Pneumonia facts

Pneumonia is inflammation of the airspaces in the lungs, most commonly due to an infection.

Pneumonia may be caused by viruses, bacteria, or fungi.

The most common bacterial type that causes pneumonia isStreptococcus pneumoniae.
Signs and symptoms of pneumonia include

fever,

chills,

cough,

shortness of breath,

fatigue.
Community-acquired pneumonia (CAP) is acquired outside of the health-care setting

and is typically less severe than hospital-acquired pneumonia (HAP).

About 20% of those with CAP require treatment in a hospital.

Antibiotics treat pneumonia by controlling the bacterial or fungal infection. The initial
choice of antibiotic depends on the organism presumed to be causing the infection as well as
local patterns ofantibiotic resistance.

Pneumonia can be fatal in up to 30% of severe cases that are managed in the
intensive-care setting.

Complications of pneumonia include sepsis, pleural effusion, andempyema.

Influenza and respiratory syncytial virus (RSV) are the most common viral causes of
pneumonia.

A chest X-ray is typically done to diagnose pneumonia.

Risk factors for pneumonia include age over 65 or under 2, having certain chronic
medical conditions (including underlying lung disease, cigarette smoking, alcoholism, and
neurological problems), or sustaining injuries that interfere with swallowing or coughing.

What is pneumonia?
Pneumonia is an inflammation of the airspaces in the lung most commonly caused by infections.
Bacteria, viruses, or fungi can cause the infection. There are also a few noninfectious types of
pneumonia that are caused by inhaling or aspirating foreign matter or toxic substances into the
lungs. Around 50,000 people die each year of pneumonia in the U.S. Although anyone of any age

can be affected, pneumonia is more common in elderly people and often occurs when the immune
system becomes weakened via a prior infection or another condition.
Pneumonia is generally more serious when it affects older adults, infants and young children, those
with chronic medical conditions, or those with weakened immune function.

What are the different types of pneumonia?

Pneumonia can be classified in different ways. Doctors often refer to pneumonia based upon the
way that the infection is acquired, such as community-acquired pneumonia or hospital-acquired
pneumonia.

Community-acquired pneumonia (CAP), as the name implies, develops outside of the

hospital or health-care environment. It is more common than hospital-acquired pneumonia. CAP
is most common in winter and affects about 4 million people a year in the U.S.

Hospital-acquired pneumonia (HAP) is acquired when an individual is already hospitalized

for another condition. HAP is generally more serious because it develops in ill patients already
hospitalized. Being on a ventilator for respiratory support increases the risk of acquiring HAP.

Other classification systems for pneumonia describe the way the inflammatory cells infiltrate the lung
tissue or the appearance of the affected tissue (see the following examples).

Bronchopneumonia causes scattered, patchy infiltrates of inflammation in the air sacs

throughout the lungs. It is more diffuse than lobar pneumonia.

Lobar pneumonia causes an inflammation of one lobe of a lung and typically involves all the
airspaces in a single lobe.

Lipoid pneumonia is characterized by the accumulation of fats within the airspaces. It can be
caused by aspiration of oils or associated with airway obstruction.

Sometimes, types of pneumonia are referred to by the type of organism that causes the
inflammation, such as bacterial pneumonia, viral pneumonia, or fungal pneumonia. The specific
organism name may also be used to describe the types of pneumonia, such as pneumococcal
(Streptococcus pneumoniae) pneumonia or Legionella pneumonia.
Other types of pneumonia that are commonly referenced include the following:

Aspiration pneumonia develops as a result of inhaling food or drink, saliva, or vomit into the
lungs. This occurs when the swallowing reflex is impaired, such as with brain injury or in an
intoxicated person.

Several types of bacteria, including Legionella pneumophila,Mycoplasma pneumoniae,

and Chlamydophila pneumoniae, cause atypical pneumonia. It is sometimes called "walking

pneumonia" and is referred to as atypical because its symptoms differ from those of other types
of bacterial pneumonia.
Pneumonia that arises from being on a ventilator for respiratory support in the intensive-care
setting is known as ventilator-associated pneumonia

What causes pneumonia? Is pneumonia contagious?

Streptococcus pneumoniae, a type of bacteria, is the most common cause of pneumonia. Legionella
pneumophila is the bacterial type that causes the pneumonia known as Legionnaires' disease. Other
bacteria types that can cause pneumonia include the bacteria that cause so-called "atypical"
pneumonia, Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumonia.
The most common cause of viral pneumonia in adults is the influenza virus. A number of different
respiratory viruses cause pneumonia in children, such as respiratory syncytial virus (RSV). While
viral pneumonia tends to be less severe than bacterial pneumonia, there is a risk of developing
secondary bacterial pneumonia when viral pneumonia is present. Other virus types that can cause
pneumonia include measles and varicella (chickenpox) viruses. Rarely, certain viruses may develop
lethal pneumonias such as SARS (severe acute respiratory syndrome) or MERS(Middle East
respiratory syndrome); both diseases are caused by different coronaviruses.
Fungi that cause pneumonia include Cryptococcus, Histoplasma, andCoccidioides. In most cases,
these organisms don't cause illness, but they can cause pneumonia in some people. Fungal
infections are most common in those with weakened immune systems due to HIV/AIDS or those
taking medications that suppress immune function. Another infection that is considered a fungal type
of pneumonia is Pneumocystis jiroveci, formerly known as Pneumocystis carinii. This organism
became known as a frequent cause of pneumonia in patients with HIV/AIDS.

What are risk factors for pneumonia?

There are a number of factors that increase the risk of developing pneumonia. These include

a weakened immune system, either due to disease such as HIV/AIDS or cancer, or to

medications that suppress immune function;

infants and children 2 years of age or younger;

age 65 and older;

having a chronic disease such as cystic fibrosis, COPD, sickle cellanemia, asthma, heart

disease, or diabetes;
swallowing or coughing problems, as may occur following stroke or other brain injury;

being a patient in an intensive-care unit of a hospital, particularly if on ventilator support;

malnutrition;

cigarette smoking

Symptoms and signs of pneumonia may be mild or severe and depend upon someone's overall state
of health as well as the type of organism causing the pneumonia. Severe symptoms include

cough,

chest pain when breathing or coughing,

labored breathing or shortness of breath,

coughing up phlegm,

fever,

chills.

Nausea, vomiting, and diarrhea are other possible symptoms that can accompany the respiratory
symptoms.
Infants and newborns may not show specific symptoms of pneumonia. Instead, they may appear
restless or lethargic. They may have a fever or cough or vomit. Older adults or those who have weak
immune systems may also have fewer symptoms and a lower temperature. A change in mental
status, such as confusion, can develop in older adults with pneumonia.

How do doctors diagnose pneumonia?

The diagnosis of pneumonia always begins with taking a medical history and performing a physical
examination to look for characteristic signs. In particular, listening to the lungs may reveal areas
where sound is diminished, wheezing, or crackling sounds in affected areas. Some commonly
performed diagnostic tests are as follows:

A chest X-ray is able to illustrate whether or not pneumonia is present, but it does not
provide information about the organism responsible for the infection.

In some cases, a chest CT scan may be performed. This will reveal more detail than the
chest X-ray.

Pulse oximetry measures the amount of oxygen in the bloodstream. The test involves a
painless sensor attached to the finger or ear. Blood levels of oxygen may be reduced in
pneumonia.

Microbiology tests to identify the causative organism. Tests may be performed on blood or
sputum. Rapid urine tests are available to identify Streptococcus pneumoniae and Legionella
pneumophila. Cultures of blood or sputum not only identify the responsible organism but can
also be examined to determine which antibiotics are effective against a particular bacterial
strain.

Bronchoscopy is a procedure in which a thin, lighted tube is inserted into the trachea and

major airways. This allows the doctor to visualize the inside of the airways and take tissue
samples if needed. Bronchoscopy may be performed in patients with severe pneumonia or if
pneumonia worsens despite antibiotic treatment.
Antibiotic medications are the treatment of choice for pneumonia caused by bacterial and fungal
infections. The exact choice of medications depends on many factors, including the following:

The organism responsible for the infection

The likelihood that the organism is resistant to certain antibiotics

The patient's underlying health condition

About 80% of cases of CAP can be managed at home with the patient taking oral antibiotics. There
are numerous treatment regimens available. Initial treatment (before the causative organism has
been identified) is called empiric treatment and is based upon the organisms most likely to be
responsible for the illness. Once the exact organism has been identified in the laboratory and
susceptibility testing performed to determine which antibiotics are effective, the treatment regimen
can be further individualized. In around 20% of cases, CAP must be managed in the hospital,
typically with intravenous antibiotics initially. HAP is managed in the hospital, typically with
intravenous antibiotics.
Antibiotics are not effective against viral pneumonia. Depending upon the type of virus that causes
pneumonia, antiviral medications can provide benefit when started early in the course of the disease.
For example, the medications oseltamivir (Tamiflu) and zanamivir (Relenza) are used to treat
influenza virus infections. Antifungal agents are used to treat most fungal pneumonias.

What are complications of pneumonia?

There are a number of potential complications of pneumonia. The infection that causes pneumonia
can spread to the bloodstream, causing sepsis. Sepsis is a serious condition that can result in
lowering of blood pressure and failure of oxygen to reach the tissues of the body. Another
complication is the accumulation of fluid in the space between the lung tissue and the chest wall
lining, known as a pleural effusion. The organisms responsible for the pneumonia may infect the fluid
in a pleural effusion, known as an empyema. Pneumonia can also result in the formation of an
abscess (collection of pus) within the lungs or airways