Pneumonia: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate pneumonia (pneumonia):

  • Dyspnea (shortness of breath) is the leading symptom, along with cough, and is reported by 68% of patients <65 years of age (80% of ≥ 65-year-old patients).
  • Other classic symptoms include pleural pain due to concomitant pleurisy (pleurisy) and fever. These symptoms are rarely reported by older patients.

Note

  • Patients-particularly elderly patients (mean age 70 years)-with community acquired pneumonia (CAP) may be afebrile but still bacteremic. Predictors of afebrile bacteremia in the CAPNETZ study were.
    • A positive pneumococcal antigen test,
    • A CRP value > 200 mg/l and
    • A urea value ≥ 30 mg/dl.
  • In up to 5% of patients with initial suspicion of infectious pneumonia, other pulmonary diseases may be present (see differential diagnoses below).

In a study from the United Kingdom, a good 86% of patients with pneumonia had at least one of the following 4 symptoms:

  • Body temperature >37.8°C (relative risk [RR] = 2.6).
  • Crackling sound in the lungs (RR = 1.8)
  • Pulse > 100 beats per minute (RR = 1.9)
  • Arterial oxygen saturation (SpO2) < 95% (finger pulse oximetry) (RR = 1.7).

Pneumonia in childhood

  • In a meta-analysis of 23 prospective cohort studies involving a total of 13,833 children (1 month to 21 years of age), no single symptom proved to be determinant for the diagnosis of community-acquired pneumonia (AEP; CAP).Associations were found for:
    • Elevated body temperature (>37.5°C); sensitivity (percentage of ill patients in whom the disease is detected by use of the test, i.e., a positive test result occurs) 80-92%, specificity (likelihood that actually healthy individuals who do not have the disease in question are also detected as healthy by the test) 47-54%.
    • Tachypnea (respiratory rate > 40/min in children > 12 months); sensitivity 79%, specificity 51%.
    • At least moderate hypoxemia (oxygen saturation ≤ 96%); sensitivity 64%, specificity of 77%.
    • Increased work of breathing + breath sounds (“grunting”), nasal winging, and thoracic retractions.
    • Chest pain (in adolescents with high probability of pneumonia).

    Normal oxygen saturation (SpO2) in peripheral arterial blood (> 96%) reduced the likelihood of pneumonia.

Further notes

  • If applicable, occurrence of abdominal findings (” pneumonia belly”).
  • Note: In newborns, reflex abdominal tension and meteorism may often be absent if peritonitis (inflammation of the peritoneum) is present.

Lobar pneumonia versus bronchopneumonia

Lobar pneumonia can be distinguished early by the acute onset of symptoms from bronchopneumonia, whose symptoms develop more gradually. Lobar pneumonia – progressive form in which inflammation of lung tissue affects entire lobes of the lung – untreated.

  • Acute onset
  • Fever – febris continua around 39-40 °C
  • Cough with sputum, which from the second day is usually reddish brown with fibrin clots
  • Tachypnea (> 20 breaths per minute at rest).
  • Shallow breathing/dyspnea (shortness of breath), possibly nasal wing breathing.
  • Chills
  • Tachycardia – heartbeat too fast: > 100 beats per minute.
  • Possible accompanying myocarditis (inflammation of the heart muscle).
  • In extensive disease central cyanosis – blue-red coloration of the skin and central mucous membranes / tongue as a result of oxygen deficiency of the blood – possible
  • Respiratory-dependent chest pain (chest pain) in a concomitant pleurisy / pleurisy.
  • Possibly hemoptysis (coughing up blood)
  • Profuse sweating
  • Frequent herpes labiales (cold sores)

Due to the current use of chemotherapeutic agents, such courses of lobar pneumonia are now rarely observed.Bronchopneumonia – form of progression in which the inflammation affects the surroundings of bronchi in a focal form.

  • Irregular fever, slowly increasing.
  • Mucopurulent sputum
  • In children, vomiting, convulsions, and signs of meningeal syndrome (disease of the meninges causing various symptoms, e.g., headache, stiff neck)

Atypical pneumonia

  • Insidious onset
  • Dry irritating cough
  • Moderate fever without chills
  • Only little sputum
  • Headache and muscle pain
  • Fatigue
  • Sore throat
  • Nausea (nausea), vomiting
  • Lower individual feeling of illness

Nosocomial pneumonia (hospital-acquired pneumonia, HAP)

Because even the suspected diagnosis should be considered relevant to therapy, the diagnosis of HAP is made when there is a new or progressive pulmonary infiltrate (radiographically visible tissue compaction within the lung that occurred as a result of an inflammatory event), in combination with two or three other criteria:

  • Leukocytes (white blood cells) > 10,000 or < 4,000.
  • Fever > 38.3 °C
  • Purulent (yellowish discolored) secretion