Pneumonia

Pneumonia is very tricky to spot. It has symptoms that are very close to cold or flu, therefore you may not realize you have pneumonia. And also, signs and symptoms can differ greatly depending on the underlying conditions that you have and the type of organism causing the infection.


Pneumonia affects the lungs and causes inflammation. It is an infection caused by bacteria, viruses, fungi, and other micro-organisms. Pneumonia usually strikes when a person’s immune system is down, most often a simple viral infection in the upper respiratory tract, cold or flu will do. Flu-like symptoms and other infections do not cause pneumonia, but they favor microbial growth and tend alter the mucous blanket. Some other factors make specific people more susceptible to infections and in-turn pneumonia.

Most of the Pneumonia cases are caused by bacteria. The streptococcus bacteria, known as pneumococcus, cause one of the most prevalent forms of pneumonia.

Symptoms of Pneumonia

With the most common type of pneumonia, symptoms start to appear quite suddenly. There is pain in chest area, which causes discomfort every time a person coughs or even breathes. This is because of the narrowing of the fine tubes in the lungs (bronchioles) and inflammation of the air sacs (alveolar sacs), which is in-turn caused by the infection.

The symptoms of pneumonia mainly include chills, fever, and shortness of breath, and also cough accompanied with yellowisly green phlegm or occasionally blood. Chest pain when breathing can also be a symptom of pneumonia, which is a result of inflammation of the membrane that lines the lungs and chest cavity.

The cough would be dry at the beginning of the illness, but later it is accompanied with phlegm that is often green/yellow or rust coloured and may be smelly. Pneumonia also is accompanied by flu-like symptoms such as fever, aches, and loss of appetite. The exact symptoms may vary depending on the type of micro-organism causing the infection and the extent of the infection.

A straightforward case of pneumonia starts to improve quickly with treatment, and generally does not cause long-term harm to the lungs. Complications, which are more common in the elderly, include a build-up of pus in the lungs (pleural effusion) and difficulty in breathing, which will require hospital admission and treatment.

Causes of Pneumonia

Pneumonia is caused by viruses, bacteria, or parasites (in rare cases) or other micro-organisms. In up to 65% of cases, the organism (for example bacteria or virus) which is causing Pneumonia is not identified even with testing. In adults, Pneumonia is most often caused by bacteria, for example Streptococcus Pneumoniae, Staphylococcus aureus, Haemophilus influenzae and Legionella. The Legionella bacteria was the cause of most-known outbreak of Pneumonia called Legionnaires’ disease. Young children are more susceptible to develop Pneumonia from exposure to a virus, for example the parainfluenza and influenza viruses, adenovirus, and respiratory syncytial virus. The chickenpox virus also causes Pneumonia in adults and children. Mycoplasma Pneumoniae causes the symptom-less or walking Pneumonia, which mostly and usually affects older children and young adults. Dried bird-droppings contain Chlamydia psittaci which when inhaled causes respiratory problems and lead to Pneumonia. Pneumocystis carinii, which is classified as a parasite as well as fungi, causes Pneumonia in people with compromised immune system, for example, those with AIDS or undergoing cancer treatment. Healthy lungs sans have bacteria or virus owing to the guard system of our respiratory system that helps keep-out foreign organisms. However, these guards will be overwhelmed when exposed to a large number of the organisms that cause Pneumonia.

Pneumonia usually starts when a person inhales infected air particles into the lungs. In other cases, it develops during or after a viral upper respiratory infection, such as a cold or the flu. Pneumonia can even occur as a complication of viral illnesses such as measles and chickenpox. Pneumonia can also develop if a person inhales infected food, vomit, or mucus (aspiration pneumonia). Some cases of pneumonia are contracted by inhaling disease-causing microbes, e.g. bacteria or virus, which infect the lungs and cause pneumonia. When an infected person sneezes or coughs, these microbes become airborne again and infect more people. And in few cases, pneumonia is caused when some mouth, throat or nose dwelling bacteria or virus enter the lungs, causing inflammation and infection. When sleeping it is quite common for people to aspirate secretions from the nose, mouth or throat. Normally, the body’s immune system and reflex response (coughing back up the secretions) will prevent a pneumonia from gaining. However, if a person’s immune system is weakened owing to another illness, a severe pneumonia can develop. People with emphysema, heart disease and swallowing problems, alcoholics and drug abusers, and people who have suffered from a stroke or seizure are more at high risk for developing pneumonia.

Once bacteria, virus, or fungi enter the lungs, they settle in the air sacs of the lung where they rapidly multiply and grow in number. As the body attempts to fight off the infection, these air sacs of the lungs fills up with fluids and pus. Bacterial pneumonias are more serious and are the most common cause for pneumonia in adults, especially Streptococcus pneumoniae (pneumococcus). Mostly, respiratory viruses are the main cause of pneumonia in young children, most prevalent between ages of 2 and 3. By school age, Mycoplasma pneumoniae becomes the most common cause. In some people, especially the elderly and those who are debilitated, bacterial pneumonia may follow flu or even a common cold. Many people contract pneumonia when staying in a hospital for other treatments. This is more serious because the patient’s immune system is impaired owing to the condition that he/she suffered previously, which required treatment. In addition to all this, there is also a greater possibility of infection with antibiotic-resistant bacteria.

Diagnosis of Pneumonia

A doctor who suspects pneumonia begins by thoroughly checking the person’s medical history and a physical examination. Bacterial pneumonia affects suddenly; the person suffers cough which is accompanied by mucus that is colored or rusty, fever, and pain along the chest wall.

Infections caused by bacteria (Mycoplasma pneumonia) and viruses start to aggravate and develop after a few days of flu-like symptoms or cold-like symptoms. They can cause a headache, pain under the breastbone, and hacky or barky cough.

The Physical Examination The very necessary diagnostic tool for pneumonia may be the stethoscope. In pneumonia, when air passes through mucous and fluids in the lungs, it produces sounds called rales and rhonchi. The doctor will definitely suspect pneumonia if he/she hears rales on one side of the chest and while the patient is lying down.

With the diagnostic tool ‘percussion’, the doctor may tap lightly on the person’s chest. This usually produces a drum like sound, but a dull thud indicates inflammation and that the lung has become firm and elastic, called consolidation; or that between the layers of the lung membrane, called pleural effusion, fluid may be collecting.

Several tests may be ordered to aid diagnosis:

  • Chest X-rays will show signs of infection in the lungs. Different types of pneumonia will often have different X-ray patterns.
  • To determine the organism that is causing pneumonia and to collect a specimen, blood and sputum tests may be performed.
  • A lung biopsy may be performed in severe cases.

Other Diagnostic Procedures

In persons with life-threatening pneumonia more strong diagnostic procedures may be required.

  • Thoracentesisis done to extract and analyze fluid from the pleura – the thin membrane that lines the outside of the lung and the chest cavity. Any collection of fluids in between the layers of pleura is called a pleural effusion. Fluid in pleura is extracted by inserting a thin long needle in between the ribs and analyzed in the laboratory.
  • If the physician wants to see inside the lungs, a bronchoscopy may be performed. In this test, a tube is inserted through the nose or mouth. The tube acts like a telescope into the respiratory system, allowing the physician to view the wind-pipe and airways for pus, abnormal mucous, or other problems.
  • The physician would use ask you to breathe into an instrument called a spirometer that measures the amount of air you breathe. This test (called spirometry) is helpful in determining how well the lungs are functioning
  • Legionella, Mycoplasma, and Chlamydia, Some of the bacteria that can cause pneumonia, cannot be seen with an ordinary microscope. They are identified using special culture techniques or by performing blood tests that detect antibodies to the organisms.
  • Aspiration pneumonia causes changes in the chest X-ray that can be seen 6 to 24 hours after inhalation. Symptoms are respiratory distress indicated by grunting, cough, and fever after the aspiration of hydrocarbons, foreign substances, or bodily fluids. Symptoms may develop in minutes or in hours depending on the amount and nature of the breathed in substance.

Treatment of Pneumonia

Treatment depends on the severity and cause of pneumonia. Bacterial pneumonia is treated with antibiotics, but it cannot be used to treat viral pneumonia.

Treatment of pneumonia comprises respiratory support, which includes O2 if necessary, and antibiotics, which are given on the basis of Gram stain results. Antibiotics are given on the basis of probabilities according to patient age, epidemiology, host risk factors, and severity of illness, if Gram stain is not performed or does not establish a diagnosis.

Antibiotics are the main fundamental therapy for pneumonia. The antibiotics that are given depend on the nature of the pneumonia and the immune status of the patient. Amoxicillin, sometimes with added clarithromycin, is used as first-line therapy in the vast majority of community patients. In North America, where the typical forms of community-acquired pneumonia are becoming more common, clarithromycin, azithromycin, and fluoroquinolones have replaced the penicillin-derived drugs as first-line therapy. In immune deficient and hospitalized patients, local guidelines generally determine which combination of (generally intravenous) antibiotics is to be used. To remove secretions, when in hospital, respiratory treatments may be necessary. Steroid medications may be used, occasionally, to reduce wheezing if there is an underlying lung disease.

Most of the patients with mild pneumonia can be treated at home with oral antibiotics. Patients should drink plenty of liquids. Coughing should not be suppressed, because this is a significant reflex for clearing the lungs. Some physicians advise taking expectorants, for example guaifenesin (Breonesin, Glycotuss, Glytuss, Hytuss, Naldecon Senior EX, Robitussin), to loosen sputum. Codeine or other stronger pain relievers may be prescribed, for severe pain. However, it have to be noted that codeine and other narcotics suppress coughing, so they should be used with care in pneumonia and often require monitoring.

Treating Infective Pneumonia

  • Even though the treatment for infective pneumonia depends on the cause, some simple steps could help speed up the recovery from pneumonia.
  • Medicines should be taken as prescribed by a doctor. If it not helping, call the doctor. Do not quit taking them unless told to do so by a doctor.
  • Take over-the-counter medicines to help control pain and fever, such as acetaminophen or ibuprofen.
  • To increase air moisture, use a cool mist humidifier or a vaporizer and make it easier to breadth. DO NOT steam.
  • Take bed rest until the body’s core temperature returns to normal (98.6 degrees F or 37 degrees C) and breathing problems and chest pains are gone. Drink up to 6–8 glasses of liquids daily to keep the mucus thin and easy to cough up.

Treatments For Aspiration Pneumonia

Most treatments for aspiration pneumonia concentrate on breathing support. An endotracheal tube (a breathing tube) is usually inserted into the trachea and O2 is pumped into the lungs.

Suction could be used to clear the air way and remove any remaining chemical or vomit out of the way. Antibiotics are prescribed only if a secondary lung infection develops.

Recovery From Pneumonia

How well a patient recovers from pneumonia depends on the type of pneumonia and the patient’s general health. Most patients with pneumonia recover completely. However, in infants under 1 year of age, the elderly, and those suffering from a serious illness, pneumonia can sometimes be fatal.

The medications mentioned in this page are to be taken only when prescribed by a physician. This page is a guide to help you understand the treatments of pneumonia better. Any medications and treatments should be taken only under a doctor’s supervision.

Prevention of Pneumonia

Cold is easily and commonly transmitted by shaking an infected person’s hands. Everyone have to wash his or her hand after coming from outside and before eating. Every-day use soap is good. Waterless hand cleansers that contain an alcohol-based gel are effective for every day use and may even destroy cold viruses. Daily diets should contain foods like fresh, dark-colored fruits and vegetables that are rich in antioxidants and also other important aiding chemicals that help improve the immune system.

Therapy to clear secretions and deep-breathing exercises help prevent pneumonia in patients at high risk, such as those who have had chest or abdominal surgery and those who are debilitated. Patients with Pneumonia also should clear secretions, which can be done by practicing deep-breathing exercises and therapy. If patients with pneumonia are short of breath or their blood oxygen level is low, supplemental oxygen is provided. Even though rest is an important part of treatment, moving around and getting out of bed and into a chair are encouraged.

Some vaccines will help prevent pneumonia in children, the elderly, and patients with diabetes, asthma, emphysema, HIV, cancer, or other chronic conditions:

  • Pneumococcal vaccine (Pneumovax, Prevnar) prevents Streptococcus pneumonia.
  • Influenza vaccine prevents pneumonia and other infections caused by flu viruses. It should be given yearly to protect against new viral strains.
  • Hib vaccine prevents pneumonia in children from Haemophilus influenzae type b.

Many types of pneumonia can be prevented with the use of vaccines. Vaccines are available to guard against pneumococcal pneumonia – pneumonia caused by the bacteria Haemophilii influenza – and pneumonia caused by the influenza virus, which also often leads to a secondary bacterial pneumonia. People above age 65 and people in high-risk groups are advised to take the pneumonia vaccine. This vaccine is effective in approximately 80 % of healthy young adults; but, it may be less effective in persons in high risk groups. Although healthy adults usually need only one shot for life-time protection. People with a chronic medical problem are encouraged to take the vaccine every 5 to 6 years. Some health professionals recommend that everyone above the age of 65 years take vaccine every 5 years

Influenza vaccine: Pneumonia is a common complication of flu (influenza), so getting an influenza shot every fall is good prevention for pneumonia.

Pneumococcal vaccine: It helps fight the pneumococcal bacterium; a vaccine is available for people at risk, usually persons who:

  • have chronic illnesses for example heart disease, lung disease, kidney disorders, sickle cell anemia or diabetes.
  • are getting well from a severe illness.
  • are in hospitals or other chronic care facilities.
  • are above 65 years or older.

Pneumonia usually occurs as a complication of ordinary respiratory infections; so, an important preventive measure is to be ware to any symptoms of respiratory trouble that linger more than few days.

Children usually take routine immunizations against Haemophilus influenzae and pertussis (whooping cough) from upto 2 months of age (The routine injection DTaP’s ‘p’ stands for pertussis immunization.) Vaccines now are also given for the pneumococcus organism (PCV), a common cause of bacterial pneumonia.

Children with chronic illnesses, who are at high risk for other types of pneumonia, may receive extra vaccines or protective immune medication. The influenza vaccine is aggressively recommended for children with chronic illnesses such as chronic lung or heart disorders or asthma, as well as otherwise healthy children. Since they are more at risk for serious complications, infants who are born prematurely may be given treatments that temporarily guard against RSV, which can lead to pneumonia in younger children.

Physicians may give prophylactic (disease-preventing) antibiotics to prevent pneumonia in children who have been exposed to someone with certain types of pneumonia, such as pertussis. Children with HIV infection may also get prophylactic antibiotics to prevent pneumonia caused by Pneumocystis carinii.

Questions To Ask Your Doctor About Pneumonia

General Tips for Gathering Information

Here are some pointers that will make it easier for you to speak to your healthcare provider:

  • Take someone else with you. It aids to have another person hear what is said, and think about questions to ask.
  • Write out your questions before you go, so you don’t forget them.
  • Pen down the answers you get, and make sure you understand what is being said. Ask for clarification, if necessary.
  • Don’t be scared to ask your questions or ask where you can find more information about what you are discussing. It is your right to know.

Specific Questions to Ask Your Healthcare Provider

  • Do my symptoms suggest pneumonia?
  • How could have I contracted this infection?
  • Do my symptoms suggest a specific type of pneumonia?
  • Are you at all concerned about the O2 level in my blood?
  • What symptoms could suggest that I’m developing a more severe case?
  • What symptoms could suggest that I’m developing complications?
  • Is my infection contagious?

About Your Risk of Developing Pneumonia

  • Do I have some other conditions that could increase my risk of pneumonia?
  • How can I decrease my risk of developing pneumonia?

About Treatment Options

  • Is it bacterial pneumonia and will it respond to antibiotics?
  • Are there any new treatments for viral pneumonia?
  • What is likely to happen without treatment?
  • What medicines are available to me?
  • What are the benefits/side effects of these medications?
  • Will these medicines interact with other medications, over-the-counter products, or dietary or herbal supplements that I am already taking?
  • Are there any complimentary or alternative therapies that will help me?
  • Are there any comfort measures you can recommend?
  • Is hospitalization required?

About Lifestyle Changes

  • Is there any life-style change I should consider to more quickly recover from pneumonia or to prevent another out-break?
  • Could you help me stop smoking?
  • Do I need to curtail some of my activities?
  • How should I know when I can resume my usual activities?

About Your Outlook

  • How long could this last?
  • Am I likely to develop complications?
  • Is this likely to occur again?

Prognosis of Pneumonia

The clinical state of the person at time of presentation is a vital predictor of the clinical course. On the basis of the severity of symptoms, underlying disease and age, many clinicians use Pneumonia Severity Score to evaluate if a patient requires hospital admission. In the United States, death from pneumococcal pneumonia is 1 in 20; in cases where the disease progresses to blood poisoning, bacteremia, 2 of 10 die and where the disease affects the brain, meningitis, 3 of 10 die.

Prognosis of pneumonia caused by Chlamydophila pneumonia is excellent. Hospitalization is uncommon, complications are rare, and most people have no residual deficits. In fact, Chlamydophila pneumoniae is a common cause of walking pneumonia, so named because most people are able to continue to walk and participate in reduced activity during infection.

Approximately 1.2 million people are hospitalized every year for pneumonia, which is the 3rd most prominent reason for hospitalizations (births and heart diseases are first and second, respectively). Even though majority of pneumonias respond well to treatment, the infections can still pose a very serious problem. Together with flu, pneumonia is the 6th leading cause for death in the US and is the leading cause for death from infection.

Hospitalized Patients For people who require hospitalization for pneumonia, the mortality rate is between 10% and 25%. If pneumonia develops in people already hospitalized for other conditions, the mortality rates are higher. They range from 50% to 70% and are greater in women than in men.

Older Adults Community-acquired pneumonias are responsible for ~350,000 to 620,000 hospitalizations in older adults every year. The elderly have less survival rates than younger people, and pneumonia and flu are the 5th major causes of death in this population. Even when older people recover from community-acquired pneumonia, they have higher than normal mortality rates over the next few years. Older adults at particular risk are those with some other medical problems and hospitalized patients.

Very Young Children About 20% of deaths in stillborn and very young infants are because of pneumonia. Little children who develop pneumonia and survive are at also at risk for developing lung problems in adulthood.

Pregnant Women Pneumonias pose a significant hazard for pregnant women.

Patients With Impaired Immune Systems Pneumonia is particularly serious in patients with compromised immune systems, particularly AIDS patients, in whom pneumonia causes about half of all deaths.

Patients With Serious Medical Conditions Pneumonia is also very dangerous in patients with diabetes, cirrhosis, sickle cell disease, cancer, and in those who have had their spleens removed.

Risk Factors for Pneumonia

The elderly (who tend to have weakened cough and gag reflexes and unsteady immune systems) and infants and young children (who have small airways and immature immune systems) are at higher risk of community-acquired pneumonia (CAP) than are young and middle-aged adults.

Particular individuals, for example the very young, elderly, and those with chronic or severe medical conditions, are, of course, at greater risk of community-acquired pneumonia (CAP). Particularly, hospitalized patients are vulnerable to staphylococci and gram-negative bacteria, which could be very dangerous, particularly in persons who are already sick.

Patients, especially the elderly, who have recently under gone surgery or suffered a traumatic injury, are more likely to develop pneumonia since they are less able to breathe deeply, cough, and get rid of mucous.

Pneumonia is most likely to occur in people whose immune system is faltered by an existing illness, such as the influenza, AIDS, or cancer, and in patients with chronic conditions, for example, kidney disease, heart disease, sickle cell disease, asthma, chronic bronchitis, diabetes, chronic obstructive pulmonary disease (COPD), emphysema, or cystic fibrosis.

College students and recruits on military bases are at greater than average risk for Mycoplasma pneumonia, which usually is mild. However, these groups are at lower risk, for more serious types of pneumonia.

Time-to-time exposure to cigarette smoke can affect the lungs in ways that make a person more likely to develop pneumonia. The risk for pneumonia in smokers of more than one pack a day is 3 times more than nonsmokers. Those who are chronically exposed to cigarette smoke are also at risk, because it can injure airways and damage the cilia. Air pollutants such as Toxic fumes and industrial smoke may also damage cilia function, which is a defense again bacteria in the lungs.

Drug and alcohol abuse is mostly associated with pneumonia. These substances act as sedatives and therefore diminish the reflexes that trigger coughing and sneezing. Alcohol also hinders with the actions of macrophages, the white blood cells that kill bacteria and other micro-organisms. Intravenous drug abusers are highly prone to pneumonia from infections that originate at the injection place and spread through the blood stream to the lungs.

Complications of Pneumonia

Complications of pneumonia that could occur include build-up of fluid in the space between the lung and chest walls (pleural effusion), pockets of pus that accumulate in the space between the lung and chest wall (empyema) or in the lung itself (lung abscess), secondary bacterial lung infection after a viral infection, secondary infection, such as a vaginal infection or infections of the digestive system, because of antibiotic therapy, bacteria in the bloodstream (bacteremia) or throughout the body (septicemia), infection caused by swelling of the covering of the spinal cord (meningitis),infection of a joint caused by spread of bacteria through the bloodstream (septic arthritis), and infection of the heart muscle or the sac surrounding the heart (endocarditis or pericarditis).

Abscesses: Abscesses in lung are thick-walled, pus-filled cavities that are formed when infection has destroyed lung tissue. They, frequently, are a result of aspiration pneumonia if a mixture of organisms is carried into the lung. Abscesses can cause hemorrhage (bleeding) in the lungs if untreated, but antibiotics that target them have significantly reduced their danger. Abscesses are most common with Staphylococcus aureus or Klebsiella pneumoniae, and uncommon with Streptococcus pneumonia.

Respiratory Failure: Respiratory failure is one of the main causes of death in people with pneumococcal pneumonia. ARDS (Acute respiratory distress syndrome) is the specific condition that occurs when the lungs are unable to function and O2 is so severely reduced that the person’s life is at risk. Failure could occur if pneumonia leads to mechanical changes in the lungs (called ventilatory failure) or O2 loss in the arteries (called hypoxemic respiratory failure).

Bacteremia: Bacteremia (bacteria in blood) is the most and prevalent complication of pneumococcus infection, although it rarely spreads to others sites. Bacteremia is a frequent-occuring complication of infection from other gram-negative organisms, including Haemophilus influenzae.

Empyema and Pleural Effusions: The pleura are 2 thin membranes:

  • Lungs are covered by visceral pleura.
  • Chest wall are covered by parietal pleura.

In few cases of pneumonia, the pleura become inflamed, that can result in breathlessness and acute chest ache when breathing.

And, in about 20% of pneumonia cases, there is build-up of the fluid between the pleural membranes that lubricates the lung. (Ordinarily the thin zone between the 2 membranes contains only a small amount of fluid.)

Collapsed Lung: In few cases, air may fill up the space between the pleural membranes, causing the lungs to collapse, a condition called pneumothorax. It can be a complication of pneumonia (specifically Streptococcus pneumoniae) or of some of the invasive procedures used to treat pleural effusion.

Other Complications of Pneumonia: : In unique cases, infection may spread from the lungs to the heart and can even spread throughout the body, sometimes causing abscesses in the brain and other organs. Coughing up blood (severe hemoptysis) is another potentially serious complication of pneumonia, particularly in persons with other lung problems such as cystic fibrosis.