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Clincal manifestation
Many patients have had an upper respiratory infection for several
days before the onset of pneumonia. Onset usually is sudden, half cases
with a shaking chill. The temperature rises during the first few hours to
39-40. The pulse accelerates. Sharp pain in the involved hemi thorax.
The cough is initially dry with pinkish or blood-flecked sputum.
Gastrointestinal symptoms such as, anorexia, nausea, vomiting,
abdominal pain, diarrhea may be mistaken as acute abdominal
inflammation.
Signs
The acutely ill patient is tachypneic, and may be observed to use
accessory muscles for respiration, and even to exhibit nasal flaring. Fever
and tachycardia are present, frank shock is unusual, except in the later
stages of infection or DIC. Auscultation of the chest reveals
bronchovesicular or tubular breath sounds and wet rales over the involved
lung. A consolidation occurs, vocal and tactile fremitus is increased.
Complications
Complications are less seen recently. If sepsis occurs, the patient may
become dusky, cyanotic, confused and shock.
1. sepsis
2. lung abscess or empyema
3. pleural effusion, pleuritis
4. ARDS , ARF
5. pneumothorax
6. Extrapulmonary infections
Laboratory examination
The peripheral white blood cell (WBC) count is often 10-30109/L, of
80% in the polymorphonuclear leukocytes. However, in alcoholics or
immunosuppressed patients. It may be normal or low of more value is the
WBC differential, which consists predominantly of polymorphonuclear
leukocytes (left shift). Before using antibiotic, the culture of blood of
20% is positive. Microscopic examination and culture of expectorated
purulent sputum between 24-48 hours can be used to identify
pneumococci. Colony counts of bacteria from bronchoalveolar lavage
washings obtained during endoscopy are seldom available early in the
course of illness. Use of the PCR may amplify pneumococcal DNA and
improve potential for detection.
X-ray examination
Chest radiographs reveal a lobar distribution and an air space pattern
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2. Cecil Textbook of Medicine21st edition
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