Signs and Symptoms of Bacterial Pneumonia

Study Notes

Signs and Symptoms of Bacterial Pneumonia

Common symptoms include fever, chills, productive cough with purulent sputum, pleuritic chest pain, dyspnea, tachypnea, and tachycardia.
In elderly patients, symptoms can be atypical, often presenting as confusion, lethargy, or a general decline in function; fever may be absent.

Routes of Exposure to Pathogens

The most common route is inhalation of airborne droplets.
Aspiration of oropharyngeal or gastric contents occurs frequently in individuals with dysphagia, alcohol use, or stroke.
Hematogenous spread, or pathogen spread through the bloodstream, is rare.
Pathogens can also extend directly from adjacent structures, such as abscesses.

Factors Preventing Clearance of Secretions

An impaired cough reflex, which may stem from stroke, sedatives, or neuromuscular diseases, can hinder secretion clearance.
Excessive mucus production, such as in chronic bronchitis, contributes to retention.
Ciliary dysfunction, often due to smoking or cystic fibrosis, impairs airflow.
A weak immune system, particularly in the elderly or immunocompromised, affects defense mechanisms.
Airway obstruction from tumors or foreign bodies can prevent effective clearance of secretions.

Bacteria Responsible for Atypical Pneumonia

Common bacterial causes include Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila, Coxiella burnetii (Q fever), and Chlamydia psittaci (exposure from birds).

Physical Exam Findings in Pneumonia

Auscultation may reveal crackles or rales over affected lung fields.
Presence of bronchial breath sounds may be noted.
Dullness to percussion may occur over areas of lung consolidation.
Increased tactile fremitus indicates lung involvement.
Egophony, characterized by E-to-A changes over consolidated areas, can be observed.

Diagnostic Studies for Bacterial Pneumonia

Chest X-ray (CXR) may show lobar consolidation, interstitial infiltrates, or cavitation.
Complete blood count (CBC) may indicate leukocytosis, often with a left shift.
Sputum culture is utilized to identify the causative organism.
Blood cultures are recommended in severe pneumonia cases or hospitalized patients.
Pulse oximetry and arterial blood gases (ABG) assess oxygenation status.
Urine antigen tests are available for detecting Legionella or Streptococcus pneumoniae.

Indicators for Admission (including CURB-65 Criteria)

CURB-65 criteria include confusion, urea levels > 7 mmol/L, respiratory rate of ≥ 30 breaths/min, low blood pressure (SBP < 90 mmHg or DBP ≤ 60 mmHg), and age ≥ 65 years.
Scoring 0-1 points suggests outpatient treatment; 2 points indicate consideration for hospitalization; scoring 3 or more warrants assessment for ICU admission.
Additional admission indicators include multilobar pneumonia, hypoxemia, significant comorbidities, or septic shock.

Empiric Therapy for Bacterial Pneumonia

Outpatient treatment for healthy patients typically includes amoxicillin; doxycycline or a macrolide (e.g., azithromycin) for atypical coverage.
Outpatient treatment for patients with comorbidities may involve amoxicillin-clavulanate or cephalosporin combined with a macrolide or doxycycline, or monotherapy with a respiratory fluoroquinolone (e.g., levofloxacin).
Inpatient treatment (non-ICU) usually includes a beta-lactam (e.g., ceftriaxone) combined with a macrolide (azithromycin) or levofloxacin.
For patients in ICU, a beta-lactam (e.g., ceftriaxone) is combined with either a macrolide or fluoroquinolone, with additional coverage for MRSA or Pseudomonas when required.

Description

This quiz covers the common signs and symptoms associated with bacterial pneumonia, including presentations in both general and elderly patients. It outlines key indicators such as fever, cough, and potential atypical symptoms. Test your knowledge on identifying these critical symptoms.