The absence of gram-positive cocci in clusters would provide sufficient evidence that the elderly person does not have staphylococcal pneumonia, a severe and often fatal illness in the elderly. We learned that if a person is on antibiotics, it renders gram stain and sputum cultures as somewhat less useful, thus forcing the medical doctor to make a less precise diagnosis. When an individual has a new infiltrate, the diagnosis is usually pneumonia. If they do not, it is called exacerbation of chronic bronchitis. The latter disorder is usually associated with sputum production.
Exacerbation produces more sputum, which changes in color and slight fever and some dyspnea.
Pneumococcal pneumonia is most easily recognized via an X-ray. A blood count could be useful, for it defines whether the patient is anemic. The blood cell count, either less than 4000 or above 20,000, is a marker for an individual who has severe pneumonia. Pneumonia has a broad range of etiologies. Further complicating the situation in the elderly is the nutritional status.