The Diagnosis of Pneumonia in Adults

Additional Laboratory or Radiological Tests and Their Rationale

A radiological test that should be performed is a chest x-ray with posteroanterior and lateral views. This mode is the recommended one in the assessment of typical bacterial pneumonia (Chavez et al., 2014). Diagnosis is made based on the clinical appearance and infiltrates observed on the chest x-ray. If the chest x-ray does not expose an infiltrate, it is prudent to perform a computed tomography, or if possible repeat the chest x-ray within one to two days.

A blood culture could be conducted to pinpoint the bacterial pathogen if bacteremia were present. It is reported that approximately 12% of all patients admitted to hospital for pneumonia have bacteremia, which is brought about by S. pneumoniae in 66% of the cases (Cilloniz et al., 2015).

Sputum tests such as Gram stain, culture, microscopy, and chemical tests can be done to identify the pathogen and determine the susceptibility of the microorganisms to antibiotics to determine the most appropriate drug. These tests are also useful in distinguishing between infections with overlapping symptoms, for instance, tuberculosis and pneumonia (Peto et al., 2014). However, the accuracy of these tests is complicated by the contamination of specimen by oral flora.

Sputum samples can also avail data on the presence of viral pathogens through direct fluorescence antibody testing or polymerase chain reaction. However, the interpretation of these findings should be done cautiously because more than a tenth of healthy adults have a respiratory virus or possible bacterial pathogen (Miyashita et al., 2015).

Expected Findings

Different observations would be made on the chest x-ray test depending on the causative microorganisms. The presence of multilobar infiltrates would be evident in Streptococcus pneumoniae or Legionella pneumophila infections (Musher & Thorner, 2014). In interstitial pneumonia caused by viruses or mycoplasma, the x-ray would reveal augmented interstitial markings, a subpleural reticular opaqueness that intensifies from the tip to the bottom of the right lung, as well as marginal honeycombing. Observation of cavitating pneumonia would be indicative of Staphylococcus aureus, fungal or mycobacterial causes.

Diagnosis

The diagnosis is pneumonia, in particular, community-acquired pneumonia. Pneumonia is the inflammation of the lung tissue, which may be present in one or both lungs. It is often caused by bacterial infections though it can be as a result of viral infections. The diagnosis was arrived at because the patient presented with symptoms consistent with pneumonia such as shortness of breath, fever, chills, right-sided chest pain, and productive cough (Wyrwich, Yu, Sato, Strutton, & Powers, 2013).

In addition, he is coughing up rust-colored mucus has chest pain that has impaired his breathing. Other signs include abnormally rapid breathing, coarse rhonchi through the right lung field as well as decreased breath sounds on the right. In pneumonia, the chest pain is usually pleuritic and is next to the affected region (Wyrwich et al., 2013), which in the patient is the right lung.

Medication and Duration of Treatment

Antibiotic treatment is the core of treatment for community-acquired pneumonia. Empiric antibiotics should be initiated within the shortest time possible following the presentation of symptoms and a confirmed diagnosis. The choice of treatment is based on likely pathogens and severity of illness due to difficulties in the identification of the causative microbes. The recommended therapy is a macrolide such as oral azithromycin 500 mg once, followed by 250 mg once a day for four other days such that the total duration of treatment is 5 days (File, Bartlett, & Thorner, 2015).

Oral clarithromycin 250 to 500 mg twice a day for seven to 14 days. Another alternative is extended-release clarithromycin 1 g once a day for seven days. For patients who are allergic to macrolides, oral doxycycline 100 mg twice a day should be given for 10 to 21 days. Doxycycline may also be administered intravenously.

References

Chavez, M. A., Shams, N., Ellington, L. E., Naithani, N., Gilman, R. H., Steinhoff, M. C.,… Checkley, W. (2014). Lung ultrasound for the diagnosis of pneumonia in adults: A systematic review and meta-analysis. Respiratory Research, 15(1), 50.

Cilloniz, C., Albert, R. K., Liapikou, A., Gabarrus, A., Rangel, E., Bello, S.,… Torres, A. (2015). The effect of macrolide resistance on the presentation and outcome of patients hospitalized for Streptococcus pneumoniae pneumonia. American Journal of Respiratory and Critical Care Medicine, 191(11), 1265-1272.

Peto, L., Nadjm, B., Horby, P., Ngan, T. T. D., van Doorn, R., Van Kinh, N., & Wertheim, H. F. (2014). The bacterial etiology of adult community-acquired pneumonia in Asia: A systematic review. Transactions of the Royal Society of Tropical Medicine and Hygiene, 108(6), 326-337.

Miyashita, N., Kawai, Y., Tanaka, T., Akaike, H., Teranishi, H., Wakabayashi, T.,… Okimoto, N. (2015). Diagnostic sensitivity of a rapid antigen test for the detection of Mycoplasma pneumoniae: Comparison with real-time PCR. Journal of Infection and Chemotherapy, 21(6), 473-475.

Musher, D. M., & Thorner, A. R. (2014). Community-acquired pneumonia. New England Journal of Medicine, 371(17), 1619-1628.

Wyrwich, K. W., Yu, H., Sato, R., Strutton, D., & Powers, J. H. (2013). Community-acquired pneumonia: Symptoms and burden of illness at diagnosis among US adults aged 50 years and older. The Patient-Patient-Centered Outcomes Research, 6(2), 125-134.

File, T. M., Jr., Bartlett, J. G., & Thorner, A. R. (2015). Treatment of community-acquired pneumonia in adults in the outpatient setting. Web.