow for the quick identification of antimicrobial resistance, such as methicillin resistance or extended-spectrum beta-lactamase (ESBL). […] The choice of the appropriate antibiotic agent for the treatment of a patient who has been admitted to the hospital is based on the presence of risk factors for MRSA or Pseudomonas (or both). […] In addition to the intravenous antibiotics above, there is growing interest in aerosolized antibiotics that have the benefit of directly penetrating the site of infection.

• #45 Diagnosis and Management of Community-Acquired Pneumonia in Adults | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/0601/p1299.html

  Duration of therapy for patients with CAP has traditionally been 10 to 14 days, but more recent evidence suggests a shorter course of up to seven days is equally effective. […] Hospitalized patients may be switched from intravenous to oral antibiotic therapy after they have clinical improvement and are able to tolerate oral medications.

• #46 Community-acquired pneumonia in adults (non COVID-19) – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/17

  Community-acquired pneumonia (CAP) is defined as pneumonia acquired outside hospital or healthcare facilities. Clinical diagnosis is based on a group of signs and symptoms related to lower respiratory tract infection with presence of fever 38C (100F), cough, mucopurulent sputum, pleuritic chest pain, dyspnoea, and new focal chest signs on examination such as crackles or bronchial breathing. […] Key diagnostic factors include cough with increasing sputum production, dyspnoea, pleuritic chest pain, rigors or night sweats, fever, abnormal auscultatory findings, confusion, and presence of risk factors. […] 1st investigations to order include chest x-ray, pulse oximetry, arterial blood gas (ABG), urea and electrolytes, full blood count, C-reactive protein (CRP), and liver function tests. […] Investigations to consider include blood culture, sputum culture (Gram stain), urinary antigen testing for legionella and pneumococcus, polymerase chain reaction (PCR) and/or serological tests, CT scan of chest, chest ultrasound, thoracocentesis and pleural fluid culture, computer tomographic pulmonary angiography (CTPA), bronchoscopy, serum procalcitonin, and point-of-care CRP.

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