Pneumonia

What Is Pneumonia?

Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages. Signs of pneumonia can include coughing, fever, fatigue, nausea, vomiting, rapid breathing or shortness of breath, chills, or chest pain. Certain people are more likely to become ill with pneumonia. This includes adults 65 years of age or older and children less than 5 years of age. People up through 64 years of age who have underlying medical conditions (like diabetes or HIV/AIDS) and people 19 through 64 who smoke cigarettes or have asthma are also at increased risk for getting pneumonia.

Sign And Symptoms

Pneumonia symptoms can vary greatly, depending on any underlying conditions you may have and the type of organism causing the infection. Pneumonia often mimics the flu, beginning with a cough and a fever, so you may not realize you have a more serious condition.
Common signs and symptoms of pneumonia may include:

Fever
Cough
Shortness of breath
Sweating
Shaking chills
Chest pain that fluctuates with breathing (pleurisy)
Headache
Muscle pain
Fatigue

Ironically, people in high-risk groups such as older adults and people with chronic illnesses or weakened immune systems may have fewer or milder symptoms than less vulnerable people do. And instead of having the high fever that often characterizes pneumonia, older adults may even have a lower than normal temperature.

Causes
When bacteria, viruses or, rarely, fungi living in your nose, mouth, sinuses, or the environment spread to your lungs, you can develop pneumonia or other infections. You can catch the bacteria or viruses from people who are infected with them, whether they are sick or not.

How is pneumonia diagnosed?

Pneumonia may be suspected when the doctor examines the patient and hears coarse breathing or crackling sounds when listening to a portion of the chest with a stethoscope. There may be wheezing, or the sounds of breathing may be faint in a particular area of the chest. A chest X-ray is usually ordered to confirm the diagnosis of pneumonia. The lungs have several segments referred to as lobes, usually two on the left and three on the right. When the pneumonia affects one of these lobes, it is often referred to as lobar pneumonia. Some pneumonias have a more patchy distribution that does not involve specific lobes. In the past, when both lungs were involved in the infection, the term "double pneumonia" was used. This term is rarely used today.
Sputum samples can be collected and examined under the microscope. If the pneumonia is caused by bacteria or fungi, the organisms can often be detected by this examination. A sample of the sputum can be grown in special incubators, and the offending organism can be subsequently identified. It is important to understand that the sputum specimen must contain little saliva from the mouth and be delivered to the laboratory fairly quickly. Otherwise, overgrowth of noninfecting bacteria may predominate. As we have used antibiotics in a broader uncontrolled fashion, more organisms are becoming resistant to the commonly used antibiotics. These types of cultures can help in directed more appropriate therapy.
A blood test that measures white blood cell count (WBC) may be performed. An individual's white blood cell count can often give a hint as to the severity of the pneumonia and whether it is caused by bacteria or a virus. An increased number of neutrophils, one type of WBC, is seen in bacterial infections, whereas an increase in lymphocytes, another type of WBC, is seen in viral infections, fungal infections, and some bacterial infections (like tuberculosis).
Bronchoscopy is a procedure in which a thin, flexible, lighted viewing tube is inserted into the nose or mouth after a local anesthetic is administered. The breathing passages can then be directly examined by the doctor, and specimens from the infected part of the lung can be obtained.
Sometimes, fluid collects in the pleural space around the lung as a result of the inflammation from pneumonia. This fluid is called a pleural effusion. If a significant amount of fluid develops, it can be removed. Usually this is done by inserting a needle into the chest cavity and withdrawing the fluid with a syringe in a procedure called a thoracentesis. Often ultrasound is used to prevent complications from this procedure. In some cases, this fluid can become severely inflamed (parapneumonic effusion) or infected (empyema) and may need to be removed by more aggressive surgical procedures. Today, most often, this involves surgery through a tube or thoracoscope. This is referred to as video-assisted thoracoscopic surgery or VATS.

Types of Pneumonia

You may have heard of community-acquired pneumonia (CAP). When someone who hasn't recently been in the hospital or another healthcare facility develops pneumonia, it's called community-acquired.
Pneumonia is associated with healthcare when someone gets the infection during or following a stay in a healthcare facility (like hospitals, long-term care facilities, and dialysis centers). These infections are labeled healthcare-associated pneumonias, which includes healthcare-associated pneumonia (HCAP), hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP).
In the U.S., the most common bacterial cause of pneumonia is Streptococcus pneumoniae (pneumococcus) and the most common viral causes are influenza, parainfluenza, and respiratory syncytial viruses. In children less than 1 year of age, respiratory syncytial virus (RSV) is the most common cause of pneumonia. Other common bacterial and viral causes of pneumonia in the U.S. include Staphylococcus aureus and adenovirus. Pneumocystis jirovecii, a fungus formerly known as Pneumocystis carinii, is a common cause of pneumonia in patients with AIDS.

Treatment

Treatments for pneumonia vary, depending on the severity of your symptoms and the type of pneumonia you have.

Bacterial. Doctors usually treat bacterial pneumonia with antibiotics. Although you may start to feel better shortly after beginning your medication, be sure to complete your entire course of antibiotics. Stopping medication too soon may cause your pneumonia to return. It also helps create strains of bacteria that are resistant to antibiotics — an increasingly serious problem. In fact, in the past decade the number of antibiotic-resistant strains of bacteria has risen dramatically. In 1994, approximately 6 percent of bacteria that caused pneumonia were resistant to antibiotics. Just 6 years later, in the year 2000, that number had jumped to 34 percent.
Viral. Antibiotics aren't effective against viral forms of pneumonia. And although a few viral pneumonias may be treated with antiviral medications, the recommended treatment is the same as for the flu — rest and plenty of fluids. Overall, it may take you longer to recover from viral pneumonia than from bacterial pneumonia.
Mycoplasma. Mycoplasma pneumonias are treated with antibiotics. Even so, recovery may not be immediate — it may take four to six weeks for you to recover completely if your pneumonia is serious. In some cases fatigue may continue long after the infection itself has cleared.

Fatigue

In addition to these treatments, your doctor may recommend over-the-counter medications to reduce fever, treat your aches and pains, and soothe the cough associated with pneumonia. You don't want to suppress your cough completely, though, since coughing helps clear your lungs. If you must use a cough suppressant, use the lowest dose that helps you get some rest.

If you have serious pneumonia — if your breathing is very labored, for instance — you may be hospitalized and treated with intravenous antibiotics or put on oxygen. Some studies seem to show, however, that you may recover as quickly at home with oral antibiotics as in the hospital, especially if you have access to qualified home health care. Sometimes you may spend three or four days in the hospital receiving intravenous antibiotics and then continue to recover at home with oral medication.

Prevention

You usually don't "catch" pneumonia from someone else. Instead, you develop the disease because your own immunity is temporarily weakened, often for no known reason. The following suggestions can help keep you healthy:

Get vaccinated. Because pneumonia can be a complication of the flu, getting a yearly flu shot is a good way to prevent pneumonia. In addition, get a vaccination against pneumococcal pneumonia at least once after age 65. Talk to your doctor about the pneumonia vaccine if you have a chronic illness such as lung or cardiovascular disease, diabetes or sickle cell anemia, if your immune system is compromised or you've had your spleen removed for any reason. A vaccine known as Prevnar can also help protect young children against pneumonia. It's recommended for all children under age 2 and for children 2 years and older who are at particular risk of pneumococcal disease, such as those with an immune system deficiency, cancer, cardiovascular disease or sickle cell anemia. Side effects of the pneumococcal vaccine are generally minor and include mild soreness or swelling at the injection site.
Wash your hands. Your hands come in daily contact with germs that can cause pneumonia. These germs enter your body when you touch your eyes or rub your nose. Washing your hands thoroughly and often can help reduce your risk.
Don't smoke. Smoking damages your lungs' natural defenses against respiratory infections.
Take care of yourself. Proper rest and a diet rich in fruits, vegetables and whole grains along with moderate exercise all help keep your immune system strong.
Protect others from infection. If you have pneumonia, try to stay away from anyone with a compromised immune system. When that isn't possible, you can help protect others by wearing a face mask and always coughing into a tissue.