Pneumonia - NYSORA | NYSORA


Learning objectives

  • Signs and symptoms of pneumonia
  • Management of pneumonia

Definition and mechanisms

  • Pneumonia is an infection that inflames the alveoli in one or both lungs
  • The alveoli may fill with fluid or pus causing cough with phlegm or pus, fever, and difficulty breathing
  • Caused by bacteria (Streptococcus pneumoniae), bacteria-like organisms (Mycoplasma pneumoniae), viruses, or fungi
  • Can also be caused by aspiration of food, fluids, vomit, or saliva
  • Can be mild to life-threatening
  • The disease may be classified by where it was acquired, such as community- or hospital-acquired or healthcare-associated pneumonia

Signs and symptoms

General symptoms
Symptoms of bacterial pneumoniaSymptoms of viral pneumoniaSymptoms of viral pneumonia
- Chest pain when breathing or coughing
- Confusion /changes in mental awareness
- Cough, which may produce phlegm
- Fatigue
- Fever and sweating
- Lower than normal body temperature
- Loss of appetite
- Nausea, vomiting, or diarrhea
- Shortness of breath
- High fever (up to 40.5 C)
- Cough with yellow, green, or bloody mucus
- Tiredness (fatigue)
- Rapid breathing
- Shortness of breath
- Rapid heart rate
- Sweating or chills
- Chest pain and/or abdominal pain, especially with coughing or deep breathing
- Loss of appetite
- Bluish skin, lips, or nails (cyanosis)
- Confusion or altered mental state
- Symptoms similar to bacterial pneumonia
- Dry cough
- Headache
- Muscle pain
- Extreme tiredness or weakness
Babies and newborns may not show any symptoms of pneumonia or their symptoms may be different from adults, including:
- Fever, chills, general discomfort, sweating/flushed skin
- Cough
- Difficulty breathing or rapid breathing (tachypnea)
- Loss of appetite
- Vomiting
- Lack of energy
- Restlessness or fussiness
Signs in babies and young children include:
- Grunting sound with breathing or noisy breathing
- A decreased amount of pee or diapers that are less wet
- Pale skin
- Limpness
- Crying more than usual
- Difficulty feeding


  • Pneumonia is most commonly classified by where or how it was acquired: 
    • Community-acquired pneumonia
    • Aspiration pneumonia
    • Healthcare-associated pneumonia
    • Hospital-acquired pneumonia
    • Ventilator-associated pneumonia
  • It may also be classified by the area of the lung affected: 
    • Lobar pneumonia 
    • Bronchial pneumonia 
    • Acute interstitial pneumonia

Risk factors


  • Bacteremia or sepsis
  • Difficulty breathing, requiring a ventilator
  • Pleural effusion
  • Lung abscess


  • Vaccination: pneumococcal vaccine, flu, COVID-19
  • Practice good hygiene
  • Do not smoke


  • Medical history
  • Physical exam
  • Blood tests
  • Chest X-ray
  • Pulse oximetry
  • Sputum test
  • CT scan
  • Arterial blood gas test
  • Pleural fluid culture
  • Bronchoscopy


Pneumonia, ABCD approach, lung protective ventilation

Be aware that:

Suggested reading

  • Morgan, A., Glossop, A., 2016. Severe community-acquired pneumonia. BJA Education 16, 167–172.
  • Sadashivaiah, JB., Carr, B., 2009. Severe community-acquired pneumonia. Continuing Eduction in Anaesthesia Critical Care & Pain. 9;3:87-91.

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