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Pneumonia


Presentation

Individuals with infectious pneumonia generally have a productive cough, sharp pain in between breaths, fever accompanied with shaking chills and an increased respiratory rate. For the elderly, confusion is often the most prominent sign [6]. In children under 5, the typical signs and symptoms are fever, fast or difficult breathing and cough.

Fever is not a specific symptom because it occurs in many other illnesses and may be absent in with more severe conditions or malnutrition. Again, children less than two months old do not present with cough. In severe cases, other symptoms to expect include a blue-tinged skin, decreased thirst, convulsions, constant vomiting, decreased levels of consciousness and temperature always at the extremes.

Both bacterial and viral cases of pneumonia have similar symptoms.

Some causative agents are linked with classic but often non-specific characteristics. For instance pneumonia caused by Klebsiella may have the “currant jelly” symptom or bloody sputum, pneumonia caused by Streptococcus pneumonia is linked with rusty and coloured sputum while Legionella-cuased pneumonia is associated with abdominal pain, diarrhea or confusion.

Fever
  • BACKGROUND: Severe fever with thrombocytopenia syndrome (SFTS) was first reported in China in 2011. Human-to-human transmission of the virus occurred occasionally in family clusters.[ncbi.nlm.nih.gov]
Pain
  • Early symptoms are similar to influenza symptoms : fever, a dry cough, headache, muscle pain, and weakness. Within a day or two, the symptoms typically get worse, with increasing cough, shortness of breath and muscle pain.[lung.org]
  • In an individual with any form of pneumonia, the sac get s filled with pus and fluid and this makes breathing painful, thereby limiting the individual’s ability to take in oxygen.[symptoma.com]
  • […] no severe problems Chest pain No chest pain or only mild pain No sore throat Sore throat How pneumonia is diagnosed Pneumonia can be difficult to diagnose because the symptoms are very similar to bronchitis, a bad cold or asthma.[beta.nhs.uk]
  • Analgesics: non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol - for mild pleuritic pain; more severe pain may require opiate analgesia but care is needed not to aggravate CO 2 retention. Nebulised saline may help expectoration.[patient.info]
Chills
  • A 53-year-old female presented with intermittent fever, chills, and dry cough since 10 days. Chest computed tomography scan showed multiple bilateral patchy infiltrates.[ncbi.nlm.nih.gov]
  • Chills iStock/George Clerk Patients with pneumonia often report teeth-chattering chills that cannot be remedied. Chills are a sign of fever and that the body is working overtime to regulate temperature.[rd.com]
  • The air sacs may fill up with fluid or pus, causing symptoms such as a cough with phlegm (a slimy substance), fever, chills, and trouble breathing. Overview Pneumonia and its symptoms can vary from mild to severe.[web.archive.org]
Fatigue
  • Fatigue (tiredness) from pneumonia can last for a month or more.[web.archive.org]
  • […] disease that is marked by inflammation of lung tissue accompanied by infiltration of alveoli and often bronchioles with white blood cells (such as neutrophils) and fibrinous exudate, is characterized by fever, chills, cough, difficulty in breathing, fatigue[merriam-webster.com]
  • Bronchitis can cause: Cough Production of mucus Shortness of breath Wheezing Chest tightness Low fever and chills Fatigue Most bronchitis is caused by viruses. The same viruses that cause colds and flu often cause acute bronchitis.[aurorahealthcare.org]
  • The fatigue can make it hard to get through the day. Learn more At 65 or older, the risk of hospitalization with pneumococcal pneumonia is over 10X greater than adults aged 18–49.[knowpneumonia.com]
Malaise
  • The elderly may present with mainly systemic complaints of malaise, fatigue, anorexia and myalgia. Young children may present with nonspecific symptoms or abdominal pain.[patient.info]
  • Initially, these patients experience fever with chills, cough, shortness of breath, headache, muscle pain, and malaise, all of which may subside in a day if there is no further exposure.[britannica.com]
  • Symptoms and signs include malaise, fever, chills, rigor, cough, dyspnea, and chest pain.[msdmanuals.com]
  • […] mild or high Shaking chills Shortness of breath (may only occur when you climb stairs or exert yourself) Other symptoms include: Confusion, especially in older people Excess sweating and clammy skin Headache Loss of appetite, low energy, and fatigue Malaise[nlm.nih.gov]
Cough
  • Cough is often distressing for patients with pneumonia. Accordingly they often use over-the-counter (OTC) cough medications (mucolytics or cough suppressants).[ncbi.nlm.nih.gov]
  • Objective measurements of cough indices (cough frequency, cough receptor sensitivity).[dx.doi.org]
  • Early symptoms are similar to influenza symptoms : fever, a dry cough, headache, muscle pain, and weakness. Within a day or two, the symptoms typically get worse, with increasing cough, shortness of breath and muscle pain.[lung.org]
Dyspnea
  • CASE SUMMARY: A 59-year-old man with a history of chronic obstructive pulmonary disease (COPD) presented with dry cough, low-grade fever, and progressive dyspnea.[ncbi.nlm.nih.gov]
  • The usual presentation occurs with insidious onset and nonspecific respiratory symptoms such as dyspnea and/or cough.[doi.org]
Dry Cough
  • She was admitted to clinic with a 2-week history of dyspnoea, dry cough and fever. Her initial examination showed her to be hypoxic on air with saturations of 77% and left basal crackles.[ncbi.nlm.nih.gov]
Sputum Production
  • Forest plot of comparison: 2 Active cycle of breathing techniques plus routine treatment versus routine treatment alone, outcome: 2.4 Duration of antibiotic therapy. 2.2.4 Duration of sputum production The mean duration of sputum production seemed to[dx.doi.org]
  • Pneumonia can first feel like a cold or the flu, but will often result in symptoms like a high fever, shaking, chills, and a cough with increased sputum production. The sputum is usually discolored and sometimes bloody.[craighospital.org]
  • Atypical pneumonia : This describes a type of pneumonia that tends to be milder, with little or no sputum production; the chest x-ray may show areas of fluid in the lungs but not in a lobar pattern.[health.harvard.edu]
Tachypnea
  • Fever, tachypnea, and auscultatory findings were not associated with pneumonia diagnosis.[doi.org]
  • Although no single finding reliably differentiates pneumonia from other causes of childhood respiratory illness, hypoxia and increased work of breathing are more important than tachypnea and auscultatory findings.[ncbi.nlm.nih.gov]
  • Definition (MSH) A pulmonary disease in humans occurring in immunodeficient or malnourished patients or infants, characterized by DYSPNEA, tachypnea, and HYPOXEMIA. Pneumocystis pneumonia is a frequently seen opportunistic infection in AIDS.[fpnotebook.com]
Vomiting
  • Aspiration pneumonia Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs.[mayoclinic.org]
  • Or, they may vomit, have a fever and cough, or appear restless, sick, or tired and without energy. Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms.[lung.org]
  • Other Common Types of Pneumonia Aspiration Pneumonia This type of pneumonia can occur if you inhale food, drink, vomit, or saliva from your mouth into your lungs.[web.archive.org]
  • Vomiting – not just vomiting from a big coughing fit, but vomiting even in between coughing fits. Blue color around the lips and face – from lack of oxygen.[askdrsears.com]
  • They may seem weak, vomit, or have diarrhea. Less common symptoms include abdominal pain and a stiff neck.[babycenter.com]
Nausea
  • […] may produce greenish, yellow or even bloody mucus Fever, sweating and shaking chills Shortness of breath Rapid, shallow breathing Sharp or stabbing chest pain that gets worse when you breathe deeply or cough Loss of appetite, low energy, and fatigue Nausea[lung.org]
  • Signs of pneumonia can include coughing, fever, fatigue, nausea, vomiting, rapid breathing or shortness of breath, chills, or chest pain. Certain people are more likely to become ill with pneumonia.[web.archive.org]
  • Common pneumonia symptoms include: Chest pain when you breathe or cough Cough that produces phlegm or mucus Fatigue and loss of appetite Fever, sweating, and chills Nausea, vomiting, and diarrhea Shortness of breath Along with these symptoms, older adults[webmd.com]
  • […] cough Confusion or changes in mental awareness (in adults age 65 and older) Cough, which may produce phlegm Fatigue Fever, sweating and shaking chills Lower than normal body temperature (in adults older than age 65 and people with weak immune systems) Nausea[mayoclinic.org]
  • A dry and/or phlegm-y cough Rapid breathing Breathlessness Chest pain Fever Sweating and shivering Loss of appetite Rapid heartbeat Coughing up blood Headaches Tiredness Nausea and vomiting Wheezing Muscle pain Confusion How are adult pneumonia sufferers[thesun.co.uk]
Diarrhea
  • Resources for 2018 Pneumonia and Diarrhea Progress Report Pneumonia and Diarrhea Progress Report: 2018 A new report finds health systems are falling woefully short of ensuring the most vulnerable children have sufficient access to prevention and treatment[worldpneumoniaday.org]
  • They may seem weak, vomit, or have diarrhea. Less common symptoms include abdominal pain and a stiff neck.[babycenter.com]
  • […] instance pneumonia caused by Klebsiella may have the “currant jelly” symptom or bloody sputum, pneumonia caused by Streptococcus pneumonia is linked with rusty and coloured sputum while Legionella-cuased pneumonia is associated with abdominal pain, diarrhea[symptoma.com]
  • One study ( Nacul 1997 ) reported on adverse outcomes including vomiting, diarrhea, irritability and bulging fontanelle.[doi.org]
Loss of Appetite
  • Early symptoms are similar to flu symptoms, which include: Fever Dry cough Headache Sore throat Loss of appetite Muscle pain Additional symptoms about a day later: High fever Cough with mucus Shortness of breath Cleveland Clinic News & More Cleveland[my.clevelandclinic.org]
  • The most common signs and symptoms are: cough fevers, sweating and shivering difficulty breathing or rapid breathing feeling generally tired and unwell loss of appetite Check your symptoms with healthdirect’s Symptom Checker for advice on when to seek[healthdirect.gov.au]
  • Fever, sweating and shivering, loss of appetite and a rapid heartbeat are all also symptoms. Less common symptoms include coughing up blood, headaches, tiredness, feeling or being sick, wheezing, muscle pain and confusion.[thesun.co.uk]
  • Other symptoms include shortness of breath, rapid-shallow breathing, chest pain, headache, excessive fatigue, and/or loss of appetite.[craighospital.org]
Abdominal Pain
  • For instance pneumonia caused by Klebsiella may have the “currant jelly” symptom or bloody sputum, pneumonia caused by Streptococcus pneumonia is linked with rusty and coloured sputum while Legionella-cuased pneumonia is associated with abdominal pain[symptoma.com]
  • pain may occur May cause a pertussis-like syndrome Chest Xray: bilateral, patchy, ground glass opacities consistent with viral pneumonia In hematopoietic stem cell transplants, the GI tract is more commonly affected than lungs; cold agglutinins are present[pathologyoutlines.com]
  • Less common symptoms include abdominal pain and a stiff neck. Streptococcus pneumoniae is the usual cause, but other bacteria (such as Staphylococcus aureus or Mycoplasma pneumoniae) can cause pneumonia, too.[babycenter.com]
  • Young children may present with nonspecific symptoms or abdominal pain. Signs: tachypnoea, bronchial breathing, crepitations, pleural rub, dullness with percussion.[patient.info]
Chest Pain
  • She presented with fever, cough, dyspnea and pleuritic chest pain. Chest radiograph showed bilateral infiltrations. Examination of bronchoalveolar lavage fluid revealed significant eosinophilia. She was diagnosed with acute eosinophilic pneumonia.[ncbi.nlm.nih.gov]
  • pain No chest pain or only mild pain No sore throat Sore throat How pneumonia is diagnosed Pneumonia can be difficult to diagnose because the symptoms are very similar to bronchitis, a bad cold or asthma.[beta.nhs.uk]
  • In two studies the presence of chest pain more than doubled the probability of M. pneumoniae .[doi.org]
  • And see your doctor right away if you have difficulty breathing, develop a bluish color in your lips and fingertips, have chest pain, a high fever, or a cough with mucus that is severe or is getting worse.[lung.org]
Cyanosis
  • A 5-month-old infant presented with cyanosis and tachypnea. He had no previous medical or birth history suggesting primary immune deficiency. He was diagnosed with interstitial pneumonia on admission.[ncbi.nlm.nih.gov]
  • […] that usually worsens when taking a deep breath, known as pleuritic pain fast heartbeat fatigue and weakness nausea and vomiting diarrhea sweating headache muscle pain confusion or delirium, especially in older adults dusky or purplish skin color, or cyanosis[medicalnewstoday.com]
  • Witnessed aspiration was followed by respiratory distress and cyanosis within two hours. The women's X-rays showed infiltrates in one or both lower lobes.[doi.org]
Tachycardia
  • A 23-month-old girl visited the emergency department with high fever, cough, first wheezing episode, chest retraction and tachycardia. The chest X-ray revealed consolidation on the left lower lung field; the cardiothoracic ratio was 60%.[ncbi.nlm.nih.gov]
  • […] infiltrations, flat frosted glass-like opacity frequently with pleuritis rarely with pleuritis rales, in lobar affliction additionally resonance reduction very discrete rales, or unsuspicious in auscultation sensation of being severely ill, tachypnea, tachycardia[flexikon.doccheck.com]
  • Physical examination revealed tachycardia, tachypnea, hypoxia and decreased breath sounds with fine crackles bilaterally. Chest X-ray showed a right lower lobe infiltrate.[dx.doi.org]
  • We thus incorporated a group with "severe sepsis", defined by standard criteria ( Bone 1993 ) which detail definitions of sepsis (fever, tachycardia, tachypnoea and leucocytosis) and end‐organ perfusion abnormalities (hypotension, oliguria, gas exchange[doi.org]
Hypertension
  • Cancer 2,574 29,310 -- 1,651 -- 5,631 Mental disorders 971 -- 1,135 850 10,194 1,849 COPD, asthma 518 24,511 816 672 -- 1,681 Osteoarthritis and other non-traumatic joint disorders 955 -- 1,034 821 5,974 1,931 Diabetes mellitus 770 -- -- 1,493 -- 2,536 Hypertension[web.archive.org]
  • [17] and may signify renal artery stenosis.[18] Prevention of recurrence is based on managing hypertension, coronary artery disease, renovascular hypertension, and heart failure.[en.wikipedia.org]
  • Short‐term use of corticosteroids may be associated with hyperglycaemia, fluid retention, and hypertension, which are typically transient ( Schäcke 2002 ).[doi.org]
Leukonychia
  • Confusion, especially in older people Excess sweating and clammy skin Headache Loss of appetite, low energy, and fatigue Malaise (not feeling well) Sharp or stabbing chest pain that gets worse when you breathe deeply or cough White nail syndrome, or leukonychia[nlm.nih.gov]
Myalgia
  • The elderly may present with mainly systemic complaints of malaise, fatigue, anorexia and myalgia. Young children may present with nonspecific symptoms or abdominal pain.[patient.info]
  • Forest plot of tests: 1 Cough, 2 Wheeze, 3 Coryza, 4 Crepitations, 5 Fever, 6 Rhonchi, 7 Shortness of breath, 8 Headache, 9 Chest pain, 10 Diarrhoea, 11 Myalgia.[doi.org]
  • […] and enlarged cervical lymph nodes Otitis media may occur children under age 1 year Upper respiratory tract infection may progress to involve lower respiratory tract with cough and shortness of breath; often with systemic symptoms of fever, headache, myalgias[pathologyoutlines.com]
  • […] historically considered important, as it differentiated those more likely to present with "typical" respiratory symptoms and lobar pneumonia from those more likely to present with "atypical" generalized symptoms (such as fever, headache, sweating and myalgia[en.wikipedia.org]
Arthralgia
  • Arthralgia and myalgia are often reported. Severe complications include pancreatitis, peritonitis, pericarditis, myocarditis, endocarditis and glomerulonephritis. Signs Vital signs should be checked.[patient.info]
  • Adverse effects Number and seriousness of adverse effects, including cases of malaise, nausea, fever, arthralgias, rash, headache and more generalised and serious signs.[doi.org]
  • Systemic adverse effects include cases of malaise, nausea, fever, arthralgia, rash, headache and more generalised and serious signs such as neurological harms.[dx.doi.org]
Headache
  • Headache affects the majority of symptomatic sufferers. Fever is relatively unusual. Symptoms may drag on for weeks or months, despite a course of appropriate antibiotics.[patient.info]
  • If you add fever, body aches and headache that come on quickly, it could be you have the flu. Pneumonia is usually a complication of cold or flu, when the illness lodges in the lungs.[fox17online.com]
Confusion
  • The clinical history of pneumonia may include one or more of: Pleuritic chest pain Shortness of breath Cough Production of sputum Rigors or night sweats Confusion.[dx.doi.org]
  • A patient's mental state may be confused or delirious. The symptoms of viral pneumonia usually develop over a period of several days. Early symptoms are similar to influenza symptoms : fever, a dry cough, headache, muscle pain, and weakness.[lung.org]
Seizure
  • A depressed gag reflex, such as from alcohol intoxication, overdose, head injury, stroke or seizure increases the risk of aspiration pneumonia [3].[ems1.com]
  • Reduced consciousness: Whether you're sedated, prone to generalized seizures, or have had anesthesia, these episodes of reduced consciousness can contribute to aspiration pneumonia.[verywell.com]
  • People with recent viral infections, lung disease, heart disease , and swallowing problems , as well as alcoholics, drug users, and those who have suffered a stroke or seizure are at higher risk for developing pneumonia than the general population.[emedicinehealth.com]
  • […] in levels of consciousness affect the swallow mechanism by both disabling the body's natural protective measures against aspiration as well as possibly causing nausea and vomiting.[1] Altered mental status can be caused by medical conditions such as seizures[en.wikipedia.org]
Grunting
  • Findings In this systematic review and meta-analysis, the presence of hypoxia and increased work of breathing (grunting, nasal flaring, and retractions) were associated with the diagnosis of pneumonia.[doi.org]
  • The presence of moderate hypoxemia (oxygen saturation 96%; LR, 2.8 [95% CI, 2.1-3.6]; sensitivity, 64%; specificity, 77%) and increased work of breathing (grunting, flaring, and retractions; positive LR, 2.1 [95% CI, 1.6-2.7]) were signs most associated[ncbi.nlm.nih.gov]
  • The following may also occur: Dyspnoea Sharp chest pain Worsening cough Fever/chills Tachycardia Pleuritic chest pain Headaches Malaise Muscle pains Cyanosis due to poorly oxygenated blood Loss of appetite Rapid breathing Wheezing or grunting during breathing[physio-pedia.com]

Workup

Physical examinations and imaging studies are the chief methods of diagnosis [7].

Diagnosis for pneumonia is often based on a combination of physical signs and a chest X-ray. The underlying cause however can be difficult to confirm as there is often no definitive test for distinguishing between pneumonia of bacterial origin and pneumonia of other origins. In children, the WHO guideline defines pneumonia clinically as decreased level of consciousness, chest indrawing, rapid respiratory rate, difficulty in breathing and/or cough.

Pulmonary Infiltrate
  • Twenty-four days after the initiation of daptomycin and sulbactam/ampicillin, he developed a fever and pulmonary infiltration.[ncbi.nlm.nih.gov]
  • The studies enrolled 151 participants with CAP or immunosuppressed patients with pulmonary infiltrates.[dx.doi.org]
Hypercapnia
  • High Flow Nasal Cannula may have a mortality benefit in pure hypoxic respiratory failure when compared with NiPPV and should be your first choice for those patients with pneumonia but without hypercapnia.[emdocs.net]
  • Despite early physiologic improvements, CPAP neither reduced the need for intubation nor improved outcomes in patients with acute hypoxaemia and non‐hypercapnia respiratory insufficiency primarily due to acute lung injury, including changes from pneumonia[dx.doi.org]
  • However, in patients diagnosed with pulmonary emphysema, even a small amount of intra-pleural cavity gas can cause serious hypoxemia and hypercapnia. 2.[ncbi.nlm.nih.gov]
Decreased Oxygen Saturation
  • There is consensus among scientists and clinicians on the life‐saving benefits of oxygen therapy for patients with severe pneumonia and signs of decreased oxygen saturation.[dx.doi.org]
Pleural Rub
  • Signs: tachypnoea, bronchial breathing, crepitations, pleural rub, dullness with percussion.[patient.info]
  • Pleural rub Chest X-ray usually done to confirm the diagnosis Sputum samples and blood tests done to diagnose the type of pneumonia that is present sputum test is done to determine whether it is a fungal or bacterial infection blood test is done to examine[physio-pedia.com]

Treatment

Pneumonia is often treated with antibiotics. Most of the cases require the intake of oral antibiotics and these are often prescribed at any health care centre [8]. The average case of pneumonia can be treated with inexpensive oral antibiotics at the community level by trained community health workers. Hospitalisation is only recommended for severe cases of pneumonia and for cases of pneumonia in infants younger than 2 months of age.

Prognosis

The prognosis is generally positive as most kinds of bacterial pneumonia stabilises with a week. Most symptoms get resolved within a week. Findings in X-ray clear within four weeks and mortality is generally low [5]. People with other lung conditions and the elderly may recover after a longer period of time (as long as 3 months).

Etiology

Pneumonia arises due to infections caused primarily by bacteria or viruses. In less common cases, fungi and parasites can bring about pneumonia. Even though over 100 types of infectious agents have been recorded, only a few of these cause the majority of pneumonia cases [2]. In 45% of infections in children, both viruses and bacteria may be responsible for the condition. In adult pneumonia infections, the figure is placed at 15%. Despite careful testing, it is possible to not isolate any causative agent in 50% of pneumonia cases.

Epidemiology

Pneumonia is a very common condition that affects around 450 million people around the world. It is equally a major cause of death amongst people of all age groups as it results in over 4 million deaths. This accounts for more than 7% of the total deaths recorded around the world each year. The rates are at their peak in children who are less than five years old and in adults who are older than the age of 75. Every year, more than 1.1 million children with the condition die every year [3]. The occurrence is 5 times lower in the developed world when compared to the developing world. In the United States for example, pneumonia is the 8th leading cause of deaths.

Sex distribution
Age distribution

Pathophysiology

Viral cases

The Viruses can enter the lung via different routes. For instance, respiratory syncytial virus is often contacted when individuals touch contaminated objects before touching their eyes or nose while other forms of viral infections occur when contaminated airborne droplets get inhaled through the mouth or nose. As soon as they get into the upper airway, the viruses will move to the lungs where the cells lining the airways, lung parenchyma and the alveoli get invaded [4].

Bacterial cases

The bacteria get into the lungs through small aspirations of organisms that reside in the throat or nose. Most normal people have these aspirations while asleep. Although the throat contains bacteria always, the potentially infectious ones are found there only at certain periods and under specific conditions. Contaminated airborne droplets are responsible for the deposition of Mycobacterium tuberculosis and Legionella pneumophilia. The bacteria can also spread via the blood. As soon as the bacteria is in the lungs, the spaces between cells and alveoli are invaded and the neutrophils and macrophages attempt to get rid of the bacteria. The resultant combination brings about the image seen in X-ray.

Prevention

The prevention of pneumonia is one of the most important strategies to reduce the incidence of child mortality. The most effective way to prevent pneumonia is immunization against measles,pertussis, Pneumococcus and Haemophilus influenzae type B.

Adequate nutrition is also important in improving the natural defences of a child beginning with exclusive breastfeeding for the first six months of life. In addition to being effective in the prevention of pneumonia, the length of periods of illness in a child is reduced greatly [9].

The number of people who fall ill with pneumonia can also be prevented by encouraging good hygiene in crowded homes and addressing of environmental factors such as indoor pollution.

For children who are infected with HIV, daily intake of cotrimoxazole is required so as to decrease the risk of contracting pneumonia.

Summary

Pneumonia is an acute respiratory infection of the lungs [1]. The lungs are filled with small sacs called alveoli. These fill when a healthy individual breathes in. In an individual with any form of pneumonia, the sac get s filled with pus and fluid and this makes breathing painful, thereby limiting the individual’s ability to take in oxygen.

Patient Information

Pneumonia is a condition that affects the air sacs in either one lung or both. Cough producing phlegm or pus, difficulty in breathing, chills and fever are common symptoms of this condition and this happens when the affected air sac gets filled with fluid or pus. 

There are different types of organisms that can cause pneumonia. This includes bacteria, viruses and fungi

The level of seriousness of this condition varies greatly but it is the most serious amongst infants, young children and people older than 65 years of age. People with underlying health conditions or weakened immune systems also get more serious cases of pneumonia. 

The chances of recovery from pneumonia is high though as there are several antiviral medications for treating it. 

References

Article

  1. Guidelines for the management of community acquired pneumonia in adults; British Thoracic Society (2009), Thorax Vol 64 Sup III
  2. Durrington HJ, Summers C; Recent changes in the management of community acquired pneumonia in adults. BMJ. 2008 Jun 21;336(7658):1429-33.
  3. Guidelines for the management of adult lower respiratory tract infections, European Respiratory Society and European Society of Clinical Microbiology and Infectious Diseases (September 2011)
  4. Chest infections - adult, Prodigy (August 2007)
  5. Bartlett JG; Is activity against "atypical" pathogens necessary in the treatment protocols for Clin Infect Dis. 2008 Dec 1;47 Suppl 3:S232-6.
  6. Rudan I, Boschi-Pinto C, Biloglav Z, et al. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008; 86:408.
  7. Harris M, Clark J, Coote N, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax 2011; 66 Suppl 2:ii1.
  8. Margolis P, Gadomski A. The rational clinical examination. Does this infant have pneumonia? JAMA 1998; 279:308.
  9. Fiore AE, Shay DK, Broder K, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep 2009; 58:1.
  10. Jokinen C, Heiskanen L, Juvonen H, et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 1993; 137:977.

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Last updated: 2019-07-11 22:42