Community-acquired pneumonia laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
While [[chest X-ray]] and [[pulse oximetry]] are routine tests among all patients with suspected pneumonia, additional laboratory tests (such as blood culture and gram sputum, sputum blood culture and gram stain, urinary antigen tests) are optional tests unless their results might alter the treatment plan. | |||
==Laboratory Tests== | ==Laboratory Tests== | ||
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|+ '''''Specific indications for additional testing in patients with pneumonia''''' | |+ '''''Specific indications for additional testing in patients with pneumonia''''' | ||
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| style="padding: 0px 5px; background: #F5F5F5;" colspan=2| Adapted from IDSA/ATS Guidelines for CAP in Adults<ref name="MandellWunderink2007">{{cite journal|last1=Mandell|first1=L. A.|last2=Wunderink|first2=R. G.|last3=Anzueto|first3=A.|last4=Bartlett|first4=J. G.|last5=Campbell|first5=G. D.|last6=Dean|first6=N. C.|last7=Dowell|first7=S. F.|last8=File|first8=T. M.|last9=Musher|first9=D. M.|last10=Niederman|first10=M. S.|last11=Torres|first11=A.|last12=Whitney|first12=C. G.|title=Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults|journal=Clinical Infectious Diseases|volume=44|issue=Supplement 2|year=2007|pages=S27–S72|issn=1058-4838|doi=10.1086/511159}}</ref> | | style="padding: 0px 5px; background: #F5F5F5;" colspan=2| Adapted from IDSA/ATS Guidelines for CAP in Adults<ref name="MandellWunderink2007">{{cite journal|last1=Mandell|first1=L. A.|last2=Wunderink|first2=R. G.|last3=Anzueto|first3=A.|last4=Bartlett|first4=J. G.|last5=Campbell|first5=G. D.|last6=Dean|first6=N. C.|last7=Dowell|first7=S. F.|last8=File|first8=T. M.|last9=Musher|first9=D. M.|last10=Niederman|first10=M. S.|last11=Torres|first11=A.|last12=Whitney|first12=C. G.|title=Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults|journal=Clinical Infectious Diseases|volume=44|issue=Supplement 2|year=2007|pages=S27–S72|issn=1058-4838|doi=10.1086/511159}}</ref> | ||
|} | |} | ||
===Routine Tests=== | ===Routine Tests=== | ||
Findings in routine blood tests are based on the severity of the disease and the cause, they can include the following:<ref name="SolomonWunderink2014">{{cite journal|last1=Solomon|first1=Caren G.|last2=Wunderink|first2=Richard G.|last3=Waterer|first3=Grant W.|title=Community-Acquired Pneumonia|journal=New England Journal of Medicine|volume=370|issue=6|year=2014|pages=543–551|issn=0028-4793|doi=10.1056/NEJMcp1214869}}</ref> | Findings in routine blood tests are based on the severity of the disease and the cause, they can include the following:<ref name="SolomonWunderink2014">{{cite journal|last1=Solomon|first1=Caren G.|last2=Wunderink|first2=Richard G.|last3=Waterer|first3=Grant W.|title=Community-Acquired Pneumonia|journal=New England Journal of Medicine|volume=370|issue=6|year=2014|pages=543–551|issn=0028-4793|doi=10.1056/NEJMcp1214869}}</ref> | ||
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*[[Thrombocytopenia]] | *[[Thrombocytopenia]] | ||
*Elevated [[BUN]] | *Elevated [[BUN]] | ||
*Findings of lactic acidosis (decreased | *Findings of lactic acidosis (decreased HCO<sub>3</sub>, increased [[lactic acid]] levels) | ||
*[[ABG]]: may show [[hypoxia]] and/or hypercapnea | *[[ABG]]: may show [[hypoxia]] and/or hypercapnea | ||
===Sputum Gram Stain and Culture=== | ===Sputum Gram Stain and Culture=== | ||
*Sputum samples should be obtained | *Sputum samples should be obtained in all patients with productive [[cough]]. | ||
*Gram-stain and culture should be performed to assess the causative agent and guide the therapy. | *Gram-stain and culture should be performed to assess the causative agent and guide the therapy. | ||
*In | *In approximately 80% of cases of [[pneumococcal pneumonia]] the sputum culture is positive.<ref name="MusherThorner2014">{{cite journal|last1=Musher|first1=Daniel M.|last2=Thorner|first2=Anna R.|title=Community-Acquired Pneumonia|journal=New England Journal of Medicine|volume=371|issue=17|year=2014|pages=1619–1628|issn=0028-4793|doi=10.1056/NEJMra1312885}}</ref> | ||
*However, the general yield of a sputum sample does not exceed 50-60%. | |||
===Blood Culture=== | ===Blood Culture=== | ||
*Blood cultures should be obtained for patients with severe disease, | *Blood cultures should be obtained for patients with severe disease, those who require hospitalization, and those who fail antibiotic therapy. | ||
*Blood | *Blood cultures may be positive in cases of hematogenous spread, such as S. aureus pneumonia, and in approximately one fourth of patients with [[pneumococcal pneumonia]]. | ||
{| | {| | ||
|[[File:Streptococcus pneumoniae bacterial colonies.jpg|thumb|left|300px|This image depicts the colonial characteristics displayed by Streptococcus pneumoniae bacterial colonies that were grown on primary isolation medium, consisting of trypticase soy agar containing 5% sheep’s blood, as well as 5mg of gentamicin/ml.<br><small>Image obtained from CDC PHIL<ref name=PHIL>{{cite web|url=http://phil.cdc.gov/phil/home.asp| title=CDC Public Health Image Library (PHIL) </ref></small>]] | |[[File:Streptococcus pneumoniae bacterial colonies.jpg|thumb|left|300px|This image depicts the colonial characteristics displayed by Streptococcus pneumoniae bacterial colonies that were grown on primary isolation medium, consisting of trypticase soy agar containing 5% sheep’s blood, as well as 5mg of gentamicin/ml.<br><small>Image obtained from CDC PHIL<ref name=PHIL>{{cite web|url=http://phil.cdc.gov/phil/home.asp| title=CDC Public Health Image Library (PHIL) </ref></small>]] | ||
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==Other Laboratory Tests== | ==Other Laboratory Tests== | ||
===Urine Antigen Test <small><small><ref name="pmid24856525">{{cite journal| author=Couturier MR, Graf EH, Griffin AT| title=Urine antigen tests for the diagnosis of respiratory infections: legionellosis, histoplasmosis, pneumococcal pneumonia. | journal=Clin Lab Med | year= 2014 | volume= 34 | issue= 2 | pages= 219-36 | pmid=24856525 | doi=10.1016/j.cll.2014.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24856525 }} </ref></small></small>=== | ===Urine Antigen Test <small><small><ref name="pmid24856525">{{cite journal| author=Couturier MR, Graf EH, Griffin AT| title=Urine antigen tests for the diagnosis of respiratory infections: legionellosis, histoplasmosis, pneumococcal pneumonia. | journal=Clin Lab Med | year= 2014 | volume= 34 | issue= 2 | pages= 219-36 | pmid=24856525 | doi=10.1016/j.cll.2014.02.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24856525 }} </ref></small></small>=== | ||
*Usually used to diagnose [[Legionella]] | *Usually used to diagnose [[Legionella]] pneumomnia. | ||
*Useful also in the diagnosis of pneumonia caused by Streptococcus pneumoniae, with a sensitivity of 74.6% | *Useful also in the diagnosis of pneumonia caused by ''Streptococcus pneumoniae'', with a sensitivity of 74.6%.<ref name="pmid24976113">{{cite journal| author=Zalacain R, Capelastegui A, Ruiz LA, Bilbao A, Gomez A, Uranga A et al.| title=Streptococcus pneumoniae antigen in urine: diagnostic usefulness and impact on outcome of bacteraemic pneumococcal pneumonia in a large series of adult patients. | journal=Respirology | year= 2014 | volume= 19 | issue= 6 | pages= 936-43 | pmid=24976113 | doi=10.1111/resp.12341 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24976113 }} </ref> | ||
*The | *The Legionella urine antigen can be detected 24 hours after the onset of the symptoms. | ||
*The | *The more sever the [[Legionella]] disease the higher the sensitivity of the urinary antigen test. | ||
*Urinary antigen | *Urinary antigen testing is not recommended for the diagnosis of pneumococcal pneumonia in children due to the high rate of false-positive results.<ref name="pmid21880587">{{cite journal| author=Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C et al.| title=The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. | journal=Clin Infect Dis | year= 2011 | volume= 53 | issue= 7 | pages= e25-76 | pmid=21880587 | doi=10.1093/cid/cir531 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21880587 }} </ref> | ||
===Polymerase Chain Reaction=== | ===Polymerase Chain Reaction=== | ||
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===Procalcitonin=== | ===Procalcitonin=== | ||
*[[Procalcitonin]] levels are associated with the severity of the pneumonia | *[[Procalcitonin]] levels are associated with the severity of the pneumonia. | ||
*This biomarker also helps to differentiate between bacterial and non-bacterial disease.<ref name="JohanssonKalin2014">{{cite journal|last1=Johansson|first1=Niclas|last2=Kalin|first2=Mats|last3=Backman-Johansson|first3=Carolina|last4=Larsson|first4=Anders|last5=Nilsson|first5=Kristina|last6=Hedlund|first6=Jonas|title=Procalcitonin levels in community-acquired pneumonia – correlation with aetiology and severity|journal=Scandinavian Journal of Infectious Diseases|volume=46|issue=11|year=2014|pages=787–791|issn=0036-5548|doi=10.3109/00365548.2014.945955}}</ref> | *This biomarker also helps to differentiate between bacterial and non-bacterial disease.<ref name="JohanssonKalin2014">{{cite journal|last1=Johansson|first1=Niclas|last2=Kalin|first2=Mats|last3=Backman-Johansson|first3=Carolina|last4=Larsson|first4=Anders|last5=Nilsson|first5=Kristina|last6=Hedlund|first6=Jonas|title=Procalcitonin levels in community-acquired pneumonia – correlation with aetiology and severity|journal=Scandinavian Journal of Infectious Diseases|volume=46|issue=11|year=2014|pages=787–791|issn=0036-5548|doi=10.3109/00365548.2014.945955}}</ref> | ||
==Infectious Diseases Society of America/American Thoracic Society consensus recommendation on diagnostics test for etiology of community-acquired pneumonia in adults. <ref name="pmid17278083">{{cite journal |author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |month=March |pmid=17278083 |doi=10.1086/511159 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17278083 |accessdate=2012-09-06}}</ref> | ==Infectious Diseases Society of America/American Thoracic Society consensus recommendation on diagnostics test for etiology of community-acquired pneumonia in adults. <ref name="pmid17278083">{{cite journal |author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |month=March |pmid=17278083 |doi=10.1086/511159 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17278083 |accessdate=2012-09-06}}</ref>== | ||
{{cquote| | {{cquote| | ||
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[[Category:Pneumonia]] | [[Category:Pneumonia]] | ||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
Latest revision as of 17:27, 18 September 2017
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Community-Acquired Pneumonia Microchapters |
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Differentiating Community-acquired pneumonia from other Diseases |
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Diagnosis |
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Case Studies |
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Community-acquired pneumonia laboratory findings On the Web |
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American Roentgen Ray Society Images of Community-acquired pneumonia laboratory findings |
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Community-acquired pneumonia laboratory findings in the news |
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Directions to Hospitals Treating Community-acquired pneumonia |
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Risk calculators and risk factors for Community-acquired pneumonia laboratory findings |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]
Overview
While chest X-ray and pulse oximetry are routine tests among all patients with suspected pneumonia, additional laboratory tests (such as blood culture and gram sputum, sputum blood culture and gram stain, urinary antigen tests) are optional tests unless their results might alter the treatment plan.
Laboratory Tests
| Diagnostic Test | Indications | ||
|---|---|---|---|
| Sputum Culture |
| ||
| Blood Culture |
| ||
| Urinary Antigen Test for Pneumococcus |
| ||
| Urinary Antigen Test for Legionella |
| ||
| Adapted from IDSA/ATS Guidelines for CAP in Adults[1] | |||
Routine Tests
Findings in routine blood tests are based on the severity of the disease and the cause, they can include the following:[2]
- Leukocytosis with left shift (in cases of bacterial pneumonia)
- Leukopenia (in cases of atypical pneumonia)
- Eosinophilia (in cases of eosinophilic pneumonia)
- Anemia
- Hyponatremia
- Thrombocytopenia
- Elevated BUN
- Findings of lactic acidosis (decreased HCO3, increased lactic acid levels)
- ABG: may show hypoxia and/or hypercapnea
Sputum Gram Stain and Culture
- Sputum samples should be obtained in all patients with productive cough.
- Gram-stain and culture should be performed to assess the causative agent and guide the therapy.
- In approximately 80% of cases of pneumococcal pneumonia the sputum culture is positive.[3]
- However, the general yield of a sputum sample does not exceed 50-60%.
Blood Culture
- Blood cultures should be obtained for patients with severe disease, those who require hospitalization, and those who fail antibiotic therapy.
- Blood cultures may be positive in cases of hematogenous spread, such as S. aureus pneumonia, and in approximately one fourth of patients with pneumococcal pneumonia.
 Image obtained from CDC PHIL[4] |
Other Laboratory Tests
Urine Antigen Test [5]
- Usually used to diagnose Legionella pneumomnia.
- Useful also in the diagnosis of pneumonia caused by Streptococcus pneumoniae, with a sensitivity of 74.6%.[6]
- The Legionella urine antigen can be detected 24 hours after the onset of the symptoms.
- The more sever the Legionella disease the higher the sensitivity of the urinary antigen test.
- Urinary antigen testing is not recommended for the diagnosis of pneumococcal pneumonia in children due to the high rate of false-positive results.[7]
Polymerase Chain Reaction
- Polymerase chain reaction (PCR) is more useful in the diagnosis of viral and mycoplasma pneumonia.
C-Reactive Protein
- C-reactive protein (CRP) may be helpful to differentiate between bacterial from viral pneumonia.
- It has been reported that CRP is elevated (> 100 mg/L) in cases of bacterial pneumonia.[8]
Procalcitonin
- Procalcitonin levels are associated with the severity of the pneumonia.
- This biomarker also helps to differentiate between bacterial and non-bacterial disease.[9]
Infectious Diseases Society of America/American Thoracic Society consensus recommendation on diagnostics test for etiology of community-acquired pneumonia in adults. [10]
| “ |
Recommended Diagnostic Tests for Etiology
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” |
For Level of evidence and classes click here.
References
- ↑ Mandell, L. A.; Wunderink, R. G.; Anzueto, A.; Bartlett, J. G.; Campbell, G. D.; Dean, N. C.; Dowell, S. F.; File, T. M.; Musher, D. M.; Niederman, M. S.; Torres, A.; Whitney, C. G. (2007). "Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults". Clinical Infectious Diseases. 44 (Supplement 2): S27–S72. doi:10.1086/511159. ISSN 1058-4838.
- ↑ Solomon, Caren G.; Wunderink, Richard G.; Waterer, Grant W. (2014). "Community-Acquired Pneumonia". New England Journal of Medicine. 370 (6): 543–551. doi:10.1056/NEJMcp1214869. ISSN 0028-4793.
- ↑ Musher, Daniel M.; Thorner, Anna R. (2014). "Community-Acquired Pneumonia". New England Journal of Medicine. 371 (17): 1619–1628. doi:10.1056/NEJMra1312885. ISSN 0028-4793.
- ↑ {{cite web|url=http://phil.cdc.gov/phil/home.asp%7C title=CDC Public Health Image Library (PHIL)
- ↑ Couturier MR, Graf EH, Griffin AT (2014). "Urine antigen tests for the diagnosis of respiratory infections: legionellosis, histoplasmosis, pneumococcal pneumonia". Clin Lab Med. 34 (2): 219–36. doi:10.1016/j.cll.2014.02.002. PMID 24856525.
- ↑ Zalacain R, Capelastegui A, Ruiz LA, Bilbao A, Gomez A, Uranga A; et al. (2014). "Streptococcus pneumoniae antigen in urine: diagnostic usefulness and impact on outcome of bacteraemic pneumococcal pneumonia in a large series of adult patients". Respirology. 19 (6): 936–43. doi:10.1111/resp.12341. PMID 24976113.
- ↑ Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C; et al. (2011). "The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America". Clin Infect Dis. 53 (7): e25–76. doi:10.1093/cid/cir531. PMID 21880587.
- ↑ Flanders, Scott A; Stein, John; Shochat, Guy; Sellers, Karen; Holland, Miles; Maselli, Judith; Drew, W.Lawrence; Reingold, Art L; Gonzales, Ralph (2004). "Performance of a bedside c-reactive protein test in the diagnosis of community-acquired pneumonia in adults with acute cough". The American Journal of Medicine. 116 (8): 529–535. doi:10.1016/j.amjmed.2003.11.023. ISSN 0002-9343.
- ↑ Johansson, Niclas; Kalin, Mats; Backman-Johansson, Carolina; Larsson, Anders; Nilsson, Kristina; Hedlund, Jonas (2014). "Procalcitonin levels in community-acquired pneumonia – correlation with aetiology and severity". Scandinavian Journal of Infectious Diseases. 46 (11): 787–791. doi:10.3109/00365548.2014.945955. ISSN 0036-5548.
- ↑ Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG (2007). "Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults". Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 44 Suppl 2: S27–72. doi:10.1086/511159. PMID 17278083. Retrieved 2012-09-06. Unknown parameter
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