pulmonary disorders
Community Acquired Pneumonia
Symptoms and Signs of Community Acquired Pneumonia
Symptoms include malaise, chills, rigor, fever, cough, dyspnea, and chest pain. Cough typically is productive in older children and adults and dry in infants, young children, and older adults. Dyspnea usually is mild and exertional and is rarely present at rest. Chest pain is pleuritic and is adjacent to the infected area. Pneumonia may manifest as upper abdominal pain when lower lobe infection irritates the diaphragm. Gastrointestinal symptoms (nausea, vomiting, diarrhea) are also common. Symptoms become variable at the extremes of age. Infection in infants may manifest as nonspecific irritability and restlessness. In older adults, the infection may manifest as confusion and obtundation. Signs include fever, tachypnea, tachycardia, crackles, bronchial breath sounds, egophony (E to A change— when, during auscultation, a patient says the letter “E” and through the stethoscope the examiner hears the letter “A”), and dullness to percussion. Symptoms and Signs may also be present. Nasal flaring, use of accessory muscles, and cyanosis are common among infants. Fever is frequently absent in older patients. Symptoms and signs were previously thought to differ by type of pathogen. For example, factors thought to suggest viral pneumonia included gradual onset, preceding symptoms of an upper respiratory infection (URI), diffuse findings on auscultation, and absence of a toxic appearance. Atypical pathogens were considered more likely when onset was less acute and are more likely during known community outbreaks. However, manifestations in patients with typical and atypical pathogens overlap considerably. In addition, no single symptom or sign is sensitive or specific enough to predict the organism. Symptoms and signs are even similar for other noninfective inflammatory lung diseases such as Hypersensitivity Pneumonitis and 