Hidden pneumonia | How do I recognize pneumonia?

Hidden pneumonia

As pneumonia can vary greatly in its course and does not always show clear symptoms, some patients are easily overlooked. This is particularly the case with atypical pneumonia, which shows little or no fever and cough. They are easily confused with colds.

In elderly people or children, pneumonia can also go undetected for a long time. The symptoms also vary depending on the pathogen spectrum, so that in the case of atypical pathogens such as certain fungi, viruses and hospital germs, pneumonia may remain clinically inapparent (i.e. without clinical signs).Blood tests and imaging diagnostics (e.g. an x-ray) are groundbreaking in this respect.

Atypical pneumonia

Atypical pneumonia is an inflammatory disease of the respiratory tract which shows weaker clinical symptoms than the typical pneumonia. Atypical pneumonia is usually caused by viruses, but in principle it can also be caused by any other pathogen. Therefore, the classification into atypical and typical pneumonia is not very useful clinically.

Atypical pneumonia shows a rather slow onset of the disease, accompanied by headache and pain in the limbs. Fever is rather rare. The cough is usually dry and only comes on after a few days. This distinguishes atypical pneumonia from typical pneumonia, which is characterized by an acute onset of the disease with high fever and productive cough.

How is pneumonia diagnosed by a doctor?

In the examination of a typical pneumonia the blood values show increased inflammation parameters. These include an elevated CRP value, an equally elevated BSG (blood sedimentation rate) and leukocytosis (increase in the white blood cells in the blood). These parameters are typically elevated during inflammation.

Procalcitonin may also be elevated. This is also an inflammation parameter. However, the increase in inflammation values is not an obligatory criterion for the presence of pneumonia.

Especially in the case of an atypical course of the disease, viral pneumonia or, for example, a disease at an advanced age, the values may turn out to be clinically unremarkable. In addition, if pneumonia is suspected, a blood gas analysis is also performed to rule out the presence of respiratory insufficiency (i.e. breathing that is no longer completely adequate). In order to secure a bacterial infection, blood cultures are also prepared with the intention of isolating and identifying the pathogen, which then enables an adequate antibiotic therapy.

When examining the thorax (chest) with the stethoscope, signs of infiltrate are expected in the case of a classical pneumonia (typical pneumonia). Infiltrates are accumulations of substances in the tissue that do not occur naturally in other tissues. These include, for example, inflammatory cells, pathogens and pus.

During auscultatory findings (listening with a stethoscope) rales are heard in classic pneumonia. These are usually absent in atypical pneumonia. As can be seen, unfortunately, the examination is not groundbreaking in all cases and therefore only a positive result in the X-ray examination (conventional X-ray) is a main criterion for making the diagnosis of pneumonia.

In general, it is quite difficult to differentiate the disease. Even the detection of pneumonia can be difficult in the absence of symptoms.