HEALTH: PNEUMONIA

HEALTH: PNEUMONIA (INFECTION - SYMPTOMS - TREATMENT) Sinuses>>

What is Pneumonia?

Pneumonia is an infection of one or both lungs. Pneumonia is an inflammation of your lungs, usually caused by infection. Bacteria, viruses, fungi or parasites can cause pneumonia. Pneumonia is a particular concern if you're older than 65 or have a chronic illness or impaired immune system. It can also occur in young people with good health.

Pneumonia can range in seriousness from mild to life-threatening. Pneumonia often is a complication of another condition, such as the flu. Antibiotics can treat most common forms of bacterial pneumonias, but antibiotic-resistant strains are a growing problem. The best approach is to try to prevent infection. You may cough, run a fever, and have a hard time breathing.

For most people, pneumonia can be treated at home. It often clears up in 2 to 3 weeks. But older adults, babies, and people with other diseases can become very ill. They may need to be in the hospital.You can get pneumonia in your daily life, such as at school or work. This is basically called community-based pneumonia. You can also get it when you are in a hospital or nursing home. This is called hospital-based pneumonia. It may be more severe because you're already ill health wise.

Prior to the discovery of antibiotics, one-third of all people who developed pneumonia subsequently died from the infection. Currently, over 3 million people develop pneumonia each year in the United States. Over a half a million of these people are admitted to a hospital for treatment. Although most of these people recover, approximately 5% will die from pneumonia. Pneumonia is the sixth leading cause of death in the United States.

Some cases of pneumonia are contracted by breathing in small droplets that contain the organisms that can cause pneumonia. These droplets get into the air when a person infected with these germs coughs or sneezes. In other cases, pneumonia is caused when bacteria or viruses that are normally present in the mouth, throat, or nose inadvertently enter the lung.

During sleep, it is quite common for people to aspirate secretions from the mouth, throat, or nose. Normally, the body's reflex response (coughing back up the secretions) and immune system will prevent the aspirated organisms from causing pneumonia. However, if a person is in a weakened health condition from another illness, a severe pneumonia can develop.

Once organisms enter the lungs, they usually settle in the air sacs of the lung where they rapidly grow in number. This area of the lung then becomes filled with fluid and pus as the body attempts to fight off the infection.

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Also see: Emphysema Lung Cancer Bronchitis Asthma Allergies Sinuses Common Cold Influenza/Flu Swine Flu

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Health: Causes of Pneumonia

Pneumonia usually starts when you breathe the germs into your lungs. You may be more likely to get the disease after having a cold or the flu. These illnesses make it hard for your lungs to fight infection, so it is easier to get pneumonia. Having a long-term, or chronic, health issue like asthma, heart disease, cancer, or diabetes also makes you more likely to get pneumonia.

Bacterial pneumonias tend to be the most serious and, in adults, the most common cause of pneumonia. The most common pneumonia-causing bacterium in adults is Streptococcus pneumoniae (pneumococcus).

Respiratory viruses are the most common causes of pneumonia in young children, peaking between the ages of 2 and 3. By school age, the bacterium Mycoplasma pneumoniae becomes more common.

In some people, particularly the elderly and those who are debilitated, bacterial pneumonia may follow influenza or even a common cold.

People who have trouble swallowing are at risk of aspiration pneumonia. In this condition, food, liquid, or saliva accidentally goes into the airways. It is more common in people who have had a stroke, Parkinson's disease, or previous throat surgery.

It is often harder to treat pneumonia in people who are in a hospital, or a nursing facility.

Your body has ways to protect your lungs from infection. In fact, you're frequently exposed to bacteria and viruses that can cause pneumonia, but your body normally uses a number of defenses, such as cough and the normal microorganisms (flora) in your body, to prevent harmful organisms from invading and overwhelming your airways. However, numerous conditions, including malnutrition and systemic illness, can lower your protection and allow harmful organisms to get past your body's defenses and into your lungs.

Once the invading organisms are in your lungs, white blood cells — a key part of your immune system — begin to attack them. The accumulating invaders, white blood cells and immune system proteins cause the tiny air sacs in your lungs to become inflamed and filled with fluid, leading to the difficult breathing that characterizes many types of pneumonia.

Classifications of pneumonia
Pneumonia is sometimes classified according to the cause of pneumonia:

Community-acquired pneumonia. This refers to pneumonia you acquire in the course of your daily life — at school, work or the gym, for instance. The most common cause is the bacterium Streptococcus pneumoniae. Another, less common cause is Mycoplasma pneumoniae, a tiny organism that typically produces milder signs and symptoms than other types of pneumonia. Walking pneumonia, a term used to describe pneumonia that isn't severe enough to require bed rest, may result from Mycoplasma pneumoniae.
Hospital-acquired (nosocomial) pneumonia. If you're hospitalized, you're at a higher risk of pneumonia, especially if you're breathing with the help of a mechanical ventilator, in an intensive care unit or have a weakened immune system. This type of pneumonia can be extremely serious, especially for older adults, young children and people with chronic obstructive pulmonary diseases (COPD) or HIV/AIDS.

Hospital-acquired pneumonia develops at least 48 hours after you're admitted to the hospital. This category includes post-operative pneumonia — most common in people older than age 70 who have abdominal or chest surgery — and health-care associated pneumonia — acquired in chronic care facilities, centers where drugs are given by intravenous drip (infusion) and kidney dialysis centers.

A common predisposing factor for this type of pneumonia is gastroesophageal reflux disease (GERD). This occurs when some of the contents of your stomach flow back into the upper esophagus. From there, the gastroesophageal contents can be inhaled (aspirated) into your windpipe and then into your lower airways. Even small amounts of gastroesophageal reflux can lead to pneumonia in people who are hospitalized.
Aspiration pneumonia. This type of pneumonia occurs when you aspirate foreign matter into your lungs — most often when the contents of your stomach enter your lungs after you vomit. This commonly happens when a brain injury or other condition affects your normal gag reflex.

Another cause of aspiration pneumonia is consuming too much alcohol. Aspiration occurs when the inebriated person passes out and then vomits due to the effects of alcohol on the stomach. If someone's unconscious, it's possible to aspirate the liquid contents and possibly solid food from the stomach into the lungs, causing aspiration pneumonia.

Difficulty swallowing, which occurs with diseases such as amyotrophic lateral sclerosis (ALS), Parkinson's disease and strokes, may also lead to aspiration pneumonia.
Pneumonia caused by opportunistic organisms. This type of pneumonia strikes people with weakened immune systems. Organisms that aren't harmful for healthy people can be dangerous for people with AIDS and other health conditions that impair the immune system, as well as people who have had an organ transplant. Medications that suppress your immune system, such as corticosteroids or chemotherapy, also can put you at risk of opportunistic pneumonia.
Other pathogens. Outbreaks of the H5N1 influenza (bird flu) virus and severe acute respiratory syndrome (SARS) have caused serious, sometimes deadly pneumonia infections, even in otherwise healthy people. Although rare, anthrax, plague and tularemia also may cause pneumonia. Some forms of fungi, when inhaled can cause pneumonia. Tuberculosis in the lung also can cause pneumonia.

Health: Risk Factors of Pneumonia

Factors associated with an increased risk of pneumonia are:

Age. If you're age 65 or older, particularly if you have other health conditions that make you more prone to developing pneumonia, you're at increased risk of pneumonia. Very young children, whose immune systems aren't fully developed, also are at increased health risk of pneumonia.

Certain diseases. These include immune deficiency diseases such as HIV/AIDS and chronic illnesses such as cardiovascular disease, emphysema and other lung diseases, and diabetes. You're also at increased risk if your immune system has been impaired by chemotherapy or long-term use of immunosuppressant drugs.

Smoking, alcohol abuse. Millions of microscopic hairs (cilia) cover the surface of the cells lining your bronchial tubes. The hairs beat in a wave-like fashion to clear your airways of normal secretions, but irritants such as tobacco smoke paralyze the cilia, causing secretions to accumulate. If these secretions contain bacteria, they can develop into pneumonia. Alcohol interferes with your normal gag reflex as well as with the action of the white blood cells that fight infection.

Hospitalization in an intensive care unit. Pneumonia acquired in the hospital tends to be more serious than other types of pneumonia. People who need mechanical ventilation are particularly at health risk, because the breathing tube bypasses the normal defenses of the upper respiratory tract, prevents coughing, may allow the stomach's contents to back up into the esophagus where they can be inhaled (aspirated), and can harbor bacteria and other harmful organisms.

Having COPD and using inhaled corticosteroids for more than 24 weeks. Research indicates that this greatly increases your health risk of developing pneumonia, possibly serious pneumonia.

Exposure to certain chemicals or pollutants. Your health risk of developing some uncommon types of pneumonia may be increased if you work in agriculture, in construction or around certain industrial chemicals or animals. Exposure to air pollution or toxic fumes can also contribute to lung inflammation, which makes it harder for the lungs to clear themselves.

Surgery or traumatic injury. People who've had surgery or who are immobilized from a traumatic injury have a higher health risk of pneumonia because surgery or serious injuries may make coughing — which helps clear your lungs — more difficult, and lying flat can allow mucus to collect in your lungs, providing a breeding ground for bacteria.

Ethnicity. If you're a Native Alaskan or from certain Native American tribes, you're at greater health risk for contracting pneumonia.

Health: Symptoms of Pneumonia

Pneumonia symptoms caused by bacteria usually come on quickly. Pneumonia symptoms caused by viruses are the same as those caused by bacteria. But they may come on slowly and often are not as obvious or as bad. When you have mild pneumonia symptoms, your doctor may call this "walking pneumonia."

Older adults may have different, fewer, or milder pneumonia symptoms. They may not have a fever. Or they may have a cough but not bring up mucus. The main sign of pneumonia in older adults may be a change in how well they think. Confusion or delirium is common. Or, if they already have a lung disease, that disease may get worse.

Most people who develop pneumonia initially have symptoms of a cold which are then followed by a high fever (sometimes as high as 104 degrees Fahrenheit), shaking chills, and a cough with sputum production. The sputum is usually discolored and sometimes bloody. People with pneumonia may become short of breath. The only pain fibers in the lung are on the surface of the lung, in the area known as the pleura. Chest pain may develop if the outer pleural aspects of the lung are involved. This pain is usually sharp and worsens when taking a deep breath, known as pleuritic pain.

In other cases of pneumonia, there can be a slow onset of symptoms. A worsening cough, headaches, and muscle aches may be the only symptoms. In some people with pneumonia, coughing is not a major symptom because the infection is located in areas of the lung away from the larger airways. At times, the individual's skin color may change and become dusky or purplish (a condition known as "cyanosis") due to their blood being poorly oxygenated.

Children and babies who develop pneumonia often do not have any specific signs of a chest infection but develop a fever, appear quite ill, and can become lethargic. Elderly people may also have few pneumonia 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 health condition.

Common pneumonia symptoms may include the following:

Fever
Cough -you will likely cough up mucus (sputum) from your lungs. Mucus may be rusty or green or tinged with blood.
Fast breathing and shortness of breath
Sweating
Shaking and "teeth-chattering" chills. You may have this only one time or many times.
Chest pain that often feels worse when you cough or breathe in.
Headache
Muscle pain
Fatigue - feeling very tired or feeling very weak.
Fast heartbeat
Nausea and vomiting
Diarrhea

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.

When to seek a health care provider
Because pneumonia can be life-threatening, see your doctor as soon as possible if you have a persistent cough, shortness of breath, chest pain, unexplained fever — especially a lasting fever of 102 F (38.9 C) or higher with chills and sweating — or if you suddenly feel worse after a cold or the flu.

Be especially prompt about seeking medical health care if you're an older adult or you smoke, drink excessively, have an injury, are undergoing chemotherapy or take medication such as prednisone that suppresses your immune system. For some older adults and people with heart failure or lung ailments, pneumonia can quickly become a life-threatening health condition.

Health: Diagnosis of Pneumonia

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

Your doctor will ask you about your symptoms and do a physical exam. He or she may order a chest X-ray and a blood test. This is usually enough for your doctor to know if you have pneumonia. You may need more tests if you have bad symptoms, are an older adult, or have other health problems. In general, the sicker you are, the more tests you will have.

Your doctor may also test mucus from your lungs to find out what germ is causing your pneumonia. Finding the exact germ can help your doctor choose the best medicine for you.

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 where 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.

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.

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 the amount of this fluid that develops is large enough, it can be removed by inserting a needle into the chest cavity and withdrawing the fluid with a syringe in a procedure called a thoracentesis. 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.

Health: Conventional Treatment of Pneumonia

Pneumonia can be a serious and life-threatening infection. This is true especially in the elderly, children, and those that have other serious health problems, such as COPD, heart disease, diabetes, and certain cancers. Fortunately, with the discovery of many potent antibiotics, most cases of pneumonia can be successfully treated. In fact, pneumonia can usually be treated with oral antibiotics without the need for hospitalization.

These antibiotics almost always cure pneumonia caused by bacteria. You need to take all of your antibiotics so you could fully recover. Do not stop taking them because you feel better. Take them exactly as your doctor instructs you.

Pneumonia can make you feel very sick. But after you take antibiotics, you should start feeling much better. Call your doctor if you do not feel better after 2 to 3 days of antibiotics. Call your doctor right away if you feel worse.

There are things you can do health wise, to feel better during your treatment. Get plenty of rest and sleep, and drink lots of liquids. Do not smoke. If your cough keeps you awake at night, talk to your doctor about using cough medicine.

You may need to go to the hospital if you have bad symptoms, a weak immune system, or another serious health issue.

Pneumonia caused by a virus usually cannot be treated with antibiotics. Home treatment, such as rest and taking care of your cough, is the only treatment.

Pneumonia treatment 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 the 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.
Viral. Antibiotics aren't effective against most viral forms of pneumonia. And although a few viral pneumonias may be treated with antiviral medications, the recommended treatment generally is rest and plenty of fluids.
Mycoplasma. Mycoplasma pneumonias are treated with antibiotics. Even so, recovery may not be immediate. In some cases fatigue may continue long after the infection itself has cleared. Many cases of mycoplasma pneumonia go undiagnosed and untreated. The signs and symptoms mimic those of a bad chest cold, so some people never seek medical attention. The symptoms generally go away on their own.
Fungal. If your pneumonia is caused by a fungus, you'll likely be treated with antifungal medication.

Dealing with your symptoms
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, because 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 pneumonia, the following measures can help you recover more quickly and decrease your health risk of complications:

Get plenty of rest. Even when you start to feel better, be careful not to overdo it.
Stay home from school or work until after your temperature returns to normal and you stop coughing up mucus. This advice depends partially on how sick you were. If uncertain, ask your doctor. Because pneumonia can recur within a week or so, it may be better not to return to a full workload until you're sure you're well.
Drink plenty of fluids, especially water. Liquids keep you from becoming dehydrated and help loosen mucus in your lungs.
Take the entire course of any prescribed medications. Stopping medication too soon can cause your pneumonia to come back and contributes to the development of antibiotic-resistant bacteria.
Keep all of your follow-up appointments. Even though you feel better, your lungs may still be infected. It's important to have your doctor monitor your progress.

When hospitalization is needed
If you have severe pneumonia, you'll be hospitalized and treated with intravenous antibiotics and possibly put on oxygen. If you don't need oxygen, 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.

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.

Follow-up treatment
Your doctor will most likely schedule a follow-up X-ray and an office visit after your initial diagnosis and treatment. By that time your infection should have cleared, but it's important for your doctor to see you, even if you're feeling better. Follow-up appointments and X-rays are especially important in smokers.

If you're not feeling better, the follow-up visit is an opportunity for your doctor to determine whether your course of treatment isn't working and order more tests to get more information about your health condition.

Health: Prevention of Pneumonia

If you are older than 65 or you have a heart or lung problem, you may want to get a pneumonia vaccine. It may not keep you from getting pneumonia. But if you do get pneumonia, you probably will not be as sick. Vaccines can help prevent pneumonia in children, the elderly, and people with diabetes, asthma, emphysema, HIV, cancer, or other chronic health conditions:

You can also lower your chances of getting pneumonia by staying away from people who have the flu, colds, measles, or chickenpox. You may get pneumonia after you have one of these illnesses. Taking deep breaths may help prevent pneumonia if you are in the hospital -- for example, while recovering from surgery. Often, a breathing device will be given to you to assist in deep breathing.

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 viral influenza pneumonia, which can lead to bacterial pneumonia. In addition, even though there is some controversy of its effectiveness, especially in older adults, doctors recommend getting a vaccination against pneumococcal pneumonia at least once after age 50, and if you have any risk factors, every five years thereafter. Your doctor will recommend a pneumonia vaccine even if you're younger than 50 if you're a smoker, if you have a lung or cardiovascular disease, certain types of cancer, diabetes or sickle cell anemia, if your immune system is compromised, or if you've had your spleen removed for any reason.

A vaccine known as pneumococcal conjugate vaccine can help protect young children against pneumonia. It's recommended for all children younger than age 2 and for children ages 2 to 5 years who are at particular health risk of pneumococcal disease, such as those with an immune system deficiency, cancer, cardiovascular disease or sickle cell anemia, or those who attend a group day care center. Side effects of the pneumococcal vaccine are generally minor and include mild soreness or swelling at the injection site.
Wash your hands. Your hands are in almost constant contact with germs that can cause pneumonia. These germs enter your body when you touch your eyes or rub the inside of your nose. Washing your hands often and thoroughly and can help reduce your health risk. When washing isn't possible, use an alcohol-based hand sanitizer, which can be more effective than soap and water in destroying the bacteria and viruses that cause disease. What's more, most hand sanitizers contain ingredients that keep your skin moist. Carry one in your purse or in your pocket.
Don't smoke. Smoking damages your lungs' natural defenses against respiratory infection.

Take care of yourself. Proper rest and a diet rich in fruits, vegetables and whole grains along with moderate exercise can help keep your immune system strong health wise.

Get treatment for GERD. Treat symptomatic GERD, and lose weight if you're overweight.

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.

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Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.

Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services

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