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Varies with type of Pneumonia
History:
- Symptoms
- Illnesses
- Surgeries
- Medications
- Habits
- Travel
- Hobbies
- Allergies
- Occupation
Physical exam:
- Skin may show a rash, cyanosis (blue lips)
- Increased heart and respiration rate (number of breaths per minute)
- Blood pressure may be low
- There may be fever
- The chest (rib cage) may expand poorly
- There may be decreased breath sounds or abnormal sounds (friction rub, rales, crackles, wheezing) due to destruction of lung tissue, narrowing of airways, or presence of fluid and pus.
- Changes in mentation - confusion, Anxiety
Tests:
- Sputum samples may be collected and sent for microscopic analysis using special stains to reveal the particular bacteria.
- Sputum may be sent for cultures grown in order to identify the organism type, along with sensitivity to antibiotics.
- Cultures may take anywhere from 48 hours (bacteria) to several weeks (TB).
- Viral cultures can be done as well.
- Blood may also be collected and sent for bacterial cultures (positive in 8-20% of B .p).
- Blood may show high ESR (viral), white blood cell count (may be normal in elderly and low in Viral p.), low oxygen levels (hypoxia), low Sodium levels (empyema or lung Abscess), high LDH (PCP), and acidity (acidosis).
- Blood can also be screened for presence of specific Proteins called antibodies.
- In Mycoplasma p., 1-2 weeks after infection there are high levels of IgM antibodies in almost 80% of patients.
- One can look for organisms such as viruses (herpes, Influenza, RSV) by doing a throat swab using a sterile Q-tip and swabbing the throat; or by performing tracheal aspiration (suction tube used to suck secretions from the trachea, i.e. the main airway).
- In PCP, an HIV test may be needed - CD4 cell count falls below 200 if HIV is present.
- Pictures of the lung are done.
- Chest X-Ray - may show infection in one or more lobes of the lungs (B. p.), diffuse pattern of infection (PCP, V. p., M. p.), and effusions.
- CAT scan or MRI is rarely necessary unless cancer or Abscess is suspected; or when preparing for a procedure.
- Your doctor may consult with an infectious diseases specialist, or a pulmonologist (lung specialist).
The pulmonologist may recommend:
- Bronchoscopy - flexible tube with a camera at its tip is passed through the mouth to the lungs, taking a sample of secretions for culture or biopsy (taking a tiny piece).
- Thoracentesis is performed by inserting a needle between the ribs and removing fluids for analysis. This is done in effusions and empyema.
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