What are the typical symptoms of pneumonia?

Symptoms of Pneumonia

Pneumonia typically presents with acute onset of productive cough with purulent sputum, fever, dyspnea, and pleuritic chest pain, often accompanied by focal chest examination findings such as crackles, consolidation, or altered breath sounds. 1

Cardinal Respiratory Symptoms

• Productive cough with mucopurulent or yellowish sputum is the hallmark symptom, indicating neutrophilic inflammation and bacterial colonization in the lower respiratory tract 1, 2
• Dyspnea (shortness of breath) reflects impaired gas exchange from alveolar consolidation and is a key presenting complaint 1, 3
• Pleuritic chest pain or chest discomfort occurs when inflammation extends to the pleural surface 4, 2
• Cough may initially be dry but typically becomes productive of blood-stained sputum in severe cases 4

Systemic Symptoms

• Fever is present in most cases, though it may be absent in elderly or immunocompromised patients 4, 3
• A single episode of shaking chills (rigor) strongly suggests pneumococcal pneumonia 4, 5
• Sweats and rigors accompany the febrile response 4
• Fatigue, malaise, and lassitude are common and may persist for weeks after acute illness 4, 6
• Headache, myalgias, and generalized body aches occur frequently 4, 6
• Anorexia and abdominal pain are nonspecific but common accompanying symptoms 4

Physical Examination Findings

• Tachypnea (respiratory rate >24 breaths/min) and tachycardia (heart rate >100 beats/min) are typical vital sign abnormalities 4, 3
• New focal chest signs including crackles, altered breath sounds, bronchial breathing, egophony, or increased fremitus indicate consolidation 4
• Dullness to percussion suggests underlying consolidation or pleural effusion 4
• Signs of increased work of breathing—including grunting, nasal flaring, lower chest wall indrawing, or intercostal retractions—have better diagnostic accuracy than individual symptoms alone 4
• Cyanosis may be present in severe cases with significant hypoxemia 4

Temporal Pattern and Onset

• Symptoms typically develop over 3-5 days, with most patients presenting within 14 days of onset 4, 1
• Acute onset with sudden development of fever and productive cough is characteristic of bacterial pneumonia, particularly pneumococcal disease 1, 5
• Gradual onset over several days may occur with atypical pathogens 6

Variations by Pathogen

• Pneumococcal pneumonia classically presents with sudden onset, single rigor, productive cough with rusty sputum, and pleuritic chest pain 4, 5
• Atypical pneumonia (Mycoplasma) may present with prominent headache, malaise, and dry cough, often with less impressive chest findings 6
• Primary viral pneumonia causes dyspnea within 48 hours of fever onset, with progression to blood-stained sputum and bilateral infiltrates 4
• Secondary bacterial pneumonia develops 4-5 days after initial viral illness, during early convalescence 4
• Putrid sputum indicates anaerobic bacterial infection 4

High-Risk Features and Danger Signs

• Severe respiratory distress with grunting, nasal flaring, head nodding, or tracheal tugging indicates severe pneumonia requiring urgent intervention 4
• Hypoxemia (oxygen saturation <90% on room air) signals significant gas exchange impairment 4, 7
• Altered mental status or confusion, particularly in elderly patients, may be the primary presenting feature 4
• Hemoptysis (coughing blood) requires immediate evaluation for complications 8

Important Clinical Pitfalls

• Absence of fever does not exclude pneumonia, especially in elderly, immunocompromised, or patients taking antipyretics 4
• Normal lung examination does not rule out pneumonia—up to 64% of radiographically confirmed cases may lack focal findings on initial presentation 4
• Symptoms alone cannot reliably distinguish bacterial from viral pneumonia or predict specific pathogens 4, 9
• Clinical diagnosis without radiographic confirmation lacks specificity because presentation overlaps with acute bronchitis, influenza, and upper respiratory infections 4, 3

Diagnostic Confirmation Required

• Chest radiograph is essential to confirm pneumonia diagnosis, as clinical symptoms and signs alone are insufficient 4, 3
• The combination of acute cough plus one of the following mandates chest X-ray: new focal chest signs, dyspnea, tachypnea, or fever >4 days 4
• C-reactive protein >50-100 mg/L increases probability of radiographic pneumonia when clinical suspicion exists 4, 7