Materiały źródłowe

• #1 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. […] Sometimes pneumonia is hard to diagnose because your symptoms may be the same as a cold or flu. […] If your provider thinks you have pneumonia, he or she may do one or more of the following tests. […] A chest X-ray is often used to diagnose pneumonia. […] If you are in the hospital, have serious symptoms, are older, or have other health problems, your provider may do other tests to diagnose pneumonia. […] 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. […] A polymerase chain reaction (PCR) test quickly checks your blood or sputum sample to find the DNA of germs that cause pneumonia. […] A chest computed tomography (CT) scan can show how much of your lungs are affected by pneumonia.

• #2 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.

• #2 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.

• #3 Pneumonia Symptoms and Diagnosis | American Lung Association

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

  Pneumonia symptoms can vary from so mild you barely notice them, to so severe that hospitalization is required. […] 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.

• #3 Pneumonia Symptoms and Diagnosis | American Lung Association

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

  Sputum test on a sample of mucus (sputum) taken after a deep cough, to look for the source of the infection. […] 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.

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

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

  Pneumonia is an infection in your lungs caused by bacteria, viruses or fungi. Pneumonia causes your lung tissue to swell (inflammation) and can cause fluid or pus in your lungs. Bacterial pneumonia is usually more severe than viral pneumonia, which often resolves on its own. […] To diagnose pneumonia, a healthcare provider will ask about your health history and conduct a physical exam. Theyll listen to your lungs with a stethoscope and may perform or order additional tests. These include imaging (like chest X-rays), pulse oximetry (checking oxygen levels in your blood), blood tests or sputum (spit) tests. […] Treatment for pneumonia depends on the cause bacterial, viral or fungal and how serious your case is. In many cases, the cause cant be determined and treatment is focused on managing symptoms and making sure your condition doesnt get worse.

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

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

  Pneumonia is an infection that causes inflammation in one or both of the lungs and may be caused by a virus, bacteria, fungi or other germs. […] 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.

• #7 Azthena logo with the word Azthena

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

  Most patients will initially have to undergo a chest x-ray. However, in severe cases, or in patients where initial treatment methods are not producing positive results, a computerized tomography (CT) scan may be performed, which generates more detailed diagnostic imagery. […] An alternative technique, used in particular for patients who are hospitalized and/or not responding to antibiotics, is bronchoscopy. This is a procedure used to visualize the airways. It involves the insertion of a tube containing a camera down the airway and into the lung where inflamed tissue may be observed. […] To assess if the lungs are operating at optimal levels with regards to their gas exchange, an arterial blood gas (ABG) test may be done. […] Given that pneumonia can be caused by one of over 30 different microorganisms, it is important to identify the underlying cause of each patient’s pneumonia, if possible. Distinguishing the causative agent is important for guiding subsequent treatment decisions.

• #10 Pneumonia Pathology – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK526116/

  According to the Infectious Diseases Society of America (IDSA) and American Thoracic Society (ATS) guidelines, a demonstratable infiltrate by chest x-ray is necessary and is considered the best method (with supportive clinical findings) for the diagnosis of pneumonia. […] Evaluation of CAP and HAP involves: Clinical Evaluation […] Radiological Evaluation […] Laboratory Evaluation […] Evaluation of VAP, on the other hand, is a bit different from that of CAP. […] Management of CAP involves initial risk stratification of the patient and to decide whether to manage the patient on an outpatient basis, in a general medicine ward, or in an intensive care unit (ICU) setting. […] Management of VAP and HaP is in accordance with the ATS/IDSA guidelines. […] The current guidelines for the management of CAP, VAP, and HAP are laid down by the American Thoracic Society in conjunction with the Infectious Diseases Society of America and are reviewed periodically.

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

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

  The sensitivity of the pneumococcal urine antigen test is 50 to 80 percent with a specificity of greater than 90 percent. […] Urine antigen tests are better at ruling in disease when positive; a negative test result does not rule out infection with a specific pathogen given its somewhat limited sensitivity. […] 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 estimated direct cost of a single CAP hospitalization ranges from $3,000 to $13,000. […] 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. […] 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. […] Treatment of patients who do not respond well to initial treatment is summarized in Table 8.

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

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

  All patients with CAP who are admitted to the intensive care unit should be treated with dual therapy. […] 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. […] 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. […] 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.

• #11 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. […] Initial evaluation should determine the need for hospitalization versus outpatient management using validated mortality or severity prediction scores. […] In patients with clinically suspected CAP, chest radiography should be obtained to confirm the diagnosis. […] 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; this testing usually is not required in outpatients. […] Mortality and severity prediction scores should be used to determine inpatient versus outpatient care for patients with CAP.

• #14 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 disease may be classified by where it was acquired, such as community- or hospital-acquired or healthcare-associated pneumonia. […] Pneumonia is typically diagnosed based on a combination of physical signs and often a chest X-ray. […] In recent years, however, the role of lung ultrasonography has gained prominence, with substantial evidence demonstrating that, in expert hands, it surpasses radiography in accuracy. […] However, the underlying cause can be difficult to confirm, as there is no definitive test able to distinguish between bacterial and non-bacterial cause.

• #14 Pneumonia – Wikipedia

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

  The overall impression of a physician appears to be at least as good as decision rules for making or excluding the diagnosis. […] In children, low oxygen levels and lower chest indrawing are more sensitive than hearing chest crackles with a stethoscope or increased respiratory rate. […] 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. […] The diagnosis of influenza-like illness can be made based on the signs and symptoms; however, confirmation of an influenza infection requires testing.

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

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

  The early diagnosis and treatment of the disease should be considered a topmost priority, because pneumonia in children and elderly patients may lead to long-lasting effects on the lungs and the development of restrictive and obstructive lung function deficiencies. […] 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.

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

  https://medlineplus.gov/pneumonia.html

  Pneumonia is an infection in one or both of your lungs. It causes the air sacs of your lungs to fill up with fluid or pus. Pneumonia can range from mild to severe, depending on what caused it, your age, and your overall health. […] Sometimes pneumonia can be hard to diagnose. This is because it can cause some of the same symptoms as a cold or the flu. It may take time for you to realize that you have a more serious condition. […] To find out if you have pneumonia, your health care provider: Will take your medical history, which includes asking about your symptoms; Will do a physical exam, which includes listening to your lungs with a stethoscope; May order various tests, such as: A chest x-ray; Blood tests such as a complete blood count (CBC) to see if your immune system is actively fighting an infection; A blood culture to find out whether you have a bacterial infection that has spread to your bloodstream.

• #19 Community-Acquired Pneumonia in Adults: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/1101/p698.html

  Community-acquired pneumonia is a leading cause of death. Diagnosis is suggested by a history of cough, dyspnea, pleuritic pain, or acute functional or cognitive decline, with abnormal vital signs (e.g., fever, tachycardia) and lung examination findings. Diagnosis should be confirmed by chest radiography or ultrasonography. […] For patients with severe community-acquired pneumonia, corticosteroids decrease the risk of adult respiratory distress syndrome and modestly reduce intensive care unit and hospital stays, duration of intravenous antibiotic treatment, and time to clinical stability without increasing major adverse events. […] In patients with suspected CAP, chest radiography or lung ultrasonography should be performed to confirm the diagnosis. […] Although Streptococcus pneumoniae remains the most commonly isolated pathogen in CAP, the relative frequency of other pathogens has increased.

• #19 Community-Acquired Pneumonia in Adults: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/1101/p698.html

  Most patients with CAP present with a combination of cough, dyspnea, pleuritic pain, fever or chills, and malaise. […] Guidelines from the Infectious Diseases Society of America advise diagnosing CAP based on suggestive examination findings and characteristic infiltrate on chest radiography with or without microbiologic data. […] Lung imaging with chest radiography has been the standard method of diagnosing pneumonia. […] Routine microbiologic testing of outpatients with CAP is unnecessary. […] The overall rate of pathogen detection among patients with CAP is 30% to 40%. […] To improve patient outcomes and reduce unnecessary antibiotic exposure, procalcitonin is being studied as a potential biomarker of severe CAP.

• #20 Pneumonia

  https://www.nhs.uk/conditions/pneumonia/

  You can catch pneumonia from someone who has it, or you can sometimes get it if you have another infection such as: flu, respiratory syncytial virus (RSV), COVID-19. […] There are several vaccines available to help protect you or your child from infections that can cause pneumonia: pneumococcal vaccine recommended for babies, adults over 65 and people at higher risk of pneumococcal infections, flu vaccine recommended during pregnancy, for adults over 65, people with certain long-term health conditions and those at high risk of catching or passing on flu, RSV vaccine recommended for adults aged 75 to 79, and during pregnancy (from 28 weeks onwards) to help protect your baby after they’re born, COVID-19 vaccine a seasonal vaccine that’s recommended for people at increased risk from COVID-19.

• #21 Ultrasound Diagnosis of Pneumonia | Emory School of Medicine

  https://med.emory.edu/departments/emergency-medicine/sections/ultrasound/case-of-the-month/lung/pneumonia.html

  Ultrasonographic artifacts may be useful in diagnosing lung pathology. Dr. Lefkove makes use of the C Line artifact to diagnose pneumonia. […] C lines may be suggestive of pneumonia in the right context. […] Ultrasound is sensitive for the diagnosis of pneumonia. In the study referenced below of 120 patients, 81 (67.5%) had a confirmed diagnosis of pneumonia. […] Lung ultrasound was positive in 80/81 (sensitivity 98%; 95% CI 93.3% to 99.9%) and negative in 37/39 (specificity 95%; 95% CI 82.7% to 99.4%). […] Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department.

• #22 Viral Pneumonia | Diagnosis & Disease Information – Pulmonology Advisor

  https://www.pulmonologyadvisor.com/ddi/viral-pneumonia/

  Diagnosis of viral pneumonia can be challenging and frequently is based on excluding bacteria as the cause. Advances in diagnostic testing, such as the availability of multiplex polymerase chain reaction (PCR) testing, which allow simultaneous identification of many viruses, have simplified the process. […] Chest X-ray can be used to confirm a diagnosis of viral pneumonia. Viral pneumonia presents with bilateral lung involvement and with interstitial infiltrates, while bacterial pneumonia typically presents with lobar involvement and alveolar infiltrates. A chest X-ray or computed tomography scan may be helpful. […] To avoid unnecessary treatment with antibiotics, clinicians first need to determine if the cause of a patients pneumonia is viral or bacterial. Clinical and radiographic features are insufficient to differentiate viral pneumonia from bacterial pneumonia. In addition, patients with pneumonia often have coinfection with both viral and bacterial pathogens. Laboratory results are necessary to confirm the etiology of pneumonia is viral.

• #23 Ultra Low Dose CT for Pneumonia Diagnosis | RSNA

  https://www.rsna.org/news/2025/march/ultra-low-dose-ct-for-pneumonia-diagnosis

  Denoised ultra-low dose CT (ULDCT) can effectively diagnose pneumonia in immunocompromised patients using only 2% of the radiation dose of standard CT, according to a study published in Radiology: Cardiothoracic Imaging. […] CT scans are the gold standard for detecting pneumonia, but repeated scans can expose patients to significant radiation. […] ULDCT reduces radiation exposure but can result in poor image quality due to added noise, which manifests as a grainy texture throughout the image. This reduction in image quality can affect the accuracy of diagnosis. […] The deep learning algorithm significantly improved the image quality and clarity of the ULDCT scans and reduced false positives. Nodules were also more easily identified on the denoised scans. […] This study paves the way for safer, AI-driven imaging that reduces radiation exposure while preserving diagnostic accuracy, Dr. Klug said. […] This pilot study identified infection with a fraction of the radiation dose, Dr. Klug said. This approach could drive larger studies and ultimately reshape clinical guidelines, making denoised ultra-low dose CT the new standard for young immunocompromised patients.

• #24 Inappropriate diagnosis of pneumonia in adult patients common, study finds | CIDRAP

  https://www.cidrap.umn.edu/antimicrobial-stewardship/inappropriate-diagnosis-pneumonia-adult-patients-common-study-finds

  A study of hospitals in Michigan found that one in eight patients treated for pneumonia were inappropriately diagnosed, researchers reported today in JAMA Internal Medicine. […] The cohort study of more than 17,000 hospitalized adults treated for pneumonia at 48 Michigan hospitals found that 12% were inappropriately diagnosed. Older patients, those with dementia, and patients presenting with altered mental status were the most likely to be improperly diagnosed. […] The researchers wanted to explore how many pneumonia patients are wrongly diagnosed, because little is known about how frequently inappropriate diagnosis occurs and what the risk factors are. The practice may also cause harm. […] „Inappropriate diagnosis of CAP may harm patients through delayed recognition and treatment of acute (eg, exacerbations of congestive heart failure), chronic (eg, pulmonary cancer), or novel diagnoses (eg, pulmonary cancer) and may lead to unnecessary antibiotic use, adverse effects, and antibiotic resistance,” they wrote.

• #25 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/

  Rapid diagnosis strategy of pneumonia for clinicians PDF to download […] 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. […] 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. […] 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. […] Hypoxemia may influence the prognosis of patients with CAP independently of the CRB-65.

• #26 Bacterial Pneumonia Workup: Approach Considerations, Routine Laboratory Tests, Blood Studies

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

  Diagnostic testing in patients with suspected pneumonia is driven mostly by the possibility that the results would significantly alter empiric therapy and management decisions and whether the test is likely to have a high yield. […] Diagnostic testing is also useful in classifying the severity of illness and site-of-care decisions (outpatient vs inpatient vs intensive care unit [ICU]). The most obvious indication for extensive diagnostic testing is in the critically ill patient. […] Various tools to assess the severity of disease and risk of death exist and are in wide use, including the PSI/PORT (ie, pneumonia severity index/Patient Outcomes Research Team score), the CURB-65 system (ie, confusion, urea, respiratory rate, blood pressure, and age 65 y), and the APACHE (ie, acute physiology and chronic health evaluation), among others discussed under Risk Stratification in the Clinical Presentation section. A number of laboratory values are commonly used in the calculation of these risk indices.

• #27 Atypical pneumonia – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/18

  Atypical pneumonia (non-COVID-19) is a community-acquired infection often seen in young adults or children living in close proximity. […] Diagnosis is mostly clinical. Molecular-based diagnosis of nasopharyngeal swabs, throat swabs or sputum can be performed. Serology can be used to confirm the diagnosis. […] Key diagnostic factors include age 50 years, persistent cough, dry cough, and long duration of symptoms. […] 1st tests to order include 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, and chest x-ray. […] Tests to consider include urinary Legionella antigen, sputum culture, molecular diagnosis of Mycoplasma pneumoniae or Chlamydophila pneumoniae, and nasopharyngeal PCR.

• #28 Community-Acquired Pneumonia: Challenges and Solutions

  https://www.healthtrackrx.com/for-practitioners/the-burden-and-challenges-of-community-acquired-pneumonia-diagnosis/

  Improved diagnostics, such as syndromic PCR with rapid turn-around time, could potentially reduce unnecessary antibiotic exposure, increase appropriate antiviral use, reduce hospital length of stays, and reduce overall patient costs. […] Recent studies have begun to examine the utility of rapid PCR for diagnosing and directing treatment for viral and bacterial pathogens causing CAP. […] As multiplex PCR has the ability to detect bacteria in the presence of contaminants, it may be able to reduce diagnostic errors associated with CAP and improve the frequency with which patients receive narrow-spectrum, pathogen-directed treatment. […] As access to PCR continues to expand, additional studies are needed to better understand the clinical utility of PCR for pneumonia and to describe the clinical outcomes associated with patients receiving a PCR test with rapid results, especially in the outpatient space.

• #29

  https://link.springer.com/article/10.2165/00003495-200060060-00004

  Compared with CAP, nosocomial pneumonia has major diagnostic problems due to the presence of other diseases able to mimic pneumonia and frequent bacterial colonisation of the lower respiratory tract. Most of the diagnostic techniques produce a high percentage of false-negative and false-positive results. This is especially true for ventilator-associated pneumonia. […] There is controversy over using a comprehensive aetiological work-up based on bronchoscopic techniques or only on quantitative culture of endotracheal aspiration. By contrast, there is consensus about the importance of the adequacy of empirical antibiotic treatment, since mortality rates are higher in patients who are inadequately treated. […] Once treatment of pneumonia has begun, it must be maintained for 48 to 72 hours because this is the minimum time to evaluate a clinical response. Antibacterial agents have to be adjusted according to microbiological findings. In nonresponding patients, pneumonia-related complications and the presence of multiresistant micro-organisms or non-covered pathogens must be ruled out.

• #30 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. […] 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.

• #31 Community-Acquired Pneumonia – Pulmonary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/pulmonary-disorders/pneumonia/community-acquired-pneumonia

  Community-acquired pneumonia is defined as pneumonia that is acquired outside the hospital. […] Diagnosis is based on clinical presentation and chest x-ray. […] Diagnosis of pneumonia is suspected on the basis of clinical presentation and infiltrate seen on chest x-ray. […] When there is high clinical suspicion of pneumonia and the chest x-ray does not reveal an infiltrate, doing computed tomography (CT) or repeating the chest x-ray in 24 to 48 hours is recommended. […] Severity of the pneumonia is estimated using a variety of clinical and laboratory factors (see Risk Stratification), which are sometimes organized using quantitative scoring systems. […] Typically, testing includes oxygen saturation, complete blood count, and a basic or complete metabolic profile. […] Differential diagnosis in patients presenting with pneumonia-like symptoms includes acute bronchitis and exacerbation of chronic obstructive pulmonary disease (COPD), which can be distinguished from pneumonia by the absence of infiltrates on chest x-ray.

• #31 Community-Acquired Pneumonia – Pulmonary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/pulmonary-disorders/pneumonia/community-acquired-pneumonia

  Chest x-ray findings generally cannot distinguish one type of infection from another, although the following findings are suggestive: Multilobar infiltrates suggest S. pneumoniae or Legionella pneumophila infection. […] Interstitial pneumonia (on chest x-ray, appearing as increased interstitial markings and subpleural reticular opacities that increase from the apex to the bases of the lungs) suggests viral or mycoplasmal etiology. […] Cavitating pneumonia suggests S. aureus or a fungal or mycobacterial etiology. […] Blood cultures, which are often obtained in patients hospitalized for pneumonia, can identify causative bacterial pathogens if bacteremia is present. […] Sputum testing can include Gram stain and culture for identification of the pathogen, but the value of these tests is uncertain because specimens often are contaminated with oral flora and overall diagnostic yield is low.

• #31 Community-Acquired Pneumonia – Pulmonary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/pulmonary-disorders/pneumonia/community-acquired-pneumonia

  Distinguishing between bacterial and viral pneumonias is challenging. […] In outpatients with mild pneumonia, with the exception of COVID-19 testing and influenza testing during influenza season, no further diagnostic testing is needed. […] For patients with moderate or severe pneumonia, a white blood cell count and measurement of electrolytes, blood urea nitrogen (BUN), and creatinine are useful to classify risk and hydration status. […] For patients with moderate or severe pneumonia who require hospitalization, 2 sets of blood cultures are obtained to assess for bacteremia and sepsis. […] Additional tests indicated in these patients include sputum Gram stain and culture, urine pneumococcal and Legionella antigen testing, respiratory viral panel by multiplex polymerase chain reaction (PCR), and HIV screening.

• #31 Community-Acquired Pneumonia – Pulmonary Disorders – MSD Manual Professional Edition

  https://www.msdmanuals.com/professional/pulmonary-disorders/pneumonia/community-acquired-pneumonia

  Diagnosis of etiology can be difficult. […] Identification of the pathogen can be useful to direct therapy and verify bacterial susceptibilities to antibiotics. […] However, because of the limitations of current diagnostic tests and the success of empiric antibiotic treatment, experts recommend limiting attempts at microbiologic identification (eg, cultures, specific antigen testing) unless patients are at high risk or have complications (eg, severe pneumonia, immunocompromise, asplenia, failure to respond to empiric therapy). […] In general, the milder the pneumonia, the less such diagnostic testing is required. […] Critically ill patients, patients in whom an antibiotic-resistant or unusual organism (eg, Mycobacterium tuberculosis, P. jirovecii) is suspected, and patients whose condition is deteriorating or who are not responding to treatment within 72 hours require the most intensive testing.

• #32 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.

• #32 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.

• #33 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.

• #33 Pneumonia – Knowledge @ AMBOSS

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

  New pulmonary infiltrate on chest imaging (e.g., CXR) AND 1 new or increased respiratory symptom: e.g., cough, sputum, dyspnea, or pleuritic pain AND 1 of the following: Fever or hypothermia, Leukocytosis, bandemia, or leukopenia, Hypoxemia. […] A new pulmonary infiltrate on chest x-ray in a patient with classic signs and symptoms of pneumonia confirms the diagnosis. […] Typical pneumonia usually appears as lobar pneumonia on x-ray, while atypical pneumonia tends to appear as interstitial pneumonia. However, the underlying pathogen cannot be conclusively identified based on imaging results alone.

• #34 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

  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. […] To evaluate a diagnostic test such as a chest radiograph, we compare its performance to a gold standard. […] Therefore, this discussion really asks, What is pneumonia, and how accurately can a chest radiograph detect it? […] Currently there is no single test that can reliably rule in or out all these features of pneumonia. […] So to what extent can a chest radiograph help? […] More importantly the interpretation of the image is often difficult and frequently inconsistent. […] In this context, the chest radiograph demonstrates none of the performance characteristics that would be associated with a diagnostic test and therefore whilst it is an important tool to help manage some patients with possible respiratory infection, it should not be required for the diagnosis of pneumonia which is a clinical syndrome.

• #35 Patient education: Pneumonia in adults (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/pneumonia-in-adults-beyond-the-basics

  Urine testing — Urine tests can be helpful for diagnosing pneumonia caused by two bacteria, Streptococcus pneumoniae and Legionella pneumophila. These tests can be done easily by a lab technician and provide immediate results. […] Blood testing — People who are hospitalized require blood testing, including a complete blood cell count (CBC) and often a blood culture. A CBC measures the number of many types of blood cells, including white blood cells (WBC); these cells increase in number when there is a bacterial infection. An increased number of WBCs is one indicator that a bacterial infection, including pneumonia, may be present. […] A blood culture is used to determine whether the infection has spread from the lungs into the blood stream. It involves taking a sample of blood from a vein and testing it for bacteria. Normally, there should be no bacteria in the bloodstream. Blood cultures are used to identify the bacteria that caused the pneumonia and to guide the choice of antibiotic. Your doctor may switch you to a different antibiotic when results of the blood or sputum cultures are completed (usually after 48 to 72 hours).

• #36 Community-Acquired Pneumonia: Diagnosis, Treatment, and More

  https://www.healthline.com/health/pneumonia/community-acquired-pneumonia

  Pneumonia is an infection in one or both lungs. […] Pneumonia affects millions of people around the world each year. […] When this happens, doctors refer to it as community-acquired pneumonia (CAP). […] CAP is the most common type of pneumonia people experience. […] This article will look at CAP, how it compares with other types of pneumonia, and what you can do to protect yourself. […] Pneumonia has many causes. […] The most common causes of CAP in the United States are: human rhinovirus (common cold), influenza virus (flu), Streptococcus pneumoniae. […] Certain conditions may increase your risk of developing CAP. […] If a doctor notices you have symptoms of CAP, they will likely perform or order the following: Medical history, Physical exam, Chest X-ray, CT scan, Complete blood count (CBC), Electrolyte panel, Blood, sputum, or urine tests, Molecular testing.

• #37 Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/10/633

  Patients with suspected HAP or VAP who are immunocompromised, hemodynamically unstable, or unable to produce timely lower respiratory tract samples for microbiologic testing merit empiric antibiotic treatment with a regimen based on individual risk factors and local antibiotic resistance. […] The diagnosis of HAP and VAP requires all of the following: New lung infiltrates on chest imaging, Respiratory decline, Fever, Productive cough. […] Once an infiltrate is observed and HAP or VAP is suspected as the cause of respiratory decline, several noninvasive tests are recommended to isolate a pathogen and promptly tailor empiric antibiotics to the culprit organism. […] Blood cultures are recommended for all patients diagnosed with HAP or VAP. […] Sputum cultures should be obtained in patients with HAP and in nonintubated patients with VAP who are capable of producing a sufficient sample, characterized by few to no squamous epithelial cells on Gram stain.

• #37 Hospital-acquired and ventilator-associated pneumonia: Diagnosis, management, and prevention | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/87/10/633

  Procalcitonin testing can help differentiate viral from bacterial pathogens in patients with HAP or VAP and potentially identify cases of coinfection. […] The duration of the antibiotic course in uncomplicated HAP and VAP is 7 days, as longer courses have not been shown to reduce rates of recurrent pneumonia, treatment failure, duration of mechanical ventilation, hospital length of stay, or mortality. […] Preventing HAP and VAP is as important as diagnosing and managing them and depends upon multiple approaches to address individual aspiration risk factors and nosocomial transmission of disease.

• #38 Pneumonia Diagnosis & Treatments Grand Rapids | Cascade Twp, MI

  https://wellcareurgentcare.com/medical-conditions/infection/pneumonia/

  This is an infection of the lungs. It causes inflammation of the air sacs in either one or both lungs. […] Pneumonia can be severe in older adults and young children, those with weak immune systems can also be affected greatly. It can be caused by bacteria, viruses or fungi. […] At WellCare Urgent Care center we can help identify the cause of your pneumonia and give you proper treatment. […] There are various treatments used for pneumonia. The treatment used will depend on the type and severity of your illness as well as your age and overall health. […] Pneumonia can be life-threatening to those who are either very young, elderly or have weak immune symptoms. If this is the case for you then you should visit an emergency room. […] If you think you have pneumonia it is important to seek care from a medical professional. Although pneumonia is fairly common, it can be life-threatening. Visit WellCare Urgent Care center in Grand Rapids to get a proper diagnosis and treatment started.

• #39 Mycoplasma Pneumoniae Infections Have Been Increasing | NCIRD | CDC

  https://www.cdc.gov/ncird/whats-new/mycoplasma-pneumoniae-infections-have-been-increasing.html

  Respiratory infections caused by the bacteria Mycoplasma pneumoniae have increased in the United States, especially in young children. […] Healthcare providers should consider M. pneumoniae as a cause of pneumonia and test when indicated. […] M. pneumoniae infections are common, with an estimated 2 million infections occurring each year in the United States. […] CDC routinely monitors emergency department care of people with pneumonia and other respiratory diseases. […] So far in 2024, CDC has seen an increase in the percentage of pneumonia-associated emergency department visits with a discharge diagnosis of M. pneumoniae. […] The M. pneumoniae discharge diagnosis data from March 31 through October 5, 2024, show an increase among all age groups across the United States, peaking in August, and remaining high.

Zobacz więcej