Fast Five Quiz: Pneumonia Key Aspects

Michael Stuart Bronze, MD

Disclosures

March 23, 2020

Physical examination findings may vary depending on the type of organism, severity of infection, coexisting host factors, and presence of complications. Signs of bacterial pneumonia may include the following:

  • Hyperthermia (fever, typically > 38°C) or hypothermia (< 35°C)

  • Tachypnea (> 18 respirations/minute)

  • Use of accessory respiratory muscles

  • Tachycardia (> 100 beats/minute) or bradycardia (< 60 beats/minute)

  • Central cyanosis

  • Altered mental status

Physical findings may include the following:

  • Adventitious breath sounds, such as rales/crackles, rhonchi, or wheezes

  • Decreased intensity of breath sounds

  • Egophony

  • Whispering pectoriloquy

  • Dullness to percussion

  • Tracheal deviation

  • Lymphadenopathy

  • Pleural friction rub

Purulent sputum is characteristic of pneumonia caused by bacterial CAP pathogens and is not usually a feature of pneumonia caused by atypical pathogens, with the exception of Legionnaires disease. Legionella pneumonia, Q fever, and psittacosis are atypical pneumonias that may present with signs of consolidation. Consolidation is not a typical feature of pneumonia caused by M pneumoniae or C pneumoniae.

Although not diagnostic of a particular causative agent, the character of the sputum may suggest a particular pathogen, as follows:

  • S pneumoniae is classically associated with a cough productive of rust-colored sputum.

  • Pseudomonas, Haemophilus, and pneumococcal species may produce green sputum.

  • Klebsiella species pneumonia is classically associated with a cough productive of red currant jelly sputum.

  • Anaerobic infections often produce foul-smelling or bad-tasting sputum.

Read more about the presentation of pneumonia.

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