Pneumonia

Bronchopneumonia; Community-acquired pneumonia

Last reviewed: May 1, 2011.

Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung. Community-acquired pneumonia is pneumonia in people who have not recently been in the hospital or another health care facility (nursing home, rehabilitation facility). See also: Hospital-acquired pneumonia

Causes, incidence, and risk factors

Pneumonia is a common illness that affects millions of people each year in the United States. Germs called bacteria, viruses, and fungi may cause pneumonia. Ways you can get pneumonia include: Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs.

You may breathe some of these germs directly into your lungs.

You breathe in (inhale) food, liquids, vomit, or fluids from the mouth into your lungs (aspiration pneumonia)

Pneumonia caused by bacteria tends to be the most serious kind. In adults, bacteria are the most common cause of pneumonia. The most common pneumonia-causing germ in adults is Streptococcus pneumoniae (pneumococcus).

Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.

Pneumocystis jiroveci pneumonia is sometimes seen in people whose immune system is not working well.

Many other bacteria can also cause pneumonia. Viruses are also a common cause of pneumonia, especially in infants and young children. See also: Respiratory syncytial virus Risk factors (conditions that increase your chances of getting pneumonia) include: Cerebral palsy Chronic lung disease (COPD, bronchiectasis, cystic fibrosis)

Cigarette smoking

Difficulty swallowing (due to stroke, dementia, Parkinson's disease, or other neurological conditions)

Immune system problem (See also: Pneumonia in immunocompromised host)

Impaired consciousness (loss of brain function due to dementia, stroke, or other neurologic conditions)

Living in a nursing facility

Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes mellitus

Recent surgery or trauma Recent cold, laryngitis, or flu

Symptoms
The most common symptoms of pneumonia are: Cough (with some pneumonias you may cough up greenish or yellow mucus, or even bloody mucus) Fever, which may be mild or high

Shaking chills

Shortness of breath (may only occur when you climb stairs) Other symptoms include:

Confusion, especially in older people Excess sweating and clammy skin Headache Loss of appetite, low energy, and fatigue

Sharp or stabbing chest pain that gets worse when you breathe deeply or cough

Signs and tests

If you have pneumonia, you may be working hard to breathe, or breathing fast. The health care provider will hear crackles when listening to your chest with a stethoscope. Other abnormal breathing sounds may also be heard through the stethoscope or via percussion (tapping on your chest wall). The health care provider will likely order a chest xray if pneumonia is suspected. Some patients may need other tests, including: Arterial blood gases to see if enough oxygen is getting into your blood from the lungs CBC to check white blood cell count CT scan of the chest Gram's stain and culture of your sputum to look for the bacteria or virus that is causing your symptoms Pleural fluid culture if there is fluid in the space around the lungs

Treatment
Your doctor must first decide whether you need to be in the hospital. If you are treated in the hospital, you will receive:

Fluids and antibiotics in your veins Oxygen therapy Breathing treatments (possibly)

It is very important that you are started on antibiotics very soon after you are admitted. You are more likely to be admitted to the hospital if you:

Have another serious medical problem Have severe symptoms

Are unable to care for yourself at home, or are unable to eat or drink

Are older than 65 or a young child

Have been taking antibiotics at home and are not getting better However, many people can be treated at home. If bacteria are causing the pneumonia, the doctor will try to cure the infection with antibiotics. It may be hard for your health care provider to know whether you have viral or bacterial pneumonia, so you may receive antibiotics. Your doctor may tell you to take antibiotics. Antibiotics help most people with pneumonia get better. Don't miss any doses. Take the medicine until it is gone, even if you start to feel better.

Do NOT take cough medicine or cold medicine unless your doctor says it is okay. Coughing helps your body get rid of mucus from your lungs.

Breathing warm, moist (wet) air helps loosen the sticky mucus that may make you feel like you are choking. These things may help: Place a warm, wet washcloth loosely over your nose and mouth.

Fill a humidifier with warm water and breathe in the warm mist.

Coughing helps clear your airways. Take a couple of deep breaths two or three times every hour. Deep breaths will help open up your lungs. Tap your chest gently a few times a day and lie with your head lower than your chest. This can help bring up mucus from the lungs. If you smoke any tobacco products, STOP. Do not allow smoking in your home. Drink plenty of liquids (as long as your health care provider says it is okay):

Drink water, juice, or weak tea Drink at least 6 to 10 cups a day Do NOT drink alcohol

Get plenty of rest when you go home. If you have trouble sleeping at night, take naps during the day.

Expectations (prognosis)
With treatment, most patients will improve within 2 weeks. Elderly or very sick patients may need longer treatment. Those who may be more likely to have complicated pneumonia include:

Older adults or very young children

People whose immune system does not work well People with other, serious medical problems such as diabetes or cirrhosis of the liver

Your doctor may want to make sure your chest x-ray becomes normal again after you take a course of antibiotics. However, it may take many weeks for your x-ray to clear up.

Complications
Possible complications include: Acute respiratory distress syndrome (ARDS) Fluid around the lung (pleural effusion) Lung abscesses

Respiratory failure (which requires a breathing machine or ventilator)

Sepsis, which may lead to organ failure

Calling your health care provider

Call your doctor if you have: A cough that brings up bloody or rustcolored mucus

Breathing (respiratory) symptoms that get worse

Chest pain that gets worse when you cough or breathe in

Fast or painful breathing Night sweats or unexplained weight loss

Shortness of breath, shaking chills, or persistent fevers Signs of pneumonia and a weak immune system (for example such 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 pulling in during breathing.

Prevention
Wash your hands often, especially after:

Blowing your nose Going to the bathroom Diapering

Also wash your hands before eating or preparing foods.

Don't smoke. Tobacco damages your lung's ability to ward off infection. Vaccines may help prevent pneumonia in children, the elderly, and people with diabetes, asthma, emphysema, HIV, cancer, or other long-term conditions: A drug called Synagis (palivizumab) is given to some children younger than 24 months to prevent pneumonia caused byrespiratory syncytial virus. Flu vaccine prevents pneumonia and other problems caused by the influenza virus. It must be given each year to protect against new virus strains. Hib vaccine prevents pneumonia in children from Haemophilus influenzae type b. Pneumococcal vaccine (Pneumovax, Prevnar) lowers your chances of getting pneumonia from Streptococcus pneumoniae.

If you have cancer or HIV, talk to your doctor about ways to prevent pneumonia and other infections.

References
Van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Lancet. 2009;374:1543-1556. [PubMed] 2. Niederman M. In the clinic. Communityacquired pneumonia. Ann Intern Med. 2009;151(7). 3. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of communityacquired pneumonia in adults. Clin Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72. [PubMed] 4. Torres A, Menndez R, Wunderink R. Pyogenic bacterial pneumonia and lung abscess. In: Mason RJ, Broaddus VC, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 32.
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Review Date: 5/1/2011. Reviewed by: Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care. University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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