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Pneumonia is a lung infection caused by bacteria, viruses, or fungi, leading to inflammation and potentially fluid or pus accumulation in the lungs. The severity and treatment vary depending on the causative pathogen and the type of pneumonia, which is categorized by how and where it was acquired: community-acquired, hospital-acquired, or ventilator-associated.
- Community-Acquired Pneumonia (CAP):
- Bacterial causes: The most common is Streptococcus pneumoniae, leading to pneumococcal disease which can also cause other infections like sinusitis and meningitis. Mycoplasma pneumoniae often causes a milder form known as atypical pneumonia. Other bacteria include Haemophilus influenzae, Chlamydia pneumoniae, and Legionella pneumophila (causing Legionnaires’ disease).
- Viral causes: Common cold viruses, influenza, COVID-19, and respiratory syncytial virus (RSV) can also lead to pneumonia.
- Fungal causes: Less common, affecting mainly those with compromised immune systems, include Cryptococcus, Pneumocystis jirovecii, and Coccidioides.
- Protozoa causes: Rare causes like Toxoplasma can lead to pneumonia.
- Hospital-Acquired Pneumonia (HAP): Occurs in patients already hospitalized for other conditions, often caused by antibiotic-resistant bacteria like methicillin-resistant Staphylococcus aureus (MRSA), making it more severe and harder to treat.
- Healthcare-Associated Pneumonia (HCAP): Develops in long-term care facilities or during extended outpatient stays, usually involving antibiotic-resistant bacteria.
- Ventilator-Associated Pneumonia (VAP): Occurs in patients using a ventilator, commonly in an ICU setting, where the causative agents can be similar to those of CAP, including drug-resistant strains.
- Aspiration Pneumonia: Results from inhaling food, liquids, or vomit into the lungs, leading to infection if not expelled.
Pneumonia’s impact varies from mild to life-threatening, posing the highest risk to infants, young children, people over 65, and those with weakened immune systems or preexisting health conditions.
Symptoms
Pneumonia can manifest with varying degrees of signs and symptoms, ranging from mild to severe, contingent upon factors such as its cause, your age, and overall health. While mild manifestations persist longer, they are often mistaken for symptoms of the flu or a common cold.
- Bacterial pneumonia signs and symptoms can appear gradually or abruptly. Among the indications are:
- Chest pain when breathing or coughing.
- Confusion or change in mental status.
- Coughing with yellow, green or bloody mucus.
- Cyanosis or bluish discoloration of skin, lips or nails.
- Fast breathing.
- Fever (up to 105 F or 40.55 C).
- Loss of appetite.
- Rapid heart rate.
- Shortness of breath.
- Sweating or chills.
- Tiredness or fatigue.
- Viral pneumonia signs and symptoms typically appear over a few days. In addition to symptoms resembling bacterial pneumonia, you may also have:
- Dry cough.
- Headache.
- Muscle pain.
- Severe tiredness or fatigue.
- Pneumonia in babies and newborns may not cause any symptoms at all or may cause symptoms that differ from those in adults, such as:
- Coughing.
- Crying more than usual.
- Difficult to feed.
- Difficulty breathing or rapid breathing (tachypnea).
- Fever or chills,
- General discomfort
- Lack of energy or restlessness.
- Less urine in diapers.
- Loss of appetite.
- Noisy breathing or grunting sound.
- Sweating, flushed skin, or pale skin.
- Vomiting.
Pneumonia can rapidly turn into a life-threatening condition in certain elderly persons, those with heart failure, and those with persistent lung issues.
Consult your healthcare provider if you experience difficulty breathing, chest pain, a persistent fever (102 F or higher), or a chronic cough (particularly if you’re producing pus in your cough).
Causes
Pneumonia is classified based on the types of germs that cause it and the location where the infection was acquired:
- Community-acquired pneumonia: This is the most common type and occurs outside of healthcare facilities.
- Bacteria: Streptococcus pneumoniae is a common cause, often following a cold or flu. This can lead to lobar pneumonia, affecting a specific part of the lung.
- Bacteria-like organisms: Mycoplasma pneumoniae, often causing milder symptoms, is referred to as “walking pneumonia.”
- Fungi: Common among individuals with chronic health issues or weakened immune systems, this type is linked to organisms found in soil or bird droppings.
- Viruses: This includes common respiratory viruses and COVID-19, which can lead to severe pneumonia, particularly in children under 5.
- Hospital-acquired pneumonia: Occurs during a hospital stay, particularly among patients on ventilators in intensive care. This type can be more severe due to antibiotic-resistant bacteria.
- Health care-acquired pneumonia: Affects individuals in long-term care or outpatient settings like dialysis centers, also caused by resistant bacteria.
- Aspiration pneumonia: Results from inhaling food, drink, vomit, or saliva into the lungs, often exacerbated by impaired gag reflex due to factors like brain injuries or substance abuse.
Risk factors
Anyone can get pneumonia. Although the bacteria and viruses that cause pneumonia are contiguous, pneumonia itself is not.
- Age: Individuals who are 65 years of age or older, as well as children ages two and under, are more likely to contract pneumonia.
- Hospitalization: If you’re in a hospital intensive care unit, you have an increased risk of pneumonia, particularly if you’re dependent on a ventilator for breathing assistance.
- Tobacco usage: Smoking weakens the body’s defenses against the viruses and bacteria that cause pneumonia.
- Other medical condition: Asthma, chronic obstructive pulmonary disease (COPD), and heart disease increase your risk of pneumonia.
Individuals who are receiving chemotherapy or long-term steroids, have undergone an organ transplant, or have HIV/AIDS are at risk.
Diagnosis
To diagnose pneumonia, your doctor will review your medical history and perform a physical exam, including using a stethoscope to listen for abnormal sounds in the lungs such as bubbling or crackling.
If pneumonia is suspected, the following tests may be recommended:
- Blood tests: These help confirm an infection and attempt to identify the causative organism, although precise identification may not always be possible.
- Chest x-ray: Assists in diagnosing pneumonia and determining the infection’s extent and location, but does not specify the type of germ responsible.
- Pulse oximetry: Measures the oxygen level in your blood, as pneumonia can hinder your lungs’ ability to move enough oxygen into your bloodstream.
- Sputum test: Involves analyzing a sample of fluid from your lungs (sputum) obtained after a deep cough to help identify the infection source.
Additional tests may be ordered for certain individuals, such as those over 65, hospitalized patients, or those with severe symptoms or underlying health conditions:
Computed tomography (CT) scan: Recommended if pneumonia does not improve as expected, providing a more detailed image of your lungs.
Pleural fluid culture: Involves extracting and analyzing fluid from the pleural space using a needle to help identify the infection type.
Treatment
The primary objective in treating pneumonia is to eradicate the illness entirely and prevent any associated complications. In many instances of community-acquired pneumonia, treatment can be administered through medication at home. While most symptoms typically subside within a few days or weeks, fatigue may linger for up to a month.
The type and severity of your pneumonia, your age, and your general health will all affect the specific treatments you receive. Among the treatment option includes:
- Cough medicine: You can use this medication to stop coughing so you can get some rest. It’s a good idea to keep coughing since it helps in the movement and release of fluid from your lungs. Furthermore, you should be aware that not many research have examined the possibility that coughing produced by pneumonia can be lessened by using over-the-counter medications. Try using the lowest dose of a cough suppressant that allows you to get the most rest.
- Fever/ pain medications: These can be taken as needed to treat pain and fever. These consist of medications like aspirin, acetaminophen, and ibuprofen.
- Antibiotics: Bacterial pneumonia is treated with these medications. Selecting the appropriate antibiotic to treat your pneumonia may require some time to determine the type of bacteria causing it. The healthcare provider might suggest switching to an alternative antibiotic if your symptoms don’t get better.
- Anti-viral: The majority of the time, viral pneumonia resolves on its own without the need for treatment. To shorten the duration of a viral infection and lessen its severity, a healthcare provider may recommend antivirals such oseltamivir, zanamivir, or peramivir.
Hospitalization may be required under certain circumstances. If you are 65 years of age or older, experience confusion concerning time, people, or places, or notice a decline in kidney function, seeking medical attention is advisable.
Additionally, if your systolic blood pressure drops below 90 millimeters of mercury (mm Hg), or your diastolic blood pressure is 60 mm Hg or lower, medical intervention may be necessary. Rapid breathing, indicated by 30 breaths or more per minute, or the need for breathing assistance, are further indicators for seeking medical care. A body temperature below the normal range, or a heart rate below 50 or exceeding 100 beats per minute, also need medical attention. These signs should prompt consideration for hospitalization and appropriate medical management.
Patients may require admission to the intensive care unit (ICU) if they necessitate mechanical ventilation or if their symptoms are severe.
For children, hospitalization might be necessary if they are under 2 months old, exhibit lethargy or excessive drowsiness, encounter breathing challenges, display low blood oxygen levels, or demonstrate signs of dehydration. These circumstances in children require medical attention and potential hospitalization to ensure thorough assessment and appropriate management.
