Data from clinical studies illustrate that the differential diagnosis of tb from bacterial pneumonia is not straightforward. 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. Differential diagnosis an overview sciencedirect topics. Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known. Differential diagnosis of usual interstitial pneumonia. Lemonovich, md, university hospitals case medical center, cleveland, ohio c ommunityacquired pneumonia cap is a significant cause of morbidity and mortality in adults. 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. Differentiation of bacterial and viral pneumonia in children. Differential diagnosis of pneumonia pt master guide. Because of the wide spectrum of associated clinical features, cap is a part of the differential diagnosis of nearly all respiratory. Many patients referred for evaluation for recurrent pneumonia are diagnosed with asthma. Diagnosis of pneumonia in children competently about. Differential diagnosis for the advanced practice nurse.
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. Differential diagnosis between communityacquired pneumonia and. Few epithelial cells diagnosis differential diagnosis many microbiologic pathogens can cause cap. She undergone computed tomography of chest and bronchoscopy to. Pneumonia is typically diagnosed based on a combination of physical signs and a. Pneumonia is one of the major infectious diseases responsible for significant morbidity and mortality throughout the world. Initial evaluation should determine the need for hospitalization versus outpatient management using validated mortality or severity prediction scores. 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. 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. Cyanosis is bluish coloration of skin or mucosa, it is easy to spot, but differential diagnosis, history and examination are very important. Differential diagnosis between communityacquired pneumonia and nonpneumonia diseases of the chest in the emergency ward. 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. Typical bacterial pneumonia statpearls ncbi bookshelf.
However, uip is not synonymous with ipf as other clinical conditions may be associated with uip, including chronic hypersensitivity pneumonitis, collagen vascular disease, drug. 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. The diagnosis of cap is usually made in patients with suggestive symptoms, signs, and. Generally speaking, a ct scan is more accurate than a chest xray although it costs more and exposes you to higher doses of radiation. Infection by bacteria or viruses is the most common cause, although infection by other microorgamisms such as rickettsi. Communityacquired pneumonia cap is a leading cause of.
What are the differential diagnoses for bacterial pneumonia. In the absence of clinical information, radiologists cannot reliably distinguish between pneumonia and. Differential diagnosis must be established with other pulmonary defects, including cdh and bronchopulmonary sequestration bps. The differential diagnosis of pneumonia in childhood. However, more testing is often needed to confirm most of these diagnoses and is generally outside the scope of a primary care provider. Communityacquired pneumonia is diagnosed by clinical features e. Blastomycosis infection often presents as an acute pneumonia. Should be suspected in patients with pneumonia who do not respond to antibiotics treatment. Read the causes, differential diagnosis, history taking, examination and investigations of cyanosis, be it central or peripheral. Diagnosis is suggested by a history of cough, dyspnea, pleuritic pain, or acute functional or cognitive decline, with abnormal vital signs e. Note the increased anteroposterior chest diameter, which is suggestive of chronic obstructive pulmonary.
Incidence, correlates, and chest radiographic yield of new lung cancer diagnosis in 3398 patients with pneumonia. Pneumonia can be generally defined as an infection of the lung parenchyma, in which consolidation of the affected part and a filling of the. Mild pneumonia should be differentiated from upper respiratory tract infection. Pneumonia is an inflammatory pulmonary process that may originate in the lung or be a focal complication of a contiguous or systemic inflammatory process. The differential diagnosis for pneumonia in the immunocompromised. Diagnosis and management of communityacquired pneumonia in. 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. Symptoms typically include some combination of productive or dry cough, chest pain, fever and difficulty breathing. Pneumonia can be a presenting complaint for various pathologies such as lung tumours, chronic obstructive pulmonary disease, or infectious diseases eg, tuberculosis. Dyspnea associated with mediastinal changes, pneumonia bacteremia, meningitis, gastrointestinal bleeding, cutaneous lesions mediastinal widening. Often they are not toxic, do not have shivers and do not seek medical attention. The differential diagnosis for patients who present with abnormalities on chest xray includes lung cancer, as well as nonmalignant diseases.
Diagnosis differential diagnosis many microbiologic pathogens can cause cap. The diagnosis of cap is usually made in patients with suggestive symptoms, signs, and radiological features. In emergency department studies, 35% of children with an asthma exacerbation have abnormalities visible on chest radiographs. May 11, 2018 you may have heard the term differential diagnosis thrown around by your doctor or others. Pneumonia traditionally has been classified as typical. Performance of a bedside creactive protein test in the diagnosis of communityacquired pneumonia in adults with acute cough.
This refers to when your doctor considers possible conditions that could be. In a child not yet diagnosed with asthma, these abnormalities are frequently interpreted as pneumonia. 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. 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. 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. Watkins, md, ms, akron general medical center, akron, ohio tracy l. After surgery, the patient recovered well, and at 2year followup in november, 2006. These include infectious causes such as tuberculosis or pneumonia, or inflammatory conditions such as sarcoidosis. 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. 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. 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. Pneumonia pneumonia can be difficult to diagnose because it shares many symptoms with other conditions, such. If your doctor still has a high suspicion for pneumonia after a negative result, she may choose to confirm the diagnosis by ct scan.
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. Community acquired pneumonia boston health care for the. Differential diagnosis of aspiration pneumonia james l. The yield of sputum cultures varies from 34 to 86%. 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. 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. The initial choice of antibiotic is made empirically. Typical bacterial pneumonia is usually lobar pneumonia with parapneumonic pleural effusions.
Differential diagnosis for a repiratory disesae outbreak. Past medical history, no infiltrates seen on chest xray. Ps shows overlapping features or may coexist in 50% to 60% of cases. Jun 01, 2011 communityacquired pneumonia cap is a significant cause of morbidity and mortality in adults. Tang kl, eurich dt, minhassandhu jk, marrie tj, majumdar sr. Differentiation of bacterial and viral pneumonia in. Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications. Radiographic images in a patient with right upper lobe pneumonia. The major differential diagnosis is asthma, and in some cases, a clear distinction between copd and asthma is not possible. Usual interstitial pneumonia navigation for this section. A number of noninfectious conditions, including neoplastic lesions, pulmonary oedema, pulmonary embolism, druginduced pneumonitis, diffuse alveolar haemorrhage syndromes, cryptogenic. This refers to when your doctor considers possible conditions that could be causing your symptoms.
It is one of the common causes of admission to the paediatric ward. Parmelee presbyterian hospital the differential diagnosis of pneumonia in childhood pneumonia. Walking pneumonia differential diagnosis of atypical. Apr 12, 2016 communityacquired pneumonia cap is a common cause of presentation to healthcare facilities. Diagnosis and management of communityacquired pneumonia in adults richard r. Diagnosis and management of communityacquired pneumonia. Overview of communityacquired pneumonia in adults uptodate. Differential diagnosis of pneumonia differential diagnosis. In this article, we will discuss about the differential diagnosis of pneumonia. Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Sep 15, 2019 it is possible that a chest xray can miss a diagnosis. Abnormalities of airway patency as well as alveolar ventilation and perfusion occur frequently due to various mechanisms. 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.
Cap is defined as an infection of the lung parenchyma that is not acquired in a hospital, longterm. Several diseases can present with similar signs and symptoms to pneumonia, such as. Pneumonia traditionally has been classified as typical, usually caused by s. The diagnosis and differential diagnosis of pneumonia. However, a chest xray cannot reliably differentiate bacterial from a nonbacterial cause. Diagnosis and management alexander kaysin, md, mph, and anthony j. The role of serum coagulation factors in the differential. In this article, we discuss and illustrate the spectrum of radiologic manifestations, diagnostic pitfalls, and differential diagnoses associated with a variety of aspiration diseases.
Differential diagnosis the onset of copd is insidious. Contribution to the differential diagnosis of pneumonia in childhood. Nov 05, 2018 a careful history and examination in patients with recurrent pneumonia are helpful to further narrow the differential diagnosis. Differential diagnosis usual interstitial pneumonia. You may have heard the term differential diagnosis thrown around by your doctor or others. Imaging plays a crucial role in the detection and management of patients with pneumonia. Cap is a part of the differential diagnosis of nearly all respiratory illnesses. Viera, md, mph, university of north carolina at chapel hill.
Pdf diagnosis and differential diagnosis of ventilator. 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. What are the differential diagnoses for pediatric pneumonia. What are the differential diagnoses for viral pneumonia. There are other conditions that can have symptoms similar to pneumonia, like bronchitis or congestive heart failure. Improved diagnosis of the etiology of communityacquired pneumonia with realtime polymerase chain reaction. 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. Noninfectious mimics of communityacquired pneumonia ncbi. Prospective evaluation of point of care ultrasonography for the diagnosis of pneumonia in children and young adults.
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. Pulmonary pulmonary symptoms may be due to a variety of conditions. These include diseases associated with tracheoesophageal or. Pneumonia traditionally has been classified as typical, usually. See diagnostic approach to communityacquired pneumonia in adults and sputum cultures for the evaluation of bacterial pneumonia. 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. Bacterial pneumonia differential diagnoses emedicine. These studies have been hampered by incomplete aetiological approaches. The differential diagnosis of communityacquired pneumonia and some nonpneumonia diseases involving the chest may sometimes be. Pathological changes may begin years before symptoms appear. 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. A number of noninfectious conditions, including neoplastic lesions, pulmonary oedema, pulmonary embolism, druginduced pneumonitis, diffuse alveolar haemorrhage syndromes. 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.
Apr 14, 2007 the diagnosis may be easily missed, because the symptoms are misinterpreted as common infection. Other potential diagnoses are easier to distinguish from cop d2. When the labs and clinical features are positive, a positive chest radiograph is considered a gold standard for diagnosis of pneumonia. These reservations aside, the guidelines are well researched and well balanced. 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. Aetiology and prediction of pneumonia in lower respiratory tract infection in primary care. This study was designed to clarify chest computerized tomography ct findings of mycoplasma pneumoniae pneumonia facilitating differential diagnosis from cap community acquired pneumonia. Communityacquired pneumonia and the use of fluoroquinolones. 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. Differential diagnosis to be considered while diagnosing pneumonia includes. The differential diagnosis of the association of pneumonia and haemorrhagic pericarditis should include viral aetiologies. Pdf mycoplasma pneumoniae, an important differential.