Pneumonia

Answer 1

Definition

Pneumonia is a respiratory condition in which there is infection of the lung.

Community-acquired pneumonia refers to pneumonia in people who have not recently been in the hospital or another health care facility (nursing home, rehabilitation facility).

See also: Hospital-acquired pneumonia

Alternative Names

Bronchopneumonia; Community-acquired pneumonia

Causes, incidence, and risk factors

Pneumonia is a common illness that affects millions of people each year in the United States. Germs called bacteria, viruses, and fungi may cause pneumonia.

Ways you can get pneumonia include:

• Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs.
• You may breathe some of these germs directly into your lungs.
• You breathe in (inhale) food, liquids, vomit, or secretions from the mouth into your lungs (aspiration pneumonia)

Pneumonia caused by bacteria tends to be the most serious. In adults, bacteria are the most common cause of pneumonia.

• The most common pneumonia-causing germ in adults is Streptococcus pneumoniae (pneumococcus).
• Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as Legionella pneumophila, nullMycoplasma pneumoniae, and Chlamydophila pneumoniae.
• Pneumocystis jiroveci pneumonia is sometimes seen in people whose immune system is impaired (due to AIDS or certain medications that suppress the immune system).
• Staphylococcus aureus, Moraxella catarrhalis, Streptococcus pyogenes, Neisseria meningitidis, Klebsiella pneumoniae, or Haemophilus influenzaeare other bacteria that can cause pneumonia.
• Tuberculosis can cause pneumonia in some people, especially those with a weak immune system.

Viruses are also a common cause of pneumonia, especially in infants and young children.

See also: Respiratory syncytial virus

Risk factors (conditions that increase your chances of getting pneumonia) include:

• Cerebral palsy
• Chronic lung disease (COPD, bronchiectasis, cystic fibrosis)
• Cigarette smoking
• Difficulty swallowing (due to stroke, dementia, Parkinson's disease, or other neurological conditions)
• Immune system problem (See also: Pneumonia in immunocompromised host)
• Impaired consciousness (loss of brain function due to dementia, stroke, or other neurologic conditions)
• Living in a nursing facility
• Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes mellitus
• Recent surgery or trauma
• Recent viral respiratory infection (common cold, laryngitis, influenza)

Symptoms

The most common symptoms of pneumonia are:

• Cough (with some pneumonias you may cough up greenish or yellow mucus, or even bloody mucus)
• Fever, which may be mild or high
• Shaking chills
• Shortness of breath (may only occur when you climb stairs)

Additional symptoms include:

• Confusion, especially in older people
• Excessive sweating and clammy skin
• Headache
• Loss of appetite, low energy, and fatigue
• Sharp or stabbing chest pain that gets worse when you breathe deeply or cough

Signs and tests

If you have pneumonia, you may be working hard to breathe, or breathing fast.

Crackles are heard when listening to your chest with a stethoscope. Other abnormal breathing sounds may also be heard through the stethoscope or via percussion (tapping on your chest wall).

The health care provider will likely order a chest x-ray if pneumonia is suspected.

Some patients may need other tests, including:

• Arterial blood gases to see if enough oxygen is getting into your blood from the lungs
• CBC to check white blood cell count
• CT scan of the chest
• Gram's stain and culture of your sputum to look for the organism causing your symptoms
• Pleural fluid culture if there is fluid in the space surrounding the lungs

Treatment

Your doctor must first decide whether you need to be in the hospital. If you are treated in the hospital, you will receive fluids and antibiotics in your veins, oxygen therapy, and possibly breathing treatments. It is very important that your antibiotics are started very soon after you are admitted.

You are more likely to be admitted to the hospital if you:

• Have another serious medical problem
• Have severe symptoms
• Are unable to care for yourself at home, or are unable to eat or drink
• Are older than 65 or a young child
• Have been taking antibiotics at home and are not getting better

However, many people can be treated at home. If bacteria are causing the pneumonia, the doctor will try to cure the infection with antibiotics. It may be hard for your health care provider to know whether you have a viral or bacterial pneumonia, so you may receive antibiotics.

Patients with mild pneumonia who are otherwise healthy are sometimes treated with oral macrolide antibiotics (azithromycin, clarithromycin, or erythromycin).

Patients with other serious illnesses, such as heart disease, chronic obstructive pulmonary disease, or emphysema, kidney disease, or diabetes are often given one of the following:

• Fluoroquinolone (levofloxacin [Levaquin], gemifloxacin [Factive], or moxifloxacin [Avelox])
• High-dose amoxicillin or amoxicillin-clavulanate, plus a macrolide antibiotic (azithromycin, clarithromycin, or erythromycin)
• Cephalosporin antibiotics (for example, cefuroxime or cefpodoxime) plus a macrolide (azithromycin, clarithromycin, or erythromycin)

If the cause is a virus, typical antibiotics will NOT be effective. Sometimes, however, your doctor may use antiviral medication.

You can take these steps at home:

• Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen), or acetaminophen. DO NOT give aspirin to children.
• Do not take cough medicines without first talking to your doctor. Cough medicines may make it harder for your body to cough up the extra sputum.
• Drink plenty of fluids to help loosen secretions and bring up phlegm.
• Get lots of rest. Have someone else do household chores.

Expectations (prognosis)

With treatment, most patients will improve within 2 weeks. Elderly or debilitated patients may need longer treatment.

Those who may be more likely to have complicated pneumonia include:

• Older adults or very young children
• People whose immune system does not work well
• People with other, serious medical problems such as diabetes or cirrhosis of the liver

Your doctor may want to make sure your chest x-ray becomes normal again after you take a course of antibiotics. However, it may take many weeks for your x-ray to clear up.

Complications

Possible complications include:

• Acute respiratory distress syndrome (ARDS), a severe form of respiratory failure
• Empyema or lung abscesses. These are infrequent, but serious, complications of pneumonia. They occur when pockets of pus form inside or around the lung. These may sometimes need to be drained with surgery.
• Respiratory failure, which requires a breathing machine or ventilator
• Sepsis, a condition in which there is uncontrolled swelling (inflammation) in the body, which may lead to organ failure

Calling your health care provider

Call your doctor if you have:

• Worsening respiratory symptoms
• Shortness of breath, shaking chills, or persistent fevers
• Rapid or painful breathing
• A cough that brings up bloody or rust-colored mucus
• Chest pain that worsens when you cough or inhale
• Night sweats or unexplained weight loss
• Signs of pneumonia and weak immune system, as with HIV or chemotherapy

Infants with pneumonia may not have a cough. Call your doctor if your infant makes grunting noises or the area below the rib cage is retracting while breathing.

Prevention

Wash your hands frequently, especially after blowing your nose, going to the bathroom, diapering, and before eating or preparing foods.

Don't smoke. Tobacco damages your lung's ability to ward off infection.

Vaccines may help prevent pneumonia in children, the elderly, and people with diabetes, asthma, emphysema, HIV, cancer, or other chronic conditions:

• A drug called Synagis (palivizumab) is given to some children younger than 24 months to prevent pneumonia caused by respiratory syncytial virus.
• Flu vaccineprevents pneumonia and other problems caused by the influenza virus. It must be given yearly to protect against new virus strains.
• Hib vaccineprevents pneumonia in children from Haemophilus influenzaetype b.
• Pneumococcal vaccine (Pneumovax, Prevnar) lowers your chances of getting pneumonia from Streptococcus pneumoniae.

If you have cancer or HIV, talk to your doctor about additional ways to prevent pneumonia and other infections.

References

Higgins K, Singer M, Valappil T, Nambiar S, Lin D, Cox E. Overview of recent studies of community-acquired pneumonia. Clin Infect Dis. 2008;47:S150-156.

Van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Lancet. 2009;374:1543-1556.

Recommended Childhood and Adolescent Immunization Schedules -- United States, 2010. Committee on Infectious Diseases. Pediatrics. 2010;125:195-196.

Advisory Committee on Immunization Practices. Recommended adult immunization schedule: United States, 2010. Ann Intern Med. 2010. 152:36-39.

Li JZ, Winston LG, Moore DH, Bent S. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med. 2007;120:783-790.

Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72.

Answer 2

Definition

Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung.

Community-acquired pneumonia is pneumonia in people who have not recently been in the hospital or another health care facility (nursing home, rehabilitation facility).

See also: Hospital-acquired pneumonia

Alternative Names

Bronchopneumonia; Community-acquired pneumonia

Causes, incidence, and risk factors

Pneumonia is a common illness that affects millions of people each year in the United States. Germs called bacteria, viruses, and fungi may cause pneumonia.

Ways you can get pneumonia include:

• Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs.
• You may breathe some of these germs directly into your lungs.
• You breathe in (inhale) food, liquids, vomit, or fluids from the mouth into your lungs (aspiration pneumonia)

Pneumonia caused by bacteria tends to be the most serious kind. In adults, bacteria are the most common cause of pneumonia.

• The most common pneumonia-causing germ in adults is Streptococcus pneumoniae (pneumococcus).
• Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as Legionella pneumophila, nullMycoplasma pneumoniae, and Chlamydophila pneumoniae.
• Pneumocystis jiroveci pneumonia is sometimes seen in people whose immune system is not working well.

Many other bacteria can also cause pneumonia.

Viruses are also a common cause of pneumonia, especially in infants and young children.

See also: Respiratory syncytial virus

Risk factors (conditions that increase your chances of getting pneumonia) include:

• Cerebral palsy
• Chronic lung disease (COPD, bronchiectasis, cystic fibrosis)
• Cigarette smoking
• Difficulty swallowing (due to stroke, dementia, Parkinson's disease, or other neurological conditions)
• Immune system problem (See also: Pneumonia in immunocompromised host)
• Impaired consciousness (loss of brain function due to dementia, stroke, or other neurologic conditions)
• Living in a nursing facility
• Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes mellitus
• Recent surgery or trauma
• Recent cold, laryngitis, or flu

Symptoms

The most common symptoms of pneumonia are:

• Cough (with some pneumonias you may cough up greenish or yellow mucus, or even bloody mucus)
• Fever, which may be mild or high
• Shaking chills
• Shortness of breath (may only occur when you climb stairs)

Other symptoms include:

• Confusion, especially in older people
• Excess sweating and clammy skin
• Headache
• Loss of appetite, low energy, and fatigue
• Sharp or stabbing chest pain that gets worse when you breathe deeply or cough

Signs and tests

If you have pneumonia, you may be working hard to breathe, or breathing fast.

The health care provider will hear crackles when listening to your chest with a stethoscope. Other abnormal breathing sounds may also be heard through the stethoscope or via percussion (tapping on your chest wall).

The health care provider will likely order a chest x-ray if pneumonia is suspected.

Some patients may need other tests, including:

• Arterial blood gases to see if enough oxygen is getting into your blood from the lungs
• CBC to check white blood cell count
• CT scan of the chest
• Gram's stain and culture of your sputum to look for the bacteria or virus that is causing your symptoms
• Pleural fluid culture if there is fluid in the space around the lungs

Treatment

Your doctor must first decide whether you need to be in the hospital. If you are treated in the hospital, you will receive:

• Fluids and antibiotics in your veins
• Oxygen therapy
• Breathing treatments (possibly)

It is very important that you are started on antibiotics very soon after you are admitted.

You are more likely to be admitted to the hospital if you:

• Have another serious medical problem
• Have severe symptoms
• Are unable to care for yourself at home, or are unable to eat or drink
• Are older than 65 or a young child
• Have been taking antibiotics at home and are not getting better

However, many people can be treated at home. If bacteria are causing the pneumonia, the doctor will try to cure the infection with antibiotics. It may be hard for your health care provider to know whether you have viral or bacterial pneumonia, so you may receive antibiotics.

Your doctor may tell you to take antibiotics. Antibiotics help most people with pneumonia get better.

• Don't miss any doses. Take the medicine until it is gone, even if you start to feel better.
• Do NOT take cough medicine or cold medicine unless your doctor says it is okay. Coughing helps your body get rid of mucus from your lungs.

Breathing warm, moist (wet) air helps loosen the sticky mucus that may make you feel like you are choking. These things may help:

• Place a warm, wet washcloth loosely over your nose and mouth.
• Fill a humidifier with warm water and breathe in the warm mist.

Coughing helps clear your airways. Take a couple of deep breaths two or three times every hour. Deep breaths will help open up your lungs.

Tap your chest gently a few times a day and lie with your head lower than your chest. This can help bring up mucus from the lungs.

If you smoke any tobacco products, STOP. Do not allow smoking in your home.

Drink plenty of liquids (as long as your health care provider says it is okay):

• Drink water, juice, or weak tea
• Drink at least 6 to 10 cups a day
• Do NOT drink alcohol

Get plenty of rest when you go home. If you have trouble sleeping at night, take naps during the day.

Expectations (prognosis)

With treatment, most patients will improve within 2 weeks. Elderly or very sick patients may need longer treatment.

Those who may be more likely to have complicated pneumonia include:

• Older adults or very young children
• People whose immune system does not work well
• People with other, serious medical problems such as Diabetes or cirrhosis of the liver

Your doctor may want to make sure your chest x-ray becomes normal again after you take a course of antibiotics. However, it may take many weeks for your x-ray to clear up.

Complications

Possible complications include:

• Acute respiratory distress syndrome (ARDS)
• Fluid around the lung (pleural effusion)
• Lung abscesses
• Respiratory failure (which requires a breathing machine or ventilator)
• Sepsis, which may lead to organ failure

Calling your health care provider

Call your doctor if you have:

• A cough that brings up bloody or rust-colored mucus
• Breathing (respiratory) symptoms that get worse
• Chest pain that gets worse when you cough or breathe in
• Fast or painful breathing
• Night sweats or unexplained weight loss
• Shortness of breath, shaking chills, or persistent fevers
• Signs of pneumonia and a weak immune system (for example such as with HIV or chemotherapy)

Infants with pneumonia may not have a cough. Call your doctor if your infant makes grunting noises or the area below the rib cage is pulling in during breathing.

Prevention

Wash your hands often, especially after:

• Blowing your nose
• Going to the bathroom
• Diapering

Also wash your hands before eating or preparing foods.

Don't smoke. Tobacco damages your lung's ability to ward off infection.

Vaccines may help prevent pneumonia in children, the elderly, and people with diabetes, Asthma, emphysema, HIV, cancer, or other long-term conditions:

• A drug called Synagis (palivizumab) is given to some children younger than 24 months to prevent pneumonia caused by respiratory syncytial virus.
• Flu vaccineprevents pneumonia and other problems caused by the influenza virus. It must be given each year to protect against new virus strains.
• Hib vaccineprevents pneumonia in children from Haemophilus influenzaetype b.
• Pneumococcal vaccine (Pneumovax, Prevnar) lowers your chances of getting pneumonia from Streptococcus pneumoniae.

If you have cancer or HIV, talk to your doctor about ways to prevent pneumonia and other infections.

References

Van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Lancet. 2009;374:1543-1556.

Niederman M. In the clinic. Community-acquired pneumonia. Ann Intern Med. 2009;151(7).

Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72.

Torres A, MenA©ndez R, Wunderink R. Pyogenic bacterial pneumonia and lung abscess. In: Mason RJ, Broaddus VC, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 32.

Reviewed By

Review Date: 05/01/2011

Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care. University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Answer 3

Everyone coughs from time to time. You might pick up a cold, have an allergy, or just get a tickle from something irritating your throat. But if you're really hacking and coughing up yellow or green mucus, and you've also got a fever, chills, and shortness of breath, you may have picked up a more serious infection, called pneumonia. And sometimes pneumonia's symptoms aren't as obvious.

Pneumonia is caused by an infection in your lung. Bacteria or viruses like these can sometimes get into your lungs through your nose or mouth and make you sick.

You're more likely to get pneumonia if you've got a problem with your immune system that makes it harder to fight off infections. You're also at greater risk if you've got a lung disease like COPD or cystic fibrosis, you've recently had the flu, or you're exposed to cigarette smoke. People who live in nursing homes are also more likely to get pneumonia.

With pneumonia, you may cough up greenish or yellow phlegm. You also may run a fever and have the chills. Pneumonia can make it hard to breathe. You may feel like you've run up a flight of stairs when you were just sitting still.

Your doctor can tell that you have pneumonia and not just a cold by listening with a stethoscope for crackle sounds in your chest. You may need a chest x-ray or blood tests to know for sure that you have pneumonia.

If bacteria caused your pneumonia, your doctor can give you antibiotics, drugs that kill bacteria. Keep taking the antibiotic until you finish the whole prescription so you don't re-infect yourself.

To help loosen all of that mucus clogging your lungs, breathe in the warm mist from a humidifier and drink plenty of water. Take it easy too. Don't try to run back to work and infect everyone else. Rest until you feel better. Whatever you do, don't smoke, it will only make your pneumonia worse.

If your pneumonia is really severe or you have another serious health problem, your doctor may recommend that you get treated in the hospital. While there, you'll get antibiotics and fluids through a vein. You may also be given oxygen to help you breathe easier.

The best way to deal with pneumonia is to avoid getting it in the first place. Older adults, children, and people with serious conditions like diabetes, asthma, cancer, and emphysema should talk to their doctor about getting vaccinated against pneumonia and the illnesses that cause it.

Once you get treated, your pneumonia should clear up within a couple of weeks. Your doctor may want to check your lungs to make sure they're clear. Sometimes pneumonia can lead to serious lung complications, so call your doctor right away if your breathing problems get worse, you have chest pain, or you cough up blood.

Reviewed By

Review Date: 10/25/2011

Alan Greene, MD, Author and Practicing Pediatrician; also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.