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Pneumonia
OverviewPneumonia is an inflammation and infection of the lungs. Although pneumonia is a special concern for older adults and those with chronic illnesses, it can also strike young, healthy people as well. There are more than 50 kinds of pneumonia that range in seriousness from mild to life-threatening. In infectious pneumonia, bacteria, viruses, fungi or other organisms attack your lungs, leading to inflammation that makes it hard to breathe. Pneumonia can affect one or both lungs. Infection of both lungs is sometimes popularly referred to as double pneumonia. In many cases pneumonia follows a common cold or the flu, but it also can be associated with other illnesses or occur on its own. It's best to do everything you can to prevent pneumonia, but if you do get sick, recognizing and treating the disease early offers the best chance for a full recovery.
Signs and symptomsPneumonia can be tricky. It often mimics a cold or the flu, so you may not realize you have a more serious condition. In addition, signs and symptoms of pneumonia vary greatly, depending on any underlying conditions you may have and the type of organism causing the infection: Bacteria. Dozens of types of bacteria can cause pneumonia. Bacterial pneumonia can occur on its own, or you may develop it after you've had an upper respiratory infection such as a cold or the flu. Signs and symptoms, which are likely to come on suddenly, include shaking chills, a high fever, sweating, chest pain (pleurisy) and a cough that produces thick, greenish or yellow phlegm. If you're an older adult or have a chronic illness, you may have fewer or milder symptoms. Still, don't treat pneumonia lightly. For people age 65 and older, or those with a chronic illness, pneumonia can be extremely serious. Viruses. About a dozen different viruses including the same viruses that cause influenza are responsible for half of all cases of pneumonia. Viral pneumonia strikes primarily in the fall and winter and tends to be more serious in people with cardiovascular or lung disease. It usually starts with a dry (nonproductive) cough, headache, fever, muscle pain and fatigue. As the pneumonia progresses, you may become breathless and develop a cough that produces phlegm. When you have viral pneumonia you run the risk of also developing a secondary bacterial pneumonia. Mycoplasma. This tiny organism causes symptoms similar to those of both bacterial and viral infections, although the symptoms appear more gradually and are often milder than are those of other kinds of pneumonia. If you've been told you have "walking pneumonia," it's probably caused by mycoplasma. You may not be sick enough to stay in bed or to seek medical care. In fact, you may never know you've had pneumonia. Mycoplasma pneumonia spreads easily in situations where people congregate and is common in child-care centers and among school children and young adults. Although not bacterial, mycoplasma pneumonia responds well to treatment with the appropriate antibiotics. Chlamydia. This bacterium causes symptoms similar to those of mycoplasma pneumonia. Although everyone is at risk, chlamydia pneumonia is most common in school-age children. Fungi. Certain types of fungus also can cause pneumonia, especially Histoplasma capsulatum, which is common in the Mississippi and Ohio River valleys. Most people experience few if any symptoms after inhaling this fungus, but some develop symptoms of acute pneumonia, and still others may develop a chronic pneumonia that persists for months. Pneumocystis carinii. Pneumonia caused by P. carinii is the most common opportunistic infection. People whose immune systems are compromised by treatment with corticosteroids, organ transplants or cancer also are at risk. The signs and symptoms of Pneumocystis carinii pneumonia (PCP) include a cough that doesn't go away, fever and trouble breathing. In the past, P. carinii was considered a type of parasite, but more recent studies suggest that this microorganism is more closely related to fungi. CausesYour lungs are two spongy organs surrounded by a moist membrane (the pleura). When you inhale, air is carried through the windpipe (trachea) to your lungs in two major airways called bronchi. Inside your lungs, the bronchi subdivide nearly 20 times into a million smaller airways (bronchioles), which finally end in clusters of tiny air sacs called alveoli. At each stage of this process, there are mechanisms to protect your lungs from infection. In fact, you're frequently exposed to bacteria and viruses that can cause pneumonia, but your body normally keeps them from entering your lungs and causing a problem. But sometimes for reasons that aren't always well understood these microorganisms can get past your body's defenses. Pneumonia is sometimes classified according to where or how you're exposed to the disease: Community-acquired pneumonia. This refers to pneumonia you acquire in the course of your daily life at school, work or the gym, for instance. Hospital-acquired (nosocomial) pneumonia. If you're hospitalized, you're much more likely to develop pneumonia, especially if you are on a mechanical ventilator, are in the intensive care unit or have a compromised immune system. This type of pneumonia can be extremely serious, especially for older adults, young children and people living with HIV/AIDS. Unfortunately, it remains a common problem in spite of stringent efforts to control it. Aspiration pneumonia. This type of pneumonia occurs when foreign matter is inhaled (aspirated) into your lungs most commonly when the contents of your stomach enter your lungs after you vomit. This most often happens when a brain injury or other condition affects your normal gag reflex. Pneumonia caused by opportunistic organisms. This type of pneumonia strikes people with compromised immune systems. Organisms that aren't harmful for healthy people can be extremely dangerous for those with AIDS, sickle cell disease and other conditions that impair the immune system. For example,P. carinii pneumonia almost never occurs in otherwise healthy people. Medications that suppress your immune system, such as corticosteroids or chemotherapy for cancers such as leukemia and lymphoma, also can put you at risk of opportunistic pneumonia. Risk factorsYou're at increased risk of pneumonia if you're age 65 or older. Very young children, whose immune systems aren't fully developed, also are at risk of pneumonia. You're also more likely to develop pneumonia if you: Have certain diseases. These include immune deficiency diseases such as HIV/AIDS and chronic illnesses such as cardiovascular disease, emphysema or diabetes. You're also at increased risk if you've had your spleen removed, or your immune system has been impaired by chemotherapy or long-term use of immunosuppressant drugs. Smoke, or abuse alcohol or drugs. Smoking damages your airways, and alcohol interferes with the action of white blood cells that fight infection. If you inject illegal drugs, there's a chance you may develop injection-site infections that can travel through your bloodstream to your lungs. Are exposed to certain chemicals or pollutants. Your risk of developing some uncommon types of pneumonia increases if you work in agriculture, construction or around certain industrial chemicals. Exposure to air pollution or toxic fumes can also contribute to lung inflammation. Live in certain parts of the country. Two types of fungus that occur in the soil in certain parts of the United States can cause lung infections and pneumonia. Coccidioidomycosis, for example, is widespread throughout Southern California and the desert Southwest. The majority of people exposed to the fungus don't get sick, but a few develop severe pneumonia. Histoplasmosis is a serious lung infection caused by a soil-borne fungus that's most prevalent in the Ohio and Mississippi River valleys. Infants, young children, older adults and people with chronic lung disease or HIV/AIDS are at increased risk of severe symptoms. When to seek medical adviceIf you think you may have pneumonia, don't hesitate to get medical care. Serious pneumonia can be life-threatening. See your doctor right away if you have a persistent cough, shortness of breath, chest pain that fluctuates with your breathing (pleurisy), an unexplained fever especially a fever of 102 F or higher for two or more days along with chills and sweats or if you suddenly feel worse after a cold or the flu. Be especially prompt about seeking medical care if you're an older adult, or you're affected by alcoholism, injury, chemotherapy or the use of drugs such as prednisone that suppress the immune system. For some older adults and people with heart failure or lung ailments, pneumonia can prove fatal in as little as 24 hours. If you've received a diagnosis of pneumonia, your doctor will most likely schedule a follow-up visit four to six weeks after your initial diagnosis and treatment. By that time your infection should have cleared up, but it's important for your doctor to see you, even if you're feeling better. You don't want your pneumonia to come back. You also want to be sure that you really had infectious pneumonia. It's especially important to make sure pneumonia has completely cleared if you're a smoker or former smoker. That's because pneumonia can sometimes occur when lung cancer obstructs one of your bronchial tubes (obstructive pneumonitis). A foreign object lodged in your lungs also can cause obstructive pneumonitis. If you're not feeling better, the follow-up visit is an opportunity for your doctor to schedule tests to determine more specifically what's causing your symptoms. Screening and diagnosis
Your doctor may first suspect pneumonia based on your medical history and a physical exam. During the exam, your doctor will listen to your lungs with a stethoscope to check for abnormal bubbling or cracking sounds (rales) and for rumblings (rhonchi) that signal the presence of thick liquid. Both these sounds may indicate inflammation caused by infection. You're also likely to have chest X-rays to confirm the presence of pneumonia and to determine the extent and location of the infection. If your immune system is compromised, or the X-rays aren't clear, you may have a more sophisticated imaging test known as a computerized tomography (CT) scan, which takes a series of computer-directed X-rays. You may also have blood tests to check your white cell count, or to look for the presence of viruses, bacteria or other organisms. Sometimes your doctor may examine a sample of your phlegm or your blood to help identify the microorganism that's causing your illness. ComplicationsHow serious pneumonia is for you depends on your overall health and the type and extent of pneumonia you have. If you're young and healthy, your pneumonia can almost certainly be treated successfully. But if you have heart failure or lung ailments, or if you're older, your pneumonia may be harder to cure. You're also more likely to develop complications, some of which can be life-threatening. Pneumonia can turn deadly, for instance, when inflammation from the disease fills the air spaces within your lungs (alveoli) and interferes with your ability to breathe. In some cases the infection may invade your bloodstream (bacteremia) . It can then spread quickly to other organs. Sometimes fluid accumulates between the thin, transparent membrane (pleura) lining your lungs and the membrane that lines the inner surface of your chest wall a condition known as pleural effusion. Normally, the pleurae are silky smooth, allowing your lungs to slide easily along your chest wall when you breathe in and out. But when your lungs become inflamed (pleurisy) often as a result of pneumonia fluid can accumulate and may become infected (empyema). In that case, you may have a tube placed between your ribs to drain the fluid. TreatmentTreatments 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 the United States. 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. 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. PreventionYou 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. SelfcareIf you have pneumonia, the following measures can help you recover more quickly and decrease your risk of complications: Get plenty of rest. Even when you start to feel better, be careful not to overdo it. Drink lots 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.
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