Viral pneumonia is an infection of the lung tissue caused by viruses such as influenza, SARS-CoV-2 or respiratory syncytial virus (RSV). Most patients recover with supportive care, while older adults, young children and people with chronic illness can develop low oxygen or a bacterial infection on top.
Key symptoms
- Fever, chills and muscle aches
- Cough, often dry at first
- Shortness of breath
- Sore throat, headache and fatigue
- Recent sick contacts or a known outbreak
What you find on exam
- Fever, fast breathing and fast heart rate
- Low oxygen saturation
- Scattered crackles or wheezes on both sides
- Signs of dehydration or confusion in older adults
Tests
- Nasal swab PCR for influenza, SARS-CoV-2 and RSV
- Chest X-ray: patchy or interstitial infiltrates, often on both sides
- Blood count, chemistry and pulse oximetry or blood gas
- Procalcitonin, sputum and blood cultures if bacterial infection is suspected
Treatment basics
- Supportive care: fluids, rest and acetaminophen for fever
- Oxygen to keep saturation in the target range
- Oseltamivir for influenza, best within 48 hours or in high-risk patients
- COVID-19 antivirals, or dexamethasone for patients who need oxygen, per current guidance
- Antibiotics only if bacterial co-infection is likely; isolation precautions
Red flags
- Oxygen saturation below 92% or rising work of breathing
- Confusion, low blood pressure or signs of sepsis
- Improvement followed by new fever and worse cough (bacterial superinfection)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; CDC, Guideline for Isolation Precautions (2007) and PPE sequence. Written by Making Synapses. Making Synapses is not affiliated with these organizations.