Pneumonia: Signs and Symptoms

by Jeremy Brown, PhD

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    00:01 What are the symptoms of pneumonia? Well actually, they are very straightforward: you have the systemic symptoms that you get with infection, fever, feeling unwell, occasionally you get the shakes, the rigors, and you are not eating and you feel terrible, you want to go to bed.

    00:16 Then there are the focal symptoms you get because it’s a lung infection, and that will be cough, producing a purulent sputum sometimes, sometimes you get blood in that as well, and the mixture of purulent sputum with blood becomes what we call rusty's sputum, a sort of brownie color sputum. You may get pleuritic chest pain if the pneumonia is causing overlying pleuritic inflammation, that’s called pleurisy, and because the pneumonia consolidation is affecting the ability of gas exchange in your lung, then you might be breathless as well. When you look at the patient to examine them, again you have the general examination findings of somebody with an acute infection, pyrexia, they don't look very well, they may have, well, they should have a tachycardia, and they have increased respiratory rate because of the problems of the consolidation. There are a few other issues, they may have herpes labialis or herpes simplex infection of the around the mouth, actually often reactivates within people with pneumonia, and if they have significant hypoxia then they will have central cyanosis. And pneumonia is a relatively common cause of acute septic shock so they might have hypotension as well. And occasionally patient have atrial fibrillation because acute lung infections are one cause of temporary atrial fibrillation. So that’s the general examination.

    01:35 When you listen to the lung, we’ve already mentioned the signs, which essentially is focal asymmetrical crackles, crepitation over the area's consolidation. And if it’s really a dense consolidation, it will be dull to percussion and there will be bronchial breathing as well. And about a third of patients with pneumonia will have a small effusion and some of those will have a pleural rub. So if somebody presents with pleuritic chest pain because of the pneumonia, the pleurisy is quite likely that they'll be a pleural rub over the area where they feel the pain. Now, if you trying to work out whether somebody has a pneumonia or an acute tracheobronchitis, and this is a very important distinguishing situation because trachebronchitis is a relatively benign disease and well settled whereas pneumonia does have the potential chance of becoming a very severe disease, then there are a few of these signs which are important. So for example, you will not get crackles if somebody has a tracheobronchitis.

    02:33 So the focal lung signs that you get in pneumonia are not present if somebody has a bronchitis.

    02:38 In the general examination if you have an acute tracheobronchitis it doesn't cause impairments of respiratory function to a significant degree unless you have an underlying lung disease.

    02:51 So in the normal patient there shouldn't be an increase of respiratory rate, they should not get cyanosis, and it should never get severe enough to cause hypotension or a particularly high pulse rate

    About the Lecture

    The lecture Pneumonia: Signs and Symptoms by Jeremy Brown, PhD is from the course Infections of the Respiratory Tract.

    Included Quiz Questions

    1. Dry cough.
    2. Rusty sputum.
    3. Fever.
    4. Dyspnea.
    5. Pleuritic chest pain.
    1. Hyper-resonant note on percussion.
    2. Dull note on percussion.
    3. Bronchial breathing.
    4. Focal asymmetrical crepitations.
    5. Small pleural effusion with or without pleuritic chest pain.

    Author of lecture Pneumonia: Signs and Symptoms

     Jeremy Brown, PhD

    Jeremy Brown, PhD

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