Symptoms of pneumonia involve mostly an upper airway infection first. There is a sudden chill followed by a fever.
There might be pain with breathing (from an inflammation of the surface of the affected lung, called “pleurisy”). A cough develops and in the next few days secretions are coughed up, called “sputum”.
This may have a yellow or greenish color (depending on which organism produces it). The patient may have labored breathing and breathe faster than normal. On examination the physician can hear an abnormal bronchial breath sound (called “bronchophonia”). There may be dullness on percussing the chest wall from an underlying pleural effusion. This also shows up on chest X-rays as does the pneumonic infiltrate.
There are four major phases of a lobar pneumonia
| 1. congestion, |
| 2. red hepatization, |
| 3. gray hepatization and finally |
| 4. resolution. |
These terms originated historically in the pathology departments of university hospitals.
When physicians did autopsies on people who had died from pneumonia, they found that during an epidemic the lungs of diseased people looked different, although they were convinced that it was the same disease that killed everybody.
Symptoms Of Pneumonia (Cough And Chest Pain)
They described the second phase as red hepatization as it looked like a liver (“hepar” = liver). When the inflammatory cells attack in the third phase of a pneumonia, the lung tissue looks grey on inspection (gray hepatization). Without complication it resolves later, but would often leave some scarring behind, if untreated. Other complications are spread of bacteria, fungi or viruses into the remainder of the body (septicemia) or into specific locations such as heart valves (endocarditis), joints (septic arthritis), abdominal cavity (peritonitis), pleural cavity (empyema) or into the central nervous system (meningitis, brain abscess).
References
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 161.
2. TC Dixon et al. N Engl J Med 1999 Sep 9;341(11):815-826.
3. F Charatan BMJ 2000 Oct 21;321(7267):980.
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 43.
5. JR Zunt and CM Marra Neurol Clinics Vol.17, No.4,1999: 675-689.
6. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 162.
7. LE Chapman : Antivir Ther 1999; 4(4): 211-19.
8. HW Cho: Vaccine 1999 Jun 4; 17(20-21): 2569-2575.
9. DO Freedman et al. Med Clinics N. Amer. Vol.83, No 4 (July 1999): 865-883.
10. SP Fisher-Hoch et al. J Virol 2000 Aug; 74(15): 6777-6783.
11. Mandell: Principles and Practice of Infectious Diseases, 5th ed., 2000 Churchill Livingstone, Inc.
12. Goldman: Cecil Textbook of Medicine, 21st ed., Copyright 2000 W. B. Saunders Company
13. PE Sax: Infect DisClinics of N America Vol.15, No 2 (June 2001): 433-455.
14. Ferri: Ferri’s Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.s
15. Rakel: Conn’s Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier
