Internal Medicine

How do I recognize pneumonia?

introduction

The pneumonia, too pneumonia is a common infectious disease in industrialized nations. Mostly it gets through bacteria caused. Pneumonia is inflammation of the alveolar space (Location of gas exchange in the lungs) or the surrounding lung tissue. One differentiates different shapes the disease, which also differ in their symptoms and complaints.
The course of the disease depends on Age and the general condition of the person concerned. There are typical such as atypical pneumonia, the course of which can be very different.

Classic (typical) Pneumonias usually go with one acute onset of illness and are caused by bacteria that one Pneumococci is called. Such pneumonia is usually still noticeable fever and productive to cough out. A productive cough is a cough with Expectoration. This is treated differently than, for example, a dry, irritating cough.
One should sit up and take notice even if symptoms like to cough, fever, chills and general exhaustion new and for no apparent reason appeared. Also Shortness of breath should make you think about possible pneumonia.

There are many other conditions that can be considered, but pneumonia should always locked out to avoid complications.
Especially with older people or with existing lung diseases should also be weak symptoms Be careful, as the course of the disease could be atypical.
Here you should pay attention to symptoms that are sometimes different from those of classic pneumonia, as these are often not even present.
Atypical pneumonias are characterized by a rather creeping onset of illness, Headache and body aches, light fever and dry cough out. You present yourself more like one cold or one mild flu. One should do this especially with the risk groups (old people, people with lung diseases like asthma, COPD, tuberculosis, people with heart failure) Keep in mind.

For oneself, the following applies: Especially with the symptoms described, it is recommended to have one doctor to seek out. Should therapy, e.g. with an antibiotic, but does not improve, or even worsen, is one further clarification also absolutely necessary.

In the adult

Pneumonia can present very differently in adults and have different causes. We differentiate according to the place of origin outpatient (in everyday life) from nosocomial (in the hospital) acquired pneumonia.

Read more on the topic: Nosocomial infection

Community-acquired pneumonia is typically characterized by a sudden onset of illness with a pronounced feeling of illness. Chills, a high fever and painful breathing occur, which are caused by concomitant pleurisy - an inflammation of the pleura. A productive cough is also typical. This is a cough with yellowish-green sputum. A cold sore often accompanies it.

Hospital pneumonia, by definition, occurs no earlier than 48-72 hours after hospital admission. These pneumonia are mostly caused by atypical germs, which is why the course of the disease can present itself very differently. If, as a patient in the hospital, you notice a change or deterioration in your own condition, if you experience a fever or general fatigue, this should always be reported to the nursing staff and the doctors, as they will promptly initiate further diagnostic measures.

Read our article about this:

Pneumonia incubation period
Pneumonia in old age

With the child

In infants and young children, one should watch out for symptoms such as fever, cough, or nostrils

Pneumonia is particularly common in children, as they are more susceptible to pathogens than healthy adults. Adequate therapy is then necessary in order to prevent severe disease in premature babies and infants, but of course also in small children and older children.
Especially in infants, the disease is severe RSV viruses feared. In infants it then shows high fever, one difficult breathing, one cyanosis (a blue discoloration of the lips and skin) and to cough. Therapy must then be initiated.

In slightly older children, bacterial infections are more likely to cause pneumonia. But fungal infections and other pathogens can also be the cause. In general, some symptoms to look out for in infants and young children include: High fever and chills, Chest and abdominal pain, distended stomach, to cough, Nostrils (Set up the nostrils on inhalation), Shortness of breath with a fast and shallow breathing as well as a accelerated pulse.

When coughing, watch out for the following: Older children are able to cough up their phlegm. Babies cannot, however, because they lack the strength to do so. You then swallow the mucus again, causing it to nausea and Vomit can lead. The cough is dry at first and then becomes slimy. You can see one yellowish to reddish expectoration.
In older children, the symptoms are one flu very similar. Here, too, gradients with light to high fever, productive but also dry to cough and general feeling of illness occur.

Particular attention should be given to children with Lung disease and diseases with a immunodeficiency become part of it. They are more likely to show atypical courses that are triggered, for example, by fungal infections. Other pathogens are of course also possible. In general, pneumonia affects these children more often. The course of the disease can be great here unspecific With Headache and body aches, dry cough and slight fever accompanied.

Read our page for more information Pneumonia in babies

On the x-ray

With pneumonia, there are major and minor criteria for securing the diagnosis. The only main criterion is a positive result in a conventional X-ray. A newly occurring infiltrate can be seen in conventional X-rays in two planes. It is difficult for an untrained eye to recognize such pathologies in the picture.

X-rays of pneumonia can also differ depending on the type of pneumonia. In general, you can see so-called shadows, which dominate the lungs as white areas. The lungs are actually filled with air and are therefore black in the X-ray to simplify the presentation. Infiltrates such as those that occur in pneumonia, on the other hand, look white.
They can appear very differently, for example as clear, large, homogeneous, white areas but also as reticulated, inhomogeneous, delicate structures.

In order to be able to recognize it better, it is advisable to compare the x-ray of the pneumonia with that of a healthy lung. This makes it easier to see the differences. In the X-ray one can distinguish bronchopneumonia from so-called lobar pneumonia. Lobar pneumonia appear as extensive shadows that are limited to the lobes of the lungs. Bronchopneumonia, on the other hand, shows a rather diffuse distribution into the lung tissue. However, it is not possible to draw conclusions about the causative pathogen from the X-ray image.

Find out all about the topic here: Diagnosis of pneumonia.

Onset of pneumonia

Classic pneumonia typically starts suddenly and with a strong feeling of illness

How pneumonia manifests itself initially depends on many factors. Not every pneumonia shows the same or a similar onset of illness. This depends, among other things, on the General condition and Age the person affected and the pathogen that causes the pneumonia. Typical pneumonia, which is mostly bacterial in nature, manifests itself in one very sudden onset of illness. Symptoms appear abruptly out of normal well-being. This abrupt onset of the disease is characterized by high fever and a very strong feeling of illness such as Exhaustion. The rise in fever is steep. There come chills and productive cough added. Bacterial pneumonia can be preceded by signs of an upper respiratory infection.

Atypical pneumonias, which are mostly caused virally, are more likely to show one creeping onset of illness. There are mostly no fever (or just very easy) and hardly any cough. The pneumonia only manifests itself after a few days. Symptoms like Headache and body aches are more likely to occur at the onset of the disease and can be an indication of pneumonia. However, it is difficult to clearly define the onset of pneumonia, as it can present differently in different people.

Hidden pneumonia

Since 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. You are easy with Colds to be confused.
Pneumonia can also go undetected for a long time in old people or children. The symptoms also vary depending on the spectrum of pathogens, so that with atypical pathogens such as certain fungi, viruses and hospital germs, pneumonia is sometimes clinically inapparent (so without any clinical signs) can stay. Blood tests and imaging diagnostics (e.g. an X-ray) are groundbreaking here.

Atypical pneumonia

Atypical pneumonia is one inflammatory disease of the respiratory tract, which shows itself with weaker clinical symptoms than typical pneumonia. Atypical pneumonias are usually caused by viruses, but can in principle also be caused by any other pathogen. Therefore, the division into atypical and typical pneumonia is not particularly useful clinically.
Atypical pneumonia is more likely creeping onset of illness, the one with Headache and body aches goes hand in hand. Fever is rare. The cough is mostly dry and is added only after a few days. This distinguishes atypical pneumonia from typical pneumonia, which is characterized by an acute onset of the disease with a high fever and productive cough.

How is pneumonia diagnosed by a doctor?

The examination of a typical pneumonia shows increased inflammation parameters in the blood values. These include an increased CRP value, an equally increased ESR (Sedimentation rate) and leukocytosis (Increase in white blood cells in the blood). These parameters are typically increased in inflammation. Procalcitonin can also be increased. This is also an inflammation parameter. However, the increase in the inflammation values is not an obligatory criterion for the presence of pneumonia.
Especially in the case of an atypical course of the disease, viral pneumonia or, for example, an illness in old age, the values can be clinically normal.
Furthermore, if pneumonia is suspected, a blood gas analysis is also carried out to determine whether respiratory failure is present (that is, breathing that is no longer completely sufficient) to be excluded.
In order to ensure a bacterial infection, blood cultures are also set up with the intention of isolating and identifying the pathogen, which then enables adequate antibiotic therapy.

Read more about this topic at: Blood tests for pneumonia

When examining the thorax (Rib cage) with the stethoscope one expects a classic pneumonia (typical pneumonia) Sign of an infiltrate. Infiltrates are accumulations of substances in the tissue that would otherwise not naturally occur there. These include, for example, inflammatory cells, pathogens and pus. In the case of auscultation (Listening with the stethoscope) rattling noises appear in 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 result in the X-ray examination (conventional x-ray) a main criterion for making a diagnosis of pneumonia. In general, it is quite difficult to differentiate between the disease. Detecting pneumonia can also be difficult if there are no symptoms.

Also read the article: Pneumonia Therapy.