Pneumonia Symptoms: Recognition and When to Seek Care

Pneumonia is lower respiratory tract infection causing alveolar inflammation. Presentation varies by age, pathogen, and host factors.

Classic Symptoms (Adults)

• Cough: Productive (purulent, rust-colored, blood-tinged) or dry
• Fever/Chills: Often >38.3°C (101°F); rigors possible
• Dyspnea: Exertional → at rest; tachypnea
• Pleuritic Chest Pain: Sharp, worse with inspiration/cough
• Fatigue, Malaise, Anorexia

Atypical Presentations

• Older Adults: Confusion, falls, functional decline, hypothermia, absence of fever
• Children: Tachypnea, retractions, grunting, nasal flaring, vomiting, abdominal pain
• Immunocompromised: Subacute, afebrile, atypical pathogens (PJP, fungal, CMV)
• "Walking Pneumonia" (Mycoplasma/Chlamydia): Gradual, dry cough, headache, low-grade fever

Red Flags for Urgent Care

• RR >30, SpO₂ <92%, confusion, hypotension
• Multilobar involvement, effusion
• Failure of outpatient therapy (48–72 hrs)
• High-risk: age >65, COPD, CHF, diabetes, immunosuppression, alcohol use

Diagnostic Workup

• CXR (infiltrate/consolidation)
• CBC, CRP, PCT, BMP, LFTs, blood cultures (if admitted)
• Sputum Gram stain/culture (if productive)
• Urinary antigen: S. pneumoniae, Legionella
• PCR panel (viruses, atypicals)

Treatment Principles

• Empiric antibiotics per local guidelines (CAP vs. HAP/HCAP)
• Severity scores: CURB-65, PSI/PORT
• Antivirals if influenza suspected (<48 hrs)
• Supportive: O₂, fluids, antipyretics, bronchodilators if wheeze

Early appropriate antibiotics reduce mortality. Vaccinate: PCV20/PPSV23, influenza, COVID, RSV (older adults).