Pneumonia is typically diagnosed based on a combination of physical signs and a chest X-ray. In adults with normal vital signs and a normal lung examination the diagnosis is unlikely. However, the underlying cause can be difficult to confirm, as there is no definitive test able to distinguish between bacterial and non-bacterial origin. The overall impression of a physician appears to be at least as good as decision rules for making or excluding the diagnosis. The World Health Organization has defined pneumonia in children clinically based on either a cough or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness.
Diagnosis
Pneumonia
Pneumonia | Diagnosis
It is typically diagnosed based on a combination of physical signs and a chest X-ray. It is typically diagnosed based on a combination of physical signs and a chest X-ray. Diagnosis is often based on symptoms and physical examination - chest X-rays, blood tests, and culture of the sputum may help confirm the diagnosis. It is typically diagnosed based on a combination of physical signs and a chest X-ray
who does the voice over for bart simpson
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Nancy Jean Cartwright
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when did she start her career?
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She moved to Hollywood in 1978 and trained alongside voice actor Daws Butler.
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who is this other voice actor?
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He worked mostly for the Hanna-Barbera animation production company where he originated the voices of many familiar characters, including Loopy De Loop.
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how did he die?
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He had suffered a stroke and been battling pneumonia in the last few months before he died.
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the disease that he battled with, what are its symptoms?
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Some combination of productive or dry cough, chest pain, fever and difficulty breathing.
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how can it be diagnosed?
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Pneumonia is typically diagnosed based on a combination of physical signs and a chest X-ray. In adults with normal vital signs and a normal lung examination the diagnosis is unlikely. However, the underlying cause can be difficult to confirm, as there is no definitive test able to distinguish between bacterial and non-bacterial origin. The overall impression of a physician appears to be at least as good as decision rules for making or excluding the diagnosis. The World Health Organization has defined pneumonia in children clinically based on either a cough or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness.
Pneumonia | Diagnosis
In hospitalised patients who develop respiratory symptoms and fever, one should consider the diagnosis. The likelihood increases when upon investigation symptoms are found of respiratory insufficiency, purulent secretions, newly developed infiltrate on the chest X-Ray, and increasing leucocyte count. If pneumonia is suspected material from sputum or tracheal aspirates are sent to the microbiology department for cultures. In case of pleural effusion, thoracentesis is performed for examination of pleural fluid. In suspected ventilator-associated pneumonia it has been suggested that bronchoscopy(BAL) is necessary because of the known risks surrounding clinical diagnoses.
Hospital-acquired pneumonia | Diagnosis
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.
Pneumonia | Diagnosis
Patients with symptoms of CAP require evaluation. Diagnosis of pneumonia is made clinically, rather than on the basis of a particular test. Evaluation begins with a physical examination by a health provider, which may reveal fever, an increased respiratory rate (tachypnea), low blood pressure (hypotension), a fast heart rate (tachycardia) and changes in the amount of oxygen in the blood. Palpating the chest as it expands and tapping the chest wall to identify dull, non-resonant areas can identify stiffness and fluid, signs of CAP. Listening to the lungs with a stethoscope (auscultation) can also reveal signs associated with CAP. A lack of normal breath sounds or the presence of crackles can indicate fluid consolidation.
Community-acquired pneumonia | Diagnosis
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever and difficulty breathing. The severity of the condition is variable. Pneumonia is usually caused by infection with viruses or bacteria, and less commonly by other microorganisms. Identifying the responsible pathogen can be difficult. 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 | Introduction
The diagnosis can be confirmed by the characteristic appearance of the chest X-ray and an arterial oxygen level (PaO) that is strikingly lower than would be expected from symptoms. Gallium 67 scans are also useful in the diagnosis. They are abnormal in about 90% of cases and are often positive before the chest X-ray becomes abnormal. Chest X-ray typically shows widespread pulmonary infiltrates. CT scan may show pulmonary cysts (not to be confused with the cyst-forms of the pathogen). The diagnosis can be definitively confirmed by histological identification of the causative organism in sputum or bronchoalveolar lavage (lung rinse). Staining with toluidine blue, silver stain, periodic acid-Schiff stain, or an immunofluorescence assay shows the characteristic cysts.
Pneumocystis pneumonia | Diagnosis
UIP may be diagnosed by a radiologist using computed tomography (CT) scan of the chest, or by a pathologist using tissue obtained by a lung biopsy.
Usual interstitial pneumonia | Diagnosis
Additional tests include X-ray computed tomography, bronchoscopy or lung biopsy.
Community-acquired pneumonia | Prognosis
The symptoms of pneumonia are fever, productive cough, shortness of breath, and pleuritic chest pain. Inspiratory crackles may be heard on exam. A chest x-ray can be useful to differentiate pneumonia from congestive heart failure. As the cause is usually a bacterial infection, antibiotics are typically used for treatment.
Shortness of breath | Pneumonia
For recurrent pneumonia, underlying lung cancer, metastasis, tuberculosis, a foreign bodies, immunosuppression, and hypersensitivity should be suspected.
Pneumonia | Differential diagnosis
CAP is diagnosed by assessing symptoms, performing a physical examination, by x-ray or by sputum examination. Patients with CAP sometimes require hospitalization, and it is treated primarily with antibiotics, antipyretics and cough medicine. Some forms of CAP can be prevented by vaccination and by abstaining from tobacco products.
Community-acquired pneumonia | Introduction
A chest radiograph is frequently used in diagnosis. In people with mild disease, imaging is needed only in those with potential complications, those not having improved with treatment, or those in which the cause is uncertain. If a person is sufficiently sick to require hospitalization, a chest radiograph is recommended. Findings do not always match the severity of disease and do not reliably separate between bacterial and viral infection. X-ray presentations of pneumonia may be classified as lobar pneumonia, bronchopneumonia, lobular pneumonia, and interstitial pneumonia. Bacterial, community-acquired pneumonia classically show lung consolidation of one lung segmental lobe, which is known as lobar pneumonia.
Pneumonia | Imaging
Several diseases can present with similar signs and symptoms to pneumonia, such as: chronic obstructive pulmonary disease, asthma, pulmonary edema, bronchiectasis, lung cancer, and pulmonary emboli. Unlike pneumonia, asthma and COPD typically present with wheezing, pulmonary edema presents with an abnormal electrocardiogram, cancer and bronchiectasis present with a cough of longer duration, and pulmonary emboli present with acute onset sharp chest pain and shortness of breath. Mild pneumonia should be differentiated from upper respiratory tract infection (URTI). Severe pneumonia should be differentiated from acute heart failure. Pulmonary infiltrates that resolved after giving mechanical ventilation should point to heart failure and atelectasis rather than pneumonia.
Pneumonia | Differential diagnosis
Fungal pneumonia can be diagnosed in a number of ways. The simplest and cheapest method is to culture the fungus from a patient's respiratory fluids. However, such tests are not only insensitive but take time to develop which is a major drawback because studies have shown that slow diagnosis of fungal pneumonia is linked to high mortality. Microscopy is another method but is also slow and imprecise. Supplementing these classical methods is the detection of antigens. This technique is significantly faster but can be less sensitive and specific than the classical methods. A molecular test based on quantitative PCR is also available from Myconostica.
Fungal pneumonia | Diagnosis
Clinical features may include initial symptoms of an upper respiratory tract infection mimicking a viral infection, usually associated with fevers, often low-grade. This may progress to the lower respiratory tract in a few days, with features often resembling those of a wheezy bronchitis. Sputum may be difficult to expectorate and is often grey or creamy in color. The cough may persist for weeks without appropriate treatment. Many cases are diagnosed after presenting chest infections that do not respond to penicillins or first-generation cephalosporins. A chest X-ray can identify alveolar consolidation. Clinical diagnosis of "H. influenzae" is typically performed by bacterial culture or latex particle agglutinations.
Haemophilus influenzae | Diagnosis
Diagnosis of "Mycoplasma pneumoniae" infections is complicated by the delayed onset of symptoms and the similarity of symptoms to other pulmonary conditions. Often, "M. pneumoniae" infections are diagnosed as other conditions and, occasionally, non-pathogenic mycoplasmas present in the respiratory tract are mistaken for "M. pneumoniae". Historically, diagnosis of "M. pneumoniae" infections was made based on the presence of cold agglutinins and the ability of the infected material to reduce tetrazolium. Causative diagnosis is dependent upon laboratory testing, however these methods are more practical in epidemiological studies than in patient diagnosis. Culture tests are rarely used as diagnostic tools; rather immunoblotting, immunofluorescent staining, hemadsorption tests, tetrazolium reduction, metabolic inhibition tests, serological assays, and polymerase chain reaction (PCR) are used for diagnosis and characterization of bacterial pneumonic infections.
Mycoplasma pneumoniae | Diagnosis
A chest X-ray or CT is necessary to differentiate between pneumonitis and pneumonia of an infectious etiology. Some degree of pulmonary fibrosis may be evident in a CT which is indicative of chronic pulmonary inflammatory processes. Diagnosis of Pneumonitis is often difficult as it depends on a high degree of clinical suspicion when evaluating a patient with a recent onset of a possible interstitial lung disease. In addition, interpreting pathologic and radiographic test results remains a challenge to clinicians. Pneumonitis is often difficult to recognize and discern from other interstitial lung diseases. Diagnostic procedures currently available include: Exposure to causative agents of pneumonitis in a specific environment can be confirmed through aero/microbiologic analysis to verify its presence.
Pneumonitis | Diagnosis
The diagnosis is typically made by clinical examination. Chest X-ray is sometimes useful to exclude bacterial pneumonia, but not indicated in routine cases. Chest x-ray may also be useful in people with impending respiratory failure. Additional testing such as blood cultures, complete blood count, and electrolyte analyses are not recommended for routine use although may be useful in children with multiple comorbidities or signs of sepsis or pneumonia. Testing for the specific viral cause can be done but has little effect on management and thus is not routinely recommended. RSV testing by direct immunofluorescence testing on nasopharyngeal aspirate had a sensitivity of 61% and specificity of 89%.
Bronchiolitis | Diagnosis
The differential diagnosis includes other types of lung disease that cause similar symptoms and show similar abnormalities on chest radiographs. Some of these diseases cause fibrosis, scarring or honeycomb change. The most common considerations include:
Usual interstitial pneumonia | Differential diagnosis
Initial descriptions of pneumonia focused on the anatomic or pathologic appearance of the lung, either by direct inspection at autopsy or by its appearance under a microscope. The discovery of x-rays made it possible to determine the anatomic type of pneumonia without direct examination of the lungs at autopsy and led to the development of a radiological classification. Early investigators distinguished between typical lobar pneumonia and atypical (e.g. Chlamydophila) or viral pneumonia using the location, distribution, and appearance of the opacities they saw on chest x-rays. Certain x-ray findings can be used to help predict the course of illness, although it is not possible to clearly determine the microbiologic cause of a pneumonia with x-rays alone.
Classification of pneumonia | By area of lung affected
Eosinophilic pneumonia is diagnosed in one of three circumstances: when a complete blood count reveals increased eosinophils and a chest X-ray or computed tomography identifies abnormalities in the lungs, when a biopsy identifies increased eosinophils in lung tissue, or when increased eosinophils are found in fluid obtained by a bronchoscopy (bronchoalveolar lavage fluid). Association with medication or cancer is usually apparent after review of a person's medical history. Specific parasitic infections are diagnosed after examining a person's exposure to common parasites and performing laboratory tests to look for likely causes. If no underlying cause is found, a diagnosis of acute or chronic eosinophilic pneumonia is made based upon the following criteria.
Eosinophilic pneumonia | Diagnosis
Pneumonia has been a common disease throughout human history. The word is from Greek πνεύμων (pneúmōn) meaning "lung". The symptoms were described by Hippocrates (c. 460–370 BC): "Peripneumonia, and pleuritic affections, are to be thus observed: If the fever be acute, and if there be pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated be of a blond or livid color, or likewise thin, frothy, and florid, or having any other character different from the common... When pneumonia is at its height, the case is beyond remedy if he is not purged, and it is bad if he has dyspnoea, and urine that is thin and acrid, and if sweats come out about the neck and head, for such sweats are bad, as proceeding from the suffocation, rales, and the violence of the disease which is obtaining the upper hand." However, Hippocrates referred to pneumonia as a disease "named by the ancients".
Pneumonia | History
Physical examination may sometimes reveal low blood pressure, high heart rate, or low oxygen saturation. The respiratory rate may be faster than normal, and this may occur a day or two before other signs. Examination of the chest may be normal, but it may show decreased expansion on the affected side. Harsh breath sounds from the larger airways that are transmitted through the inflamed lung are termed bronchial breathing and are heard on auscultation with a stethoscope. Crackles (rales) may be heard over the affected area during inspiration. Percussion may be dulled over the affected lung, and increased, rather than decreased, vocal resonance distinguishes pneumonia from a pleural effusion.
Pneumonia | Physical exam
Evaluation of aspiration is generally performed with a video fluoroscopic swallowing study involving radiologic evaluation of the swallowing mechanism via challenges with liquid and solid food consistencies. These studies allow for evaluation of penetration to the vocal folds and below but are not a sensitive and specific marker for aspiration. Additionally, it is difficult to distinguish between aspiration pneumonia and aspiration pneumonitis. Aspiration pneumonia is typically diagnosed by a combination of clinical circumstances (people with risk factors for aspiration) and radiologic findings (an infiltrate in the proper location). A chest x-ray is typically performed in cases where any pneumonia is suspected, including aspiration pneumonia.
Aspiration pneumonia | Diagnosis
Pigs usually cough and may show more severe respiratory signs if secondary bacteria have invaded. This may lead to signs of pneumonia and systemic involvement. Diagnosis relies on culture and isolation of the bacteria but this can be challenging. PCR, ELISA, fluorescent antibody testing and post-mortem findings all help in making the diagnosis.
Porcine enzootic pneumonia | Clinical signs and diagnosis
He also reported the results of surgical drainage of empyemas. Maimonides (1135–1204 AD) observed: "The basic symptoms that occur in pneumonia and that are never lacking are as follows: acute fever, sticking pleuritic pain in the side, short rapid breaths, serrated pulse and cough." This clinical description is quite similar to those found in modern textbooks, and it reflected the extent of medical knowledge through the Middle Ages into the 19th century. Edwin Klebs was the first to observe bacteria in the airways of persons having died of pneumonia in 1875. Initial work identifying the two common bacterial causes, "Streptococcus pneumoniae" and "Klebsiella pneumoniae", was performed by Carl Friedländer and Albert Fraenkel in 1882 and 1884, respectively.
Pneumonia | History
Increased vibration of the chest when speaking, known as tactile fremitus, and increased volume of whispered speech during auscultation can also indicate the presence of fluid. Several tests can identify the cause of CAP. Blood cultures can isolate bacteria or fungi in the bloodstream. Sputum Gram staining and culture can also reveal the causative microorganism. In severe cases, bronchoscopy can collect fluid for culture. Special tests, such as urinalysis, can be performed if an uncommon microorganism is suspected. Chest X-rays and X-ray computed tomography (CT) can reveal areas of opacity (seen as white), indicating consolidation. CAP does not always appear on x-rays, sometimes because the disease is in its initial stages or involves a part of the lung not clearly visible on x-ray.
Community-acquired pneumonia | Diagnosis
The chest x-ray is distinctive with features that appear similar to an extensive pneumonia, with both lungs showing widespread white patches. The white patches may seem to migrate from one area of the lung to another as the disease persists or progresses. Computed tomography (CT) may be used to confirm the diagnosis. Often the findings are typical enough to allow the doctor to make a diagnosis without ordering additional tests. To confirm the diagnosis, a doctor may perform a lung biopsy using a bronchoscope. Many times, a larger specimen is needed and must be removed surgically. Plain chest radiography shows normal lung volumes, with characteristic patchy unilateral or bilateral consolidation.
Cryptogenic organizing pneumonia | Imaging
The presence of chest pain in children with pneumonia doubles the probability of "Mycoplasma pneumoniae". In general, in adults, investigations are not needed in mild cases. There is a very low risk of pneumonia if all vital signs and auscultation are normal. C-reactive protein (CRP) may help support the diagnosis. For those with CRP less than 20 mg/L without convincing evidence of pneumonia, antibiotics are not recommended. Procalcitonin may help determine the cause and support defcisions about who should receive antibiotics. Antibiotics are encouraged if the procalcitonin level reaches 0.25 μg/L, strongly encouraged if it reaches 0.5 μg/L, and strongly discouraged if the level is below 0.10 μg/L.
Pneumonia | Diagnosis
The typical symptoms of UIP are progressive shortness of breath and cough for a period of months. In some patients, UIP is diagnosed only when a more acute disease supervenes and brings the patient to medical attention.
Usual interstitial pneumonia | Signs and symptoms
The pragmatic challenge is to distinguish from aspiration pneumonia with an infectious component because the former does not require antibiotics while the later does. While some issues, such as a recent history of exposure to substantive toxins, can foretell the diagnosis, for a patient with dyphagia the diagnosis may be less obvious, as the dyshagic patient may have caustic gastric contents damaging the lungs which may or may not have progressed to bacterial infection. The following tests help determine how severely the lungs are affected:
Chemical pneumonitis | Diagnosis
Arterial blood gases may reveal hypoxemia when tested in a lab. Respiratory alkalosis may also be present. Peripheral lymphocytosis can be observed. A lung biopsy may also be indicated.
Lymphocytic interstitial pneumonia | Diagnosis
Coccidioidomycosis diagnosis relies on a combination of an infected person's signs and symptoms, findings on radiographic imaging, and laboratory results. The disease is commonly misdiagnosed as bacterial community-acquired pneumonia. The fungal infection can be demonstrated by microscopic detection of diagnostic cells in body fluids, exudates, sputum and biopsy tissue by methods of Papanicolaou or Grocott's methenamine silver staining. These stains can demonstrate spherules and surrounding inflammation. With specific nucleotide primers, "C.immitis" DNA can be amplified by polymerase chain reaction (PCR). It can also be detected in culture by morphological identification or by using molecular probes that hybridize with "C.immitis" RNA.
Coccidioidomycosis | Diagnosis
Diagnosis of ventilator-associated pneumonia is difficult and is not standardized. The criteria used for diagnosis of VAP varies by institution, but tends to be a combination of several of the following radiographic, clinical sign, and laboratory evidence: As an example, some institutions may require one clinical symptoms such as shortness of breath, one clinical sign such as fever, plus evidence on chest xray and in tracheal cultures. There is no gold standard for getting cultures to identify the bacteria, virus, or fungus that is causing the pneumonia, and there are invasive and non-invasive strategies for obtaining the culture sample. One non-invasive strategy collects cultures from the trachea of people with symptoms of VAP.
Ventilator-associated pneumonia | Diagnosis
With the advent of modern microbiology, classification based upon the causative microorganism became possible. Determining which microorganism is causing an individual's pneumonia is an important step in deciding treatment type and length. Sputum cultures, blood cultures, tests on respiratory secretions, and specific blood tests are used to determine the microbiologic classification. Because such laboratory testing typically takes several days, microbiologic classification is usually not possible at the time of initial diagnosis.
Classification of pneumonia | By area of lung affected
The diagnosis of acute chest syndrome is made difficult by its similarity in presentation with pneumonia. Both may present with a new opacification of the lung on chest x-ray. The presence of fevers, low oxygen levels in the blood, increased respiratory rate, chest pain, and cough are also common in acute chest syndrome. Diagnostic workup includes chest x-ray, complete cell count, reticulocyte count, ECG, and blood and sputum cultures. Patients may also require additional blood tests or imaging (e.g. a CT scan) to exclude a heart attack or other pulmonary pathology.
Acute chest syndrome | Diagnosis
The cysts resemble crushed ping-pong balls and are present in aggregates of two to eight (and not to be confused with "Histoplasma" or "Cryptococcus", which typically do not form aggregates of spores or cells). A lung biopsy would show thickened alveolar septa with fluffy eosinophilic exudate in the alveoli. Both the thickened septa and the fluffy exudate contribute to dysfunctional diffusion capacity that is characteristic of this pneumonia. "Pneumocystis" infection can also be diagnosed by immunofluorescent or histochemical staining of the specimen, and more recently by molecular analysis of polymerase chain reaction products comparing DNA samples. Notably, simple molecular detection of "P.
Pneumocystis pneumonia | Diagnosis
Healthcare-associated pneumonia seems to have fatality rates similar to hospital-acquired pneumonia, worse than community-acquired pneumonia but less severe than pneumonia in ventilated patients. Besides clinical markers like tachypnea (fast breathing) or a high white cell count (leukocytosis), the prognosis seems to be influenced by the underlying associated diseases (comorbidities) and functional capacities (for example, the ADL score). Many patients have a decreased health condition after the episode.
Hospital-acquired pneumonia | Prognosis
A physical examination will often reveal decreased intensity of breath sounds, wheezing, rhonchi, and prolonged expiration. Most physicians rely on the presence of a persistent dry or wet cough as evidence of bronchitis. A variety of tests may be performed in people presenting with cough and shortness of breath: Decreased breath sounds, crackles, wheezing, and rhonchi that clears with coughs may be heard in the chest. Dullness to percussion and pleural rub suggest disease extension beyond the bronchi such as seen with pneumonia. Paroxysms of cough followed by inspiratory whoop and vomiting suggests pertussis.
Acute bronchitis | Diagnosis
As differential diagnoses, a subphrenic abscess, bowel interposed between diaphragm and liver (Chilaiditi syndrome), and linear atelectasis at the base of the lungs can simulate free air under the diaphragm on a chest X-ray.
Pneumoperitoneum | Differential diagnosis
In terms of the diagnosis of "Klebsiella" pneumonia the following can be done to determine if the individual has this infection, including "susceptibility testing" for (ESBL) "Extended Spectrum β-Lactamase", as well as:
Klebsiella pneumoniae | Diagnosis
PCR is the most rapid and effective way to determine the presence of "M. pneumoniae", however the procedure does not indicate the activity or viability of the cells present. Enzyme immunoassay (EIA) serological assays are the most common method of "M. pneumoniae" detection used in patient diagnosis due to the low cost and relatively short testing time. One drawback of serology is that viable organisms are required, which may overstate the severity of infection. Neither of these methods, along with others, has been available to medical professionals in a rapid, efficient and inexpensive enough form to be used in routine diagnosis, leading to decreased ability of physicians to diagnose "M.
Mycoplasma pneumoniae | Diagnosis
Pneumonia can be classified in several ways, most commonly by where it was acquired (hospital versus community), but may also by the area of lung affected or by the causative organism. There is also a combined clinical classification, which combines factors such as age, risk factors for certain microorganisms, the presence of underlying lung disease or systemic disease and whether the person has recently been hospitalized.
Classification of pneumonia | Introduction
Classification can be complex, and the combined efforts of clinicians, radiologists, and pathologists can help in the generation of a more specific diagnosis. Idiopathic interstitial pneumonia can be subclassified based on histologic appearance into the following patterns: Usual interstitial pneumonia is the most common type.
Idiopathic interstitial pneumonia | Diagnosis
Tuberculosis should be suspected when a pneumonia-like illness has persisted longer than three weeks, or when a respiratory illness in an otherwise healthy individual does not respond to regular antibiotics.
Tuberculosis diagnosis | Medical history
In some cases, chest CT can reveal pneumonia not seen on x-rays. However, congestive heart failure or other types of lung damage can mimic CAP on x-ray.
Community-acquired pneumonia | Diagnosis
Histopathology of lung biopsy or bronchoalveolar lavage may indicate lipid-laden macrophages. Laboratory results may show highly elevated inflammatory markers.
Fire breather's pneumonia | Diagnosis
"M. pneumoniae" infections can be differentiated from other types of pneumonia by the relatively slow progression of symptoms. A positive blood test for cold-hemagglutinins in 50–70% of patients after 10 days of infection (cold-hemagglutinin-test should be used with caution or not at all, since 50% of the tests are false-positive), lack of bacteria in a Gram-stained sputum sample, and a lack of growth on blood agar. PCR has also been used.
Mycoplasma pneumonia | Diagnosis
New or progressive infiltrate on the chest X-ray with one of the following: In an elderly person, the first sign of hospital-acquired pneumonia may be mental changes or confusion. Other symptoms may include:
Hospital-acquired pneumonia | Signs and symptoms
This method is easily misdiagnosed, because pulmonary infections look like tuberculosis, pneumonia, or spirochaetosis. A lung biopsy can also be used to diagnose this parasite.
Paragonimus westermani | Diagnosis
Diagnosis is generally made by endoscopy with biopsy to evaluate histology. Review of symptoms and associated conditions is important.
Duodenitis | Diagnosis
However, findings may vary, and other patterns are common in other types of pneumonia. Aspiration pneumonia may present with bilateral opacities primarily in the bases of the lungs and on the right side. Radiographs of viral pneumonia may appear normal, appear hyper-inflated, have bilateral patchy areas, or present similar to bacterial pneumonia with lobar consolidation. Radiologic findings may not be present in the early stages of the disease, especially in the presence of dehydration, or may be difficult to interpret in the obese or those with a history of lung disease. Complications such as pleural effusion may also be found on chest radiographs.
Pneumonia | Imaging
Another is more invasive and advocates a bronchoscopy plus bronchoalveolar lavage (BAL) for people with symptoms of VAP. Both strategies also require a new or enlarging infiltrate on chest x-ray as well as clinical signs/symptoms such as fever and shortness of breath. There is no strong evidence to suggest that an invasive method to collect cultures is more effective than a non-invasive method. In addition, a quantitative approach to assessing the culture (performing a bacterial count of the pathogen that is causing the pneumonia) does not appear to be superior to a qualitative approach (determining the presence of the pathogen).
Ventilator-associated pneumonia | Diagnosis
Pneumonitis refers to lung inflammation; pneumonia refers to pneumonitis, usually due to infection but sometimes non-infectious, that has the additional feature of pulmonary consolidation. Pneumonia is most commonly classified by where or how it was acquired: community-acquired, aspiration, healthcare-associated, hospital-acquired, and ventilator-associated pneumonia. It may also be classified by the area of the lung affected: lobar pneumonia, bronchial pneumonia and acute interstitial pneumonia; or by the causative organism. Pneumonia in children may additionally be classified based on signs and symptoms as non-severe, severe, or very severe. The setting in which pneumonia develops is important to treatment, as it correlates to which pathogens are likely suspects, which mechanisms are likely, which antibiotics are likely to work or fail, and which complications can be expected based on the person's health status.
Pneumonia | Classification
A full clinical diagnosis can only be made from a lung biopsy of the tissue, fully best performed by a VATS, done by a cardio-thoracic surgeon. Some pulmonologists may first attempt a bronchoscopy; however, this frequently fails to give a full or correct diagnosis. Lung biopsies performed on patients with NSIP reveal two different disease patterns – cellular and fibrosing – which are associated with different prognoses. The cellular pattern displays chronic inflammation with minimal fibrosis. The fibrosing pattern displays interstitial fibrosis with various inflammation levels. Both patterns are uniform and lack the prominent fibroblastic foci that are found in other types of idiopathic interstitial pneumonia.
Non-specific interstitial pneumonia | Diagnosis
Findings on chest x-ray supportive of aspiration pneumonia include localized consolidation depending on the patient's position when the aspiration occurred. For example, people that are supine when they aspirate often develop consolidation in the right lower lobe of the lung. Sputum cultures are not used for diagnosing aspiration pneumonia because of the high risk of contamination. Clinical symptoms may also increase suspicion of aspiration pneumonia, including new difficulty breathing and fever after an aspiration event. Likewise, physical exam findings such as altered breath sounds heard in the affected lung fields may also be suggestive of aspiration pneumonia. Some cases of aspiration pneumonia are caused by aspiration of food particles or other particulate substances like pill fragments; these can be diagnosed by pathologists on lung biopsy specimens.
Aspiration pneumonia | Diagnosis
pneumoniae" infections.
Mycoplasma pneumoniae | Diagnosis
pneumoniae".
Streptococcus pneumoniae | Diagnosis
Pneumonia has historically been characterized as either typical or atypical depending on the presenting symptoms and thus the presumed underlying organism. Attempting to make this distinction based on symptoms however has not been found to be accurate and The American Thoracic Society does not recommend its use.
Classification of pneumonia | By cause
Radiologically, the main feature required for a confident diagnosis of UIP is honeycomb change in the periphery and the lower portions (bases) of the lungs. On high-resolution computed tomography (HRCT), the following categories, depending on imaging findings, have been recommended by a collaborative effort by the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and the Latin American Thoracic Society: There may be superimposed CT features such as mild ground-glass opacity, reticular pattern and pulmonary ossification.
Usual interstitial pneumonia | Radiology
Chest radiographs (X-ray photographs) often show a pulmonary infection before physical signs of atypical pneumonia are observable at all. This is occult pneumonia. In general, occult pneumonia is rather often present in patients with pneumonia and can also be caused by "Streptococcus pneumoniae", as the decrease of occult pneumonia after vaccination of children with a pneumococcal vaccine suggests. Infiltration commonly begins in the perihilar region (where the bronchus begins) and spreads in a wedge- or fan-shaped fashion toward the periphery of the lung field. The process most often involves the lower lobe, but may affect any lobe or combination of lobes.
Atypical pneumonia | Diagnosis
Up to half of those with Legionnaires' disease have gastrointestinal symptoms, and almost half have neurological symptoms, including confusion and impaired cognition. "Relative bradycardia" may also be present, which is low to normal heart rate despite the presence of a fever. Laboratory tests may show that kidney functions, liver functions, and electrolyte levels are abnormal, which may include low sodium in the blood. Chest X-rays often show pneumonia with consolidation in the bottom portion of both lungs. Distinguishing Legionnaires' disease from other types of pneumonia by symptoms or radiologic findings alone is difficult; other tests are required for definitive diagnosis.
Legionnaires' disease | Signs and symptoms
In some senses, the process of diagnosis is always a matter of assessing the "likelihood" that a given condition is present in the patient. In a patient who presents with haemoptysis (coughing up blood), the haemoptysis is very much more likely to be caused by respiratory disease than by the patient having broken their toe. Each question in the history taking allows the medical practitioner to narrow down their view of the cause of the symptom, testing and building up their hypotheses as they go along. Examination, which is essentially looking for clinical signs, allows the medical practitioner to see if there is evidence in the patient's body to support their hypotheses about the disease that might be present.
Medical sign | As tests
A chest x-ray is useful to confirm or rule out a pneumothorax, pulmonary edema, or pneumonia. Spiral computed tomography with intravenous radiocontrast is the imaging study of choice to evaluate for pulmonary embolism.
Shortness of breath | Imaging
For optimal management of a pneumonia patient, the following must be assessed: pneumonia severity (including treatment location, e.g., home, hospital or intensive care), identification of causative organism, analgesia of chest pain, the need for supplemental oxygen, physiotherapy, hydration, bronchodilators and possible complications of emphysema or lung abscess.
Lower respiratory tract infection | Pneumonia
The project aims to evaluate the utility of the Binax NOW® S. pneumoniae immuno-chromatographic test, for diagnosing pneumococcal pneumonia and sepsis in low- and middle-income countries. Detection of pneumococcal pneumonia and sepsis is limited by the poor sensitivity of existing diagnostic methods, hindering accurate measurement of disease burden where the Binax NOW® test may enable the identification of additional pneumococcal cases among patients with pneumonia and sepsis.
Orin Levine | LEAP: Evaluation of the Binax NOW® S. pneumoniae test for use in blood of pneumonia and sepsis patients in low- and middle-income countries
On clinical examination, crackles are common, and more rarely, patients may have clubbing (<5% of cases). Laboratory findings are nonspecific. Almost 75% of people have symptoms for less than two months before seeking medical attention. A flu-like illness, with a cough, fever, a feeling of illness (malaise), fatigue, and weight loss heralds the onset in about 40% of patients. Doctors do not find any specific abnormalities on routine laboratory tests or on a physical examination, except for the frequent presence of crackling sounds (called rales) upon auscultation with a stethoscope by the care provider. Pulmonary function tests usually show that the amount of air the lungs can hold is below normal.
Cryptogenic organizing pneumonia | Diagnosis
The rule uses demographics (whether someone is older, and is male or female), the coexistence of co-morbid illnesses, findings on physical examination and vital signs, and essential laboratory findings. This study demonstrated that patients could be stratified into five risk categories, Risk Classes I-V, and that these classes could be used to predict 30-day survival.
Pneumonia severity index | Development
The histologic hallmarks of UIP, as seen in lung tissue under a microscope by a pathologist, are interstitial fibrosis in a "patchwork pattern", honeycomb change and fibroblast foci (see images below).
Usual interstitial pneumonia | Histology
Traditionally, clinicians have classified pneumonia by clinical characteristics, dividing them into "acute" (less than three weeks duration) and "chronic" pneumonias. This is useful because chronic pneumonias tend to be either non-infectious, or mycobacterial, fungal, or mixed bacterial infections caused by airway obstruction. Acute pneumonias are further divided into the classic bacterial bronchopneumonias (such as "Streptococcus pneumoniae"), the atypical pneumonias (such as the interstitial pneumonitis of "Mycoplasma pneumoniae" or "Chlamydia pneumoniae"), and the aspiration pneumonia syndromes. Chronic pneumonias, on the other hand, mainly include those of "Nocardia", "Actinomyces" and "Blastomyces dermatitidis", as well as the granulomatous pneumonias ("Mycobacterium tuberculosis" and atypical mycobacteria, "Histoplasma capsulatum" and "Coccidioides immitis").
Classification of pneumonia | Clinical
Dignam was initially admitted to hospital with a suspected chest infection; this progressed to pneumonia. After numerous tests were carried out in March 2013, he was diagnosed with amyloidosis. Upon returning to consciousness Dignam spoke of having had a near-death experience that prompted doctors to inject him with two shots of adrenaline. Dignam said, "There was a blockage in my arm where the adrenaline was going in so they had to slit the side of my neck, straight into the jugular and right down into my heart. I felt like I had died for a minute or so, nothing seemed to matter, then suddenly the adrenaline restarted my heart." He underwent chemotherapy for the condition, and as of September 2017, continues to receive chemotherapy.
Christy Dignam | Cancer diagnosis
Friedländer's initial work introduced the Gram stain, a fundamental laboratory test still used today to identify and categorize bacteria. Christian Gram's paper describing the procedure in 1884 helped to differentiate the two bacteria, and showed that pneumonia could be caused by more than one microorganism. Sir William Osler, known as "the father of modern medicine", appreciated the death and disability caused by pneumonia, describing it as the "captain of the men of death" in 1918, as it had overtaken tuberculosis as one of the leading causes of death in this time. This phrase was originally coined by John Bunyan in reference to "consumption" (tuberculosis).
Pneumonia | History
Respiratory diseases may be investigated by performing one or more of the following tests
Respiratory disease | Diagnosis
Symptoms include cough, difficulty breathing, and fatigue.
Non-specific interstitial pneumonia | Symptoms
Laboratory tests typical of chronic eosinophilic pneumonia include increased levels of eosinophils in the blood, a high erythrocyte sedimentation rate, iron deficiency anemia, and increased platelets. A chest X-ray can show abnormalities anywhere, but the most specific finding is increased shadow in the periphery of the lungs, away from the heart.
Eosinophilic pneumonia | Diagnosis
If pneumonia deteriorates after 72 hours, it could be due to nosocomial infection or excerbation of other underlying comorbidities. About 10% of those discharged from hospital are readmitted due to underlying co-morbidities such as heart, lung, or neurological disorders, or due to new onset of pneumonia. Complications may occur in particular in the elderly and those with underlying health problems. This may include, among others: empyema, lung abscess, bronchiolitis obliterans, acute respiratory distress syndrome, sepsis, and worsening of underlying health problems.
Pneumonia | Prognosis
Signs and symptoms may develop over several days or weeks and may include: shortness of breath and/or difficulty breathing (of gradual onset), fever, dry/non-productive cough, weight loss, night sweats, chills, and fatigue. Uncommonly, the infection may progress to involve other visceral organs (such as the liver, spleen, and kidney).
Pneumocystis pneumonia | Signs and symptoms
Acute eosinophilic pneumonia is most likely with respiratory failure after an acute febrile illness of usually less than one week, changes in multiple areas and fluid in the area surrounding the lungs on a chest X-ray, and eosinophils comprising more than 25% of white blood cells in fluid obtained by bronchoalveolar lavage. Other typical laboratory abnormalities include an elevated white blood cell count, erythrocyte sedimentation rate, and immunoglobulin G level. Pulmonary function testing usually reveals a restrictive process with reduced diffusion capacity for carbon monoxide. Chronic eosinophilic pneumonia is most likely when the symptoms have been present for more than a month.
Eosinophilic pneumonia | Diagnosis
Relying on DNA detection, this is the most sensitive and specific test available for fungi but it is limited to detecting only pneumocystis jirovecii and aspergillus.
Fungal pneumonia | Diagnosis
Pneumonia is an illness which can result from a variety of causes, including infection with bacteria, viruses, fungi, or parasites. Pneumonia can occur in any animal with lungs, including mammals, birds, and reptiles. Symptoms associated with pneumonia include fever, fast or difficult breathing, nasal discharge, and decreased activity. Different animal species have distinct lung anatomy and physiology and are thus affected by pneumonia differently. Differences in anatomy, immune systems, diet, and behavior also affects the particular microorganisms commonly causing pneumonia. Diagnostic tools include physical examination, testing of the sputum, and x-ray investigation. Treatment depends on the cause of pneumonia; bacterial pneumonia is treated with antibiotics.
Pneumonia (non-human) | Introduction
Towards the end of the first week, stupor or even coma can result in severe cases. The second week is more akin to acute bacteremic pneumococcal pneumonia with continuous high fevers, headaches, cough, and dyspnea. X-rays show patchy infiltrates or a diffuse whiteout of lung fields. Complications in the form of endocarditis, liver inflammation, inflammation of the heart's muscle, joint inflammation, keratoconjunctivitis (occasionally extranodal marginal zone lymphoma of the lacrimal gland/orbit), and neurologic complications (brain inflammation) may occasionally occur. Severe pneumonia requiring intensive-care support may also occur. Fatal cases have been reported (less than 1% of cases).
Psittacosis | Signs and symptoms
A rapid respiratory rate is defined as greater than 60 breaths per minute in children under 2 months old, greater than 50 breaths per minute in children 2 months to 1 year old, or greater than 40 breaths per minute in children 1 to 5 years old. In children, low oxygen levels and lower chest indrawing are more sensitive than hearing chest crackles with a stethoscope or increased respiratory rate. Grunting and nasal flaring may be other useful signs in children less than five years old. Lack of wheezing is an indicator of "Mycoplasma pneumoniae" in children with pneumonia, but as an indicator it is not accurate enough to decide whether or not macrolide treatment should be used.
Pneumonia | Diagnosis
Serological testing is typically used to obtain a definitive diagnosis. Most serological tests would succeed only after a certain period of time past the symptom onset (usually a week). The differential diagnosis list includes typhus, ehrlichiosis, leptospirosis, Lyme disease, and virus-caused exanthema (measles or rubella).
Trench fever | Diagnosis
Diagnoses of Farmer's lung is difficult due to its similarity to cold and flu-like symptoms. Doctors diagnose patients with Farmer's lung under the following conditions: Examination procedures may include: • taking a blood test
Farmer's lung | Diagnosis
The disease caused by ORT is characterized by pneumonia, pleuritis and air sacculitis on postmortem examination. However diagnosis should be confirmed using laboratory tests such as bacterial culture, PCR, agar gel precipitation, ELISA and serum agglutination.
Ornithobacterium rhinotracheale | Diagnosis
A chest X-ray and complete blood count may be useful to exclude other conditions at the time of diagnosis. Characteristic signs on X-ray are hyperinflated lungs, a flattened diaphragm, increased retrosternal airspace, and bullae, while it can help exclude other lung diseases, such as pneumonia, pulmonary edema, or a pneumothorax. A high-resolution CT scan of the chest may show the distribution of emphysema throughout the lungs and can also be useful to exclude other lung diseases. Unless surgery is planned, however, this rarely affects management. A saber-sheath trachea deformity may also be present. An analysis of arterial blood is used to determine the need for oxygen; this is recommended in those with an FEV less than 35% predicted, those with a peripheral oxygen saturation less than 92%, and those with symptoms of congestive heart failure.
Chronic obstructive pulmonary disease | Other tests
Usually initial therapy is empirical. If sufficient reason to suspect influenza, one might consider oseltamivir. In case of legionellosis, erythromycin or fluoroquinolone. A third generation cephalosporin (ceftazidime) + carbapenems (imipenem) + beta lactam & beta lactamase inhibitors (piperacillin/tazobactam)
Hospital-acquired pneumonia | Treatment
Diagnosis during the acute phase can be made by obtaining a peripheral blood smear with Giemsa stain, Columbia blood agar cultures, immunoblot, indirect immunofluorescence, and PCR. Diagnosis during the chronic phase can be made using a Warthin-Starry stain of wart biopsy, PCR, and immunoblot.
Carrion's disease | Diagnosis
Tuberculosis is diagnosed by finding "Mycobacterium tuberculosis" bacteria in a clinical specimen taken from the patient. While other investigations may strongly suggest tuberculosis as the diagnosis, they cannot confirm it. A complete medical evaluation for tuberculosis (TB) must include a medical history, a physical examination, a chest X-ray and microbiological examination (of sputum or some other appropriate sample). It may also include a tuberculin skin test, other scans and X-rays, surgical biopsy.
Tuberculosis diagnosis | Introduction
Hopkin spent periods in pulmonary medicine practice, in medical student teaching (Fellow and Supervisor of clinical students at Brasenose College, Oxford, 1992–99), and in research at Birmingham and Oxford. In those periods he developed a robust bronchoscopic lavage method to secure precise microbial diagnostics and improved survivals for pneumonia in immuno-suppressed subjects. With Anne Wakefield, he settled the fungal taxonomic status of the important opportunistic pathogen, pneumocystis, and devised a precise mitochondrial rRNA diagnostic for pneumocystis pneumonia, applicable to simple non-invasive simple clinical samples and adopted worldwide.
Julian Hopkin | Career
The diagnostic criteria for acute exacerbation of COPD generally include a production of sputum that is purulent and may be thicker than usual, but without evidence of pneumonia (which involves mainly the alveoli rather than the bronchi). Also, diagnostic criteria may include an increase in frequency and severity of coughing, as well as increased shortness of breath. A chest X-ray is usually performed on people with fever and, especially, hemoptysis (blood in the sputum), to rule out pneumonia and get information on the severity of the exacerbation. Hemoptysis may also indicate other, potentially fatal, medical conditions. A history of exposure to potential causes and evaluation of symptoms may help in revealing the cause the exacerbation, which helps in choosing the best treatment.
Acute exacerbation of chronic obstructive pulmonary disease | Diagnosis
Diagnosis starts with physical exam, observation, and interview of the patient. Imaging to diagnose dilation of the colon involves one view abdominal xray or obstruction series (PA chest, erect abdomen, and supine abdomen images). If further imaging is needed CT may be ordered.
Ogilvie syndrome | Diagnosis
In this second report he noted that he had examined more than 50 additional cases of pneumonia and that he had identified bacteria in nearly all of them and that sections from which the bacteria were absent were from the lungs of patients dying late in the course of the disease. Friedländer also noted that it was necessary to use special stains (e.g. the Gram Stain) to see the bacteria because using ordinary stains (H&E) nuclei and fibrin stained the same way as bacteria and thus obscured the ability to see the bacteria. As a result, "Klebsiella pneumoniae" is often called "Friedländer's bacterium" or "Friedländer's bacillus".
Carl Friedländer | Introduction
Characteristic biopsy findings show filling of the alveoli (and sometimes terminal bronchioles) with an amorphous eosinophilic material, which stains strongly positive on PAS stain and the PAS diastase stain. The surrounding alveoli and pulmonary interstitium remain relatively normal. Electron microscopy of the sample, although not typically performed due to impracticality, shows lamellated bodies representing surfactant. An alternative diagnosis with similar histomorphologic findings is "Pneumocystis jirovicii" pneumonia.
Pulmonary alveolar proteinosis | Diagnosis
In addition to letters from patients, early physicians also recognised the importance of examining bodily excretions in establishing a diagnosis. Nathaniel Johnston (1627–1705) had carried out an extensive correspondence practice with his patients. In one instance a writer had sent a letter to him enclosing specimens of his wife's sputum and urine as samples. He had hoped that Johnston might use the specimens to narrow the diagnosis of his wife's chronic cough. Even as early as the 1830s, there was an attempt at reducing the subjectivity of findings and narrations. Julius Herisson, an early inventor of sphygmomanometer (blood pressure measuring apparatus) in 1834, recommended that numerical aspects (quantitative data such as beats per minute) of pulse were more informative than their descriptive characteristics.
In absentia health care | Johnston
With treatment, most types of bacterial pneumonia will stabilize in 3–6 days. It often takes a few weeks before most symptoms resolve. X-ray findings typically clear within four weeks and mortality is low (less than 1%). In the elderly or people with other lung problems, recovery may take more than 12 weeks. In persons requiring hospitalization, mortality may be as high as 10%, and in those requiring intensive care it may reach 30–50%. Pneumonia is the most common hospital-acquired infection that causes death. Before the advent of antibiotics, mortality was typically 30% in those that were hospitalized. However, for those whose lung condition deteriorates within 72 hours, the problem is usually due to sepsis.
Pneumonia | Prognosis
The simplest procedure for 'in field diagnosis' is the detection of antibodies by latex agglutination (LAT) as it is quick and simple to run, and has a long shelf-life. Other procedures used for diagnosis include growth inhibition disc tests (GI), direct and indirect fluorescent antibody tests, complement fixation tests (CFT), indirect haemagglutination test (IHA), ELISA and PCR. These have varying degrees of efficacy. Isolation of "M. capricolum "subsp. "capripneumoniae" from clinical samples is the only way to definitively diagnose the infection but it is not normally performed as it is time consuming and difficult.
Contagious caprine pleuropneumonia | Diagnosis
It is diagnosed by examination of tissue, i.e. biopsy.
Intestinal spirochetosis | Diagnosis
Definitive diagnose of cuffitis is obtained by endoscopy.
Cuffitis | Diagnosis
Diagnosis is considered confirmed when the organism is isolated from a sterile body site. In this respect, "H. influenzae" cultured from the nasopharyngeal cavity or sputum would not indicate "H. influenzae" disease, because these sites are colonized in disease-free individuals. However, "H. influenzae" isolated from cerebrospinal fluid or blood would indicate "H. influenzae" infection.
Haemophilus influenzae | Diagnosis