What you should know about pneumonia
Symptoms, Treatment, In children, Causes, Risk factors, Types, Prevention, Diagnosis
Pneumonia is an infection of the lungs with a range of possible causes. It can be a serious and life-threatening disease.
It normally starts with a bacterial, viral, or fungal infection.
The lungs become inflamed, and the tiny air sacs, or alveoli, inside the lungs fill up with fluid.
Pneumonia can occur in young and healthy people, but it is most dangerous for older adults, infants, people with other diseases, and those with impaired immune systems.
In the United States (U.S.), around 1 million people are treated in the hospital for pneumonia each year, and around 50,000 die from the disease.
Here are some key points about pneumonia.
Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages.
It is the leading cause of death due to infection in children younger than 5 years of age worldwide.
Pneumonia and influenza together are ranked as the eighth leading cause of death in the U.S.
Those at high risk for pneumonia include older adults, the very young, and people with underlying health problems.
Symptoms
Pneumonia is a serious lung infection with a number of possible causes.
The first symptoms of pneumonia usually resemble those of a cold or flu. The person then develops a high fever, chills, and cough with sputum.
Common symptoms include:
cough
rusty or green phlegm, or sputum, coughed up from lungs
fever
fast breathing and shortness of breath
shaking chills
chest pain that usually worsens when taking a deep breath
known as pleuritic pain
fast heartbeat
fatigue and weakness
nausea and vomiting
diarrhea
sweating
headache
muscle pain
confusion or delirium, especially in older adults
dusky or purplish skin color, or cyanosis, from poorly oxygenated blood
Symptoms can vary depending on other underlying conditions and the type of pneumonia.
Treatment
Treatment depends on the type and severity of the pneumonia.
Bacterial types of pneumonia are usually treated with antibiotics.
Viral types of pneumonia are usually treated with rest and plenty of fluids. Antiviral medications can be used in influenza.
Fungal types of pneumonia are usually treated with antifungal medications.
Doctors commonly prescribe over-the-counter (OTC)
medications to help manage the symptoms of pneumonia. These include treatments for reducing fever, reducing aches and pains, and suppressing coughs.
In addition, it is crucial to rest and drink plenty of fluids. Staying hydrated helps to thin out thick phlegm and mucus, making it easier to cough up.
Hospitalization for pneumonia may be required if symptoms are especially bad or if an individual has a weakened immune system or other serious illnesses.
In the hospital, patients are generally treated with intravenous antibiotics and fluids. They may need a supplemental oxygen supply.
In children
In most children, the immune system can protect them from pneumonia. If a child does develop pneumonia, it is usually due to a virus.
Symptoms include:
difficulty breathing
not feeding properly
coughing
fever
irritability
dehydration
Toddlers may complain of pain in their chest, and they may vomit after coughing.
Treatment includes plenty of rest and a regular intake of fluids. The doctor may suggest over-the-counter for abdominal problems, but cough medicines will not help. Adults should not smoke around children, especially if they have pneumonia.
Causes
Bacteria and viruses are the main causes of pneumonia.
Pneumonia-causing germs can settle in the alveoli and multiply after a person breathes them in.
Pneumonia can be contagious. The bacteria and viruses that cause pneumonia are usually inhaled.
They can be passed on through coughing and sneezing, or spread onto shared objects through touch.
The body sends white blood cells to attack the infection. This is why the air sacs become inflamed. The bacteria and viruses fill the lung sacs with fluid and pus, causing pneumonia.
Risk factors
Those most at risk include people who:
are aged under 5 years or over 65 years
smoke tobacco, consume large amounts of alcohol, or both
have underlying conditions such as cystic fibrosis, chronic obstructive pulmonary disorder (COPD), asthma, or conditions that affect the kidneys, heart, or liver
have a weakened or impaired immune system, due, for example, to AIDS, HIV, or cancer
take medicines for gastroesophageal reflux disease (GERD)
have recently recovered from a cold or influenza infection
experience malnutrition
have been recently hospitalized in an intensive care unit
have been exposed to certain chemicals or pollutants
Some groups are more prone than others to pneumonia, including Native Alaskan or certain Native American ethnicities.
Types
There are different types of pneumonia, depending on their cause.
Bacterial pneumonia: The most common cause is the bacterium Streptococcus pneumoniae (S. pneumoniae), but many different bacteria can cause pneumonia
Viral pneumonia: This can result from the respiratory syncytial virus (RSV) and influenza types A and B, known as the flu
Aspiration pneumonia: This can happen when a person breathes food, liquids, or stomach contents into the lungs. This type is not contagious.
Fungal pneumonia: This can result from a condition such as valley fever, caused by the Coccidioides fungus.
Hospital-acquired pneumonia: This can occur in patients being treated for other conditions, for example, those attached to a respirator, or breathing machine.
Regardless of the cause, the signs and symptoms will be similar.
Prevention
There are two different vaccines to prevent pneumococcal disease, the most common bacterial cause of pneumonia.
These cover a wide variety of pneumococcal infections and are recommended for both children and adults, depending on their health conditions.
pneumococcal conjugate vaccine, or Prevnar
pneumococcal polysaccharide vaccine, or Pneumovax
Keeping to a vaccination schedule can help prevent infection.
Prevnar (PCV13) is normally included as part of an infant’s routine immunizations.
It is recommended for children under 2 years, adults over 65 years, and those between the ages of 2 and 64 years with certain medical conditions.
Pneumovax (PPSV23) is recommended for children and adults who are at increased risk of developing pneumococcal infections.
This includes:
adults aged 65 years or older
people with diabetes
those with chronic heart, lung, or kidney disease
people who consume large amounts of alcohol or who smoke
those without a spleen
Those aged between 2 and 64 years with certain other medical conditions may be advised to have this vaccine
The vaccine may not completely protect older adults from pneumonia, but it can significantly reduce the risk of developing pneumonia and other infections caused by S. pneumoniae), including blood and brain infections.
Along with vaccinations, physicians recommend:
regular hand washing
covering the mouth and nose when coughing or sneezing
refraining from smoking
eating healthfully
exercising 5 days a week
staying away from the sputum or cough particles of others with pneumonia
Most people recover from pneumonia in 1 to 3 weeks. Those at risk of severe symptoms should ensure they keep up their vaccinations.
Diagnosis
A doctor will ask about symptoms and medical history and will carry out a physical examination.
An X-ray can show if there is any damage to the lungs.
They may suspect pneumonia if they hear coarse breathing, wheezing, crackling, or decreased breath sounds when listening to the chest through a stethoscope.
The doctor may also check the oxygen levels in the blood with a painless monitor on the finger called a pulse oximeter.
Chest X-rays can confirm a pneumonia diagnosis and show which areas of the lungs are affected.
A CT scan of the chest may provide more detailed information.
Blood tests measure the white blood cell count.
This helps determine how severe the infection is, and whether a bacteria, virus, or fungus is the likely cause.
Blood cultures may reveal whether the microorganism from the lungs has spread into the blood stream.
An arterial blood gas (ABG) blood test may provide a more accurate reading of the body’s oxygen and carbon dioxide levels and other factors.
A sputum analysis can determine which organism is causing the pneumonia.
A bronchoscopy is sometimes used for further investigation.
A thin, flexible, and lighted tube called a bronchoscope is passed down into the lungs. This enables the doctor to examine directly the infected parts of the airways and lungs. The patient is under anesthetic.
And Also:
Pneumonia Symptoms and Diagnosis
Pneumonia is an infection that inflames your lungs' air sacs (alveoli). The air sacs may fill up with fluid or pus, causing symptoms such as a cough, fever, chills and trouble breathing.
What Are the Symptoms of Pneumonia?
Pneumonia symptoms can vary from so mild you barely notice them, to so severe that hospitalization is required. How your body responds to pneumonia depends on the type germ causing the infection, your age and your overall health.
The signs and symptoms of pneumonia may include:
Cough, which may produce greenish, yellow or even bloody mucus
Fever, sweating and shaking chills
Shortness of breath
Rapid, shallow breathing
Sharp or stabbing chest pain that gets worse when you breathe deeply or cough
Loss of appetite, low energy, and fatigue
Nausea and vomiting, especially in small children
Confusion, especially in older people
Questions about your symptoms?
Bacterial pneumonia, which is the most common form, tends to be more serious than other types of pneumonia, with symptoms that require medical care. The symptoms of bacterial pneumonia can develop gradually or suddenly. Fever may rise as high as a dangerous 105 degrees F, with profuse sweating and rapidly increased breathing and pulse rate. Lips and nailbeds may have a bluish color due to lack of oxygen in the blood. A patient's mental state may be confused or delirious.
The symptoms of viral pneumonia usually develop over a period of several days. Early symptoms are similar to influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within a day or two, the symptoms typically get worse, with increasing cough, shortness of breath and muscle pain. There may be a high fever and there may be blueness of the lips.
Symptoms may vary in certain populations. Newborns and infants may not show any signs of the infection. Or, they may vomit, have a fever and cough, or appear restless, sick, or tired and without energy. Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. Older adults who have pneumonia sometimes have sudden changes in mental awareness. For individuals that already have a chronic lung disease, those symptoms may worsen.
When to call a doctor
If you think you or your child has symptoms of pneumonia, don't wait for the disease to get even worse before you seek care. Call your doctor. And see your doctor right away if you have difficulty breathing, develop a bluish color in your lips and fingertips, have chest pain, a high fever, or a cough with mucus that is severe or is getting worse.
It's especially important to get medical attention for pneumonia if you are in a high-risk group, including adults older than age 65, children age two or younger, people with an underlying health condition or weakened immune system. For some of these vulnerable individuals, pneumonia can quickly become a life-threatening condition.
How Is Pneumonia Diagnosed?
Sometimes pneumonia can be difficult to diagnose because the symptoms are so variable, and are often very similar to those seen in a cold or influenza. To diagnose pneumonia, and to try to identify the germ that is causing the illness, your doctor will ask questions about your medical history, do a physical exam, and run some tests.
Medical history
Your doctor will ask you questions about your signs and symptoms, and how and when they began. To help figure out if your infection is caused by bacteria, viruses or fungi, you may be asked some questions about possible exposures, such as:
Any recent travel
Your occupation
Contact with animals
Exposure to other sick people at home, work or school
Whether you have recently had another illness
Physical exam
Your doctor will listen to your lungs with a stethoscope. If you have pneumonia, your lungs may make crackling, bubbling, and rumbling sounds when you inhale.
Diagnostic Tests
If your doctor suspects you may have pneumonia, they will probably recommend some tests to confirm the diagnosis and learn more about your infection. These may include:
Blood tests to confirm the infection and to try to identify the germ that is causing your illness.
Chest X-ray to look for the location and extent of inflammation in your lungs.
Pulse oximetry to measure the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream.
Sputum test on a sample of mucus (sputum) taken after a deep cough, to look for the source of the infection.
If you are considered a high-risk patient because of your age and overall health, or if you are hospitalized, the doctors may want to do some additional tests, including:
CT scan of the chest to get a better view of the lungs and look for abscesses or other complications.
Arterial blood gas test, to measure the amount of oxygen in a blood sample taken from an artery, usually in your wrist. This is more accurate than the simpler pulse oximetry.
Pleural fluid culture, which removes a small amount of fluid from around tissues that surround the lung, to analyze and identify bacteria causing the pneumonia.
Bronchoscopy, a procedure used to look into the lungs' airways. If you are hospitalized and your treatment is not working well, doctors may want to see whether something else is affecting your airways, such as a blockage. They may also take fluid samples or a biopsy of lung tissue.