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Pneumonia
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What is pneumonia?

Pneumonia is an infection of one or both lungs which is usually caused by a bacteria, virus, or fungus. Prior to the discovery of antibiotics, one third of all people who developed pneumonia subsequently died from the infection. Currently, over 3 million people develop pneumonia each year in the United States. Over a half a million of these people are admitted to a hospital for treatment. Although most of these people recover, approximately five percent will die from pneumonia. Pneumonia is the sixth leading cause of death in the United States.

How do people "catch pneumonia?"

Most cases of pneumonia are contracted by breathing in small droplets that contain the bacteria or virus that can cause pneumonia. These droplets get into the air when a person infected with these germs coughs or sneezes. In other cases, pneumonia is caused when bacteria or viruses that are normally present in the mouth, throat, or nose inadvertently enter the lung. During sleep it is quite common for people to aspirate secretions from the mouth, throat, or nose. Normally, the body's reflex response (coughing back up the secretions) and immune system will prevent a pneumonia from starting. However, if a person is in a weakened condition from another illness, a severe pneumonia can develop. People with emphysema, heart disease, and swallowing problems, as well as alcoholics, drug users and those who have suffered a stroke or seizure are at higher risk for developing pneumonia.

Once the bacteria, virus or fungus enter the lungs, they usually settle in the air sacs of the lung where they rapidly grow in number. This area of the lung then becomes filled with fluid and pus as the body attempts to fight off the infection.

What are the symptoms of pneumonia?

Most people who develop pneumonia initially have symptoms of a cold which is then followed by a high fever (sometimes as high as 104 degrees), shaking chills, and a cough with sputum production. The sputum is often bloody. Chest pain may develop on one side and the patient may become short of breath. In other cases of pneumonia, there can be a slow onset of symptoms. A worsening cough, headaches, and muscle aches may be the only symptoms. At times, the individual's skin color may change and become dusky or purplish due to their blood being poorly oxygenated.

Children and babies often do not have any specific signs of a chest infection, but develop a fever, appear quite ill, and can become lethargic. Elderly people may also have few symptoms with pneumonia

How is pneumonia diagnosed?

Pneumonia may be suspected when the doctor examines the patient and hears coarse breathing or crackling sounds when listening to a portion of the chest with a stethoscope. There may be wheezing or the sounds of breathing may be faint in a particular area of the chest. A chest x-ray is usually ordered to confirm the diagnosis of pneumonia. Sputum samples can be collected and examined under the microscope. If the pneumonia is caused by a bacteria, it can often be detected by this examination. A sample of the sputum can be grown in special incubators and the offending bacteria can be subsequently identified. A blood test can be performed (called a CBC) and the white blood cell count of this test can often give a hint as to the severity of the pneumonia and whether it is caused by a bacteria or a virus.

Bronchoscopy is a procedure in which a thin, flexible lighted viewing tube is inserted into the nose or mouth after a local anesthetic is administered. The breathing passages can then be directly examined by the doctor and specimens from the infected part of the lung can be obtained. Sometimes, fluid collects around the lung as a result of the inflammation from pneumonia. This fluid is called a pleural effusion. If the amount of this fluid that develops is large enough, it can be removed by inserting a needle into the chest cavity and withdrawing the fluid with a syringe. This procedure is called a thoracentesis.

What are some of the organisms that cause pneumonia and how are they treated?

The most common cause of a bacterial pneumonia is Streptococcus pneumoniae. There is usually an abrupt onset of the illness with shaking chills, fever and a rust-colored sputum. The infection spreads into the blood in 20-30% of cases and if this occurs 20-30% of these patients die. A vaccine (PNEUMOVAX) is available and is recommended for people who have diabetes, steroid-dependent asthma, alcoholism, cigarette abuse and in those persons who have had their spleen removed.

Antibiotics often used in the treatment of this pneumonia include penicillin, ampicillin-clavulanate (AUGMENTIN), and erythromycin.

Hemophilus influenza is a bacteria that often causes pneumonia in people suffering from emphysema or alcoholism. Useful antibiotics are cefuroxime (CEFTIN), ampicillin-clavulanate (AUGMENTIN), ofloxacin (FLOXIN), and trimethoprim-sulfamethoxazole (BACTRIM, SEPTRA).

Mycoplasma pneumonia is often a slowly developing infection. Symptoms include fever, chills, muscle aches, diarrhea, and rash. This bacteria is the principal cause of many pneumonias in the summer and fall months and is often referred to as "atypical pneumonia." Erythromycin, clarithromycin (BIAXIN), and azithromycin (ZITHROMAX) are antibiotics commonly prescribed for mycoplasma pneumonia.

Legionnaire's disease is caused by the bacteria Legionella pneumoniae and is most often found in contaminated water supplies and air conditioners. It is a potentially fatal infection if not accurately diagnosed. Pneumonia is part of the overall infection and symptoms include high fever, a relatively slow heart rate, diarrhea, nausea, vomiting, and chest pain. Older men, smokers, and persons whose immune systems are suppressed are at higher risk to develop Legionnaire's disease. Erythromycin and other similar antibiotics are the treatment of choice in this infection.

Viral pneumonias do not typically respond to antibiotic treatment. These pneumonias usually resolve over time with the body's immune system fighting off the infection. It is important to make sure that a bacterial pneumonia does not secondarily develop. If it does, then the bacterial pneumonia is treated with appropriate antibiotics.

Fungal pneumonias that can occur include actinomycosis, nocardiosis, histoplasmosis, coccidiomycosis, blastomycosis, aspergillosis, and cryptococcosis. These are responsible for a relatively small percentage of pneumonias in the United States. Each has specific antibiotic treatments among which are amphotericin B, fluconazole (DIFLUCAN), penicillin, and sulfonamides.

Conclusions

Pneumonia can be a serious and life-threatening infection. This is true especially in the elderly, children and those that have other serious medical problems such as emphysema, heart disease, diabetes, and certain cancers. Fortunately, with the discovery of many potent antibiotics, most pneumonias are successfully treated. In fact, most pneumonias can be treated with oral antibiotics and without the need for hospitalization.

Pneumonia at a glance

  • Pneumonia is a lung infection that can be caused by different types of microorganisms.
  • Symptoms of pneumonia include cough with sputum production, fever, and chest pain when breathing in.
  • Diagnosis of pneumonia is suspected when a doctor hears abnormal sounds in the chest and confirmed by a chest x-ray.
  • Bacteria causing pneumonia can be identified in sputum by culturing.
  • A pleural effusion is a fluid collection around the inflamed lung.
  • Bacterial and fungal (but not viral) pneumonia can be treated with antibiotics.

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