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Essentials of Diagnosis
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Productive cough, fever, rigors, dyspnea, early pleuritic chest pain
Consolidating lobar pneumonia on chest radiograph
Gram-positive diplococci on Gram stain of sputum
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General Considerations
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High fever, productive cough, occasional hemoptysis, and pleuritic chest pain
Rigors may occur initially but are uncommon later in the course
Bronchial breath sounds are an early sign
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Diagnosis requires isolation of the organism in culture, although the Gram stain of sputum can be suggestive
Sputum and blood cultures, positive in 60% and 25% of cases of pneumococcal pneumonia, respectively, should be obtained prior to initiation of antimicrobial therapy in patients who are admitted to the hospital
A good-quality sputum sample (< 10 epithelial cells and > 25 polymorphonuclear leukocytes per high-power field) typically shows gram-positive diplococci
A rapid urinary antigen test for Streptococcus pneumoniae, with sensitivity of 70–80% and specificity > 95%, can assist with early diagnosis
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Chest radiograph classically shows a lobar pneumonia with consolidation and occasionally effusion
Cannot radiographically differentiate pneumococcal pneumonia from other pneumonias because of significant overlap
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