Pneumonia Testing

Because there are many types of pneumonia that can affect people in different ways, it is important to always review your test results with a doctor who can most clearly explain what they mean in your situation.

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In many situations, the doctor may be able to quickly determine whether you have pneumonia based on your symptoms and imaging tests that look at your lungs. Additional tests may be needed to assess the cause, severity, and optimal treatment.

The timeline for receiving pneumonia test results depends on the situation. In some cases, results from initial testing may be available within a few hours to a few days. However, getting the details about test results may take longer when a greater number of pneumonia tests are required.

If you have already been diagnosed with pneumonia, you may have additional testing to learn more about the cause and severity of your condition. Follow-up testing can also be used to observe how well treatment is working.

It is especially important to see a doctor about these symptoms if you have risk factors for developing more complicated pneumonia. Make sure to reach out to a health care professional if you are over 65 years old, have a preexisting lung condition, and/or have a compromised immune system.

The decision to order a pneumonia test is determined by a doctor based on your specific situation. You should talk to a doctor or nurse if:

Testing is most often performed if you have symptoms that could be caused by pneumonia. This testing can help diagnose or rule out pneumonia as a cause of those symptoms.

The goal of any pneumonia test can depend on many factors including the type of pneumonia a person has along with their age, overall health, and symptom severity. A doctor is in the best position to explain the purpose of a particular pneumonia test in any individual patient&#;s case.

Pneumonia tests may be performed for one or more of the following reasons:

Types of Pneumonia Tests

Various types of pneumonia tests may be performed based on a patient&#;s symptoms and overall health. In most cases, initial testing for pneumonia involves a physical examination, medical history review, and a chest x-ray. These steps often allow for an initial diagnosis to be made.

Recommendations for further testing are tailored to a patient&#;s situation. In general, patients who have more severe symptoms, may require hospitalization, or who are at higher risk of complications are more likely to undergo additional pneumonia testing.

The following sections provide details about the different types of tests that may be involved in the diagnosis and evaluation of pneumonia.

Medical history review and physical exam

Pneumonia testing usually begins with an initial examination by a doctor that includes both a review of your medical history and a physical exam. This process helps the doctor understand your situation, check for signs of pneumonia, and look for the possible complications of an infection.

A medical history review includes a discussion of your current symptoms as well as your overall health and medical history. The doctor will usually ask about how long you have had symptoms and may ask questions about your medications, vaccinations, if you have been around other people who are sick, if you smoke cigarettes, or if you have other health issues that may affect your risk for pneumonia.

A physical exam for pneumonia typically includes using a stethoscope to listen to your lungs. A health care provider may tap on your chest and ask you to take several breaths while they listen. During this exam, the doctor is checking to see if they hear certain sounds that are associated with pneumonia.

Most of the time, additional tests are needed after this clinical evaluation. In some situations, a medical history review and physical exam may be sufficient to diagnose mild cases of pneumonia.

Chest imaging tests

If your medical history review and physical exam suggest pneumonia, the doctor will normally suggest an imaging test to look more closely at your lungs.

A chest x-ray is the typical imaging test used to diagnose pneumonia. This testing can show the presence of a pneumonia infection in the lungs.

Although less often used in pneumonia testing, a computed tomography (CT) scan of the chest may be considered in select situations. A CT scan provides more detailed images and are usually used when the initial chest x-ray has unexpected results, if symptoms are abnormal, or if symptoms may be explained by another lung condition.

In some hospitals and medical offices, an ultrasound of the lung may be used to help diagnose pneumonia. This method of imaging is not as common, but it may be most useful when it is otherwise difficult to perform a chest x-ray or CT scan.

Tests to assess overall health

Because pneumonia can trigger a range of potential complications, it is common for tests that assess your overall health to be included as part of pneumonia testing. Examples of these tests include:

• Complete blood count (CBC) with differential: This test measures the amount of each type of blood cell in a blood sample taken from a vein in your arm. In addition to providing insight about overall health, a CBC can show if there is an elevated level of white blood cells, which is associated with some infections.
• Basic metabolic panel (BMP): This is another routine blood test that assesses kidney function, electrolytes, and blood sugar levels.

Tests to assess lung function

Pneumonia directly affects the lungs, so the doctor may recommend one or more pulmonary function tests to check how well your lungs are working to provide oxygen to your body.

One type of pulmonary function test is pulse oximetry, which checks whether there is enough oxygen in your blood. The test uses a sensor clipped to your ear or finger that estimates your blood oxygen levels.

Another way of evaluating your blood oxygen levels is with an arterial blood gases test. This test uses a sample of blood taken from an artery and measures the amount of oxygen, blood pH, and carbon dioxide.

Tests to find the cause of pneumonia

Pneumonia testing may include a range of tests to identify why pneumonia occurred. There are many potential causes of pneumonia including an infection with a bacteria, virus, or fungus. When the cause is known, the doctor can choose a tailored therapy that offers the most benefit and least risk.

This kind of testing is not routinely performed in patients with mild cases of pneumonia. Trying to identify the cause is of greater importance when a patient is hospitalized or at higher risk of severe complications from pneumonia.

Although many tests are available to look for the underlying cause, in the majority of cases, no single cause can be conclusively identified.

The following sections describe different types of tests that may be used to detect the cause of pneumonia. Each section is organized based on the type of sample that is used for testing.

Sputum tests

Sputum is a thick kind of mucus produced in the lungs that is also known as phlegm. It is distinct from saliva or spit because its thickness helps it trap and remove pathogens from the lungs. For this reason, sputum can be analyzed to check for signs of bacteria, viruses, or other pathogens.

There are three main ways that a sputum sample can be obtained. The least invasive way of collecting sputum is by coughing deeply so that sputum can be spit into a cup. Before this, you may inhale a vapor that makes it easier to produce a testable amount of sputum.

When this method fails to produce sufficient sputum, other procedures may be necessary:

• Bronchoscopy: This is a procedure that inserts a flexible scope with a camera into the lungs. This allows the doctor to look more closely at the inside of the lungs. During the test, a small brush may collect a sputum sample, or a saline solution can be used to wash a sample of sputum out so that it can be analyzed. This procedure is known as bronchoalveolar lavage.
• Lung biopsy: This is a surgery that involves removing a sample of tissue from the lung. A lung biopsy is rarely necessary for pneumonia and is generally reserved for special cases and less common types of pneumonia.

Once a sputum sample has been collected, there are a number of different ways that it may be analyzed:

• Culture: In a sputum culture test, the lab places sputum in a special dish for a few days to see if bacteria or other infectious germs grow. If they do, the lab may be able to identify the specific bacteria or other pathogen that caused pneumonia.
• Gram stain: A Gram stain involves applying a purple-colored substance, known as the Gram stain, to the sample. Depending on how the sample changes color, it can indicate the type of infection present. A sputum gram stain may be repeated multiple times over several days, and it can be combined with a sputum culture test.
• Fungal smear: A fungal smear looks for presence of a fungal infection by examining a sputum sample under a microscope.
• Polymerase chain reaction (PCR): PCR is a type of molecular test that uses special laboratory techniques to check for the presence of the genetic material of a pathogen in a sputum sample. These tests can look for one or more kinds of bacteria or viruses.
• Direct fluorescent antibody (DFA): A sputum DFA test requires adding a fluorescent dye to a sputum sample that is then looked at under a special microscope. When certain infections are present, the sample will appear to glow.

Throat or nasal swab tests

Some tests use a swab of the throat, nostrils, or the area at the back of the nose to look for viruses that can cause respiratory symptoms and pneumonia.

Most people with pneumonia are tested for influenza and, during the global COVID-19 pandemic, the SARS-CoV-2 virus that causes COVID-19. Depending on a patient&#;s symptom severity and risk factors, swab tests may be used to look for other respiratory viruses.

Blood tests

Blood tests can be used to try to determine the cause of pneumonia.

Blood culture tests involve using a blood sample to try to grow bacteria in a lab. The test usually takes a few days to see if any bacteria grow, at which point they can be identified and targeted for treatment. Blood cultures can also detect possible complications such as an infection that has entered the bloodstream.

Another type of blood test that may be prescribed is a beta-D-glucan test. Beta-D-glucan is part of the cell walls of fungi, so this test can help detect a fungal infection that may have caused pneumonia.

Sometimes pneumonia testing may include blood tests that look for procalcitonin or C-reactive protein (CRP). These are substances in the blood that are associated with inflammation. These tests may be used to help distinguish between causes of inflammation and to assess a patient&#;s response to treatment.

Urine tests

A urine sample can be analyzed for the presence of two bacteria that can cause pneumonia, Streptococcus pneumoniae and Legionella pneumophila. These tests work by looking for antigens, which are substances found on the surface of the bacteria that trigger an immune response.

Pleural fluid tests

Sometimes pneumonia can be tied to the buildup of liquid in the pleura, which is the area between the wall of the chest and the lining on the outside of the lungs.

In a procedure called thoracentesis, a sample of this fluid can be removed by inserting a needle through the chest wall and into the pleural space. In a pleural fluid test, this sample can be analyzed under a microscope or used to try to culture bacteria in the laboratory in order to look for an underlying infection causing pneumonia.

Pneumonia affects millions of people every year. According to the Centers for Disease Control and Prevention (CDC), more than 400,000 people require evaluation and treatment in an emergency department and more than 50,000 people die from the disease. But complications can be prevented.

Finding out you have pneumonia is the first step, then learning what type of pneumonia you have&#;bacterial, viral, or fungal&#;is essential for proper treatment. Note that diagnostic steps may vary for people who are generally healthy and develop symptoms (community-acquired pneumonia) compared to those who are in a hospital or other healthcare setting.

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Physical Examination

Fever, cough, and shortness of breath could be symptoms of pneumonia. Your healthcare provider with start an evaluation by checking your vital signs and taking a detailed medical history.

They will measure your temperature, blood pressure, heart rate, and respiratory rate and will also check your oxygen level using pulse oximetry. This is done by placing a small device on your finger to estimate the percentage of oxygen in your blood. Low levels of oxygen are concerning and may mean that you need to be put on oxygen.

Using a stethoscope, a practitioner will listen to your lungs. They are listening to crackling sounds or wheezing. Decreased sounds in one area could mean that pneumonia has formed there. Tapping on your back over that area may help to determine the extent of infection or if there is an associated fluid collection.

Do not be surprised if you are asked to say the letter "E" out loud. If you have fluid in your lungs, it will sound like "A" when listening through the stethoscope.

Labs and Tests

While the physical exam can raise suspicion for pneumonia, the diagnosis can be strengthened using a variety of tests. Your healthcare provider may or may not use the following tests. Know that most are simple and straightforward on your part&#;a simple blood draw or sample collection, quick and painless.

Complete Blood Count

A complete blood count is a simple and inexpensive test. A white blood count is one of the blood counts measured. If it is elevated, infection or inflammation is present. It does not specifically let you know if you have pneumonia.

Procalcitonin

Procalcitonin is a precursor of calcitonin, a protein that is released by cells in response to toxins. It is measured via a blood test. Interestingly, the levels increase in response to bacterial infections but decrease in viral ones.

Results are usually positive within four hours of bacterial infection and peak within 12 to 48 hours. While it does not let you know what type of bacteria is present, it indicates that antibiotic treatment may be necessary.

The use of procalcitonin is still being explored in the diagnosis of community-acquired pneumonia and is not currently a routine blood test for every person with symptoms of pneumonia.

Sputum Culture and Gram Stain

If you are an outpatient, your healthcare provider may not order a sputum culture to identify whether you have bacterial pneumonia and the causative organism. However, if you are hospitalized and develop pneumonia symptoms, they may order a sputum culture.

If you want to learn more, please visit our website Pneumonia Rapid Test.

Unfortunately, collecting a good-quality sputum sample can be difficult, especially if someone has a dry cough. It often gets contaminated with normal bacteria that live in the respiratory tract.

A sample should be collected before you are treated with antibiotics. You'll be asked to cough up some sputum with as little saliva as possible. If you are having trouble doing so, a healthcare provider may use a device with a light and tiny camera placed down your throat. They will help relax you with medications during the procedure, and there are few side effects outside of a potential slightly sore throat. 

Once collected, a Gram stain is applied to part of the specimen and examined under a microscope. A good-quality sputum sample will show several white blood cells but few epithelial cells. Bacteria will appear red or violet and, based on their appearance, can be categorized as one of two classes of bacteria. Narrowing the diagnosis makes it easier to choose an appropriate antibiotic.

To find out what specific bacteria is causing your illness, your sample will be cultured in Petri dishes. Once the bacteria or fungi grow, it is tested against different antibiotics to see what treatments will be most effective.

The problem is that it may take days to get a definitive culture result. Also, certain bacteria like S. pneumoniae are difficult to grow and can give false-negative results. Because of the challenges in getting a good-quality sample, this test is more commonly used for people in the hospital rather than those living in the community.

Urine Antigen Tests

Urine antigen tests are not routinely ordered for outpatients who have symptoms of pneumonia, but they may be ordered for people who develop pneumonia symptoms in a hospital setting.

Bacterial pneumonia caused by S. pneumoniae and Legionella species has a high incidence of complications. Antigens from these bacteria are excreted in the urine. A simple urine test is available to look for these antigens.

The results are rapidly available and studies have shown them to be more accurate than Gram stain or culture. Another advantage of the test is that treatment with antibiotics will not alter the results.

The problem is that urine antigen tests are less accurate in milder cases of pneumonia. It also only tests for one serotype of Legionella although there are many species. Also, unlike with culture, there is no way to use the results to determine what antibiotics would be most effective for treatment.

Serology

Serologic tests are not routine for pneumonia for outpatients but may be ordered for people who develop pneumonia symptoms in the hospital.

Some bacteria are difficult to grow in culture and do not have a urine antigen test available for screening. Chlamydia, Mycoplasma, and some Legionella species are atypical bacteria that fall into this category.

There are serologic blood tests that may be able to determine when and if you have been infected. Serology measures antibodies formed against a specific pathogen. IgM antibodies indicate a new infection whereas IgG antibodies usually show that you have been infected in the past. It can sometimes be difficult to know when IgM antibodies transitioned to IgG antibodies.

PCR and Enzyme Immunoassays

It can be difficult to culture a virus. Instead, viral infections are more commonly diagnosed using polymerase chain reaction (PCR) and enzyme immunoassays. To perform any of these tests, a sample must be collected. Depending on what virus is being considered, this sample can be blood, sputum, nasal secretions, or saliva.

PCR is a test that screens for the presence of specific viral or bacterial DNA in a sample. It is an alternative to serology to screen for atypical bacteria. While results are often available in one to six hours, PCR cannot be performed on-site. It must be processed by a laboratory.

Enzyme immunoassays, however, can be performed as a point of care test with results available in 15 minutes to an hour. These immunoassays use antibodies to detect the presence of specific viral antigens and can screen for multiple viruses at one time.

Pneumonia is a common complication of COVID-19. For COVID-19 testing, the most accurate specimen is collected from the nose. This is the part of the upper respiratory tract where concentrations of the virus may be greatest. A flexible six-inch cotton swab is inserted into the nose and along the back of your throat where it is left in place for 15 seconds.

The same swab is then inserted into the other nostril to maximize how much mucous is collected for the test. Studies are then performed to assess if genetic material from the virus is present.

Imaging

Imaging studies are often performed before laboratory tests. If you are otherwise healthy, a healthcare provider may treat you for pneumonia based on physical exam and imaging studies alone.

Chest X-Ray

If pneumonia is suspected based on symptoms and physical exam, the standard of care is to get a chest X-ray. A chest X-ray may show an infiltrate, which is a collection of pus, blood, or protein in the lung tissue. It can also reveal other signs of lung disease like cavitations and pulmonary nodules.

Your practitioner usually cannot differentiate between bacterial and viral infections based on imaging alone. However, an infiltrate that fills all or most of one or more lobes of the lungs is likely to be bacterial pneumonia caused by S. pneumoniae.

CT Scan

It is possible that a chest X-ray can miss a diagnosis. If your healthcare provider still has a high suspicion for pneumonia after a negative result, she may choose to confirm the diagnosis by CT scan. Generally speaking, a CT scan is more accurate than a chest X-ray although it costs more and exposes you to higher doses of radiation.

The test is performed by placing you flat in a donut-shaped machine that takes pictures. The study is painless and completed in minutes, but it is important to lie still during the test to get the best images.

Bronchoscopy

In severe cases that do not respond to therapy, your healthcare provider may pursue further imaging to look for other causes. This evaluation may include bronchoscopy, where a thin camera is guided through your nose or mouth down into your lungs.

Bronchoscopy visualizes big airways (trachea or windpipe and large bronchi)&#;not lungs. Your practitioner may decide to take some fluid from your airway for culture if your phlegm culture is negative and you are immunosuppressed or if you have a chronic illness requiring a precise diagnosis of the cause of your pneumonia. Bronchoscopy is almost never done in an otherwise healthy adult with community-acquired pneumonia.

Differential Diagnosis

There are other conditions that can have symptoms similar to pneumonia, like bronchitis or congestive heart failure. If someone has asthma, bronchiectasis, or chronic obstructive pulmonary disease (COPD), it could be a flare-up of their known lung disease. In the worst-case scenario, it could be a warning sign of lung cancer.

However, don't be alarmed by these possibilities. The best thing for you to do is visit your healthcare provider for a proper diagnosis. In most cases, once diagnosed, pneumonia can be well taken care of.

Frequently Asked Questions

• Do you need a chest X-ray to diagnose pneumonia?

  It is recommended that any suspected case of pneumonia be confirmed with an X-ray. If the X-ray is inconclusive or more information is needed, other tests may be ordered, such as a CT scan. However, in some cases, a practitioner may prescribe antibiotics based on symptoms and a physical exam without a chest X-ray.
  

• Can pneumonia be mistaken for other illnesses?

  Yes. There are other conditions with similar symptoms, some of which can be differentiated with a chest X-ray, blood tests, pulmonary functions tests (PFTs), and other investigations. These include:

  • Acute bronchitis
  • Asthma
  • Bronchiolitis obliterans
  • Congestive heart failure
  • COPD
  • Endocarditis
  • Lung abscess
  • Lung cancer
  • Pulmonary embolism

• How do you get a sputum culture to test for bacterial pneumonia?

  You may be asked to cough into a specimen cup to provide a sample of phlegm to be tested. If you&#;re unable to cough up a sample, your healthcare provider may perform a bronchoscopy in which a tube is inserted into your airway and a sample is sucked or swabbed out.

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