What are the main causes of typical community-acquired pneumonia. How is typical bacterial pneumonia evaluated and diagnosed. What are the most effective treatment options for community-acquired pneumonia. How can healthcare teams improve outcomes for pneumonia patients.

Understanding Typical Bacterial Pneumonia

Pneumonia is a severe acute lower respiratory tract infection affecting the pulmonary parenchyma in one or both lungs. It ranks as the sixth leading cause of death in the United States and is the only infectious disease among the top ten causes of mortality. Typical bacterial pneumonia, a subset of community-acquired pneumonia (CAP), is a common and potentially serious condition with significant morbidity and mortality rates.

Types of Pneumonia

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

• Community-acquired pneumonia (CAP): The most common type
• Nosocomial pneumonia:
  • Hospital-acquired pneumonia (HAP)
  • Ventilator-associated pneumonia (VAP)
  • Healthcare-associated pneumonia (HCAP)

CAP is diagnosed in non-hospitalized patients or within 48 hours of hospital admission for previously ambulatory patients. It is further divided into “typical” and “atypical” pneumonia. HAP develops more than 48 hours after hospital admission, while VAP occurs in patients mechanically ventilated for over 48 hours after endotracheal intubation. HCAP affects ambulatory patients with extensive healthcare contact within the past 3 months.

Causes and Risk Factors of Typical Bacterial Pneumonia

Typical bacterial pneumonia is primarily caused by airborne infections. The most common bacterial pathogens responsible for this condition include:

• Streptococcus pneumoniae (most common cause worldwide)
• Staphylococcus aureus
• Group A Streptococcus
• Klebsiella pneumoniae
• Haemophilus influenzae
• Moraxella catarrhalis
• Anaerobic bacteria
• Gram-negative organisms

These organisms can be easily cultured on standard media or identified through Gram staining, unlike atypical organisms.

Predisposing Factors

While a predisposing condition is not necessary to acquire pneumonia, certain factors increase the likelihood of developing a lung infection:

• Advanced age (over 65 years)
• Immunosuppression
• Diabetes
• Cystic fibrosis
• Lung cancer
• Conditions increasing the risk of aspiration (e.g., stroke, seizures, anesthesia, drug intoxication)
• Cigarette smoking
• Alcoholism
• Malnutrition
• Bronchial obstruction from tumors

Epidemiology of Community-Acquired Pneumonia

The overall rate of CAP is approximately 5-7 per 1000 persons per year. Several factors influence the prevalence and incidence of CAP:

• Gender: Higher rates observed in males
• Age: Incidence increases with advancing age
• Seasonality: More common during winter months

The combination of pneumonia and influenza is a significant cause of mortality, ranking as the eighth most common cause of death in the US and the seventh in Canada as of 2005.

Pathophysiology of Typical Bacterial Pneumonia

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

The development of pneumonia involves a complex interplay between host defenses and the virulence of the invading pathogen. When the balance tips in favor of the pathogen, infection and inflammation of the lung tissue occur, leading to the clinical manifestations of pneumonia.

Host Defense Mechanisms

The respiratory system employs several defense mechanisms to protect against infection:

• Mechanical barriers: Nasal hairs, mucus, and cilia in the airways
• Innate immune responses: Alveolar macrophages, neutrophils, and antimicrobial peptides
• Adaptive immune responses: T-cells and antibodies

When these defense mechanisms are overwhelmed or impaired, pathogens can establish themselves in the lung tissue, leading to pneumonia.

Clinical Presentation and Diagnosis

The clinical presentation of typical bacterial pneumonia can vary, but common symptoms include:

• Fever and chills
• Cough with purulent sputum
• Dyspnea (shortness of breath)
• Chest pain
• Fatigue and weakness

Diagnosis of typical bacterial pneumonia involves a combination of clinical assessment, physical examination, and diagnostic tests.

Physical Examination

Key findings on physical examination may include:

• Tachypnea (rapid breathing)
• Tachycardia (rapid heart rate)
• Decreased breath sounds
• Crackles or rales on auscultation
• Dullness to percussion over affected lung areas

Diagnostic Tests

Several diagnostic tests can help confirm the diagnosis and identify the causative organism:

• Chest X-ray: The gold standard for diagnosing pneumonia
• Blood tests: Complete blood count, C-reactive protein, and procalcitonin levels
• Sputum culture and Gram stain
• Blood cultures
• Polymerase chain reaction (PCR) tests for specific pathogens
• Urine antigen tests for Streptococcus pneumoniae and Legionella pneumophila

Treatment Strategies for Typical Bacterial Pneumonia

The treatment of typical bacterial pneumonia primarily involves antimicrobial therapy, supportive care, and management of complications.

Antimicrobial Therapy

The choice of antibiotics depends on several factors, including the severity of illness, patient risk factors, and local resistance patterns. Common empiric antibiotic regimens include:

• For outpatient treatment:
  • Amoxicillin or doxycycline for healthy individuals
  • Respiratory fluoroquinolone (e.g., levofloxacin) or beta-lactam plus macrolide combination for patients with comorbidities
• For inpatient treatment:
  • Beta-lactam (e.g., ceftriaxone) plus macrolide (e.g., azithromycin)
  • Respiratory fluoroquinolone monotherapy

Treatment duration typically ranges from 5 to 7 days for uncomplicated cases, with longer courses necessary for severe infections or complications.

Supportive Care

Supportive measures are crucial in managing patients with pneumonia:

• Oxygen therapy for hypoxemic patients
• Adequate hydration and nutritional support
• Pain management and antipyretics for symptomatic relief
• Chest physiotherapy to improve mucus clearance

Management of Complications

Complications of pneumonia may require additional interventions:

• Pleural effusion: Thoracentesis or chest tube drainage if significant
• Empyema: Surgical debridement or video-assisted thoracoscopic surgery (VATS)
• Respiratory failure: Mechanical ventilation
• Sepsis: Early goal-directed therapy and hemodynamic support

Prevention and Vaccination

Preventing typical bacterial pneumonia involves a multifaceted approach, with vaccination playing a crucial role.

Pneumococcal Vaccination

Two types of pneumococcal vaccines are available:

• Pneumococcal conjugate vaccine (PCV13): Recommended for all children and adults 65 years and older
• Pneumococcal polysaccharide vaccine (PPSV23): Recommended for adults 65 years and older and younger adults with certain risk factors

Influenza Vaccination

Annual influenza vaccination is recommended for all individuals 6 months and older, as influenza infection can predispose to bacterial pneumonia.

Lifestyle Modifications

Several lifestyle changes can help reduce the risk of pneumonia:

• Smoking cessation
• Limiting alcohol consumption
• Maintaining good hand hygiene
• Managing chronic medical conditions effectively

Prognosis and Long-term Outcomes

The prognosis for typical bacterial pneumonia varies depending on several factors, including the patient’s age, comorbidities, and the severity of the infection. Mortality rates for CAP range from less than 1% for outpatients to 5-10% for hospitalized patients and can exceed 30% for those requiring intensive care unit admission.

Prognostic Factors

Several factors influence the prognosis of patients with typical bacterial pneumonia:

• Age: Older patients generally have poorer outcomes
• Comorbidities: Conditions such as chronic obstructive pulmonary disease (COPD), diabetes, and heart failure can complicate recovery
• Severity of illness: Assessed using scoring systems like CURB-65 or Pneumonia Severity Index (PSI)
• Timely initiation of appropriate antibiotics
• Development of complications such as bacteremia or empyema

Long-term Consequences

While many patients recover fully from typical bacterial pneumonia, some may experience long-term consequences:

• Decreased lung function
• Increased risk of recurrent pneumonia
• Cardiovascular complications
• Cognitive impairment in elderly patients

Regular follow-up and monitoring are essential to address these potential long-term effects and optimize patient outcomes.

Role of the Interprofessional Team in Managing Typical Bacterial Pneumonia

Effective management of typical bacterial pneumonia requires a coordinated effort from an interprofessional healthcare team. Each member plays a crucial role in ensuring optimal patient care and outcomes.

Key Team Members and Their Roles

• Primary Care Physicians: Responsible for initial diagnosis, treatment initiation, and follow-up care
• Pulmonologists: Provide specialized care for complicated cases or patients with underlying lung diseases
• Infectious Disease Specialists: Offer expertise in managing antibiotic-resistant infections or atypical presentations
• Nurses: Administer medications, monitor patient progress, and provide patient education
• Respiratory Therapists: Assist with oxygen therapy, chest physiotherapy, and mechanical ventilation when necessary
• Pharmacists: Ensure appropriate antibiotic selection, dosing, and monitoring for adverse effects
• Nutritionists: Address nutritional needs and support during recovery
• Physical Therapists: Aid in early mobilization and rehabilitation

Improving Care Coordination

To enhance patient outcomes, healthcare teams can implement several strategies:

• Regular team meetings to discuss complex cases
• Implementing standardized care protocols based on evidence-based guidelines
• Utilizing electronic health records for seamless communication and documentation
• Conducting multidisciplinary rounds in inpatient settings
• Developing clear discharge plans and ensuring appropriate follow-up care

By fostering effective collaboration and communication among team members, healthcare providers can ensure comprehensive, patient-centered care for individuals with typical bacterial pneumonia.

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.

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.

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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.

causes, symptoms, diagnosis and treatment

Pneumonia (pneumonia) is an inflammatory disease of the lungs. The disease is accompanied by damage to the lung tissue. Pneumonia can affect both individual foci, segments, and the lungs completely (totally).

During inflammation of the lungs, the alveoli and interstitial tissue (the connective tissue that is directly involved in the formation of the stroma – the basis of the lungs) are most affected.

Bacteria, viruses, toxins can lead to inflammation, damage to the lungs.

Pneumonia accounts for about 30% of inflammatory diseases of the lower respiratory tract.

The most common cases of pneumonia are people with chronic bronchitis, infections of the nose and throat, and heart failure.

At the same time, older people get pneumonia more often than young people, and the disease is more severe in them. If in young people sluggish focal pneumonia is more common, then in the elderly, acute pneumonia is not uncommon at once with damage to several segments of the lungs.

Smokers are also more likely to get pneumonia than non-smokers. This is due to the fact that the mucous membrane of the bronchi in smokers is thinner, and the protective reactions of the bronchopulmonary system are weakened.

The pathogenesis of pneumonia

The mechanism of origin – the pathogenesis of pneumonia is complex. It all depends on how the infection got into the body.

Ways of getting infection, toxins into the body are different:

• Through the bronchi ( bronchogenic pathogenesis). Bacteria, viruses enter the lungs by airborne droplets – directly from the inhaled air or indirectly (from the nose), upon contact of the mucous membranes (nose, eyes) with a surface on which there are viruses, bacteria.
• Through the blood (hematogenous pathogenesis). Such pneumonia most often develop against the background of sepsis – a purulent-septic lesion of the blood.
• Through the lymph . From the lymph, microorganisms penetrate to the epithelial cells of the bronchopulmonary system and adhere to them.
• From within (endogenous pathogenesis). In this case, the mechanism of the onset of the disease begins with a disturbed microflora (for example, the synthesis of mucins (glycoproteins) is disrupted in a person. Because of this, problems arise with mucociliary clearance, the task of which is to directly remove the rhinobronchial secret.

After bacteria, toxins, viruses enter the lungs, cytokines proteins (peptide information molecules). They are activated during the movement of neutrophils (parts of leukocytes), macrophages involved in the inflammatory process. It is cytokines that regulate the development of local defense reactions.

But if the bronchopulmonary protection is impaired, the immune system is weak, autoallergic and allergic reactions occur in the body, inflammation of the lungs occurs.

If fungi are to blame for the occurrence of the disease, then a characteristic feature of the mechanism of the development of the disease is the active reproduction of fungal cultures, the migration of leukocytes and the accumulation of serous fluid in the bronchioles, alveoli.

Symptoms of pneumonia

• Fever. Severe chills, temperature up to 40 °C. Occurs as a protective reaction of the body. Fever helps the body adapt to the effects of pyrogenic (biologically active) substances of viral and bacterial origin.
• Cough. May be dry or wet. Sputum can be watery and in the form of pus, mucus – yellowish, greenish, with advanced pneumonia – bloody,
• Lack of appetite. The body gives a kind of signal to the gastrointestinal tract so that it does not waste energy on digesting food. After all, these forces are needed to fight the disease. Especially with pneumonia, you do not want to eat heavy food (meat, mushrooms, legumes).
• Stitches in chest. Especially the pain intensifies on a deep breath.

Shortness of breath, palpitations, feeling of lack of oxygen (the heart begins to pump blood intensively).

Blue tint for lips, nails . This symptom is a direct reaction to the lack of oxygen in the body.

Unreasonable anxiety.

Causes of pneumonia

Pneumonia can be caused by both infection and other irritants.

Infectious pneumonia can be caused by:

• pneumococci (a species of streptococci),
• staphylococci,
• coronoviruses,
• influenza and parainfluenza viruses,
• fungi (genus Candida and yeast), 9003 0
• Mycoplasma,
• Adenoviruses,
• Klepsiella
• Herpes,
• Pseudomonas aeruginosa,
• Legionella,
• Enteroviruses (Coxsackie, EUHO ),
• rhinovirus.

Bacterial pneumonia – most common. Pneumonia caused by viruses and fungi is less common

If pneumonia is non-infectious, then the reasons may be the following:

• prolonged exposure to chemical vapors;
• injuries (accident, unsuccessful operations)
• burns.
• radiation in the treatment of cancer.

Classification and stages of development of pneumonia

It is the cause of the disease – infectious and non-infectious – that is the main criterion for the classification of pneumonia. At the same time, if pneumonia is caused by an infection, bacterial viral and fungal pneumonia is isolated:

• Bacterial pneumonia is an inflammation of the lungs that develops against the background of damage to the lung tissue by gram-negative and bacterial bacteria. The disease is accompanied by irritation of the pleura (lining the lung from the outside and the chest from the inside) and infiltration of the lung parenchyma (including the alveoral walls). If bacterial inflammation of the lungs is not treated in a timely manner, part of the lung tissue may necrosis, an abscess, gangrene may occur on the lung.
• Viral pneumonia is an acute disease with severe intoxication. The frequency of occurrence is closely related to epidemiological outbreaks (ARVI, coronovirus)
• Fungal pneumonia (pneumomycosis) is an inflammation of the lungs caused by the multiplication of strains of fungi in the alveoli and lung parenchyma. One of the most difficult types of pneumonia to diagnose.

One of the most dangerous is viral pneumonia, complicated by a bacterial or fungal infection. It is with such pneumonia that the risk of death is high.

Pathologies are typical and atypical. There are effective drugs and techniques for the treatment of typical pneumonias. Atypical pneumonias are more difficult to treat. The most complex atypical pneumonias are viral. Among bacterial pneumonias, the most problematic are atypical pneumonias caused by intracellular pathogens – chlamydia, legionella.

Essential for the diagnosis and treatment of pneumonia is their classification depending on the lesion (stage of lesion).

• Total . The lungs are completely affected.
• Groovy . One share is affected. It is extremely rare in children, but in adults, especially with bacterial pneumonia, it is a common occurrence.
• Single and double sided . Affects only the right or left or both lungs.
• Drain. There are several foci of inflammation, but almost immediately they merge into one.
• Segmental – affects one or more bronchopulmonary segments

Complications of pneumonia

Complications of pneumonia can affect both the lungs themselves and other organs.

Complications directly to the lungs

The most common complications that affect the lungs themselves:

• Pulmonary fibrosis . One of the most dangerous complications. The lung tissues are replaced by connective tissue, the respiratory area is significantly reduced, and respiratory failure occurs. At first, it is noticeable only when moving, and then at rest. The more connective tissue grows, the more progressing inflammation of the lungs.
• Acute respiratory failure – complete hypoxia. It begins with a feeling of lack of air, in the absence of medical care, a hypoxic coma occurs.
• Pleurisy – deposits of fibrin on the pleura, accumulation of fluid in the pleural cavity, formation of adhesions. As a result, the mobility of the diaphragmatic dome is significantly limited. As a result, chronic respiratory failure develops. If not only liquid, but also pus accumulates in the cavity, purulent pleurisy develops, which is the cause of death.
• Destruction – response to purulent-necrotic infection. Accompanied by a sharp increase, pain in the sternum, the release of fetid sputum. With untimely measures taken, the probability of death is 2-5%, with intensive medical therapy under the control of pulmonologists, the prognosis is favorable.

Complications of the heart

Pneumonia is quite difficult for those who have heart problems.

A significant problem is the risk of complications on the heart itself:

• Myocarditis – inflammation of the heart muscle. At the same time, conductivity is also impaired. As a result, the patient is faced with the problem of palpitations, shortness of breath, swelling of the veins.
• Pericarditis – inflammation of the sheets of the pericardium. Consequences – severe shortness of breath – especially when moving and general weakness.
• Endocarditis – the formation of vegetations on the heart valves. A person begins to be haunted by shortness of breath and heavy sweating.

Diagnosis

When pneumonia is suspected, a comprehensive diagnosis is important:

• X-ray of the lungs. Recommended both for suspected disease and a month after treatment. X-ray allows you to see parenchymal (focal, diffuse) blackouts, to consider the pulmonary pattern (it is enhanced during infiltration).
• X-ray computed tomography of the chest. Most often prescribed if the X-ray of the lungs does not show the dynamics, and for some reason the treatment does not help the patient, or it is important for the doctor to examine the lungs of patients in those sections in which they are poorly accessible on the X-ray.
• Laboratory diagnostics. An important role is played by a complete blood count (especially leukocytes), a biochemical blood test and a sputum test.

• Bronchospasm. Endoscopic method. It is used if you need to find out if it is really pneumonia or an anatomical anomaly of the lung, a foreign object in the airways, a tumor.

In some cases, an ultrasound of the heart is additionally performed. Especially if there is a suspicion that not only the lungs, but also the heart muscle are inflamed.

Treatment

Treatment is based on stopping the cause of the disease, relieving symptoms and maintaining body reserves:

• Anti-infective drug therapy. Drugs are selected strictly based on what is the pathogen. Therefore, therapy can be antibacterial, antiviral, antifungal.

Among antibacterial drugs, amoxicillin, macrolides, cephalosporins, cephalosporins, fluoroquinolones, carbapenems, aminoglycosides give a good effect. If pneumonia is mixed or the exact pathogen is not identified, sometimes several drugs are combined. If pneumonia is of a viral nature, anciclovir, cidofovir is prescribed. Foscarnet and other drugs. It all depends on the type of virus. With fungal pneumonia, antimycotic drugs are prescribed. With an unknown pathogen, a combined antibiotic therapy of 2-3 drugs is prescribed. The course of treatment can last from 7-10 to 14 days, it is possible to change the antibiotic.

• Symptomatic therapy. As symptoms, patients with pneumonia are prescribed expectorant, antipyretic, antihistamine (antiallergic) drugs.
• Physiotherapy. This type of treatment is relevant only at the stage when there is no fever. Effective options for physiotherapy – UHF, massage, electrophoresis.

Prognosis

For a long time, most pneumonias were associated with a risk of death. But with the development of pharmacology, the advent of antibiotics, antiviral and antimycotic agents, if treatment is started in a timely manner, in most cases, especially if a person does not have chronic diseases, the prognosis is favorable.

The main thing is that the cause of the disease (bacteria, viruses, fungus) should be identified in a timely manner and drug therapy should be started on time.

Timely treatment is also the minimization of complications. The main thing is to take into account the general condition of the patient, comorbidities. The greatest risk of complications is in the elderly, children under 5 years of age, people with chronic diseases of the heart, respiratory tract, kidneys, and weakened immune systems.

The best result of treatment and a favorable prognosis is provided by complex treatment in a hospital setting.

Prevention

One of the main methods of pneumonia is vaccination. There is no universal vaccine for pneumonia. But a very good result is given by vaccinations of pneumococcus (the most common causative agent of bacterial pneumonia) and from influenza.

Vaccination against pneumococcus and influenza is especially indicated for people from high-risk groups:

• people over 65;
• suffering from bronchial asthma, chronic bronchitis,
• after myocardial infarction,
• persons with ischemic heart disease, cardiomyopathies.

Also (with strict control and assessment of the situation by an infectious disease specialist) such vaccinations can be indicated for people with severe liver diseases and HIV.

An extremely important element of prevention is breathing exercises. If a person regularly does breathing exercises, then his ventilation of the lungs improves significantly, it is easier for him to monitor his breathing, the respiratory apparatus strengthens, accumulated sputum regularly leaves (and there is no risk of congestion).

It is better to start with breathing exercises in the supine position of the body

1. Put your left hand on your stomach, your right hand on your sternum. Inhale and inflate your belly. Then exhale slowly with the maximum possible retraction of the abdomen. At the first lesson, repeat the exercise for one minute. After three weeks, do the exercise for 3 minutes.
2. Inhale the air and clearly pronounce the sounds “ha”, “m”, “r” and “g”. The exercise time, as in the previous case, is from 1 to 3 minutes.

If the exercises are well tolerated, you can take on more complex options: for example, try the exercises from the Strelnikova complex or practice yoga.

Since pneumonia can have a different nature, and its course is possible in different forms, the approach to diagnosis, prevention, and treatment should be comprehensive. It is best to treat pneumonia not at home, but in a hospital setting. Extensive experience in the treatment of pneumonia – the doctors of the pulmonology department of the 5th hospital in Minsk. The hospital has a comprehensive diagnostic base. There are experienced doctors on staff. Including, in addition to pulmonologists, the hospital has an excellent staff of cardiologists, which is important to minimize the risk of complications. There are all conditions for treatment and rehabilitation.

Our tips for quick recovery

Content Nice

• 1.4.1 Hospitalization
• 1.4.2 Course of treatment
• 1.4.3 Restoration after treatment

1. 8 About the need for rest with pneumonia

Find out how to correctly diagnose and treat pneumonia! The article presents the main symptoms, causes of the disease and tips for caring for the sick.

Pneumonia is a serious disease that causes inflammation of the lungs. Most patients with this diagnosis have unpleasant symptoms such as coughing, chest stiffness, and shortness of breath that may linger for weeks or months. How to quickly defeat this disease?

By following the advice of experts on the treatment of pneumonia, you can shorten your recovery time and avoid possible complications. In this article, we will share with you several methods that will help you quickly deal with this disease and return to a normal lifestyle.

It is important to remember that every body is different and it is much better if you consult your doctor before starting any treatment. However, these tips can help you recover faster and improve your health while fighting pneumonia.

Introduction to pneumonia

Pneumonia is an infectious lung disease caused by various pathogens, including bacteria, viruses, fungi, and others. Pneumonia is always accompanied by inflammation of the lung tissue, which leads to impaired lung function and a deterioration in the general condition of a person. Depending on the type of pathogen and the severity of the disease, pneumonia can occur in various forms and cause different symptoms.

Signs of pneumonia

The main symptoms of pneumonia include:

• severe chest pain worsened by deep breathing;
• cough with expectoration, usually greenish or yellowish;
• fever up to 38-39 degrees;
• Karaculosis, rapid breathing;
• general weakness and fatigue, loss of appetite, sleep disturbance.

If these symptoms appear, you should consult a doctor for diagnosis and treatment. In most cases, pneumonia is treated in a hospital, using antibiotics and other medications.

Symptoms of pneumonia

Pneumonia is a serious illness that requires immediate medical attention. Among the main symptoms of pneumonia are:

1. Cough – usually begins as dry, then becomes mucous or mucopurulent.
2. Shortness of breath – may occur even at rest.
3. Chest pain – usually located on the side of the lung affected.
4. Weakness and fatigue – increases with time, especially after physical activity.
5. High temperature – can reach 39-40 degrees.
6. Cold sweat and shivering – usually observed in the first days of the disease.

If you experience more than one of these symptoms, see your doctor for professional medical attention and treatment as soon as possible. Early contact with a doctor and timely treatment will help prevent complications and return to a healthy life faster.

Less than 1.5 liters

0%

1.5-2 liters

0%

More than 2 liters

0% 019

Pneumonia is a serious lung disease that requires immediate treatment. However, in order to begin treatment, it is necessary to correctly diagnose. How it’s done?

• Medical examination . If you have symptoms of pneumonia, the first thing to do is to see a doctor. The doctor will examine and listen to the patient’s complaints.
• Laboratory tests . To make a diagnosis of pneumonia, laboratory tests of blood, sputum, and bacteriological studies may be required.
• Chest x-ray . An x-ray machine allows you to see changes in the lungs, which is the main method for diagnosing pneumonia.

Signs of pneumonia can vary, so do not self-diagnose. If you feel a deterioration in health and suspect that you have pneumonia, consult a doctor and go through all the necessary examinations.

Treatment of pneumonia in hospital

Hospitalization

If pneumonia is suspected, the doctor may order hospitalization. This is because sometimes home treatments may not be effective enough and more serious treatment is needed.

Course of treatment

Treatment of pneumonia in the hospital is carried out by medical specialists and depends on the severity of the disease. Usually, in the early stages of treatment, it is focused on treating the symptoms and eliminating the causes that caused pneumonia. Of the main methods of treatment can be distinguished:

• Antibiotics
• Glucocorticosteroids
• Breathing exercises
• Oxygen therapy
• Nebulization
• Surgery (in extreme cases)

900 43

Recovery after treatment

After discharge from the hospital, the recommendations of medical specialists should be fully implemented, as pneumonia can recur. The rehabilitation process after treatment is a gradual recovery of the body with the help of special sets of measures: proper nutrition, exercise, adherence to the daily routine and other factors that affect the medical result.

Pneumonia home treatment

Pneumonia home treatment is only possible for mild cases. But before taking any measures, it is necessary to consult a doctor and follow his recommendations.

When prescribing treatment, the doctor may prescribe antibiotics, antivirals, mucolytics, etc. It is also important to observe the regime of drinking and eating. It is necessary to drink plenty of fluids and avoid fatty and heavy foods, as well as limit the consumption of alcohol and smoking.

To facilitate breathing, you can use inhalations, foot bathing with soda, therapeutic compresses on the chest, massage. However, it is important not to abuse alternative methods of treatment and not to postpone a visit to the doctor if the condition worsens.

• Drink plenty of fluids (water, juices, compotes).
• Observe the diet (refuse fatty and junk food).
• Take antibiotics and other medicines prescribed by your doctor.
• Use inhalations, foot bathing with soda, therapeutic compresses on the chest, massage.
• Do not overuse traditional treatments and do not delay a visit to the doctor if the condition worsens.

How to take medicines for pneumonia

When treating pneumonia, it is important to strictly follow the doctor’s recommendations and take the medicines correctly. First of all, it is necessary to take anti-inflammatory and antibacterial drugs, which must be recognized by a doctor. Observe the dosage and frequency of administration, do not skip medications, even if the symptoms begin to decrease.

It is important to understand that antibiotics can be combined with probiotics in order to preserve the normal microflora of the gastrointestinal tract. However, the intake of these drugs must be coordinated with the doctor.

If you are taking multiple medications, remember to periodically pause between two medications taken at the same time. This will help reduce the burden on the liver and kidneys.

Some medicines must be taken before meals and others after. Carefully study the instructions and do not call for medicines on the “tooth” – this can increase the risk of side effects.

Do not take any additional medicines without your doctor’s approval, even if these medicines have previously helped you get rid of other diseases. The doctor will select the drug, taking into account the complexity of the treatment and the degree of lung damage.

What to do if pneumonia does not go away

Pneumonia is a serious disease that requires proper treatment and management. If you find that your pneumonia is not getting better, there are a few things you can do.

• See a doctor . If you notice that your symptoms are not improving, or even getting worse, do not hesitate to contact your doctor. He may change your treatment regimen or prescribe more powerful medications for a faster recovery.
• Follow doctor’s advice . When you seek help from a doctor, it is very important to follow all his recommendations. He may prescribe a special dietary regimen and exercise to maintain lung health, which must be followed.
• Change the day mode . With pneumonia, it is recommended to remain calm and not overload the body. But if you feel that your body can no longer stay in bed, then you can change your daily routine. For example, you can do moderate exercise or learn to meditate.
• Use folk remedies . Some folk remedies can help fight pneumonia. For example, you can drink herbal teas, use mustard plasters or use herbal tinctures. But before using any folk remedies, it is recommended to consult a doctor.
• Maintain your immunity . A strong immune system will help you fight many diseases more effectively, including pneumonia. Therefore, it is recommended to consume more vitamins, minerals and other nutrients that help strengthen immunity.

About the need for rest in case of pneumonia

Pneumonia is a serious lung disease that can lead to unpredictable consequences if not properly or insufficiently treated. One of the main factors of recovery is rest, which is necessary for the patient both in the early stages of the disease and during treatment.

With pneumonia, the body begins to fight the disease-causing microbe that has entered the lungs, which entails a large load on the immune system. During an illness, it is important to give the body the opportunity to concentrate on fighting the infection, so it is recommended to stay in bed and avoid physical activity.

It is important to start resting on time and not abuse active leisure until the period of complete recovery has passed. A weakened body may not be able to withstand long walks, sports, or other physical activities.

In addition, it is very important to take your medicines regularly and follow your diet during the pneumonia period. All this will not be enough if you do not give your body a rest.

By following your doctor’s advice, resting, and taking care of your body, you can quickly return to your normal life. Take care of your health, watch how you feel and don’t forget that proper rest is all you need to recover!

Pneumonia diet: what you need to know

When you have pneumonia, it is very important to watch your diet so that the body can quickly cope with the disease and get the necessary nutrients. There are certain foods that should be eliminated from the diet, as well as those that, on the contrary, can help the body fight infection.

What not to eat

• Fatty meats and fish
• Fat-rich broths
• Sweets and confectionery
• Fast food and prepared meals
• Spicy and fried foods
• Alcoholic beverages

What you can eat

The following foods will help the body recover faster:

• Vegetables and fruits (especially those rich in vitamin C)
• Chicken meat and turkey
• Fish (especially those rich in omega-3 acids)
• Protein (eggs, legumes, etc.)
• Dairy products (kefir, yogurt, cottage cheese)

the amount of nutrients. However, do not forget that during the period of illness a person may lose his appetite, so it is important to monitor the amount of consumed substances. Also, be sure to drink enough water to help the body get rid of toxins and speed up the healing process.



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Q&A:

What is pneumonia and how is it treated?

Pneumonia is an infectious disease of the lungs. Treatment should only be carried out under medical supervision. Antibiotics and anti-inflammatory drugs are prescribed, and symptoms are treated.

I feel weak and short of breath. Could this be pneumonia?

Yes, these symptoms may be related to pneumonia. It is necessary to consult a doctor and undergo a diagnosis in order to avoid complications and start treatment on time.

What folk remedies help with pneumonia?

Folk remedies can help with pneumonia only as an additional remedy. For example, juniper water, resin ointment, propolis. But it is important to note that they do not replace drug therapy.

What should be the regimen for pneumonia?

Pneumonia requires bed rest and rest. It is recommended to increase fluid intake in order to facilitate the excretion of sputum. It is also important to reduce physical activity.

What diet should be followed for pneumonia?

If you have pneumonia, increase your intake of protein, vitamins, and minerals to help your body fight infection. It is recommended to eat light but nutritious foods such as broths, jelly, eggs, dairy products and fruits.

Is it possible to play sports during the treatment of pneumonia?

It is not recommended to play sports during the treatment of pneumonia, as this can aggravate the disease and lead to complications. In any case, before starting any physical activity, you should consult your doctor.

Habits that can help you recover from pneumonia

Recovering from pneumonia takes time and effort, but there are habits that can help speed up the recovery process.

Breathing exercises

After pneumonia, the lungs may be weak and unable to fully ventilate, which can lead to coughing, shortness of breath and other breathing problems. Regular breathing exercises can strengthen lung function and bring it back to normal.

Nutrition

A healthy and balanced diet can help your body recover from pneumonia. Include more vegetables, fruits, protein foods and healthy fats in your diet. Drinking enough fluids is also very important to remove toxins from the body and keep the whole system working.

Rest

After an illness, it often seems to us that we have fully recovered and can return to the usual rhythm of life. However, it is important to understand that our body has been weakened, and it needs time to fully recover. Try to get enough sleep and rest to give your body a chance to fight off the infection and fully recover.

Medication adherence

If your doctor has prescribed medication, it is important that you take it regularly and as directed. This will help speed up recovery and prevent possible complications. Remember that the absence of symptoms does not mean a complete recovery, so continue taking your medications even after you feel better.

• Total: If you have been diagnosed with pneumonia, don’t despair. Although recovery may take time, the habits listed above will help you feel better and get back to your normal life sooner.

Pneumonia Prevention

To avoid getting sick, there are certain precautions you need to take:

• Strengthen your body – Proper nutrition, regular exercise and a healthy lifestyle strengthen the immune system and help fight possible diseases, including pneumonia.
• Avoid crowds – The more people around you, the more likely you are to contract viruses and bacteria.
• Maintain hand hygiene – Frequent hand washing before eating and after contact with other people and objects will help reduce the risk of infection.