Diagnosing pneumonia by history and physical exam
– overall: individual symptoms or signs have inadequate test characteristics to rule in or out the diagnosis of pneumonia
– normal lung exam: likelihood ratio of 0.57 (CI 0.39 – 0.83) – does not substantially reduce the probability of pneumonia
– asymmetric respirations – in one study guaranteed the diagnosis of pneumonia (LR infinity, CI 3.2), but rare finding
PCP pneumonia diagnostic options:
– induced sputum (limited by need for trained technicians to collect a high quality sample) – diagnostic yield of 50-90%
– bronchoscopy with BAL – >90% yield in HIV infected patients
– transbronchoscopic or surgical lung biopsy
Indications for steroids in PCP: used in moderate to severe disease:
- PaO2 <70mmHg on room air and/or
- A-A gradient of >35mmHg
- Evernote link: http://www.evernote.com/l/AoP0feWt7t9IOb4oMR8HtLpRVyHjK-t4zxE/
- Thomas CF, Limper AH. Pneumocystis pneumonia. NEJM 2004; 350:2487-2498.
- Metlay JP, Kapoor WN, Fine MJ. Does This Patient Have Community-Acquired Pneumonia? Diagnosing Pneumonia by History and Physical Examination. JAMA.1997;278(17):1440-1445.