Which clinical history findings are characteristic of pneumococcal pneumonia?

Updated: Aug 27, 2018
  • Author: Claudia Antonieta Nieves Prado, MD; Chief Editor: John L Brusch, MD, FACP  more...
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Answer

Classic pneumococcal pneumonia often develops in older children and adults. Sometimes preceded by a viral illness, there is acute onset of high fever, rigors, productive cough, pleuritic chest pain, dyspnea, tachypnea, tachycardia, malaise, and fatigue. Patients typically appear ill and may appear anxious. On physical examination, rales can be heard in most patients. About half of all patients exhibit dullness to percussion, and splinting due to pain may be seen.

In children (particularly school-aged and younger children), the potential manifestations of pneumonia are broad and often nonspecific, including mild respiratory symptoms, with or without a cough on initial presentation; tachypnea, dyspnea, and splinting; high fever; abdominal pain and/or distention; anorexia; emesis (often suggesting a primary gastrointestinal disease); meningeal signs due to meningeal irritation with right upper lobe pneumonias; or chest pain due to pleural irritation.

In elderly patients with pneumococcal pneumonia, tachypnea may be the primary presenting sign. Temperature elevations may be mild or absent.

S pneumoniae is also the most common cause of CAP in HIV-infected patients.

The most common complication of pneumococcal pneumonia is pleural effusion. In patients with concomitant parapneumonic effusion or empyema, physical examination may reveal dullness to percussion, decreased breath sounds, and decreased tactile fremitus at the bases. Although up to 40% of patients with pneumococcal pneumonia may have pleural effusion, only an estimated 10% of these patients have enough fluid to aspirate; of these, only 2% meet the diagnostic criteria for empyema. [30, 31, 47]


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