Diagnosis and Treatment of Peumonia
Diagnosis of pneumonia initially consists of recording a patient’s medical history and asking the individual questions regarding his or her symptoms. Additionally the doctor would likely take the temperature of the individual to check for fever, and listen to the patient’s chest with a stethoscope to listen for audible crackling, rattling, rumbling or bubbling sounds [17,18,19], shown in Figure 1. This initial physical test is generally sufficient to screen for pneumonia [17]. Chest x-rays and other tests can be used to confirm the doctor’s initial prognosis of the patient based on the individual’s physical exam. Depending on the severity of the pneumonia, chest CT scans, pulse oximetry, pleural fluid culture, bronchoscopy, sputum tests, blood tests, or additional diagnostic tests may also be performed [17,18,19].
Treatment of pneumonia, and the success of the treatment, mostly depends on the cause of the infection. Luckily, the less severe forms of pneumonia can be treated by inexpensive (approximately $0.21 - $0.42) [21], low-tech medication and care [2]. Furthermore, early recognition of the symptoms and rapid treatment drastically improve the likelihood of recovery [20]. Many types of pneumonia, including tuberculosis pneumonia and PCP have a high survival rate if symptoms are recognized early [1]. Oral antibiotics will serve as sufficient treatment in most bacterial pneumonia [2] cases and can be distributed inexpensively. A doctor may also recommend fever reducers or cough medicine to reduce some of the symptoms caused by pneumonia [15]. More severe forms of the infection may involve hospitalization with fluid drainage, surgical removal of fluid, or ventilation [15]. For adult and younger patients, treatment will likely be effective within two weeks, whereas older individuals or individuals with a disability might require more time to recover [1,6]. Complications that can arise without proper treatment include respiratory failure, pleurisy, lung abscesses, and blood poisoning [7,16]. Consequently, if not treated properly, pneumonia (especially bacterial pneumonia) can become life-threatening.
In developing countries, a chest radiograph is often recommended to improve diagnostic precision of pneumonia. However, in many communities, this is not available due to the cost of the equipment, technicians, and individuals capable of interpreting results. This diagnostic technique also imposes an unaffordable delay in diagnosis and treatment [20]. Some clinicians have suggested that in communities without x-ray imaging capabilities, diagnosis should be completed on site to avoid potential delays and inconsistencies in image interpretation during the patient’s treatment process [20]. It has been suggested, taking into consideration the potential error involved in a physical examination, that abnormal breath sounds in the patient can be the best predictor of bacterial pneumonia [20]. Other strong predictors included temperature greater than 37.8 °C, chest pain, and rapid heart and respiratory rate [20]. In a study analyzing the accuracy of using lung sounds for diagnosis, it was shown that the absence of auscultatory findings during a physical examination excluded pneumonia with a 95% certainty [20]. The same study indicated that using both auscultatory findings and abnormal vital signs proved to be highly effective (approximately 97%) in diagnosing pneumonia [20]. Therefore, given this information, the initial physical exam of the patient plays a vital role in pneumonia diagnosis, especially in developing countries with areas unable to afford an x-ray device.
Treatment of pneumonia, and the success of the treatment, mostly depends on the cause of the infection. Luckily, the less severe forms of pneumonia can be treated by inexpensive (approximately $0.21 - $0.42) [21], low-tech medication and care [2]. Furthermore, early recognition of the symptoms and rapid treatment drastically improve the likelihood of recovery [20]. Many types of pneumonia, including tuberculosis pneumonia and PCP have a high survival rate if symptoms are recognized early [1]. Oral antibiotics will serve as sufficient treatment in most bacterial pneumonia [2] cases and can be distributed inexpensively. A doctor may also recommend fever reducers or cough medicine to reduce some of the symptoms caused by pneumonia [15]. More severe forms of the infection may involve hospitalization with fluid drainage, surgical removal of fluid, or ventilation [15]. For adult and younger patients, treatment will likely be effective within two weeks, whereas older individuals or individuals with a disability might require more time to recover [1,6]. Complications that can arise without proper treatment include respiratory failure, pleurisy, lung abscesses, and blood poisoning [7,16]. Consequently, if not treated properly, pneumonia (especially bacterial pneumonia) can become life-threatening.
In developing countries, a chest radiograph is often recommended to improve diagnostic precision of pneumonia. However, in many communities, this is not available due to the cost of the equipment, technicians, and individuals capable of interpreting results. This diagnostic technique also imposes an unaffordable delay in diagnosis and treatment [20]. Some clinicians have suggested that in communities without x-ray imaging capabilities, diagnosis should be completed on site to avoid potential delays and inconsistencies in image interpretation during the patient’s treatment process [20]. It has been suggested, taking into consideration the potential error involved in a physical examination, that abnormal breath sounds in the patient can be the best predictor of bacterial pneumonia [20]. Other strong predictors included temperature greater than 37.8 °C, chest pain, and rapid heart and respiratory rate [20]. In a study analyzing the accuracy of using lung sounds for diagnosis, it was shown that the absence of auscultatory findings during a physical examination excluded pneumonia with a 95% certainty [20]. The same study indicated that using both auscultatory findings and abnormal vital signs proved to be highly effective (approximately 97%) in diagnosing pneumonia [20]. Therefore, given this information, the initial physical exam of the patient plays a vital role in pneumonia diagnosis, especially in developing countries with areas unable to afford an x-ray device.