Pneumonia PDF

# Pneumonia ## Overview Pneumonia is an inflammation of the airspaces (alveoli; singular alveolus) in the lung most commonly caused by infections. - Bacteria, viruses, or fungi (infrequently) can cause the infection. - There are also a few noninfectious types of pneumonia that are caused by inh...

# Pneumonia ## Overview Pneumonia is an inflammation of the airspaces (alveoli; singular alveolus) in the lung most commonly caused by infections. - Bacteria, viruses, or fungi (infrequently) 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. - The alveoli becomes filled with fluid or pus, making it difficult to breathe. Pneumonia affects all age groups, however, it is generally more serious when it affects older adults, infants and young children, those with chronic medical conditions, or those with weakened immune function via a prior infection or another condition. ## Symptoms Pneumonia symptoms can be mild to life-threatening. The most common symptoms of pneumonia can include: - Coughing that may produce phlegm (mucus) - Fever - Shortness of breath - Chills Additional symptoms include: - Sharp or stabbing chest pain that gets worse when you breathe deeply or cough - Headache - Excessive sweating and clammy skin - Loss of appetite, low energy, and fatigue - Confusion, especially in older people Other symptoms can vary according to the cause and severity of the infection, as well as the age and general health of the individuals. - Infants and children under 5 years of age may suffer fast breathing, vomiting, lack energy, difficulty drinking or eating. - Adults may have a lower-than-normal body temperature. ## Causes Pneumonia can be caused by microbes such as bacteria, viruses, fungi, and mycoplasma. - It can also be acquired through infected ventilators or by inhaling bacteria from food, drink or saliva into the lungs or in certain infectious environment such as hospital and community. - Pneumonia may also be caused by inhaling various chemicals and environmental agents. Most kinds of pneumonia are contagious. - Both viral and bacterial pneumonia can spread to others through inhalation of airborne droplets from a sneeze or cough. - You can become infected with fungal pneumonia from the environment, but it doesn't spread from person to person. The various causes of pneumonia give rise to the different types of pneumonia that exist. These include: **1. Bacterial pneumonia:** - The most common cause of bacterial pneumonia is *Streptococcus pneumoniae*. - *Chlamydophila pneumonia* and *Legionella pneumophila* can also cause bacterial pneumonia. - It may cause a fever as high as 105°F along with profuse sweating, bluish lips and nails, and confusion. **2. Viral pneumonia:** - Respiratory viruses are often the cause of pneumonia, especially in young children and older people. - Viral pneumonia is usually not serious and lasts for a shorter time than bacterial pneumonia. - May start with flu-like symptoms, such as wheezing. - A high fever may occur after 12-36 hours. **3. Mycoplasma Pneumonia:** - Mycoplasma organisms are not viruses or bacteria, but they have traits common to both. - Mycoplasmas generally cause mild cases of pneumonia, most often in older children and young adults. **4. Fungal pneumonia:** - Fungi from soil or bird droppings can cause pneumonia in people who inhale large amounts of the organisms. - They can also cause pneumonia in people with chronic diseases or weakened immune systems. **5. Pneumocystis jirovecii pneumonia (PCP):** - One kind of fungal pneumonia. - This condition generally affects people with weakened immune systems, such as those with AIDS. - In fact, PCP can be one of the first signs of infection with AIDS. - Other examples of Fungi that cause pneumonia include Cryptococcus, Histoplasma, and Coccidioides. **6. Hospital-acquired pneumonia (HAP):** - This type of bacterial pneumonia is acquired during a hospital stay. - It can be more serious than other types, because the bacteria involved may be more resistant to antibiotics. **7. Community-acquired pneumonia (CAP):** - This refers to pneumonia that is acquired outside of a medical or institutional setting. **8. Aspiration pneumonia:** - This type of pneumonia occurs when you inhale bacteria into your lungs from food, drink, or saliva. - This type is more likely to occur if you have a swallowing problem or if you become too sedated from the use of medications, alcohol, or some types of illicit drugs. **9. Ventilator-associated pneumonia (VAP):** - When people who are using a ventilator get pneumonia, it's called VAP. ## Risk Factors Anyone can get pneumonia, but some people have increased risk: - Infants from birth to age 2 years, and individuals ages 65 years or older - People who have had a stroke, have problems swallowing, or are bedridden - People with weakened immune systems because of disease or use of medications such as steroids or certain cancer drugs and autoimmune disorders - People who smoke, misuse certain types of illicit drugs, or take alcohol excessively - People with certain chronic medical conditions such as asthma, cystic fibrosis, diabetes, or heart failure ## Diagnosis Typically, pneumonia can be diagnosed through chest X-ray and physical examination. - Listening to your lungs with a stethoscope for any abnormal sounds, such as crackling. - Depending on the severity of the symptoms and risk of complications, other forms of diagnosis can be carried out. These include: - A blood test. This test can confirm an infection, but it may not be able to identify what's causing it. - A sputum test. This test can provide a sample from your lungs that may identify the cause of the infection. - Pulse oximetry. An oxygen sensor placed on one of your fingers can indicate whether your lungs are moving enough oxygen through your bloodstream. - A urine test. This test can identify the bacteria *Streptococcus pneumoniae* and *Legionella pneumophila*. - A CT scan. This test provides a clearer and more detailed picture of your lungs. - A fluid sample. If your doctor suspects there is fluid in the pleural space of your chest, they may take fluid using a needle placed between your ribs. This test can help identify the cause of your infection. - A bronchoscopy. This test looks into the airways in your lungs. It does this using a camera on the end of a flexible tube that's gently guided down your throat and into your lungs. Your doctor may do this test if your initial symptoms are severe, or if you're hospitalized and your body is not responding well to antibiotics. ## Treatment 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. Your treatment will depend on the type of pneumonia you have, how severe it is, and your general health. 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 ### Antibiotics - Most cases of bacterial pneumonia can be treated with oral antibiotics such as levofloxacin, Cefuroxime, Cefpodoxime and cefprozil which are effective in managing pneumonia caused by *S..pneumoniae*. - Most people respond to the antibiotics in one to three days. - In severe cases of hospitalization, intravenous cephalosporin (third generation) may be combined with macrolides in treating resistant forms of *S, pneumonia*. ### Antiviral medications - Can provide benefit when started early in the course of the disease, for example: - *oseltamivir* (Tamiflu) - *zanamivir* (Relenza) - *rimantadine* - *amantadine* - *ganciclovir* - These are used to treat influenza virus infections and are also used in viral pneumonia. ### Macrolides - *azithromycin*, *clarithromycin* are the best antibiotics in treating pneumonia caused by *mycoplasma*. ### Antifungal agents - Used to treat most fungal pneumonias. ### Hospital Acquired Pneumonia (HAP) and Community Acquired Pneumonia (CAP) - Managed in the hospital, typically with intravenous antibiotics. ### Over the counter (OTC) medications - *aspirin*, *ibuprofen* and *acetaminophen* helps to relieve your pain and fever, as needed. ### Cough medicine - May also be recommended to calm your cough so you can rest. - Coughing helps remove fluid from your lungs, so you don't want to eliminate it entirely. ## Complications Most people respond to treatment and recover from pneumonia. However, for some people, pneumonia can worsen other existing disease conditions such as diabetes, hypertension, congestive heart failure and emphysema or cause complications. - For certain people, pneumonia increases their risk of having a heart attack. - These complications occur mainly in individuals with weakened immune systems. Complications can include: **1. Bacteremia:** - Bacteria from the pneumonia infection may spread to the bloodstream which can lead to dangerously low blood pressure, septic shock, and in some cases, organ failure. **2. Lung abscesses:** - These are cavities in the lungs that contain pus. **3. Impaired breathing:** - You may have trouble getting enough oxygen when you breathe. You may need to use a ventilator. **4. Acute respiratory distress syndrome:** - This is a severe form of respiratory failure. It's a medical emergency. **5. Pleural effusion:** - If your pneumonia is not treated, you may develop fluid around your lungs in your pleura. - The pleura are thin membranes that line the outside of your lungs and the inside of your rib cage. - The fluid may become infected and need to be drained. **6. Death:** - In some cases, pneumonia can be severe and when not properly treated worsens existing diseases and can lead to death. ## Prevention In many cases, pneumonia can be prevented through the following ways: **1. Pneumonia vaccine:** - The first line of defense against pneumonia is to get vaccinated. - There are two pneumococcal vaccines which can help protect against bacterial pneumonia. - These include *PPSV23* (Pneumovax), a pneumococcal polysaccharide vaccine against 23 types of the bacteria, and *PCV13* (Prevnar 13), a pneumococcal conjugate vaccine that protects against 13 types of the bacteria. - *PCV13* or *Prevnar 13*, is currently recommended for all children younger than 2 years of age, all adults 65 years of age or older, and people 2-64 years of age with certain medical conditions. - *PPSV23* is currently recommended for all adults 65 years of age or older and for people who are 2 years of age or older and at high risk for pneumococcal disease (for example, those with sickle cell disease, HIV infection, or other immune compromising conditions). - *PPSV23* is also recommended for use in adults 19-64 years of age who smoke cigarettes. - There is no evidence about the safety of *PCV13* or *PPSV23* vaccine use in pregnancy. - Hence, women who need the vaccine should be vaccinated before a pregnancy, if possible. - The U.S. Centers for Disease Control and Prevention (CDC) recommends the two pneumococcal vaccines for all adults 65 years or older. - The *PCV13* and *PPSV23* should not be given at the same time when both vaccines are recommended. - A dose of the *PCV13* should be given first, followed by a dose of *PPSV23* at another visit to a health care provider. - These vaccines may not always prevent pneumococcal pneumonia, but they may prevent serious complications of pneumonia if it does occur. **2. Other prevention:** - It is not possible to prevent all types of pneumonia, but one can take steps to reduce the chance of contracting the condition by: - Quitting smoking - Practicing good hand-washing - Avoiding contact with people who have colds, the flu, or other infections - Cover your coughs and sneezes, and dispose off used tissues promptly. - Maintain a healthy lifestyle to strengthen your immune system; Get enough rest, eat a healthy diet, and get regular exercise. - Pneumonia can often be a complication of the flu, so be sure to also get an annual flu shot. - Avoidance of areas where fungal pathogens are endemic is recommended to prevent fungal pneumonias. - There is no antifungal vaccine available; however, for some high-risk patients, some doctors have recommended prophylactic antifungal drugs. ## Side Effects of Pneumonia Vaccine Any type of vaccine has the potential to cause an allergic reaction, which can be severe, but this side effect is rare. - This would happen within minutes to a few hours after receiving the vaccine. - *PCV13* can cause drowsiness, temporary loss of appetite, or redness, swelling, or tenderness in children where the shot was given. - Mild fever and irritability are other common side effects. - Adults receiving pneumococcal vaccines have reported pain, redness, rash, and swelling where the shot was given; also mild fever, fatigue, headache, chills, or muscle pain.