What are the key facts about pneumococcal pneumonia. How does age affect the risk of contracting this disease. What chronic conditions increase susceptibility to pneumococcal pneumonia. How can vaccination help prevent this potentially serious illness.

What is Pneumococcal Pneumonia and Who’s at Risk?

Pneumococcal pneumonia is a serious bacterial infection that can significantly impact one’s health and daily life. This potentially severe disease can disrupt your routine for weeks and may even necessitate hospitalization. Understanding the risk factors and preventive measures is crucial for maintaining good health, especially as we age.

Age as a Key Risk Factor

One of the primary risk factors for pneumococcal pneumonia is age. As we grow older, our immune system naturally weakens, making us more susceptible to various infections. Even if you maintain an active and healthy lifestyle, being 65 or older significantly increases your risk of contracting pneumococcal pneumonia.

Chronic Health Conditions and Increased Risk

While age is a significant factor, certain chronic health conditions can further elevate the risk of pneumococcal pneumonia in adults 19 and older. These conditions include:

• Chronic lung disease
• Chronic heart disease
• Diabetes
• Weakened immune system

It’s important to note that the presence of multiple chronic conditions can compound the risk. Let’s explore how these conditions affect different age groups:

Risk Increase in Adults with Chronic Conditions Compared to Healthy Adults of the Same Age

• Chronic Lung Disease:
  • Ages 18-49: 19.1 times higher risk
  • Ages 50-64: 16.3 times higher risk
  • Ages 65+: 9.2 times higher risk
• Chronic Heart Disease:
  • Ages 18-49: 6.9 times higher risk
  • Ages 50-64: 7.1 times higher risk
  • Ages 65+: 4.4 times higher risk
• Diabetes:
  • Ages 18-49: 4.7 times higher risk
  • Ages 50-64: 4.4 times higher risk
  • Ages 65+: 3.3 times higher risk

Recognizing the Symptoms of Pneumococcal Pneumonia

Identifying the symptoms of pneumococcal pneumonia early can lead to prompt treatment and better outcomes. The common symptoms include:

• High fever
• Excessive sweating and shaking chills
• Persistent coughing
• Difficulty breathing or shortness of breath
• Chest pain

If you experience these symptoms, especially if you fall into a high-risk category, it’s crucial to seek medical attention promptly.

Preventive Measures: The Importance of Vaccination

Pneumococcal pneumonia can occur at any time, in any season, making prevention a year-round concern. Vaccination plays a pivotal role in reducing the risk of contracting this serious illness.

Who Should Consider Vaccination?

The Centers for Disease Control and Prevention (CDC) recommends that certain groups discuss pneumococcal pneumonia vaccination with their healthcare providers:

• Adults aged 19-64 with specific chronic health conditions
• All adults 65 years or older

It’s important to understand that the pneumococcal vaccines do not contain live bacteria, so you cannot contract pneumococcal pneumonia from the vaccination itself.

Vaccination Availability

Pneumococcal pneumonia vaccines are widely accessible. You can typically obtain them at:

• Doctor’s offices
• Local pharmacies
• Some local health departments

Assessing Your Personal Risk for Pneumococcal Pneumonia

Understanding your individual risk factors is crucial in determining your susceptibility to pneumococcal pneumonia. Several key factors contribute to increased risk:

Age-Related Risk

As mentioned earlier, age plays a significant role in pneumococcal pneumonia risk. The natural decline of the immune system as we age makes us more vulnerable to infections, including pneumococcal pneumonia.

Chronic Health Conditions

Certain chronic health conditions can make the body more susceptible to serious illnesses like pneumococcal pneumonia. These conditions include:

• Diabetes
• Chronic heart disease
• Chronic obstructive pulmonary disease (COPD)
• Asthma
• Weakened immune system

Lifestyle Factors: Smoking

Smoking is a significant risk factor for pneumococcal pneumonia. It damages the delicate lung tissue, making the lungs more vulnerable to infections. If you’re a smoker, your risk of contracting pneumococcal pneumonia is higher compared to non-smokers of the same age and health status.

The Impact of Multiple Risk Factors

It’s important to note that the presence of multiple risk factors can compound your overall risk for pneumococcal pneumonia. For instance:

• If you’re over 65 and have a chronic health condition, your risk is higher than someone over 65 without any chronic conditions.
• If you’re a smoker with a chronic health condition, your risk is elevated compared to a non-smoker with the same condition.
• The combination of advanced age, chronic health conditions, and smoking creates a significantly higher risk profile.

Personalized Risk Assessment: Understanding Your Vulnerability

To better understand your personal risk for pneumococcal pneumonia, consider the following factors:

Age-Based Risk

If you’re 65 or older, you’re in a higher risk category regardless of other factors. This is due to the natural age-related decline in immune function.

Health Condition-Based Risk

If you have one or more chronic health conditions, particularly those affecting the heart, lungs, or immune system, your risk is elevated. The more conditions you have, the higher your risk.

Smoking-Related Risk

Current smokers have a higher risk due to compromised lung health. Even if you’re younger and don’t have chronic health conditions, smoking significantly increases your vulnerability to pneumococcal pneumonia.

Taking Action: Steps to Reduce Your Risk

After assessing your risk factors, it’s important to take proactive steps to protect your health:

Consult Your Healthcare Provider

Regardless of your risk profile, it’s crucial to discuss your pneumococcal pneumonia risk with your healthcare provider. They can provide personalized advice based on your individual health status and risk factors.

Consider Vaccination

If you fall into a high-risk category, discuss the possibility of vaccination with your healthcare provider. Remember, vaccination is one of the most effective ways to prevent pneumococcal pneumonia.

Lifestyle Modifications

If you’re a smoker, consider quitting or seeking support to do so. Smoking cessation can significantly reduce your risk of pneumococcal pneumonia and improve your overall health.

Manage Chronic Conditions

If you have chronic health conditions, work closely with your healthcare provider to manage them effectively. Well-controlled chronic conditions can help reduce your risk of complications, including pneumococcal pneumonia.

The Importance of Ongoing Awareness and Prevention

Pneumococcal pneumonia is a serious illness that requires ongoing awareness and preventive measures. By understanding your risk factors and taking appropriate action, you can significantly reduce your chances of contracting this potentially severe disease.

Regular Health Check-ups

Schedule regular check-ups with your healthcare provider, especially if you’re in a high-risk category. These visits allow for ongoing assessment of your risk factors and provide opportunities to discuss any new health concerns.

Stay Informed

Keep yourself updated on the latest information regarding pneumococcal pneumonia prevention and treatment. Medical advice and recommendations may change over time, so staying informed is crucial for maintaining optimal health.

Promote Awareness

Share your knowledge about pneumococcal pneumonia with friends and family, especially those who may be at increased risk. Raising awareness can help others take necessary precautions and seek appropriate medical advice.

By taking a proactive approach to understanding and preventing pneumococcal pneumonia, you can protect your health and potentially avoid the serious complications associated with this disease. Remember, prevention is always better than cure, and with the right knowledge and actions, you can significantly reduce your risk of pneumococcal pneumonia.

Pneumococcal Pneumonia | American Lung Association

Pneumococcal Pneumonia Fast Facts

What Is It & Who’s At Risk?

Pneumococcal pneumonia is a potentially serious disease you shouldn’t ignore. It can disrupt your life for weeks and even land you in the hospital.

The immune system naturally weakens with age, so even if you’re healthy and active, being 65 or older is a key risk factor for pneumococcal pneumonia.

Other factors like certain chronic health conditions further increase pneumococcal pneumonia risk in adults 19 and older compared with healthy adults of same age. With each chronic condition your risk increases further.

Increased Risk
In adults 19+ with the following chronic conditions as compared to healthy adults of the same age.
	Aged 18-49	Aged 50-64	Aged 65+
Chronic Lung Disease	19. 1x	16.3x	9.2x
Chronic Heart Disease	6.9x	7.1x	4.4x
Diabetes	4.7x	4.4x	3.3x

Common Symptoms

High Fever

Excessive sweating and shaking chills

Coughing

Difficulty breathing, shortness of breath and chest pain

Prevention

Pneumococcal pneumonia can strike any time, anywhere, in any season, so now is the time to talk to a healthcare provider about vaccination. You can’t get pneumococcal pneumonia from getting vaccinated, because pneumococcal vaccines do not contain live bacteria. The CDC recommends adults 19-64 with certain chronic health conditions and all adults 65 or older talk to a healthcare provider about pneumococcal pneumonia vaccination. Pneumococcal pneumonia vaccines are available today at many doctor’s offices, local pharmacies and at some local health departments.

If you’re 19 or older with certain underlying medical conditions, you can get vaccinated against pneumococcal pneumonia.

Learn key facts about pneumococcal pneumonia.

Conozca los datos clave sobre la neumonía neumocócica.

Now that you have the facts, learn more about your personal risk for pneumococcal pneumonia.

Your Risk Assessment

Answer these three questions to learn more about your risk.

Age, chronic health conditions and lifestyle factors may increase your risk for getting pneumococcal pneumonia. If you’re 19 or older with a chronic health condition or 65 or older, you may be at increased risk.

What is your age?

19-64

65+

Please Select an Age Range

As we age, our immune systems aren’t as effective at fighting off infections and helping to protect us from vaccine-preventable disease.

Do you have any of these chronic conditions?

Diabetes, chronic heart disease, COPD, asthma, or a weakened immune system.

Yes, I have one or more chronic conditions

No, I don’t have any chronic conditions

Please Indicate Chronic Conditions

In addition to age, certain chronic health conditions can make the body more vulnerable to serious illnesses such as pneumococcal pneumonia.

Do you smoke?

Please Indicate if You Smoke

Smoking damages fragile lung tissue, making lungs more vulnerable to infection.

3.4

Your Summary

Your age, health conditions, and smoking history can contribute to an increased risk for getting pneumococcal pneumonia. Talk to your healthcare provider about your risk factors and how vaccines may help protect you.

Your Risk Factors

• Age
• Chronic Conditions
• Current Smoker

3.5

Your Summary

Your age and health conditions may put you at increased risk for getting pneumococcal pneumonia. Talk to your healthcare provider about your risk factors and how vaccines may help protect you.

Your Risk Factors

• Age
• Chronic Conditions

3.6

Your Summary

Your age and smoking history may put you at increased risk for getting pneumococcal pneumonia. Talk to your healthcare provider about your risk factors and how vaccines may help protect you.

Your Risk Factors

• Age
• Current Smoker

3.7

Your Summary

Although you haven’t selected any health conditions or behavior choices that would increase your risk, age is still a key risk factor for pneumococcal pneumonia due in large part to the natural, age-related decline of the immune system. Talk to your healthcare provider about your risk factors and how vaccines may help protect you.

Your Risk Factors

• Age

3.8

Your Summary

Although your age and health conditions are not risk factors, your smoking history may increase your risk for getting pneumococcal pneumonia. Talk to your healthcare provider about your risk factors and how vaccines may help protect you.

Your Risk Factors

• Current Smoker

3.9

Your Summary

Although your age and behaviors are not risk factors, you have health conditions that may increase your risk for getting pneumococcal pneumonia. Talk to your healthcare provider about your risk factors and how vaccines may help protect you.

Your Risk Factors

• Chronic Conditions

3.10

Your Summary

Although you’re not currently in an elevated-risk age group, your health conditions and smoking history may put you at increased risk for pneumococcal pneumonia. Talk to your healthcare provider about your risk factors and how vaccines may help protect you.

Your Risk Factors

• Chronic Conditions
• Current Smoker

3.11

Your Summary

Your answers to these three questions indicate that you are not in an elevated risk group. If you have concerns, please talk to your healthcare provider. And remember, even if you’re otherwise healthy, it’s always important to recognize your risks as you age.

Developed by the American Lung Association in partnership with Pfizer Inc.
The health information contained herein is provided for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made with a healthcare provider, considering the unique characteristics of the patient. The American Lung Association does not endorse products, devices or services. This content is intended only for U.S. residents.

Reviewed and approved by the American Lung Association Scientific and Medical Editorial Review Panel.

Page last updated: February 8, 2023

Typical Bacterial Pneumonia – StatPearls

Continuing Education Activity

The severe form of acute lower respiratory tract infection that affects the pulmonary parenchyma in one or both lungs is known as pneumonia. It is a common disease and a potentially serious infectious disease with considerable morbidity and mortality. Pneumonia is the sixth leading cause of death and the only infectious disease in the top ten causes of death in the United States. Community-acquired pneumonia is diagnosed in non-hospitalized patients or a previously ambulatory patient within 48 hours after admission to the hospital. CAP is further divided into “typical” and “atypical.” HAP develops more than 48 hours after hospital admission. Patients who are mechanically ventilated for more than 48 hours after endotracheal intubation can develop pneumonia known as VAP. HCAP occurs in ambulatory patients who are not hospitalized and have had extensive healthcare contact within the last 3 months. This activity reviews the evaluation and management of typical community-acquired pneumonia and highlights the role of interprofessional team members in collaborating to provide well-coordinated care and enhance patient outcomes.

Objectives:

• Explain the causes of
  typical community-acquired pneumonia.

• Describe the evaluation of a patient with typical community-acquired pneumonia.

• Summarize the treatment options for typical community-acquired pneumonia.

• Explore modalities to improve care coordination among interprofessional team members in order to improve outcomes for patients affected by typical community-acquired pneumonia.

Access free multiple choice questions on this topic.

Introduction

The severe form of acute lower respiratory tract infection that affects the pulmonary parenchyma in one or both lungs is known as pneumonia. It is a common disease and a potentially serious infectious disease with considerable morbidity and mortality. Pneumonia is the sixth leading cause of death and the only infectious disease in the top ten causes of death in the United States.

Pneumonia can be classified into 2 types based on how the infection is acquired:

1. Community-acquired pneumonia (CAP): Most common type

2. Nosocomial pneumonia  

• Hospital-acquired pneumonia (HAP)

• Ventilator-associated pneumonia (VAP)

• Healthcare-associated pneumonia (HCAP)

Community-acquired pneumonia is diagnosed in non-hospitalized patients or a previously ambulatory patient within 48 hours after admission to the hospital. CAP is further divided into “typical” and “atypical.”

HAP develops more than 48 hours after hospital admission. Patients who are mechanically ventilated for more than 48 hours after endotracheal intubation can develop pneumonia known as VAP. HCAP occurs in ambulatory patients who are not hospitalized and have had extensive healthcare contact within the last 3 months.

Etiology

Pneumonia occurs secondary to airborne infection which includes bacteria, virus, fungi, parasites, among others.

The typical bacteria which cause pneumonia are Streptococcus pneumoniae, Staphylococcus aureus, Group A Streptococcus, Klebsiella pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, anaerobes, and gram-negative organisms. These organisms can be easily cultured on standard media or seen on Gram stain, unlike atypical organisms.

Streptococcus pneumoniae is the most commonly identified bacterial cause of CAP in all age groups worldwide. Methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, and other Enterobacteriaceae are the predominant causes of HAP, VAP, and HCAP.

Although it is not necessary to have a predisposing condition to acquire pneumonia, having such factors makes a person more likely to develop the lung infection. Any condition or disease that impairs the host immune response, for example, older age (older than 65 years), immunosuppression, diabetes, cystic fibrosis, lung cancer, among others. Conditions which increase the risk of macro- or micro-aspiration include stroke, seizures, anesthesia, drug intoxication. Cigarette smoking, alcoholism, malnutrition, obstruction of bronchi from tumors are other common predisposing conditions.

Epidemiology

The overall rate of CAP is 5-7 per 1000 persons per year. The rate of CAP is higher in males and increases with increasing age. It is more commonly seen in winter months. The combination of Pneumonia and Influenza causes high mortality and was the eighth most common cause of death in the US and the seventh most common cause of death in Canada in 2005.

Pathophysiology

The pulmonary system and the airways are continuously exposed to particulate matter and environmental pathogens. The healthy airways normally contain some bacterial species and are not sterile. The most common mechanism through which the micro-organisms or pathogens reach the lung is known as micro-aspiration. Hematogenous spread and macro-aspiration are other mechanisms.

However, the pulmonary defense mechanisms such as cough reflex, mucociliary clearance system, immune response help maintain low levels of the microbiome. CAP occurs when there is a defect in normal host defense, or a virulent pathogen overwhelms the immune response or a large infectious microbial inoculum. The invasion and propagation of these virulent strains of bacteria in the lung parenchyma following micro-aspiration cause the host immune response to kick in leading to a cascade of inflammatory response causing pneumonia.

Alveolar macrophage is the predominant immune cell which responds to lower airway bacteria. However, a stronger immune response comes into play when an overwhelming virulent pathogen or a large inoculum causes these alveolar macrophages to recruit polymorphonuclear neutrophils(PMN) to phagocytose and engulf these bacteria. The alveolar macrophages release cytokines namely, tumor necrosis factor-alpha and interleukins. Interleukin-8 and granulocyte colony-stimulating factor promotes neutrophil chemotaxis and maturation. The leakage of the alveolar-capillary membrane due to cytokines can lead to a decrease in compliance and hence, dyspnea. Cytokines such as IL-1 and TNF can lead to constitutional symptoms such as fever. Bacterial pneumonia is a result of this inflammatory response. These cytokines are essential for the immunity but, the excess can lead to sepsis and multiorgan failure. The body tries to balance the deleterious effects of cytokines by attenuation of several inflammatory mechanisms by IL-10.

Microbial virulence factors and predisposing host conditions make a person more vulnerable to pneumonia.[3]

Histopathology

Based on the area of the lung involved, pneumonia can be classified histologically into lobular, lobar, bronchopneumonia, and interstitial. The major types of acute bacterial pneumonia include:

• Bronchopneumonia: A descending infection started around bronchi and bronchioles, which then spreads locally into the lungs. Lower lobes are usually involved. Patchy areas of consolidation which represents neutrophil collection in the alveoli and bronchi.

• Lobar pneumonia: Acute exudative inflammation of the entire lobe. Uniform consolidation with a complete or near complete consolidation of a lobe of a lung. Majority of these cases are caused by Streptococcus pneumoniae.

Lobar pneumonia has 4 classical stages of inflammatory response if left untreated, namely:

1. Congestion/consolidation in the first 24 hours in which the lungs are heavy, red, and, boggy. Microscopically characterized by vascular engorgement and intra-alveolar edema. Many bacteria and few neutrophils are present.

2. Red hepatization/early consolidation begins 2 to 3 days after consolidation and lasts for 2 to 4 days and named because of firm liver-like consistency. The affected lung is red-pink, dry, granular and, airless. Fibrin strands replace the edema fluid of the previous phase. Microscopically marked cellular exudate of neutrophils with some showing ingested bacteria, extravasation of erythrocytes, desquamated epithelial cells, and fibrin within the alveoli are seen. The alveolar septa become less prominent because of the exudate.

3. Grey hepatization/late consolidation occurs 2 to 3 days following red hepatization and lasts for 4 to 8 days. The lung appears gray with liver-like consistency due to fibrinopurulent exudate, progressive disintegration of red blood cells, and hemosiderin. The macrophages begin to appear.

4. Resolution and restoration of the pulmonary architecture start by the eighth day. The enzymatic action begins centrally and spreads peripherally which liquefies the previous solid fibrinous content and eventually restores aeration. Macrophages are the predominant cells which contain engulfed neutrophils and debris.

Toxicokinetics

The most common cause of typical bacterial pneumonia worldwide is Pneumococcus. The polysaccharide capsule of Streptococcus pneumoniae inhibits the complement binding to the cell surface and hence, inhibits phagocytosis. Virulent pneumococcal proteins such as IgA1 protease, neuraminidase, pneumolysin, autolysin, and the surface protein A further help the organism to counteract the host immune response and allow it to cause infection in humans.

Genetic mutations causing an active efflux of drug and eventually resistance have led to an increase in drug-resistant Streptococcus Pneumoniae (DRSP) over the last few years.

Alteration in penicillin-binding protein has increased the penicillin resistance and an increased rate of penicillin-resistant S. pneumoniae. Penicillin resistance occurs due to failure to bind to the microbe cell wall.[1][2]

History and Physical

The signs and symptoms vary according to disease severity. The common symptoms of bacterial pneumonia include fever, cough, sputum production (may or may not be present). The color and quality of sputum provide the clue to microbiological etiology. Bacterial pneumonia mostly presents with mucopurulent sputum.

Pleuritic chest pain due to localized inflammation of pleura can be seen with any kind of pneumonia but, is more common with lobar pneumonia. Constitutional symptoms such as fatigue, headache, myalgia, and arthralgias can also be seen.

Severe pneumonia can lead to dyspnea and shortness of breath. In severe cases, confusion, sepsis, and multi-organ failure can also manifest.

Tachypnea, increased vocal fremitus, egophony (E to A changes), dullness to percussion are the major clinical signs depending on the degree of consolidation and presence/absence of pleural effusion. Chest auscultation reveals crackles, rales, bronchial breath sounds.

The respiratory rate closely correlates with the degree of oxygenation and, therefore essential in determining the severity. Hypoxia is seen in severe pneumonia, which leads to hyperventilation.

Evaluation

To start with the evaluation of any pneumonia, clinical suspicion based on careful patient history and physical exam should always be followed by chest radiography which is the most important initial test.

Chest x-ray not only shows the presence of the disease and demonstrates pulmonary infiltrate, but also provides the clue to the diagnosis whether its lobar, interstitial, unilateral or bilateral. Typical bacterial pneumonia is usually lobar pneumonia with para-pneumonic pleural effusions. However, a chest x-ray cannot reliably differentiate bacterial from a non-bacterial cause. When the labs and clinical features are positive, a positive chest radiograph is considered a gold standard for diagnosis of pneumonia. Although computed tomography (CT) is a more reliable and accurate test, its use is limited due to relatively high radiation exposure and high cost. It can sometimes be done with high clinical syndrome favoring pneumonia with a negative chest x-ray.  In a hospitalized patient with high clinical suspicion and negative radiograph, empiric presumptive antibiotic treatment should be started followed by a repeat chest x-ray after 24 to 48 hours.

Complete blood count (CBC) with differentials, inflammatory biomarkers ESR and acute phase reactants are indicated to confirm the evidence of inflammation and assess severity. Leukocytosis with a leftward shift is a major blood test abnormality whereas leukopenia can occur and points towards poor prognosis.

Sputum Gram stain and culture should be done next if lobar pneumonia is suspected. The most specific diagnostic test for lobar pneumonia is sputum culture. It is very important to identify the cause for the proper treatment.

It is preferable to test for influenza during the winter months as the combination of influenza and pneumonia is fatal.

CURB-65 and pneumonia severity index help in the stratification of the patients and to determine if the patient needs hospitalization for treatment.

Routine diagnostic tests are optional for outpatients with pneumonia, but hospitalized patients should undergo sputum culture, blood culture, and/or urine antigen testing preferably before the institution of antibiotic therapy.

Thoracocentesis, bronchoscopy, pleural biopsy, or pleural fluid culture are invasive tests and are carried out very occasionally.

An open lung biopsy is the ultimate specific diagnostic test.[6]

Treatment / Management

The treatment depends on the severity of the disease. It is important to determine whether the patient needs to be treated inpatient or as an outpatient. CURB-65 pneumonia severity score or expanded CURB-65 can be used to stratify patients. One point for each factor which includes:

• Confusion

• Uremia (BUN greater than 20 mg/dL

• Respiratory rate greater than 30 per minute

• Hypotension (SBP less than 90 and DBP less than 60)

• Age older than more than 65 years

Patients with comorbid conditions such as renal disease, liver disease, cancer, chronic lung disease usually do better with inpatient treatment with IV medications.

A CURB-65 score of greater than or equal to 2 is an indication for hospitalization. A score of greater than or equal to 4 is an indication for intensive care unit (ICU) admission and more intense therapy.

Depending on the clinical response, the therapy is indicated for 5 to 7 days. A favorable clinical response is the resolution of tachypnea, tachycardia, hypotension; absence of fever for more than 48 hours. In case of delayed response, the therapy should be extended.

Empiric therapy recommended for the following:

• Outpatient/non-hospitalized patient management: Empiric therapy is almost always successful and usually testing is not required. In patients with no comorbidity, monotherapy with macrolides, such as azithromycin and clarithromycin are the first choice. Alternatively, newer fluoroquinolones like levofloxacin, moxifloxacin, or gemifloxacin can be used. The therapy is targeted against mycoplasma and chlamydia pneumoniae which are the common causes of less severe CAP. Patients with comorbid conditions (chronic lung or heart disease, diabetes, smoking, HIV, among others) do well with newer fluoroquinolones alone or with a combination of beta-lactam and a macrolide.

• Inpatient non-ICU management: The recommended therapy includes newer fluoroquinolones alone or a combination of beta-lactam/second or third-generation cephalosporin and a macrolide.

• Inpatient ICU management: The recommended therapy is a combination of macrolide/newer fluoroquinolone and a beta-lactam. Ampicillin-sulbactam or ertapenem can be used in patients with risk of aspiration. If there is a risk of Pseudomonas infection, a combination of anti-pseudomonal beta-lactam with anti-pseudomonal fluoroquinolone is indicated. For MRSA, vancomycin or linezolid should be added. In case of complications such as empyema, chest tube drainage is required. Surgical decortication is needed in case of multiple loculations.

All hospitalized patients who test positive for influenza virus must be treated with oseltamivir irrespective of the onset of illness.

Once the exact cause is determined, specific therapy should be initiated.[3][4][5]

Differential Diagnosis

• Asthma or reactive airway disease

• Viral Pneumonia

• Pneumonia, Fungal

• Pneumonia, Atypical bacterial

• Lung Abscess

• Bronchiectasis

• Bronchiolitis

• Asthma

• Acute and Chronic Bronchitis

• Atelectasis

• Croup

• Respiratory distress syndrome

• Aspiration of a foreign body[6][7]

Complications

• Pleural effusion

• Empyema

• Lung Abscess

• Septicemia

• Bacteremia

Enhancing Healthcare Team Outcomes

Pneumonia is a common infectious lung disease. It requires interprofessional care and the involvement of more than one subspecialty. This patient-centered approach involving a physician with a team of other health professionals, physiotherapists, respiratory therapists, nurses, pharmacists, and support groups working together for the patient plays an important role in improving the quality of care in pneumonia patients. It not only decreases the hospital admission rates but also positively affect the disease outcome. For healthy patients, the outcomes after treatment are excellent but in the elderly and those with comorbidities, the outcomes are guarded.

Review Questions

• Access free multiple choice questions on this topic.

• Comment on this article.

Figure

Lung Abscess, CT Scan, Computer Tomography, Thick-walled cavitary lesion in the right lung is an abscess, Diffuse ground glass infiltrates that are present in both lungs represent pneumonia. Contributed by Wikimedia Commons, Yale Rosen (CC by 2.0) https://creativecommons.org/licenses/by/2.0/ (more…)

Figure

Combination of two x-rays, A represents a normal healthy Chest x-ray, B represents a Chest X-ray documenting Q fever pneumonia, Pathology. Contributed by Wikimedia Commons (Public Domain)

Figure

Lung X-ray of patient showing infection with pneumocystis carinii, Pneumonia. Contributed by The National Institutes of Health (NIH)

Figure

MAI pneumonia. Image courtesy S Bhimji MD

Figure

Streptococcus Pneumoniae example antibiogram. Contributed by Zachary Sandman, BA

References

1.

Yamaguchi M, Minamide Y, Terao Y, Isoda R, Ogawa T, Yokota S, Hamada S, Kawabata S. Nrc of Streptococcus pneumoniae suppresses capsule expression and enhances anti-phagocytosis. Biochem Biophys Res Commun. 2009 Dec 04;390(1):155-60. [PubMed: 19799870]

2.

Cools F, Torfs E, Vanhoutte B, de Macedo MB, Bonofiglio L, Mollerach M, Maes L, Caljon G, Delputte P, Cappoen D, Cos P. Streptococcus pneumoniae galU gene mutation has a direct effect on biofilm growth, adherence and phagocytosis in vitro and pathogenicity in vivo. Pathog Dis. 2018 Oct 01;76(7) [PubMed: 30215741]

3.

Segreti J, House HR, Siegel RE. Principles of antibiotic treatment of community-acquired pneumonia in the outpatient setting. Am J Med. 2005 Jul;118 Suppl 7A:21S-28S. [PubMed: 15993674]

4.

Pineda L, El Solh AA. Severe community-acquired pneumonia: approach to therapy. Expert Opin Pharmacother. 2007 Apr;8(5):593-606. [PubMed: 17376015]

5.

Liu JL, Xu F, Zhou H, Wu XJ, Shi LX, Lu RQ, Farcomeni A, Venditti M, Zhao YL, Luo SY, Dong XJ, Falcone M. Corrigendum: Expanded CURB-65: a new score system predicts severity of community-acquired pneumonia with superior efficiency. Sci Rep. 2018 Aug 09;8:47005. [PMC free article: PMC6083369] [PubMed: 30091425]

6.

Hauswaldt J, Blaschke S. [Dyspnea]. Internist (Berl). 2017 Sep;58(9):925-936. [PubMed: 28608125]

7.

Berliner D, Schneider N, Welte T, Bauersachs J. The Differential Diagnosis of Dyspnea. Dtsch Arztebl Int. 2016 Dec 09;113(49):834-845. [PMC free article: PMC5247680] [PubMed: 28098068]

Disclosure: Parul Pahal declares no relevant financial relationships with ineligible companies.

Disclosure: Venkat Rajasurya declares no relevant financial relationships with ineligible companies.

Disclosure: Sandeep Sharma declares no relevant financial relationships with ineligible companies.

Pneumonia can occur due to prolonged stress

World Pneumonia Day is celebrated annually on November 12th. Children suffer the most from this disease, it is the first cause of death among them all over the world. However, the disease is common among completely different social groups and ages: both weakened chronics and generally healthy and successful young people suffer from pneumonia. What is this disease and is it possible to reduce the risk of encountering it? Asked to talk about it Head of the Department of Pulmonology at the Botkin Hospital Svetlana Nikolaevna Shvaiko .

Pneumonia is an infectious and inflammatory disease of the lung tissue, most often the alveoli (respiratory sections in the lung) are affected. In our time, despite the fact that the latest antibiotics have appeared and there is the possibility of vaccination, the number of pneumonias is steadily increasing. According to statistics, pneumonia is the most common cause of death. I note, by the way, that Sergei Petrovich Botkin, whose name the hospital bears, made a huge contribution to the study of pneumonia. He’s still at 19century was engaged in the most dangerous – croupous – pneumonia, when the mortality rate from this disease was very high.

Pneumonia risk groups

Pneumonia affects people of completely different ages and social status. However, there are risk groups – children, the elderly, patients with other chronic diseases, smokers and alcohol abusers. Smoking, for example, supports the inflammatory process in the bronchi, so the infection joins much more often. The most severe pneumonia is in alcoholics, they simply have a lightning-fast course. And often it is in people who drink pneumonia that ends in death.

But young patients also get pneumonia. Yes, this is no longer a risk group, but even with a good standard of living, nutrition, and the absence of bad habits, a person “suddenly” gets pneumonia. He just worked very hard and rested very little. But prolonged stress significantly reduces immunity. Hypothermia under certain circumstances is also a risk factor.

But it is important to note that pneumonia does not just happen. As a rule, this is the first bell that not everything is safe in the body and it is time to change something in habits and lifestyle. Yes, most often you need to quit drinking and smoking.

Diagnosis, symptoms, treatment

What are the signs of pneumonia in the common cold? Firstly, the high temperature lasts longer than 3 days, sometimes even after taking antipyretics, plus severe intoxication, weakness, shortness of breath, fatigue, headache and cough, chest pain. These symptoms should make you see a doctor immediately. It is recommended to conduct an x-ray of the respiratory organs: the diagnosis of “pneumonia” is determined radiographically, fluorography can be done. In fact, not all cases of pneumonia are diagnosed; many pass as a viral infection. It happens that therapists immediately prescribe antibiotics and quickly achieve an effect.

The most important thing in the successful treatment of pneumonia is to see a doctor as soon as possible. Pneumonia can now be cured in most cases, but there are also fatal outcomes. They are associated, as a rule, with the presence of immunodeficiency in patients. And this is not only HIV, but various chronic diseases that lead to a weakening of the immune system – and respiratory diseases, and hematological, and oncological very often, and diabetes mellitus. Pneumonia often accompanies many illnesses.

Severe pneumonia occurs against the background of chronic lung diseases: chronic obstructive pulmonary disease (COPD), bronchiectasis. All of them are characterized by a protracted course, and the use of antibiotics alone is not enough, endoscopic lung cleansing is necessary, which allows you to achieve a good effect.

How is it transmitted?

Pneumonia is transmitted by airborne droplets or household contact. Ventilate the room more often. In the cold season, viral infections cause the addition of a bacterial infection and, as an outcome, pneumonia. Entrance gates of infection are also viral infections. The infection can get into the lungs and through the lymphatic flow when there is some kind of focus of chronic infection in the body, for example, carious teeth.

Vaccination

There are vaccines against pneumonia, but they do not guarantee that you will never get it. The fact is that many different microbes can cause pneumonia. The most dangerous of them is pneumococcus, it is precisely such pneumonia – croupous, pneumococcal – that most often leads to death. The existing vaccine is just from this type. Now it contains antibodies to the main serotypes of pneumococcus. I will add that these vaccinations are not included in the mandatory set of children, but if the child is often sick, then such a vaccination is worth doing. It is also recommended for older people over 65 and those suffering from chronic diseases.

Tips

The main advice is to follow a healthy lifestyle, do not smoke or abuse alcohol, and do not overwork at work, be sure to find time for rest. Lead an active lifestyle: any moderate physical activity is useful. After all, the lungs do not have muscle mass, they themselves are furs, so they need to be regularly inflated with the help of our pectoral muscles. Regular exercise in the fresh air will ventilate the lungs well, there will be no stagnation in them.

Pneumonia in children: a horrendous mortality rate

According to the World Health Organization (WHO), 16% of all deaths among children under 5 years of age are due to pneumonia. In 2015, this disease claimed 920,136 children’s lives worldwide. In this article, we will look at how to recognize the symptoms of pneumonia in children, as well as how to treat it and reduce the chances of a child getting sick again. First, let’s figure out what exactly this dangerous disease is.

This is a form of acute respiratory infection that affects the lungs. The latter are made up of small sacs called alveoli that fill with air when a person breathes. Inflammation of the lungs in children occurs when the alveoli fill with fluid and pus, which makes breathing painful and oxygen consumption is severely limited. This disease can affect both one or both lungs at the same time.

The symptoms of the disease vary depending on the age of the child, as well as on what exactly caused the inflammation.

• Fever,
• Rapid and/or difficult breathing,
• Cough,
• Vomiting,
• Irritation and fatigue,
• Chest pain, especially while coughing,
• Abdominal pain.

Very often, pneumonia in a child discourages the desire to eat, which greatly worries parents. It is important to understand that as soon as the patient feels better, the appetite will return. The main task of parents is to make sure that their child consumes a lot of liquid. To do this, it is necessary to give the child water, breast milk (or milk from a bottle), compotes, and so on more often.

In neonates and infants under 1 month of age, the main symptoms of pneumonia to look out for are: abdomen (under chest) while breathing,

Symptoms of pneumonia in a child older than 1 month may also include:

• Frequent coughing,
• Difficulty breathing and abdominal muscle retraction,
• Very pronounced, loud breathing and wheezing.

If the pneumonia is in the lower part of the lungs, near the belly, the baby will have a high fever, as well as abdominal pain or vomiting. There are no breathing problems.

If the inflammation is caused by bacteria , the symptoms appear quite abruptly – fever and shortness of breath. viral pneumonia is characterized by a more gradual onset of symptoms, the most common of which is wheezing.

If you suspect inflammation, be sure to call your pediatrician. Call the doctor immediately if your child has these symptoms:

• Breathing difficulties,
• Lips or nails become bluish or grey,
• If ​​the temperature has reached 38.9 °C – for children of any age,
• If ​​the baby is less than 6 months old and the temperature has exceeded 38°C.

What are the causes of pneumonia in children?

Various microbes can be responsible for this disease: viruses, bacteria, fungi, parasites. The most common causes of pneumonia include:

• Pneumococcus is the most common cause of bacterial inflammation in children,
• Haemophilus influenzae type B is the second most common cause of bacterial origin,
• Respiratory syncytial virus is the most common cause of viral pneumonia among young patients,
• Other viruses that can cause inflammation include influenza virus, adenovirus, rhinovirus, metapneumovirus, and also the parainfluenza virus that causes croup,
• HIV-infected infants most commonly develop pneumocystis pneumonia, which is responsible for at least 25% of all inflammatory deaths.

Treatment of pneumonia in children

Most cases are treated at home. To do this, parents need to ensure that the child drinks enough fluids and rests a lot. If the patient complains of chest pain, he can be given panadol (paracetamol). It’s not worth spending money on cough medicines, they still do not help with pneumonia in children.

If the infection was caused by bacteria , the child must be given an antibiotic. In most cases, after the start of taking the drug within 24-48 hours, the patient becomes much better. The temperature will drop, the baby will breathe easier, he will become more energetic. Cough may bother for a few more days or weeks. It is very important to complete the entire course of antibiotics for pneumonia, even if the patient feels well. Usually the drug is prescribed for 7-10 days.

If the doctor is 100% sure that the child has a viral pneumonia, antibiotics are not prescribed, because these drugs destroy only a bacterial infection. The recovery period in this case will last longer – from two to four weeks.

Treatment pneumonia in hospital 90 005

In some cases, the child needs hospitalization:

• If ​​the baby is less than 1 year old,
• If ​​the baby is unable to take medication,
• If ​​the baby is dehydrated,
• If ​​the baby has serious breathing problems,
• If ​​the baby suffers from chronic lung or heart disease.
• If ​​the baby has a weakened immune system.

Hospital treatment for pneumonia involves intravenous antibiotics (in case of a bacterial infection). Sometimes patients receive oxygen therapy, which helps fill the lungs with oxygen and makes breathing easier.

Prevention of pneumonia

In order to protect your child from this life-threatening disease, experts recommend:

Vaccination receive immunization against Haemophilus influenzae type B, pneumococcus, measles and whooping cough. According to scientists from the World Health Organization (WHO), the first dose of pneumococcal vaccine should be administered after the baby reaches two months of age. Vaccination is the most effective way to prevent pneumonia.

Do not share toys and utensils with other children

Remind children who are in elementary school not to share toys and utensils with other children. Unfortunately, this habit is extremely difficult to cultivate in a child who attends kindergarten.

According to Australian doctors, children who are vaccinated significantly reduce the risk of catching an infection in kindergarten or school.

Wash hands more often

Encourage your child to wash their hands with soap and water after blowing their nose, coughing or sneezing.

Avoid secondhand smoke

Do not smoke around children or allow others to do so. Tobacco smoke increases the risk of infection and worsens the symptoms of pneumonia in a child.