Pneumonia
Community-acquired pneumonia is a lung infection confirmed by chest imaging, since exam findings alone are not reliable enough to diagnose or exclude it -- a distinction that matters for telehealth. Care follows the 2019 ATS/IDSA CAP guideline.
Symptoms
Fever, cough (often productive), shortness of breath, chest pain with breathing, and fatigue; older adults may present with confusion instead of classic symptoms.
Causes and risk
Bacteria (commonly Streptococcus pneumoniae) and viruses both cause CAP. Age 65+, chronic lung or heart disease, smoking, and a weakened immune system all raise risk and severity.
How it is evaluated
Severity scoring (CURB-65 or the Pneumonia Severity Index) guides the outpatient-versus-hospital decision per the ATS/IDSA guideline; CURB-65 (or CRB-65, which drops the lab-dependent urea component) is more practical without in-person labs.
Treatment
Outpatient antibiotic regimens follow the 2019 ATS/IDSA guideline directly, including a macrolide caveat -- macrolide monotherapy is only appropriate where local pneumococcal resistance is under 25% -- and broader coverage for patients with significant comorbidities.
When to seek care
Difficulty breathing, bluish lips, confusion, chest pain, or a high fever that doesn't respond to treatment are reasons for emergency evaluation rather than continued outpatient care.