Bonveda's Blog

Women with CAP present with a large number of possible symptoms. Respiratory symptoms may include cough (produc-tive or not ), dyspnea, chest pain (pleuritic or not), and hemoptysis. Other symptoms may include fatgue; malaise; fever; chills or rigors; headache; myalgias; diaphoresis , especially night sweats; generalized weakness; anorexia; and abdominal pain. In the elderly, common presenting symptoms may only consist of confusion, worsening of an underlying chronic illness, and/ or falls. Unfortunately, no specific symptom or combination of symptoms on history can con firm the diagnosis of pneumonia. One review of the literature found that no single item in the clinical history, even when combined with physical examination, raised the odds of pneumonia high enough to confirm the diagnosis without a chest radiograph.
A focused history can give many clues to potential etiologies and prognosis of CAP in primary care. Medical history of respiratory diseases such as asthma, chronic obstructive pulmonary disease or restrictive pulmonary disease, CHF, and dementia should be gathered. Medication history may provide clues to potential etiologies, for example, recent antibiotics, immunosuppresants, and sedatives, the last of which increase the risk of aspiration, especially in the elderly. Exploration of personal history should include use or abuse, including amount and duration, of tobacco, alcohol, and other recreational drugs. Exposure to children in day care or to hospitalized patients may increase chances of exposure to resistant organisms. Family history should include information about contagious diseases, like tuberculosis, and hereditary pulmonary conditions like asthma, cystic fibrosis, and antitrypsin deficiency.
Occupational history should investigate potential exposure to infectious agents and hazardous substances. C. psittaci (psittacosis) is seen in patients with a history of regular contact with birds. C. burnetii (Q fever) should be considered in patients with pneumonia who report contact with farm or newborn animals. F. tularensis (tularemia) can be transmitted by vectors like the dog tick or the lone star tick or by handling infected rabbits, hares, squirrels, or rodents. Toxin exposures to be considered include asbestos, silicon, coal, beryllium,iron oxide, and others. Details should include severity and duration of exposure and protective measures used during the exposure.