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Community-acquired pneumonia is the leading infectious cause of death and is the sixth leading cause of death overall. Initial treatment decisions are based on clinical manifestations, laboratory and radiographic findings, and epidemiologic considerations.

Clinical Diagnosis

Symptoms usually include fever, malaise and cough, especially productive cough. Patients also may have pleurisy, dyspnea, or hemoptysis. Eighty percent of patients are febrile.

Physical exam findings may include tachypnea, tachycardia, rales, rhonchi, bronchial breath sounds, and dullness to percussion over the involved area of lung pulmonia.

Chest radiograph usually shows infiltrates. The chest radiograph may reveal signs of complicated pneumonia, such as multilobar infiltrates, volume loss, or pleural effusion. If the film is normal, pneumonia is unlikely, and other causes for the acute respiratory syndrome should be sought.

Further testing is required if there are severe signs and symptoms (heart rate greater than 140 beats per minute, altered mental status, respiratory rate greater than 30 breaths per minute) or underlying diseases, such as diabetes mellitus or heart disease. Additional tests may include a complete blood count, pulse oximetry or arterial blood gas analysis.

Outpatient treatment is appropriate for most young, otherwise healthy patients. Patients with more severe illness, older patients and those with underlying diseases should be considered for hospital admission.