# Commission Implementing Decision (EU) 2018/945 of 22 June 2018 on the communicable diseases and related special health issues to be covered by epidemiological surveillance as well as relevant case definitions (Text with EEA relevance), Division 4.1.10: PN: Pneumonia

Extent: E+W+S+N.I.

Two or more serial chest X-rays or CT-scans with a suggestive image of pneumonia for patients with underlying cardiac or pulmonary disease. In patients without underlying cardiac or pulmonary disease one definitive chest X-ray or CT-scan is sufficient
AND at least one of the following symptoms
Fever > 38 °C with no other cause
Leukopenia (< 4 000 WBC/mm3) or leucocytosis (≥ 12 000 WBC/mm3)
AND at least one of the following (or at least two if clinical pneumonia only = PN 4 and PN 5)
New onset of purulent sputum, or change in character of sputum (colour, odour, quantity, consistency)
Cough or dyspnea or tachypnea
Suggestive auscultation (rales or bronchial breath sounds), ronchi, wheezing
Worsening gas exchange (for example, O2 desaturation or increased oxygen requirements or increased ventilation demand)
and according to the used diagnostic method
(a) Bacteriologic diagnostic performed by:
Positive quantitative culture from minimally contaminated LRT specimen (PN 1)
Broncho-alveolar lavage (BAL) with a threshold of ≥ 104 CFU/ml or ≥ 5 % of BAL obtained cells contains intracellular bacteria on direct microscopic exam (classified on the diagnostic category BAL)
Protected brush (PB Wimberley) with a threshold of ≥ 103 CFU/ml
Distal protected aspirate (DPA) with a threshold of ≥ 103 CFU/ml
Positive quantitative culture from possibly contaminated LRT specimen (PN 2)
Quantitative culture of LRT specimen (for example, endotracheal aspirate) with a threshold of 106 CFU/ml
(b) Alternative microbiology methods (PN 3)
Positive blood culture not related to another source of infection
Positive growth in culture of pleural fluid
Pleural or pulmonary abscess with positive needle aspiration
Histologic pulmonary exam shows evidence of pneumonia
Positive exams for pneumonia with virus or particular germs (for example, Legionella, Aspergillus, mycobacteria, mycoplasma, Pneumocystis jirovecii):
Positive detection of viral antigen or antibody from respiratory secretions (for example, EIA, FAMA, shell vial assay, PCR)
Positive direct exam or positive culture from bronchial secretions or tissue
Seroconversion (for example, influenza viruses, Legionella, Chlamydia)
Detection of antigens in urine (Legionella)
(c) Others
Positive sputum culture or non-quantitative LRT specimen culture (PN 4)
No positive microbiology (PN 5)

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Source: https://www.legislation.gov.uk/eudn/2018/945/annex/II/division/4/division/4.1/division/4.1.10 (the official version)
Page: https://openlegislation.uk/eu-decision-2018-945/annex-II/division-4/division-4.1/division-4.1.10
Contains public sector information licensed under the Open Government Licence v3.0. Source: legislation.gov.uk, The National Archives.