Bacterial pneumonia differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Arooj Naz

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Overview

Bacterial Pneumonia has various subclassifications, all with distinct underlying causes. Prevalent organisms have been mentioned below.

Differentiating Bacterial Pneumonia from other Diseases

Differential Diagnosis of Pneumonia by Infectious Agent

Disease	Findings	Common Organisms
Typical Bacterial		S. pneumoniae, H. influenzae, S. aureus, Klebsiella pneumoniae, anaerobes, group A streptococci, Moraxella catarrhalis.
Atypical Bacterial		Mycoplasma pneumoniae, Legionella spp, Chlamydophila pneumoniae, and C. psittaci.
Viral		Influenza virus, Parainfluenza virus, Adenovirus, Rhinovirus, RSV, SARS, MERS-CoV,
Fungi		Cryptococcus spp, Pneumocystis jirovecii, Histoplasma capsulatum, Coccidioides spp, Aspergillus spp
Parasite

Differential Diagnosis of Pneumonia

Disease	Findings
Acute bronchitis	No infiltrates seen on the chest X-ray.
Asthma	Past medical history, no infiltrates seen on chest X-ray.
Bronchiolitis obliterans	Should be suspected in patients with pneumonia who do not respond to antibiotics treatment.
Congestive heart failure	Bilateral pulmonary edema, shortness of breath.
COPD	Past medical history, no infiltrates on chest X-ray, fever is uncommon.
Empyema	CXR showing features of pleural effusion, inflammatory markers on thoracocentesis.
Endocarditis	Finding of septic pulmonary emboli
Gastroesophageal reflux disease (GERD)	Normal chest X-ray, symptoms are worse during night and associated with meals.
Lung abscess	Chest X-ray shows signs of lung abscess.
Lung cancer	Weight loss, clear sputum. CT scan and biopsy are helpful in ruling out malignancy.
Pertussis	Productive cough for weeks, nasopharyngeal aspirate aids in diagnosis.
Pulmonary embolus	A high degree of suspicion should be kept for pulmonary embolus. Chest X-ray may be normal.
Sinusitis	Sinus tenderness, post nasal drip.
Vasculitis	Systemic manifestations of collagen vascular disease may be seen.