How do I recognize pneumonia?


Pneumonia, also called pneumonia, is a common infectious disease in industrialized nations. Mostly it is caused by bacteria. Pneumonia is inflammation of the alveolar space ( site of gas exchange in the lung ) or surrounding lung tissue. A distinction is made between different forms of the disease, which also differ in their symptoms and complaints.
The course of the disease depends on the age and general condition of the person affected. There are typical as well as atypical pneumonia, whose course can be completely different.

Classic ( typical ) pneumonia is usually associated with an acute onset of illness and is caused by bacteria called pneumococci . Such pneumonia usually continues to be characterized by fever and productive cough. A productive cough is a cough with a sputum. This is treated differently than, for example, a dry cough.
You should be careful even if symptoms such as cough, fever, chills and general fatigue have occurred new and no apparent reason. Even shortness of breath should make you think of a possible pneumonia.

There are many other conditions that may be considered, but pneumonia should always be excluded to avoid complications.
Especially in the elderly or in existing lung diseases should be given even with weak symptoms, as an atypical disease could be present.
Here you should pay attention to some other symptoms than classic pneumonia, as these are often not even available.
Atypical pneumonia is characterized by a creeping onset of illness, headache and body aches, mild fever and dry cough. They are more like a cold or a mild flu. This should be especially in the risk groups ( old people, people with lung diseases such as asthma, COPD, tuberculosis, people with heart failure ) in mind.

For one thing is true: Especially with the described symptoms, it is recommended to see a doctor. If a therapy, eg with an antibiotic, be initiated, but no improvement or even a deterioration, a further clarification is also essential.

In the adult

Pneumonia can be very different in adults and have different causes. We distinguish on an outpatient basis ( in an everyday environment ) from nosocomial ( in hospital ) acquired pneumonia.

Community-acquired pneumonia is typically characterized by a sudden onset of illness with a pronounced malady. It comes to chills, high fever and pain during breathing, which come through an accompanying pleurisy - an inflammation of the pleura. Furthermore, a productive cough is typical. This is a cough with yellowish-green sputum. Also, a cold sore often occurs concomitantly.

By definition, hospital pneumonia occurs 48-72 hours after hospitalization at the earliest. These pneumonia are usually caused by atypical germs, which is why their disease can present quite different. If, as a patient in the hospital, you notice a change or worsening of your condition, a fever or a general feeling of fatigue, this should always be reported to the nursing staff and the doctors, as they will promptly take further diagnostic measures.

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With the child

Infants and toddlers should be aware of symptoms such as fever, coughing or nostrils

Children are particularly likely to be affected by pneumonia because they are more susceptible to pathogens than healthy adults. An adequate therapy is then necessary in order to prevent particularly severe courses in premature babies, infants but naturally also in infants and older children.
Particularly in infants severe disease progression is feared by RSV viruses. In infants, high fever, difficulty in breathing, cyanosis ( a blue color of the lips and the skin ) and coughing appear. Therapy must then be initiated.

Older children are more likely to have bacterial infections that cause pneumonia. But also fungal infections and other pathogens can be the cause. In general, infants and toddlers should be aware of the following symptoms: high fever and chills, chest and abdominal pain, bloated abdomen, cough, nasal congestion ( inhalation of the nostrils ), dyspnoea with rapid and shallow breathing, and an accelerated pulse.

When coughing, pay attention to the following: Older children are able to cough up their mucus. However, babies can not do this because they lack the strength to do so. They then swallow the mucus again, which can lead to nausea and vomiting. The cough is initially dry and then becomes slimy. Here you can see a yellowish to reddish ejection.
In older children, the symptoms of flu are very similar. Here, too, can occur with mild to high fever, productive but also dry cough and general malaise.

Special attention should be given to children with lung diseases and diseases with immunodeficiency. In them, more frequent atypical courses, which are triggered, for example, by fungal infections. Other pathogens are of course possible. In general, these children are more often affected by pneumonia. The disease can be very unspecific associated with head and body aches, dry cough and mild fever.

On the x-ray

In pneumonia, there are major and minor criteria for securing the diagnosis. The only main criterion is a positive finding in conventional X-ray. This shows a newly occurred infiltrate in conventional X-ray in two levels. For an untrained eye, it is difficult to recognize such pathologies in the picture.

X-rays of pneumonia may also differ depending on the form of pneumonia. In general, one sees so-called shadows, which dominate as white areas in the lungs. The lung is actually filled with air and therefore black in the X-ray image, to simplify it. Infiltrates, as they occur in pneumonia, however, look white.
They may appear very differently, for example, as distinct, large, homogeneous, white surfaces, but also as reticulate, inhomogeneous, delicate structures.

To better recognize it, it can be compared to the X-ray of pneumonia with that of a healthy lung. This makes it easier to recognize the differences. In the radiograph one can distinguish bronchopneumonia from so-called lobar pneumonia. Lobar pneumonias show up as large-scale shadows that are limited to the lobes of the lungs. Bronchopneumonia, on the other hand, shows a rather diffuse distribution into the lung tissue. A conclusion from the X-ray on the causative agent is not possible.

Beginning pneumonia

A classic pneumonia typically begins suddenly and with a strong sense of malady

How pneumonia manifests itself at first depends on many factors. Not every pneumonia shows the same or similar onset of illness. This depends, among other things, on the general condition and age of the person affected as well as the pathogen that causes the pneumonia. A typical pneumonia, which is mostly bacterial nature, manifests itself in a very sudden onset of illness. The symptoms abruptly come out of normal well-being. This abrupt onset of illness is characterized by a high fever and a very strong sense of illness and fatigue. The fever rise is steep. Chills and productive coughing are added. Bacterial pneumonia can be preceded by signs of an upper respiratory tract infection.

Atypical pneumonia, which is usually caused virally, shows a rather creeping onset of disease. There is usually no fever ( or very light ) and hardly cough. The pneumonia manifests itself only after a few days. Symptoms such as headache and body aches are more likely to occur at the beginning of the illness and may be an indication of pneumonia. However, it is difficult to clearly define incipient pneumonia because it can be different in different people.

Hidden pneumonia

Because pneumonia can vary greatly in its course and does not always show clear symptoms, some patients are easily overlooked. This is especially the case with atypical pneumonia, which shows little or no fever and cough. They are easily confused with colds.
In old people or children, the pneumonia may also remain undetected for a long time. The symptoms also vary depending on the spectrum of pathogens, so that in atypical pathogens such as certain fungi, viruses and hospital germs, the pneumonia may remain partially clinically inapparent ( ie without clinical signs ). Blood tests and diagnostic imaging (eg an x-ray) are groundbreaking here.

Atypical pneumonia

An atypical pneumonia is an inflammatory disease of the respiratory tract, which manifests itself with weaker clinical symptoms than typical pneumonia. Most are atypical pneumonia caused by viruses, but can also be caused in principle by any other pathogen. Therefore, the classification into atypical and typical pneumonia is clinically not very useful.
An atypical pneumonia shows a rather creeping onset of illness, which is accompanied by headache and limb pain. Fever is rare. The cough is usually dry and comes only after a few days. This distinguishes the atypical pneumonia from the typical pneumonia, which is characterized by an acute onset of illness with a high fever and productive cough.

How is the pneumonia diagnosed at the doctor?

In the study of a typical pneumonia, increased inflammatory parameters are shown in the blood values. These include increased CRP, increased ESR ( erythrocyte sedimentation rate ) and leukocytosis ( increase in white blood cells in the blood ). These parameters are typically elevated in inflammation. Procalcitonin may also be elevated. It is also an inflammatory parameter. However, elevation of inflammatory values ​​is not an obligatory criterion for the presence of pneumonia.
Especially with an atypical disease, a viral pneumonia or, for example, a disease in old age, the values ​​may be clinically unremarkable.
Furthermore, in the case of suspected pneumonia, a blood gas analysis is also made to rule out the presence of respiratory insufficiency ( ie no longer completely sufficient respiration ).
In order to ensure a bacterial infection, you also create blood cultures with the intention to isolate and identify the pathogen, which then allows for adequate antibiotic therapy.

When examining the thorax ( chest ) with the stethoscope is expected in a classic pneumonia ( typical pneumonia ) signs of an infiltrate. Infiltrates are accumulations of substances in the tissues that otherwise do not naturally occur there. These include, for example, inflammatory cells, pathogens and pus. In auscultatory findings ( listening to the stethoscope ), rattle sounds appear in a classic pneumonia. These are usually absent in atypical pneumonia.

As you can see, the examination is unfortunately not groundbreaking in all cases and therefore only a positive finding in the X-ray examination ( conventional X-ray ) is a main criterion for the diagnosis of pneumonia. In general, the distinction of the disease is quite difficult. The detection of pneumonia can also be difficult if there are no symptoms.

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