PNEUMONIA

Pneumonia is an infection of one or both of the lungs caused by bacteria, viruses, or fungi.  As the infection progresses, the alveoli (tiny air sacs) in the lungs become inflamed.  

  • Lobar pneumonia is isolated to individual lobes within the lungs.

  • Bronchial pneumonia (bronchopneumonia) is scattered throughout the lungs.

CAUSES

The main types of pneumonia are:

  • Bacterial pneumonia:  This type is caused by various bacteria.  These organisms are opportunistic and usually become a problem if you are already ill, and your immune system is compromised.  

  • Viral pneumonia:  This type is caused by many different viruses.  The most well known of these viruses is the flu.  Viral pneumonias can predispose someone to catching a bacterial pneumonia.

  • Mycoplasma pneumonia:  This causes an atypical pneumonia that generally causes a pneumonia with mild symptoms.

  • Other pneumonias:  There are countless other organisms that can cause pneumonia, but with far less frequency.

 

RISK FACTORS

Anyone can get pneumonia, but the following pose the greatest risk:

  • Adults ages 65 and older

  • Children younger than age 2

  • Certain medical conditions, particularly respiratory conditions

  • Smoking

 

SYMPTOMS

Bacterial pneumonia symptoms include:

  • Bluish color to lips and fingernails

  • Confused mental state or delirium, especially in older people

  • Cough that produces green, yellow, or bloody mucus

  • Fever

  • Heavy sweating

  • Loss of appetite

  • Low energy and extreme tiredness

  • Rapid breathing

  • Rapid pulse

  • Shaking chills

  • Sharp or stabbing chest pain that’s worse with deep breathing or coughing

  • Shortness of breath that gets worse with activity

Viral pneumonia symptoms are similar to that of bacterial pneumonia:

  • Headache

  • Increasing shortness of breath

  • Muscle pain

  • Weakness

  • Worsening of the cough

Mycoplasma pneumonia is different in that patients have a severe cough that may produce mucus.

 

DIAGNOSIS

Diagnosis can usually be made through a history and physical exam.  The following tests may be used to confirm the diagnosis:

  • Chest X-ray:   This test takes a picture of the lungs.  Areas of "consolidation", "infiltrates", or "haziness" can often be associated with pneumonia, but need to be correlated clinically.

  • Blood tests:  Blood tests may help in determining if the body is mounting an immune response to the infection.  An arterial blood gas may be ordered to determine if there is any significant impairment to lung function.

  • Sputum culture:  For this test, the patient will cough up sputum and spit it into a sterile container.  This sample will be analyzed to try and find out what organism is the source of the infection.

  • Pulse oximetry:  This requires a small clip to be placed on the finger.  This will measure the percentage of hemoglobin in the bloodstream bound with oxygen.  As the infection worsens, this number will drop and could indicate the need for supplemental oxygen.

  • Chest CT scan:  These imaging tests have more detail than x-rays.  If an infection does not respond to treatment or is more severe, a CT could help to quantify the extent of the infection more meaningfully than an x-ray.

  • Bronchoscopy:  Using a bronchoscope, the physician will directly examine the lungs.  This can be very helpful in that the physician can "clean" the lungs while performing, and also obtain sputum cultures from specific areas.

  • Pleural fluid culture:  Sometimes when there is an infection, fluid can build up between the lung and the pleural lining that surrounds it.  If this fluid impairs breathing significantly, a physician will perform a procedure called a Thoracentesis to extract the fluid.  This fluid can then be sent for cultures to try and determine which organism is causing the infection.

 

TREATMENT

Treatment must be tailored to the specific type of pneumonia that you have.  If symptoms are mild to moderate, you can usually manage at home by making sure to hydrate properly, eat well, get rest, and treat symptoms such as fever and cough with over the counter medications.  Your physician can prescribe antibiotics if bacterial pneumonia is suspected.  Viral pneumonias will usually resolve on there own over time.  If your symptoms do not improve or become more severe, you may need to be treated in the hospital setting.  A change in mentation or oxygen saturation levels below 90% would be early indicators of the need to seek treatment in the hospital setting.

 

PREVENTION

Adults older than 65 and children younger than 5 Children should get yearly pneumonia and flu vaccines.  In addition, anyone with chronic conditions should also get vaccinated to guard against severe illness.  Staying active and doing breathing exercises when congested can help to prevent pneumonia or at the least reduce symptoms if you do become infected.

COMPLICATIONS

Though most people can recover at home, some will have a more severe response.  Complications may include:

  • Lung abscesses:  Small pockets of fluid can accumulate near the infection site.  These small pockets may have to be drained in order to begin resolving the infection.

  • Sepsis:  If the infection manages to spread beyond the localized area that it began in and gets into the bloodstream, the body has a massive generalized response.  This response can result in a condition called Sepsis where the patients blood pressure becomes dangerously low and they are at risk for organ damage.

  • Respiratory failure:  This begins with the deterioration of the patients ability to breath on their own.  BiPAP or High Flow Nasal Cannula may be used to try and prevent the patient from having to go on the ventilator.  If they cannot be managed with these modalities, intubation and mechanical ventilation will be initiated

  • Acute respiratory distress syndrome (ARDS):  Causes respiratory failure due to a massive inflammatory response that reduces the elasticity of the lungs.  These patients need to be placed on a ventilator ASAP.

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