Bacterial pneumonia history and symptoms

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

Overview

Detailed information pertaining to a patient's history may greatly assist in determining the underlying cause of pneumonia. Some common symptoms seen in a majority of patients include cough, fever, and a pleuritic chest pain. Specific signs and symptoms, such as diarrhea, hyponatremia, and anemia may increase the suspiciousness of specific causative organisms. Details pertaining to cough may assist in identifying the underlying cause. It is also important to inquire about risk factors and comorbidities as they can provide important information regarding the bacterial infection.

History

In order to understand the underlying cause of pneumonia, it is imperative that health care providers assess the patient's risk factors, as well as comorbidities and any other conditions that may provide further information. Affected individuals should be inquired regarding:

• Duration of symptoms
• Presence of cough
  • Dry
  • Productive (Inquire about the amount and colour)
    • Productive cough may be indicative of:
      • Currant Jelly sputum: Klebsiella
      • Rust coloured sputum: Streptococcus pneumoniae
      • Green sputum: Hemophilus, Pseudomonas
      • Foul smelling/ bad-tasting sputum: Anaerobes
  • Hemoptysis
• Details pertaining to fever
  • Temperature
  • Duration
  • Pattern
  • Presence or absence of any chills
• Associated chest pain

Certain exposures should also be inquired about. These include but are not limited to:

• Exposure to and use of equipment such as water coolers and water tanks as well as air-conditioners (may indicate a Legionella pneumonia infection)
• Significant time spent in crowded areas especially homeless shelters, jails and prisons. Residing in poverty stricken areas can also contribute to infection development (may indicate a Streptococcus pneumonia, Mycobacteria, Mycoplasma, or Chlamydia infection)
• Recent animal Exposure (eg, Chlamydia psittaci is found in individuals with exposure to birds)
• Recent exposure with sick individuals

Symptoms

Common Symptoms

• Fever
• Chills
• Productive cough
• Dyspnea
• Chest pain (pleuritic)
• Weight loss

Elderly patients may experience:

• Weakness
• Lethargy
• Altered mental status
• Dyspepsia
• Absence of fever

Uncommon Symptoms

• Fatigue
• Headache
• Myalgia
• Arthralgia
• Diarrhea and hyponatremia (indicative of Legionella)
• Anemia and jaundice (hemolytic anemia) (indicative of Mycoplasma)