Pneumonia is typically diagnosed based on a combination of physical signs and a. Differential diagnosis to be considered while diagnosing pneumonia includes. The aim of this article is to provide a guide to a systemic approach for diagnosis and treatment of children with recurrent pneumonia while not over investigating those with common but usually unrecognised conditions such as asthma or recurrent simple viral infections. Aspiration pneumonia is always an alternative diagnosis and should be suspected if pneumonia is present bilaterally in the dependent or posterior portions of the lungs. Communityacquired pneumonia cap is a leading cause of. These include diseases associated with tracheoesophageal or. Typical bacterial pneumonia is usually lobar pneumonia with parapneumonic pleural effusions. For the sake of completeness, the differential diagnosis of bacterial pneumonia with haemorrhagic pericarditis 1 should include chlamydia infection in immunocompetent subjects, 2 and the association of pneumonia and staphylococcal pericarditis.
Infection by bacteria or viruses is the most common cause, although infection by other microorgamisms such as rickettsi. A number of noninfectious conditions, including neoplastic lesions, pulmonary oedema, pulmonary embolism, druginduced pneumonitis, diffuse alveolar haemorrhage syndromes, cryptogenic. Viera, md, mph, university of north carolina at chapel hill. Few epithelial cells diagnosis differential diagnosis many microbiologic pathogens can cause cap.
Differential diagnosis of usual interstitial pneumonia. Foley research and educational hospital of the university of illinois the diagnosis and differential diagnosis of pneumonia the diagnosis of pneumonia the existence of a pneumonic consolidation of the lung usually is readily recognized. You may have heard the term differential diagnosis thrown around by your doctor or others. Apr 14, 2007 the diagnosis may be easily missed, because the symptoms are misinterpreted as common infection.
However, more testing is often needed to confirm most of these diagnoses and is generally outside the scope of a primary care provider. Sep 15, 2019 it is possible that a chest xray can miss a diagnosis. Differential diagnosis for a repiratory disesae outbreak. The diagnosis of cap is usually made in patients with suggestive symptoms, signs, and. Diagnosis and management of communityacquired pneumonia in. When the labs and clinical features are positive, a positive chest radiograph is considered a gold standard for diagnosis of pneumonia. These include infectious causes such as tuberculosis or pneumonia, or inflammatory conditions such as sarcoidosis. Diagnosis is suggested by a history of cough, dyspnea, pleuritic pain, or acute functional or cognitive decline, with abnormal vital signs e. This study was designed to clarify chest computerized tomography ct findings of mycoplasma pneumoniae pneumonia facilitating differential diagnosis from cap community acquired pneumonia caused. Note the increased anteroposterior chest diameter, which is suggestive of chronic obstructive pulmonary. After surgery, the patient recovered well, and at 2year followup in november, 2006.
Should be suspected in patients with pneumonia who do not respond to antibiotics treatment. In the absence of clinical information, radiologists cannot reliably distinguish between pneumonia and. This refers to when your doctor considers possible conditions that could be. Differential diagnosis must be established with other pulmonary defects, including cdh and bronchopulmonary sequestration bps. Pneumonia can be a presenting complaint for various pathologies such as lung tumours, chronic obstructive pulmonary disease, or infectious diseases eg, tuberculosis. Noninfectious mimics of communityacquired pneumonia.
Pneumocystis pneumonia pcp is a serious infection caused by the fungus pneumocystis jirovecii most people who get pcp have a medical condition that weakens their immune system, like hivaids, or take medicines that lower the bodys ability to fight germs and sickness. Know the cause, clinical manifestations, differential diagnosis, and general approach to the diagnosis, treatment, and prevention strategies of the different types of pneumonia in children of various age groups. Typical bacterial pneumonia statpearls ncbi bookshelf. Diagnosis of pneumonia in children competently about. Communityacquired pneumonia is diagnosed by clinical features e. Pathological changes may begin years before symptoms appear. Differentiation of bacterial and viral pneumonia in children. Overview of communityacquired pneumonia in adults uptodate. Diagnosis and management of hospitalacquired pneumonia in. Often they are not toxic, do not have shivers and do not seek medical attention. These studies have been hampered by incomplete aetiological approaches.
Radiographic images in a patient with right upper lobe pneumonia. Pdf mycoplasma pneumoniae, an important differential. However, a chest xray cannot reliably differentiate bacterial from a nonbacterial cause. If someone has asthma, bronchiectasis, or chronic obstructive pulmonary disease copd, it could be a flareup. However, uip is not synonymous with ipf as other clinical conditions may be associated with uip, including chronic hypersensitivity pneumonitis, collagen vascular disease, drug toxicity. What are the differential diagnoses for pediatric pneumonia. Symptoms typically include some combination of productive or dry cough, chest pain, fever and difficulty breathing. Dyspnea associated with mediastinal changes, pneumonia bacteremia, meningitis, gastrointestinal bleeding, cutaneous lesions mediastinal widening. The differential diagnosis of communityacquired pneumonia and some nonpneumonia diseases involving the chest may sometimes be. Differential diagnosis between communityacquired pneumonia and nonpneumonia diseases of the chest in the emergency ward.
In this article, we discuss and illustrate the spectrum of radiologic manifestations, diagnostic pitfalls, and differential diagnoses associated with a variety of aspiration diseases. Pneumonia can be generally defined as an infection of the lung parenchyma, in which consolidation of the affected part and a filling of the. It is one of the common causes of admission to the paediatric ward. The role of serum coagulation factors in the differential.
Risk factors include older age and medical comorbidi ties. The diagnosis of cap is usually made in patients with suggestive symptoms, signs, and radiological features. If your doctor still has a high suspicion for pneumonia after a negative result, she may choose to confirm the diagnosis by ct scan. Oct 25, 2019 pneumonia can be generally defined as an infection of the lung parenchyma, in which consolidation of the affected part and a filling of the alveolar air spaces with exudate, inflammatory cells, and fibrin is characteristic. Pneumonia can be generally defined as an infection of the lung parenchyma, in which consolidation of the affected part and a filling of the alveolar air spaces with exudate, inflammatory cells, and fibrin is characteristic. This study was designed to clarify chest computerized tomography ct findings of mycoplasma pneumoniae pneumonia facilitating differential diagnosis from cap community acquired pneumonia. The differential diagnosis for pneumonia in the immunocompromised. Cyanosis is bluish coloration of skin or mucosa, it is easy to spot, but differential diagnosis, history and examination are very important. The major differential diagnosis is asthma, and in some cases, a clear distinction between copd and asthma is not possible. Although lobar pneumonia is generally conceded to be one of the easiest diseases in which to make a correct diagnosis, it is well recognized that its differentiation in the early stages, and. The differential diagnosis of communityacquired pneumonia and some non pneumonia diseases involving the chest may sometimes be differential diagnosis of the association of pneumonia and. Many published studies have addressed the differentiation of bacterial from viral pneumonia using clinical, 2 5 radiological, 2 9 and routine haematological tests, 2 5, 9 11 but these methods have not been found to be sufficiently reliable in differential diagnosis. Therefore, a diagnosis of a bronchopulmonary sequestration was made, and the patient was referred to thoracic surgeons who carried out a left lower lobe resection. Pneumonia traditionally has been classified as typical, usually caused by s.
Differential diagnosis usual interstitial pneumonia. In a child not yet diagnosed with asthma, these abnormalities are frequently interpreted as pneumonia. Diagnosis differential diagnosis many microbiologic pathogens can cause cap. Differential diagnosis an overview sciencedirect topics. Performance of a bedside creactive protein test in the diagnosis of communityacquired pneumonia in adults with acute cough. Nov 05, 2018 a careful history and examination in patients with recurrent pneumonia are helpful to further narrow the differential diagnosis. Pneumonia traditionally has been classified as typical, usually. Because of the wide spectrum of associated clinical features, cap is a part of the differential diagnosis of nearly all respiratory. Communityacquired pneumonia is a leading cause of death. A number of noninfectious conditions, including neoplastic lesions, pulmonary oedema, pulmonary embolism, druginduced pneumonitis, diffuse alveolar haemorrhage syndromes.
Apr 12, 2016 communityacquired pneumonia cap is a common cause of presentation to healthcare facilities. Pulmonary tuberculosis in the differential diagnosis of. Diagnosis and management of communityacquired pneumonia in adults richard r. Mild pneumonia should be differentiated from upper respiratory tract infection.
Cap is defined as an infection of the lung parenchyma that is not acquired in a hospital, longterm. Differential diagnosis for the advanced practice nurse. The differential diagnosis of the association of pneumonia and haemorrhagic pericarditis should include viral aetiologies. However, uip is not synonymous with ipf as other clinical conditions may be associated with uip, including chronic hypersensitivity pneumonitis, collagen vascular disease, drug. The term atypical pneumonia is applied to nonlobar patchy or interstitial infiltrates on chest xray where the causative organism is not identified on gram stain or culture of sputum. Ps shows overlapping features or may coexist in 50% to 60% of cases.
There are other conditions that can have symptoms similar to pneumonia, like bronchitis or congestive heart failure. Noninfectious mimics of communityacquired pneumonia ncbi. Other potential diagnoses are easier to distinguish from cop d2. What are the differential diagnoses for bacterial pneumonia. Pneumonia is an inflammatory pulmonary process that may originate in the lung or be a focal complication of a contiguous or systemic inflammatory process. Idiopathic pulmonary fibrosis ipf, the most common and lethal of the idiopathic interstitial pneumonias, is defined by a radiological andor pathological pattern of usual interstitial pneumonia uip. Cap is a part of the differential diagnosis of nearly all respiratory illnesses. Diagnosis and management of communityacquired pneumonia. Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care.
Initial evaluation should determine the need for hospitalization versus outpatient management using validated mortality or severity prediction scores. Although lobar pneumonia is generally conceded to be one of the easiest diseases in which to make a cor rect diagnosis, it is well recognized that its differentia tion in the early stages, and particularly in children. Pulmonary pulmonary symptoms may be due to a variety of conditions. Differential diagnosis is also used more loosely, to refer simply to a list of the most common causes of a given symptom, to a list of disorders similar to a given disorder, or to such lists when they are annotated with advice on how to narrow the list down frenchs index of differential diagnosis is an example. Generally speaking, a ct scan is more accurate than a chest xray although it costs more and exposes you to higher doses of radiation. Walking pneumonia differential diagnosis of atypical. Differential diagnosis cap is a common working diagnosis and is frequently on the differential diagnosis of patients presenting with a pulmonary infiltrate and cough, patients with respiratory tract. Differentiation of bacterial and viral pneumonia in. A 24yearold chinese lady presented with 2 weeks of fever and 1 week of cough to us after being given antibiotic by the primary care physician. Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known. Blastomycosis infection often presents as an acute pneumonia. Communityacquired pneumonia and the use of fluoroquinolones. Bacterial pneumonia differential diagnoses emedicine.
The aim of this study was to identify the participations of the serum coagulations and fibrinolysis factors that contribute to the differential diagnosis of the patients with communityacquired pneumonia cap without effusion, uncomplicated parapneumonic effusion ucppe and complicated parapneumonic effusion cppe. Differential diagnosis the onset of copd is insidious. The differential diagnosis of pulmonary infiltrates in patients with aids is presented approach to acute abdominal pain in pregnant and postpartum women view in chinese complaint in a patient with lower lobe pneumonia. Data from clinical studies illustrate that the differential diagnosis of tb from bacterial pneumonia is not straightforward. She undergone computed tomography of chest and bronchoscopy to. This refers to when your doctor considers possible conditions that could be causing your symptoms. Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. In this article, we will discuss about the differential diagnosis of pneumonia.
The initial choice of antibiotic is made empirically. See diagnostic approach to communityacquired pneumonia in adults and sputum cultures for the evaluation of bacterial pneumonia. Prospective evaluation of point of care ultrasonography for the diagnosis of pneumonia in children and young adults. Diagnosis of pneumonia is based on symptoms and signs of an acute lower respiratory tract infection, and can be confirmed by a chest xray showing new shadowing that is not due to any other cause such as pulmonary oedema or infarction. The differential diagnosis of pneumonia in childhood.
An initial sputum gram stain and culture or an invasive respiratory sample as appropriate should be obtained in all hospitalized patients with cap sputum quality should be ensured. Pdf diagnosis and differential diagnosis of ventilator. Watkins, md, ms, akron general medical center, akron, ohio tracy l. Tang kl, eurich dt, minhassandhu jk, marrie tj, majumdar sr. May 11, 2018 you may have heard the term differential diagnosis thrown around by your doctor or others. Many patients referred for evaluation for recurrent pneumonia are diagnosed with asthma. Pneumonia pneumonia can be difficult to diagnose because it shares many symptoms with other conditions, such. Diagnosis and management alexander kaysin, md, mph, and anthony j. Should be suspected in patients with pneumonia who do not respond. Jun 01, 2011 communityacquired pneumonia cap is a significant cause of morbidity and mortality in adults.
In emergency department studies, 35% of children with an asthma exacerbation have abnormalities visible on chest radiographs. Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications. Contribution to the differential diagnosis of pneumonia in childhood. Incidence, correlates, and chest radiographic yield of new lung cancer diagnosis in 3398 patients with pneumonia. The yield of sputum cultures varies from 34 to 86%. Differential diagnosis between communityacquired pneumonia and. A careful history and examination in patients with recurrent pneumonia are helpful to further narrow the differential diagnosis.
The differential diagnosis for patients who present with abnormalities on chest xray includes lung cancer, as well as nonmalignant diseases. Usual interstitial pneumonia navigation for this section. Lemonovich, md, university hospitals case medical center, cleveland, ohio c ommunityacquired pneumonia cap is a significant cause of morbidity and mortality in adults. Differential diagnosis of pneumonia differential diagnosis. The diagnosis and differential diagnosis of pneumonia. Past medical history, no infiltrates seen on chest xray. Communityacquired pneumonia cap is a common cause of presentation to healthcare facilities. Imaging plays a crucial role in the detection and management of patients with pneumonia. Improved diagnosis of the etiology of communityacquired pneumonia with realtime polymerase chain reaction.
Differential diagnosis of aspiration pneumonia james l. Differential diagnosis of pneumonia in children when conducting differential diagnosis, it is necessary to take into account the age of the child, since in different age periods the pathological processes in the lungs have their own peculiarities. Read the causes, differential diagnosis, history taking, examination and investigations of cyanosis, be it central or peripheral. Differential diagnosis myriam aburto 1, inmaculada herraez 2, david iturbe 3 and ana jimenezromero 4 1 department of respiratory medicine, galdakao hospital, 48960 galdako, spain 2 department of radiology, university hospital of leon, 24071 leon, spain. What are the differential diagnoses for viral pneumonia. An initial sputum gram stain and culture or an invasive respiratory sample as appropriate should be obtained in all hospitalized patients with cap sputum quality should be ensured pmns25lpf. Community acquired pneumonia boston health care for the. Pneumonia is one of the major infectious diseases responsible for significant morbidity and mortality throughout the world. Differential diagnosis of pneumonia pt master guide. These reservations aside, the guidelines are well researched and well balanced. Abnormalities of airway patency as well as alveolar ventilation and perfusion occur frequently due to various mechanisms.
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