What are the main types of bacteria that cause pneumonia. How can you recognize the symptoms of bacterial pneumonia. What are the most effective prevention methods for bacterial pneumonia. How is bacterial pneumonia diagnosed and treated. Who is at higher risk for developing bacterial pneumonia. What are the global impacts of pneumonia, especially on children. How can pneumonia be prevented in children worldwide.

Understanding Bacterial Pneumonia: A Comprehensive Overview

Bacterial pneumonia is a serious lung infection caused by various bacteria, with Streptococcus pneumoniae (pneumococcus) being the most common culprit. This condition occurs when bacteria invade the lungs, causing inflammation and fluid buildup in the air sacs (alveoli). While these bacteria can harmlessly reside in the throat of healthy individuals, they can become problematic if the body’s immune defenses are compromised.

How Does Bacterial Pneumonia Develop?

The progression from harmless bacteria to a full-blown lung infection involves several steps:

1. Bacteria colonize the throat
2. Weakened immune system allows bacterial spread
3. Bacteria travel to the lungs
4. Infection and inflammation of the alveoli
5. Fluid accumulation in the lungs

This process can lead to severe respiratory issues and other complications if left untreated.

Identifying High-Risk Groups for Bacterial Pneumonia

Certain populations are more susceptible to developing bacterial pneumonia. Understanding these risk factors can help in prevention and early intervention.

Who is Most at Risk?

• Adults aged 65 and older
• Individuals with chronic conditions (asthma, diabetes, heart disease)
• Post-surgery patients
• Those with poor nutrition or vitamin deficiencies
• Immunocompromised individuals
• Smokers and heavy alcohol consumers
• People with viral pneumonia
• Recent organ transplant recipients
• HIV-positive individuals
• Patients with leukemia, lymphoma, or severe kidney disease

Recognizing these risk factors can prompt early medical intervention and preventive measures.

Recognizing the Symptoms of Bacterial Pneumonia

Bacterial pneumonia can manifest quickly or develop gradually over several days. Being aware of the symptoms is crucial for timely diagnosis and treatment.

Common Symptoms to Watch For:

• High fever (up to 105°F)
• Productive cough with colored mucus
• Severe chills and shaking
• Shortness of breath, especially during movement
• Extreme fatigue
• Decreased appetite
• Sharp chest pain, particularly when coughing or breathing deeply
• Profuse sweating
• Rapid breathing and heart rate
• Bluish tint to lips and fingernails
• Confusion, particularly in older adults

Is rapid onset of symptoms always indicative of bacterial pneumonia? While sudden symptom development can occur with bacterial pneumonia, it’s not always the case. Some individuals may experience a gradual worsening of symptoms over several days. The key is to seek medical attention if you experience any combination of these symptoms, regardless of their onset speed.

Preventive Measures Against Bacterial Pneumonia

Prevention plays a crucial role in combating bacterial pneumonia. Vaccination and lifestyle changes are two primary strategies for reducing the risk of infection.

Vaccination Options

Two main types of pneumococcal vaccines are available:

1. PCV13 (Prevnar 13): Recommended for:
   • Adults 65 and older
   • Children under 5
   • High-risk individuals
2. PPSV23 (Pneumovax): Advised for:
   • Adults 65 and older
   • Children over 2 at high risk
   • Smokers and asthmatics aged 19-64

Do these vaccines provide complete protection against all types of pneumonia? While these vaccines are highly effective against the most common strains of pneumococcal bacteria, they don’t protect against all types of pneumonia. However, they significantly reduce the risk of severe pneumococcal disease and its complications.

Lifestyle Modifications for Prevention

In addition to vaccination, several lifestyle changes can help reduce the risk of bacterial pneumonia:

• Quit smoking
• Limit alcohol consumption
• Maintain a balanced diet rich in vitamins and minerals
• Exercise regularly to boost overall health
• Practice good hygiene, including frequent handwashing
• Get adequate sleep to support immune function
• Manage chronic health conditions effectively

By incorporating these preventive measures, individuals can significantly reduce their risk of developing bacterial pneumonia.

Diagnostic Approaches for Bacterial Pneumonia

Accurate diagnosis of bacterial pneumonia is crucial for effective treatment. Healthcare providers employ various methods to confirm the presence of the infection and determine its severity.

Primary Diagnostic Tools

1. Physical Examination: Doctors listen to lung sounds using a stethoscope to detect fluid accumulation.
2. Chest X-ray: This imaging test can reveal areas of infection in the lungs.
3. Pulse Oximetry: A non-invasive test to measure blood oxygen levels.
4. Blood Tests: These can help identify the presence of infection and determine its severity.
5. Sputum Tests: Analysis of coughed-up mucus can identify the specific bacteria causing the infection.
6. CT Scan: For a more detailed view of the lungs, especially in complex cases.

Why is a combination of diagnostic methods often necessary? Each diagnostic tool provides different information about the infection. While a physical exam and chest X-ray can indicate the presence of pneumonia, blood tests and sputum analysis help identify the specific pathogen and guide treatment choices. In some cases, a CT scan may be needed for a more comprehensive evaluation, especially if complications are suspected or the diagnosis is unclear.

Treatment Strategies for Bacterial Pneumonia

Once diagnosed, bacterial pneumonia requires prompt and appropriate treatment to prevent complications and promote recovery.

Primary Treatment Approaches

• Antibiotic Therapy: The cornerstone of treatment for bacterial pneumonia.
• Pain and Fever Management: Over-the-counter medications to alleviate discomfort.
• Rest and Hydration: Essential for supporting the body’s healing process.
• Humidification: To help loosen mucus and ease breathing.

How long does it typically take to recover from bacterial pneumonia? While many patients start feeling better within a few days of starting antibiotics, complete recovery can take several weeks. It’s crucial to finish the entire course of antibiotics as prescribed, even if symptoms improve, to prevent antibiotic resistance and ensure all bacteria are eliminated.

Severe Cases and Hospitalization

In severe cases or for high-risk individuals, hospitalization may be necessary. Hospital treatments can include:

• Intravenous (IV) antibiotics
• Oxygen therapy
• Intravenous fluids for hydration
• Respiratory treatments to help clear the lungs

Hospitalization allows for close monitoring and more intensive treatment, particularly for those with severe symptoms or underlying health conditions.

Global Impact of Pneumonia: A Focus on Children

Pneumonia remains a significant global health concern, particularly affecting children in developing countries. Understanding its impact is crucial for implementing effective prevention and treatment strategies worldwide.

Pneumonia’s Toll on Child Health

• Leading cause of death in children under 5 years old
• Responsible for 740,180 child deaths in 2019
• Accounts for 14% of all under-5 deaths globally
• Disproportionately affects South Asia and sub-Saharan Africa

Why does pneumonia have such a significant impact on children in certain regions? Several factors contribute to the high mortality rate among children in developing countries, including:

• Limited access to healthcare
• Malnutrition
• Lack of safe drinking water and sanitation
• High prevalence of other infectious diseases
• Limited vaccination coverage

These factors create a perfect storm for pneumonia to thrive and cause severe complications in young children.

Prevention Strategies for Children Worldwide

Despite the challenges, pneumonia in children is largely preventable with simple interventions:

1. Vaccination: Immunization against common pneumonia-causing pathogens like Streptococcus pneumoniae and Haemophilus influenzae type b (Hib).
2. Improved Nutrition: Ensuring adequate nutrition, including breastfeeding for infants, to boost immune function.
3. Clean Environment: Providing access to clean water and improving sanitation to reduce exposure to pathogens.
4. Indoor Air Quality: Reducing indoor air pollution, particularly from cooking fires.
5. Healthcare Access: Improving access to basic health services and early treatment of respiratory infections.

Implementing these strategies on a global scale could significantly reduce the burden of pneumonia on children’s health.

Emerging Research and Future Directions in Pneumonia Management

As our understanding of bacterial pneumonia evolves, new research continues to shape prevention, diagnosis, and treatment strategies. Staying informed about these developments is crucial for healthcare providers and patients alike.

Advancements in Pneumonia Research

• Rapid Diagnostic Tests: Development of quick, accurate tests for identifying specific pneumonia-causing pathogens.
• Novel Antibiotics: Research into new antibiotic formulations to combat resistant strains of bacteria.
• Immunotherapy: Exploring the use of immune-boosting treatments to enhance the body’s natural defenses against pneumonia.
• Personalized Medicine: Tailoring treatment approaches based on individual patient characteristics and the specific pathogen involved.
• Microbiome Studies: Investigating the role of the lung microbiome in pneumonia susceptibility and recovery.

How might these advancements change the landscape of pneumonia treatment in the coming years? The integration of rapid diagnostics could lead to more targeted antibiotic use, potentially reducing the risk of antibiotic resistance. Personalized treatment approaches may improve outcomes by considering factors such as genetic predisposition and individual immune responses. Additionally, a better understanding of the lung microbiome could open up new avenues for prevention and treatment strategies.

Global Health Initiatives

Several global health initiatives are focusing on reducing the burden of pneumonia, especially in vulnerable populations:

1. Expanded Vaccination Programs: Efforts to increase access to pneumococcal and Hib vaccines in low-income countries.
2. Integrated Management of Childhood Illness (IMCI): WHO and UNICEF’s strategy to improve child health in resource-limited settings.
3. Clean Cooking Initiatives: Programs to reduce indoor air pollution from traditional cooking methods.
4. Health System Strengthening: Efforts to improve healthcare infrastructure and access in developing countries.

These initiatives aim to address the multifaceted challenges of pneumonia prevention and treatment on a global scale.

As research progresses and global health efforts continue, the outlook for managing bacterial pneumonia is becoming increasingly optimistic. However, continued vigilance, research investment, and global cooperation are essential to further reduce the impact of this significant health threat.

Bacterial Pneumonia: Symptoms, Causes, Treatment, Prevention

Bacterial pneumonia is an infection of your lungs caused by certain bacteria. The most common one is Streptococcus (pneumococcus), but other bacteria can cause it too. If you’re young and basically healthy, these bacteria can live in your throat without causing any trouble. But if your body’s defenses (immune system) become weak for some reason, the bacteria can go down into your lungs. When this happens, the air sacs in your lungs get infected and inflamed. They fill up with fluid, and that causes pneumonia.

You have a higher risk of getting bacteria pneumonia if you:

• Are 65 or older
• Have other conditions like asthma, diabetes, or heart disease
• Are recovering from surgery
• Don’t eat right or get enough vitamins and minerals
• Have another condition that weakens your body’s defenses
• Smoke
• Drink too much alcohol
• Have viral pneumonia

People who have a weakened immune system also have an increased risk for bacterial pneumonia. These include those who recently had an organ transplant. People who are HIV positive, or who have leukemia, lymphoma, or severe kidney disease also stand a greater chance of developing the infection.

Symptoms

The symptoms can come on fast and furious, or they can creep up on you over a few days. Common symptoms are:

• High fever up to 105 F
• Coughing out greenish, yellow, or bloody mucus
• Chills that make you shake
• Feeling like you can’t catch your breath, especially when you move around a lot
• Feeling very tired
• Low appetite
• Sharp or stabby chest pain, especially when you cough or take a deep breath
• Sweating a lot
• Fast breathing and heartbeat
• Lips and fingernails turning blue
• Confusion, especially if you’re older

Prevention

There are two kinds of shots for bacterial pneumonia:

PCV13 (Prevnar 13) is for:

• People 65 or older
• Kids under 5 years
• People who have a high risk of bacterial pneumonia

PPSV23 (Pneumovax) is for:

• People 65 or older
• Children older than 2 who have a high risk of bacterial pneumonia
• People between 19 and 64 who smoke or have asthma

Talk to your doctor to find out if you or your child should get a shot.

Besides getting shots, you can lower your risk of getting bacterial pneumonia by doing these things:

Diagnosis

Your doctor might be able to tell if you have bacterial pneumonia just by examining you and asking questions about your symptoms and general health. They’ll probably listen to your lungs with a stethoscope. That will allow them to hear sounds that show there’s fluid in your lungs. But if they are not sure, you might have to get a chest X-ray.

Some people may need extra tests. These might include:

• Pulse oximetry (a small gizmo clipped to your finger that checks for enough oxygen in your blood)
• Blood tests
• Tests of the gunk you cough up (“sputum”)
• CT scan to look more closely at your lungs

Treatment

Your doctor probably will prescribe antibiotics. It’s very important that you finish all of these. Otherwise the bacteria may not all be killed and you could get sick all over again. Your doctor might also suggest medication for pain and fever.

Other things you can do to help yourself get better:

• Get lots of rest.
• Drink plenty of fluids (they’ll loosen up the gunk in your lungs so you can cough it out).
• Use a humidifier or take a warm bath (more gunk-loosening).
• Don’t smoke.
• Stay home until your fever goes down and you aren’t coughing anything out.

Most people who are treated for bacterial pneumonia start feeling better in a few days, but it can take a few weeks before you feel 100% better. Make sure you keep your follow-up appointments so your doctor can check your lungs.

If the pneumonia is stubborn or severe, you might have to go to the hospital. If you go to the hospital you might get:

• Oxygen treatment
• IV fluids and medications
• Treatments to help loosen up the gunk

Pneumonia

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.

Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed 740 180 children under the age of 5 in 2019, accounting for 14% of all deaths of children under five years old but 22% of all deaths in children aged 1 to 5. Pneumonia affects children and families everywhere, but deaths are highest in South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be prevented with simple interventions, and treated with low-cost, low-tech medication and care.

Causes

Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:

• Streptococcus pneumoniae – the most common cause of bacterial pneumonia in children;
• Haemophilus influenzae type b (Hib) – the second most common cause of bacterial pneumonia;
• respiratory syncytial virus is the most common viral cause of pneumonia;
• in infants infected with HIV, Pneumocystis jiroveci is one of the most common causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.

Transmission

Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child’s nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this is of critical importance for treatment and prevention.

Presenting features

The presenting features of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. In children under 5 years of age, who have cough and/or difficult breathing, with or without fever, pneumonia is diagnosed by the presence of either fast breathing or lower chest wall indrawing where their chest moves in or retracts during inhalation (in a healthy person, the chest expands during inhalation). Wheezing is more common in viral infections.

Very severely ill infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.

Risk factors

While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child’s immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.

Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child’s risk of contracting pneumonia.

The following environmental factors also increase a child’s susceptibility to pneumonia:

• indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)
• living in crowded homes
• parental smoking.

Treatment

Pneumonia should be treated with antibiotics. The antibiotic of choice for first line treatment is amoxicillin dispersible tablets. Most cases of pneumonia require oral antibiotics, which are often prescribed at a health centre. These cases can also be diagnosed and treated with inexpensive oral antibiotics at the community level by trained community health workers. Hospitalization is recommended only for severe cases of pneumonia.

Prevention

Preventing pneumonia in children is an essential component of a strategy to reduce child mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.

Adequate nutrition is key to improving children’s natural defences, starting with exclusive breastfeeding for the first 6 months of life. In addition to being effective in preventing pneumonia, it also helps to reduce the length of the illness if a child does become ill.

Addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.

In children infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of contracting pneumonia.

Economic costs

The cost of antibiotic treatment for all children with pneumonia in 66 of the countdown to 2015 countries for maternal, newborn and child survival is estimated at around US$ 109 million per year. The price includes the antibiotics and diagnostics for pneumonia management.

WHO response

The WHO and UNICEF integrated Global Action Plan for Pneumonia and Diarrhoea (GAPPD) aims to accelerate pneumonia control with a combination of interventions to protect, prevent, and treat pneumonia in children with actions to:

• protect children from pneumonia including promoting exclusive breastfeeding and adequate complementary feeding;
• prevent pneumonia with vaccinations, hand washing with soap, reducing household air pollution, HIV prevention and cotrimoxazole prophylaxis for HIV-infected and exposed children;
• treat pneumonia focusing on making sure that every sick child has access to the right kind of care — either from a community-based health worker, or in a health facility if the disease is severe — and can get the antibiotics and oxygen they need to get well;

A number of countries including Bangladesh, India, Kenya, Uganda and Zambia have developed district, state and national plans to intensify actions for the control of pneumonia and diarrhoea. Many more have integrated diarrhoea and pneumonia specific action into their national child health and child survival strategies.

Effective diagnosis and treatment of pneumonia is critical to improve child survival. In order to meet the Sustainable Development Goal targets for SDG 3.2.1 – reducing child mortality – ending preventable diarrhoea and pneumonia-related deaths is an urgent priority. 

Community-Acquired Pneumonia in Adults | Cedars-Sinai

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What is community-acquired pneumonia?

Pneumonia is a type of lung infection. It can cause breathing problems and other symptoms.
In community-acquired pneumonia (CAP), you get infected in a community setting. It
doesn’t happen in a hospital, nursing home, or other healthcare center.

Your lungs are part of your
respiratory system. This system supplies fresh oxygen to your blood and removes carbon
dioxide, a waste product. When you breathe in air through your nose and mouth, it
reaches the tiny air sacs of the lung (alveoli) through a series of tubes. From here,
oxygen flows into your blood. Carbon dioxide flows out from the blood into the alveoli
and you then breathe it out.

Many germs can grow inside your
body and cause disease. Specific types of germs can cause lung infection and pneumonia
when they invade. This can cause your respiratory system to work poorly. For example,
oxygen may not be able to get into your blood as easily. That can cause shortness
of
breath. If your body can’t get enough oxygen to survive, pneumonia may lead to
death.

Sometimes these germs can spread
from person to person. When someone infected with one of these germs sneezes or coughs,
you might breathe the germs into your lungs. If your immune system doesn’t kill the
germs first, the germs might grow and cause pneumonia.

CAP can result from infection with many types of germs. These include bacteria, viruses,
fungi, or parasites. Symptoms from pneumonia can range from mild to severe. Certain
types of germs are more likely to lead to serious infection.

CAP is more common during the
winter months, in older adults. But it can affect people of any age. It can be very
serious especially in older adults, young children or people with other health
problems.

What causes community-acquired pneumonia?

Many different types of germs can
cause pneumonia. But certain types cause CAP more often. Worldwide, Streptococcus
pneumoniae is a bacteria that is most often responsible for CAP in adults. Some other
common bacteria that cause CAP are:

• Haemophilus influenzae
• Mycoplasma pneumoniae
• Chlamydia pneumoniae
• Legionella
• Gram-negative bacilli
• Staphylococcus aureus

The flu (influenza) virus is the
major viral cause of CAP. Having the flu also makes you more likely to get bacterial
pneumonia. This type is often worse than viral pneumonia. Other types of viruses can
also cause CAP, such as parainfluenza virus, echovirus, adenovirus, and coxsackievirus.
In fact, viruses are likely responsible for most episodes of CAP. Fungi and parasites
may also cause CAP.

Who is at risk for community-acquired pneumonia?

Certain things may raise your risk for CAP. Some of these are:

• Smoking
• Weak immune system, such as from drug
  treatment or a health problem like diabetes, cancer, or HIV
• Other lung problems such as chronic obstructive pulmonary disease
• Other health problems such as kidney failure
• Use of certain medicines, including proton-pump inhibitors
• Heavy alcohol use

You also have a higher risk if you come into contact with other people who have pneumonia.

What are the symptoms of community-acquired pneumonia?

Symptoms of CAP often develop quickly. These symptoms may include:

• Shortness of breath
• Coughing
• Heavy sputum
• Fever and chills
• Chest pain that is worse when you breathe or cough
• Upper belly (abdomen) pain with
  nausea, vomiting, or diarrhea

Your healthcare provider might
notice other signs. These are a fast heartbeat, fast breathing rate, or certain sounds
on a lung exam.

How is community-acquired pneumonia diagnosed?

Your healthcare provider will ask about your more recent symptoms and your past health
problems. He or she will also do a physical exam, including a careful exam of your
lungs.

Lab tests can be very helpful in diagnosing CAP. Some tests you might need are:

• Chest X-ray, which often confirms the diagnosis
• Blood tests to check for infection and oxygen status of your blood
• Blood culture tests to see if a germ is growing in your bloodstream
• Tests of your sputum to see if a germ is present there

How is community-acquired pneumonia treated?

Your treatment may vary based on your symptoms and the type of germ causing the pneumonia.
If you have severe pneumonia, you will likely need to stay in the hospital for some
time. If you only have mild symptoms, you can probably get treatment at home.

Antibiotics are a key treatment for
bacterial CAP. Your healthcare provider will likely start you on this medicine even
before identifying the type of bacteria (or other germ). The type of antibiotic can
vary
based on the germs known to be in your community, as well as your other health problems.
Your healthcare provider will want to treat you with an antibiotic that is likely
to
kill whatever germ is causing your illness. But antibiotics don’t help in treating
viral
pneumonia and can often cause more harm than good.

If you are getting treatment at
home, you will probably take an antibiotic by mouth for 5 to 7 days. In most cases,
you
will start to feel better a few days after you start treatment.

If you need to stay in the hospital, you will also need antibiotics specific to your
case. In some cases, you may need to take these by IV (intravenously). Your healthcare
provider might first start you on a certain antibiotic and then switch you to another
one as your blood tests show what kind of germ is causing your infection. You may
also need extra support, such as:

• Extra oxygen
• Fluids, if you are dehydrated
• Breathing treatments
• Respiratory support such as with a ventilator, for a severe case

Most people start responding to treatment within a few days. A small portion of people
who are treated in the hospital don’t respond to treatment within this time. If your
symptoms don’t end, you may need a different antibiotic or treatment for complications
from CAP.

What are possible complications of community-acquired
pneumonia?

Lung abscess and, rarely, empyema are possible complications of CAP. In empyema, a
collection of pus builds in the space between the lung and the chest wall. You usually
need antibiotics and drainage to treat it. A CT scan can often help diagnose these
problems.

Respiratory failure and death are
other possible complications. These are more likely to happen in older adults or those
with other health problems.

What can I do to prevent community-acquired pneumonia?

You can lower your chances of
getting CAP by having a yearly flu shot. The pneumococcal vaccines protect against
S.
pneumoniae and may help in preventing CAP. Healthcare providers advise this shot for
all
people older than 65. You may need it before this time if you have:

• Chronic heart, lung, liver, or kidney
  disease
• Diabetes
• Alcoholism
• HIV
• Weak immune system

Smokers and people living in
long-term care facilities should also get this shot before age 65. There are
two2vaccines against S. pneumoniae. Your healthcare provider may advise that you get
both. You may need booster shots of the vaccine if you have your first pneumococcal
vaccine before age 65 or if you have a weakened immune system.

Practicing good hygiene can also
help you lower your risk for CAP. That includes frequent handwashing.

When should I call my healthcare provider?

Get treatment right away if you
have symptoms of pneumonia. If you are being treated for CAP as an outpatient, call
your
healthcare provider if your symptoms don’t improve in a few days after starting
treatment, or they get worse.

Key points about community-acquired pneumonia

• Pneumonia is a type of lung infection. It can cause breathing problems and other symptoms.
  In CAP, infection occurs outside of a healthcare setting.
• CAP is a leading cause of death in older adults. Most healthy young adults recover
  from CAP without a problem.
• CAP can cause shortness of breath, fever, and cough.
• You might need to stay in the hospital to be treated for CAP.
• Most cases of CAP are caused by viruses and don’t require treatment with antibiotics.
• Antibiotics are the key treatment for most types of CAP caused by bacteria.
• Getting your vaccines as advised can
  help lower your risk for CAP.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells
  you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments,
  or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also
  know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you do not take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that
  visit.
• Know how you can contact your provider if you have questions.

Medical Reviewer: Barry Zingman MD

Medical Reviewer: Rita Sather RN

Medical Reviewer: L Renee Watson MSN RN

© 2000-2021 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional’s instructions.

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Symptoms, Treatment, Causes & Prevention

Overview

In a person with pneumonia, the airways (bronchi) swell and the air spaces (alveoli) fill with mucus and other fluids.

What is pneumonia?

Pneumonia is an infection in one or both of your lungs caused by bacteria, viruses or fungi. When there is an infection in the lungs, several things happen, including:

• Your airways swell (become inflamed)
• The air sacs in the lungs fill with mucus and other fluids

How do the lungs work?

Your lungs’ main job is to get oxygen into your blood and remove carbon dioxide. This happens during breathing. You breathe 12 to 20 times per minute when you are not sick. When you breathe in, air travels down the back of your throat and passes through your voice box and into your windpipe (trachea). Your trachea splits into two air passages (bronchial tubes). One bronchial tube leads to the left lung, the other to the right lung. For the lungs to perform their best, the airways need to be open as you breathe in and out. Swelling (inflammation) and mucus can make it harder to move air through the airways, making it harder to breathe. This leads to shortness of breath, difficulty breathing and feeling more tired than normal.

How common is pneumonia?

Approximately 1 million adults in the United States are hospitalized each year for pneumonia and 50,000 die from the disease. It is the second most common reason for being admitted to the hospital — childbirth is number one. Pneumonia is the most common reason children are admitted to the hospital in the United States. Seniors who are hospitalized for pneumonia face a higher risk of death compared to any of the top 10 other reasons for hospitalization.

Is pneumonia contagious?

Certain types of pneumonia are contagious (spread from person to person). Pneumonia caused by bacteria or viruses can be contagious when the disease-carrying organisms are breathed into your lungs. However, not everyone who is exposed to the germs that cause pneumonia will develop it.

Pneumonia caused by fungi are not contagious. The fungi are in soil, which becomes airborne and inhaled, but it is not spread from person to person.

How is pneumonia spread from person to person?

Pneumonia is spread when droplets of fluid containing the pneumonia bacteria or virus are launched in the air when someone coughs or sneezes and then inhaled by others. You can also get pneumonia from touching an object previously touched by the person with pneumonia (transferring the germs) or touching a tissue used by the infected person and then touching your mouth or nose.

How long do I remain contagious if I have pneumonia?

If you have bacterial pneumonia, you are still considered contagious until about the second day after starting to take antibiotics and you no longer have a fever (if you had one). If you have viral pneumonia, you are still considered contagious until you feel better and have been free of fever for several days.

Who is most at risk for getting pneumonia?

People who have an increased risk of pneumonia include:

• People over the age of 65 and infants under age 2. The weakening immune system of older people makes them less able to fight off illnesses. Similarly, the immune system of infants is still developing and not at full-strength, making them more susceptible to infection.
• People with a health-caused weakened immune system. Examples include:
• People who have health conditions that affect the lungs or heart. Examples include:
• People who have neurological conditions that make swallowing difficult. These people are at risk for pneumonia caused by aspiration. Examples include:
• People who are in the hospital. In particular, people in the ICU or anyone recovering who spends a large amounts of time lying on their backs. This position allows fluids, mucus or germs to settle in the lungs. People who need ventilators to breathe are at even greater risk since they have a difficult time coughing up germs that could cause a lung infection.
• People who smoke or drink alcohol. Smoking damages lung tissue and long-term alcohol abuse weakens the immune system.
• People who are exposed to toxic fumes, chemicals or secondhand smoke. These contaminants weaken lung function and make it easier to develop a lung infection.
• Pregnant women. Being pregnant increases the risk of developing pneumonia. This is due to the immune system of a mother not working at full strength because the body is working harder to support the growth of the baby.

Symptoms and Causes

What causes pneumonia?

Pneumonia can be caused by a wide variety of bacteria, viruses or fungi. Pneumonia is most commonly classified by the type of germ that causes it and by the location where the person became infected.

Community-acquired pneumonia is the most common type of pneumonia. This type of pneumonia occurs outside of a hospital or other healthcare facility. Causes include:

• Bacteria: Streptococcus pneumoniae is the most common bacterial cause of pneumonia.
• Mycoplasma pneumoniae and other atypical bacteria: Other types of bacteria with unique features can cause different types of pneumonia. These include Mycoplasma pneumoniae (causes “walking” pneumonia), Chlamydia pneumoniae (causes Chlamydia pneumonia) and Legionella pneumoniae (causes Legionnaires’ disease).
• Viruses: Any virus that causes a respiratory tract infection (infections of the nose, throat, trachea [windpipe], and lungs) can cause pneumonia. The viruses that cause colds and flu (influenza) can cause pneumonia.
• Fungi (molds): Pneumonia caused by fungi is the least common as pneumonia. Fungus in the soil in certain parts of the United States can become airborne and cause pneumonia. One example is valley fever.

Hospital-acquired pneumonia develops during a stay in the hospital for another illness. This type of pneumonia can be more serious because the person is already sick and antibiotics typically used may be less effective. Bacteria adapt and change over time when exposed to antibiotics, making them less effective (called antimicrobial resistance). People in hospitals spread their drug-resistant bacteria to others, leading to more severe and difficult-to-treat cases of pneumonia. People who are on breathing machines (ventilators) are at increased risk for hospital-acquired pneumonia.

Long-term care facility-acquired pneumonia occurs in long-term care facilities (such as nursing homes) or outpatient, extended-stay clinics. Like hospitalized patients, drug-resistant bacteria are found in this setting.

Aspiration pneumonia is another type of pneumonia. Aspiration is when solid food, liquids, saliva or vomit go down the trachea (windpipe) and into the lungs instead of going down the esophagus and into the stomach. If you can’t cough up these substances, these particles remain in lung tissue and can become infected and pneumonia may develop.

What are the signs and symptoms of bacterial versus viral pneumonia in adults?

Symptoms of pneumonia can range from mild (cold- or flu-like symptoms) sometimes called “walking pneumonia” to severe. How serious your case of pneumonia depends on the particular germ causing pneumonia, your overall health, and your age.

Bacterial pneumonia: Symptoms of bacterial pneumonia can develop gradually or suddenly. Symptoms include:

• High fever (up to 105° F)
• Tiredness (fatigue)
• Trouble breathing: rapid breathing or shortness of breath
• Sweating
• Chills
• Cough with mucus (might be greenish in color or contain a small amount of blood)
• Chest pain and/or abdominal pain, especially with coughing or deep breathing
• Loss of appetite
• Confused mental state or changes in awareness (especially in older adults)

Viral pneumonia: Symptoms usually develop over a period of several days. Early symptoms are similar to flu symptoms, which include:

• Fever
• Dry cough
• Headache
• Sore throat
• Loss of appetite
• Muscle pain
• Weakness

Additional symptoms appearing about a day later include:

• Higher fever
• Cough with mucus
• Shortness of breath

How can I tell if I have pneumonia versus the common cold or the flu?

Do I have a cold or could it be the flu or even pneumonia? It’s tough to tell the difference but critical to know when to seek medical care

Watch for these ongoing symptoms that occur in pneumonia:

• Serious congestion or chest pain.
• Difficulty breathing.
• A fever of 102 or higher.
• Coughing that produces pus.

Pneumonia symptoms last longer than cold and flu. If your symptoms aren’t severe, it’s okay to try such home remedies as getting more rest, drinking more fluids and taking some over-the-counter medicines and see what happens. But if you don’t see improvement in your symptoms after three to five days, or if you are experiencing more serious symptoms such as dizziness or severe difficulty breathing, see your healthcare provider. Don’t let it go. Pneumonia-like symptoms in very young children or in adults older than 65 are a cause for concern. Also, pneumonia can cause permanent lung damage if left untreated for too long. And always seek immediate care if you experience chest pain or have breathing difficulties.

What are the signs and symptoms of pneumonia in children?

The signs and symptoms of pneumonia in children vary from child to child and also depend on your child’s age, cause of the infection, and severity of their illness.

Usual symptoms include:

• Fever, chills, general discomfort, sweating/flushed skin.
• Cough.
• Rapid breathing (tachypnea).
• Difficulty breathing, which can be seen as:
  • A widening of nostrils while breathing (nasal flaring)
  • Inward movement of chest wall when a child breaths in (lower chest in-drawing). With normal breathing, chest moves outward when breathing in.
• Wheezing.
• Pain in chest, especially when coughing or breathing deeply.
• Bluish tint to lips or nails due to decreased oxygen level in the blood.
• Loss of appetite.
• Vomiting.
• Increased tiredness (fatigue).

Babies and toddlers may show these symptoms:

• Cough.
• Fever.
• Difficulty feeding.
• Trouble breathing. Makes a grunting sound with breathing; noisy or rattly breathing.
• Temporarily stop breathing during sleep.
• Decreased amount of urine production.
• Pale color
• Appear limp.
• Cry more than usual. Are restless or more fussy.

Adolescents have the same symptoms as adults, including:

• Cough.
• Fever.
• Difficulty breathing/shortness of breath.
• Chest pain.

Newborns are at greater risk of pneumonia caused by bacteria present in the birth canal. In young children, viruses are the main cause of pneumonia.

Pneumonia caused by bacteria tends to happen suddenly, starting with fever and fast breathing. Symptoms appear more slowly and tend to be less severe when pneumonia is caused by viruses.

Are symptoms of pneumonia different in seniors?

Older adults may have milder symptoms and may not have a fever. A sudden change in mental state is sometimes a sign of pneumonia in this age group.

Is it possible to have pneumonia without having a fever?

It’s not the norm but, yes, it’s possible to have pneumonia with a low fever or even no fever. If this occurs, it’s usually in the very young (newborns and infants) and in older adults or adults with a weakened immune system.

What are the complications of pneumonia?

Anyone can experience complications from pneumonia. However, people in high-risk groups are more likely to develop complications, including:

• Breathing difficulties: Pneumonia can make breathing difficult. Pneumonia plus an existing lung disorder (such as COPD, emphysema, asthma) can make breathing even more difficult. Breathing difficulties may require a hospital stay to receive oxygen therapy or breathing and healing assistance with the use of a breathing machine (ventilator).
• Fluid buildup in the lungs (called pleural effusion or “water on the lungs”): Pneumonia can cause a buildup in the fluid between the membranes that line the lungs and the inside of the chest cavity. It is a serious condition that makes breathing difficult. Pleural effusion can be treated by draining excess fluid with a catheter, chest tube or by surgery.
• Bacteria in the bloodstream (bacteremia): The bacteria that cause pneumonia can leave your lungs and enter your bloodstream, spreading the infection to other organs. This condition is treated with antibiotics.
• Lung abscess. A lung abscess is a pus-filled cavity in the lung that is caused by a bacterial infection. It can be treated by draining the pus with a long needle or removing it by surgery.

Diagnosis and Tests

How is pneumonia diagnosed?

Your doctor will do a thorough exam. During your exam he or she will:

• Ask about your health history and conduct a physical exam.
• Listen to your lungs with a stethoscope.
• Possibly order a chest X-ray to look for signs of pneumonia and the extent of the infection.
• Conduct a pulse oximetry test to measure the amount of oxygen in your blood (indicates how well your lungs are moving oxygen into your bloodstream).
• Order laboratory tests of your blood and/or mucus to determine the type of infection – bacteria, virus, or fungus – that has caused pneumonia.

If you are a high-risk patient, your doctor may order other tests.

Management and Treatment

How is pneumonia treated?

How pneumonia is treated depends on the germs that cause it.

• Bacterial pneumonia: Bacterial pneumonia is usually treated with antibiotics. The specific antibiotic choice depends on such factors as your general health, other health conditions you may have, the type of medications you are currently taking (if any), your recent (if any) use of antibiotics, any evidence of antibiotic resistance in the local community and your age. Medicines to relieve pain and lower fever may also be helpful. Ask your doctor if you should take a cough suppressant. It’s important to be able to cough to clear your lungs.
• Viral pneumonia: Antibiotics are not used to fight viruses. (In some cases antibiotics may be given to fight a bacterial infection that is also present.) There are no treatments for most viral causes of pneumonia. However, if the flu virus is thought to be the cause, antiviral drugs might be prescribed, such as oseltamivir (Tamiflu®), zanamivir (Relenza®), or peramivir (Rapivab®), to decrease the length and severity of the illness. Over-the-counter medicines to relieve pain and lower fever are usually recommended. Other medicines and therapies such as breathing treatments and exercises to loosen mucus may be prescribed by your doctor.
• Fungal pneumonia: Antifungal medication is prescribed if a fungus is the cause of your pneumonia.

Is pneumonia treated any differently in children?

Essentially no. Just like adults, bacterial causes of pneumonia in children may be treated with antibiotics. Antibiotics are not used to treat pneumonia caused by viruses. Flu-related pneumonia may be treated with antiviral medicine if caught early in the course of illness. Most cases of pneumonia are treated with “comfort care” measures that ease symptoms. These may include:

• Drinking more fluids.
• Getting more rest.
• Taking over-the-counter medicines for cough and acetaminophen for fever. Be sure to check with your healthcare provider or pharmacist if you have any questions or concerns about giving medicines to your child.
• Using a cool mist humidifier in your child’s room.

How soon after treatment for pneumonia will I begin to feel better?

How soon you will feel better depends on several factors, including:

• Your age
• The cause of your pneumonia
• The severity of your pneumonia
• If you have other “at-risk” conditions

If you are generally healthy, most symptoms of bacterial pneumonia usually begin to improve within 24 to 48 hours after starting treatment. Symptoms of viral pneumonia usually begin to improve within a few days after starting treatment. A cough can last for several weeks. Most people report being tired for about a month after contracting pneumonia.

When would I need to be hospitalized for pneumonia?

If your case of pneumonia is more severe, you may need to stay in the hospital for treatment. Hospital treatments may include:

• Oxygen
• Fluids, antibiotics and other medicines given through an IV (directly into the vein)
• Breathing treatments and exercises to help loosen mucus

People most likely to be hospitalized are those who are most frail and/or at increased risk, including:

• Babies and young children
• People over age 65
• People with weakened immune systems
• People with health conditions that affect the heart and lungs

It may take six to eight weeks to return to a normal level of functioning and well-being if you’ve been hospitalized with pneumonia.

Prevention

Are vaccines available to prevent pneumonia?

Yes, there are two types of vaccines (shots) specifically approved to prevent pneumonia caused by pneumococcal bacteria. Similar to a flu shot, these vaccines won’t protect against all types of pneumonia, but if you do come down with pneumonia, it’s less likely to be as severe or potentially life-threatening – especially for people who are at increased risk for pneumonia.

• Bacterial pneumonia: Two pneumonia vaccines, Pneumovax23® and Prevnar13®, protect against the most common causes of bacterial pneumonia.
  • Pneumovax23® protects against 23 different types of pneumococcal bacteria. It is recommended for all adults 65 years of age and older and children over 2 years of age who are at increased risk for pneumonia.
  • Prevnar13® protects against 13 types of pneumonia bacteria. It is recommended for all adults 65 years of age and older and children under 2 years of age. Ask your healthcare provider about these vaccines.
• Viral pneumonia: Get a flu vaccine (shot) once every year. Flu vaccines are prepared to protect against that year’s virus strain. Having the flu can make it easier to get bacterial pneumonia.

If you have children, ask their doctor about other vaccines they should get. Several childhood vaccines help prevent infections caused by the bacteria and viruses that can lead to pneumonia.

Besides vaccination, what else can I do to prevent bacterial and viral pneumonia?

Receiving all recommended vaccinations is one of the best ways to prevent pneumonia. Additionally, there are several other ways to prevent pneumonia, including:

• Quitting smoking, and avoiding secondhand smoke. Smoking damages your lungs.
• Washing your hands before eating, before handling food, after using the restroom, and after being outside. If soap is not available, use an alcohol-based hand sanitizer.
• Avoiding being around people who are sick. Ask them to visit when they are feeling better.
• Not touching or sharing objects that are shared with others. Germs can be transferred from object to you if you touch your nose or mouth without washing or sanitizing your hands first.
• Eating a healthy diet, exercise, and get enough rest. Healthy habits keep your immune system strong.
• Getting treated for any other infections or health conditions you may have. These conditions could weaken your immune system, which could increase your chance of infections.
• Avoiding excessive consumption of alcohol.

Outlook / Prognosis

What is the outlook for pneumonia?

People who are otherwise healthy often recover quickly when given prompt and proper care. However, pneumonia is a serious condition and can be life-threatening if left untreated and especially for those individuals at increased risk for pneumonia.

Even patients who have been successfully treated and have fully recovered may face long-term health issues. Children who have recovered from pneumonia have an increased risk of chronic lung diseases. Adults may experience:

• Decreased ability to exercise
• Worsening of cardiovascular disease
• Mental decline
• General decline in quality of life for months or years

Living With

What can I do to feel better if I have pneumonia?

• Finish all medications and therapies prescribed by your doctor. Do not stop taking antibiotics when you start feeling better. Continue taking them until no pills remain. If you don’t take all your antibiotics, your pneumonia may come back.
• If over-the-counter medicines to reduce fever have been recommended (aspirin, acetaminophen, ibuprofen, naproxen), take as directed on the label. Never give aspirin to children.
• Drink plenty of fluids to help loosen phlegm.
• Quit smoking if you smoke. Don’t be around others who smoke or vape. Surround yourself with as much clean, chemical-free air as possible.
• Use a humidifier, take a steamy shower or bath to make it easier for you to breathe.
• Get lots of rest. Don’t rush your recovery. It can take weeks to get your full strength back.

If at any time you start to feel worse, call your doctor right away.

When can I return to work, school and regular activities if I have pneumonia?

You typically can resume your normal activities if your symptoms are gone, mild or improving and you do not have new or worsening:

• Shortness of breath or tiredness (less energy)
• Chest pain
• Mucus, fever or cough

If you are generally healthy, most people feel well enough to return to previous activities in about a week. However, it may take about a month to feel totally back to normal.

When should I see a doctor?

Call your doctor if you:

• Have new or worsening:
  • Shortness of breath with activities or when lying down
  • Fever or cough with mucus
  • Tiredness (fatigue)
• Have a change in appetite (less hunger)
• Feel uneasy and know that something is not right

If you or your loved one with symptoms is in a high, “at-risk” group, see your doctor as soon as possible. Pneumonia can become a life-threatening condition.

When should I go to the emergency room?

Go to the emergency room or call 911 if you:

• Struggle to breathe or are short of breath while sitting still
• Have new or worsening chest pain
• Are confused or cannot think clearly

Bacterial Pneumonia – an overview

The Bacterial Etiology of Pneumonia

The evidence for bacterial pneumonia agents comes from two classes of studies, each with important limitations. One is the prospective observational study (often simply surveillance). These are primarily hospital based and rely heavily on blood cultures. Thus most bacterial pneumonia pathogens are substantially underestimated. Another limitation is that most of these studies consist of hospitalized children, represent more severe illness, and may not represent most pneumonia cases. The second type of study is the vaccine trial, including vaccine probe studies, where the attributable burden from a specific pathogen is estimated from the proportion of pneumonia prevented by that vaccine. There are two important caveats. First, bacteria and viruses may interact,⁵ for example, pneumococcal vaccine may reduce influenza-positive pneumonia⁶; thus not all pneumonia prevented by a vaccine is directly pathogen specific. Second, vaccine efficacy is influenced by which pathogen strains are included in the vaccine and must be accounted for to adjust disease burden estimates.⁷

Two recent studies in Streptococcus pneumoniae (pneumococcus) and in Haemophilus influenzae type b (Hib) provide pathogen-specific pneumonia burden estimates, relying heavily upon vaccine efficacy trials. In 2000 there were 826,000 pneumococcal deaths, of which 90% were pneumonia.⁸ The global pneumococcal pneumonia incidence was 2228/100,000 child-years (13.8 million cases), or 8.6% of all clinical childhood pneumonia. The case fatality rate was 5%, or 36% of all pneumonia deaths. Southeast Asia had the highest number of pneumonia cases, whereas Africa had the highest pneumonia incidence. In that same period, there were 8.13 million illnesses caused by Hib.⁹ The global incidence of Hib pneumonia was 1304/100,000 children <5 years. Again, the highest number of cases was in Southeast Asia, followed by Africa, the Western Pacific, and the Mediterranean. This study estimated Hib-related chest x-ray (CXR)–confirmed pneumonia at 15% to 21%. Together, these analyses suggest that pneumococcus and Hib account for 30% to 50% of severe pneumonia among children in LMIC.¹ Other bacteria in childhood pneumonia include Staphylococcus aureus, Klebsiella pneumoniae, non-typeable H. influenzae (Papua New Guinea and the Gambia), non-typhoid Salmonella spp. (sub-Saharan Africa), and Salmonella typhi (South Asia). Two atypical bacteria, Mycobacterium tuberculosis (primarily from lung aspirates) and Mycoplasma pneumoniae, have been commonly reported. Recent multisite investigations have confirmed many of these pathogens in severe childhood pneumonia,^10,11 with additional multi-site analyses pending publication.¹²

Community-Acquired Pneumonia in Infants and Children

1. British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in childhood. Thorax.
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Pneumonia Symptoms and Causes | Everyday Health

Bacteria are the most common cause of pneumonia in adults.

Bacterial pneumonia may follow a viral infection, like a cold or the flu (influenza). This type of pneumonia usually affects one area of the lung and is referred to as lobar pneumonia.

Types of bacteria that cause pneumonia include:

• Streptococcus pneumoniae
• Legionella pneumophila, the cause of Legionnaires’ disease, or Legionellosis
• Mycoplasma pneumoniae
• Chlamydophila pneumoniae
• Haemophilus influenzae type B (Hib)

Streptococcus pneumoniae, also known as pneumococcus, is the most common cause of bacterial pneumonia in adults, called pneumococcal pneumonia. (2)

It may be prevented by a vaccine. The Centers for Disease Control and Prevention (CDC) recommends two pneumonia vaccines for adults 65 years and older: pneumococcal conjugate vaccine, or Prevnar 13 (PCV13), and pneumococcal polysaccharide vaccine, or Pneumovax 23 (PPSV23). (3)

According to the CDC:

• You should receive a dose of the pneumococcal conjugate vaccine (PCV13) first, followed at least one year later by a dose of the pneumococcal polysaccharide vaccine (PPSV23).
• If you’ve already received any doses of PPSV23, the dose of PCV13 should be given at least one year after the most recent PPSV23 dose.
• If you’ve already received a dose of the PCV13 at a younger age, another dose is not recommended.

Mycoplasma pneumoniae usually infects younger adults who work in crowded areas, such as schools, homeless shelters, or prisons. (4)

Chlamydophila pneumoniae causes a mild pneumonia infection that usually affects people older than 60. (5)

Haemophilus influenzae type B (Hib) infection can be prevented with a vaccine, called the Hib vaccine. It’s recommended for all children younger than age 5 and is usually given to infants starting at 2 months old. (6)

Most bacteria that cause pneumonia are pyogenic bacteria, which means that they form pus, a combination of debris from serum, dead bacteria, and white blood cells. A cough that produces discolored mucus in the presence of fever and shortness of breath can be a classic sign of bacterial pneumonia.

Other bacterial pneumonia symptoms include:

• High fever
• Chills
• Rapid breathing
• Pain when coughing or breathing deeply
• Shortness of breath
• Exhaustion
• Loss of appetite

Bacterial pneumonias tend to be more serious with more noticeable symptoms than other types of pneumonia.

Pneumonia Overview – Summary of Relevant Conditions

Cough is a common respiratory symptom that can be problematic for diagnosis as it accompanies a number of diseases. [35] Madison JM, Irwin RS. Cough: a worldwide problem. Otolaryngol Clin North Am. 2010 Feb; 43 (1): 1-13, vii.
http://www.ncbi.nlm.nih.gov/pubmed/20172252?tool=bestpractice.com
A cough can be classified by its duration. An acute cough that lasts less than 3 weeks and is most often caused by a viral upper respiratory tract infection.A subacute cough lasts 3–8 weeks and is usually post-infectious. [36] Kwon NH, Oh MJ, Min TH, et al. Causes and clinical features of subacute cough. Chest. 2006 May; 129 (5): 1142-7.
http://www.ncbi.nlm.nih.gov/pubmed/16685003?tool=bestpractice.com
If the cough lasts longer than 8 weeks, a systematic approach to finding out the cause and choosing the most optimal treatment is necessary. Common causes of chronic cough (cough lasting> 8 weeks) in nonsmoking adults with normal chest radiographs who are not taking ACE inhibitors are upper respiratory tract cough syndrome, asthma, gastroesophageal reflux disease, and asthmatic eosinophilic bronchitis.[37] Irwin RS, French CL, Chang AB, et al. Classification of cough as a symptom in adults and management algorithms: CHEST guideline and expert panel report. Chest. 2018 Jan; 153 (1): 196-209.
https://journal.chestnet.org/article/S0012-3692(17)32918-5/fulltext

http://www.ncbi.nlm.nih.gov/pubmed/29080708?tool=bestpractice.com
[38] Irwin RS, Baumann MH, Bolser DC, et al. Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines. Chest.2006 Jan; 129 (1 Suppl): 1-23S.
https://journal.chestnet.org/article/S0012-3692(15)52825-0/fulltext

http://www.ncbi.nlm.nih.gov/pubmed/16428686?tool=bestpractice.com
Patients with a chronic cough (usually with phlegm), fever, general malaise, chest pain and dullness of the percussion sound, weakening of breathing sounds, and wheezing on physical examination should be evaluated for pneumonia.

Two cocktails for me: people on mechanical ventilation began to be individually treated with “bacteria killers” | Articles

Specialists of Rospotrebnadzor create drugs against bacteria that cause pneumonia in ventilated patients who have acquired resistance to antibiotics .Each remedy is developed individually, taking into account the characteristics of the patient’s body and pathology. In 84% of cases, after using the drug, all bacteria that have caused a critical condition and are not amenable to other drugs die, the developers say. Experts noted that bacterial infections on ventilators are a common problem, often leading to the death of patients, especially those with COVID-19.

Kill the killer

When carrying out invasive ventilation for more than two days, there is a high risk of so-called hospital pneumonia , according to the National Medical Research Center of Cardiology. Mortality among people with nosocomial infection is significantly higher than than among patients who escaped such a fate. This is due to the fact that the bacteria that cause the infection are often resistant to the drugs traditionally used for treatment. Previously, it was believed that the problem of nosocomial infections lies in the clinic environment: some bacteria acquired resistance to antibiotics and took root well in hospitals . However, with the advent of COVID-19, the number of people in intensive care units connected to ventilators has increased.It became clear that could be a different problem.

– A huge number of bacteria live in the human intestine, and some of them, under the influence of medical measures, can acquire drug resistance, – said the Deputy Director for Medical Biotechnology of the Moscow Research Institute of Epidemiology and Microbiology (FBUN MNIIEM) named after V.I. G.N. Gabrichevsky Rospotrebnadzor, Head of the Scientific and Methodological Center for the Study and Identification of Bacteriophages, Professor of the Russian Academy of Sciences Andrei Aleshkin.- These strains of bacteria sooner or later get through parts of the ventilator into the lungs, and the patient eventually infects himself, developing bacterial pneumonia . Moreover, it is impossible to block this channel of infection with any conventional antibiotics. Perhaps we will always live with such pathogens of pathology.

Photo: Izvestia / Dmitry Korotaev

In a severe or extremely severe course of COVID-19, the human body is greatly weakened not only by the virus itself, but also by immunosuppressants , which are often given during treatment, added the doctor of medical sciences, infectious disease doctor, deputy director for clinical work of the N.N.G.N. Gabrichevsky Rospotrebnadzor Tatyana Ruzhentsova.

“A very large number of patients on mechanical ventilation receive complications in the form of a bacterial infection,” the expert said. – Bacteria previously suppressed by immunity enter various tissues (primarily those affected by the SARS-Cov-2 virus), and the process of infection begins. Given that COVID-19 severely affects the lungs, more often bacterial complications manifest themselves in the form of pneumonia. And we must remember that potentially dangerous bacteria live throughout the human body, not only in the intestines, but also in the oral cavity, on the mucous membranes of the genitals, on the skin.Let me remind you that such bacteria do not cause any symptoms in a healthy person.

Recently, when working with patients, scientists have often encountered strains of bacteria that cause pneumonia. This confirms that microorganisms often begin to actively multiply in the lungs, already weakened by the coronavirus.

The problem of bacterial pneumonia on mechanical ventilation has become aggravated recently , I agreeAcademician B.V. Petrovsky Roman Komnov.

Photo: Izvestia / Kristina Kormilitsyna

– It can be caused both by the bacteria of the person himself and by the inhabitants of hospitals, the expert said. – Although, in my opinion, nosocomial strains still account for more deaths than bacteria from the patient’s body. The former are more resistant to antibiotics, due to the fact that they “learned” more and more to deal with drugs.

Upgrade for phages

At the Institute.G.N. Gabrichevsky Rospotrebnadzor developed a method of so-called personalized phage therapy . It consists in the fact that scientists, within one to three weeks, select the composition, dosage and route of administration of the drug for a particular patient based on bacteriophages (viruses that infect bacterial cells) . There are ready-made products of this kind on the market, but their effectiveness can be no more than 10%, experts say.

Reference from Izvestia

Bacteriophages work like this.Phage elements located on it in the form of thorns bind to the surface molecules of the bacteria. Further, the bacteriophage genetic material is introduced into the bacterial body due to structures acting like a syringe. After that, young phages begin to gather inside the bacteria in parts, their number grows, and soon they leave the bacterial cell. In this process, the metabolism of the bacterium is rebuilt – some cellular proteins are destroyed. So the bacterium dies, and the phages find themselves new “food”.For humans, bacteriophages are completely safe: these viruses are unable to penetrate the cells that make up the human body.

Since 2014, more than 500 patients have passed through the Scientific and Methodological Center for the Study and Identification of Bacteriophages. 84% of them, after a few days of such therapy, had no bacteria in the infected organ.

The researchers take a ready-made preparation from bacteriophages as a basis. Manufacturers do not disclose the exact composition and strains: only the general name of the bacteria against which the agent is intended is known.Next, scientists are working on the “upgrade” of the drug.

– First, we determine which bacteriophage strains the bacteria that kill the patient are sensitive to, – said Andrey Aleshkin. – Bacteria are usually already provided by doctors from the hospital where the patient has come – they are taken from the affected organ. We inoculate a cocktail of phages on the “lawn” of bacteria in Petri dishes. Further, after incubation in a thermostat for several hours, we check whether phages multiply on a given bacterial culture.

Photo: Izvestia / Dmitry Korotaev

Also, scientists are checking whether there are antibodies to bacteriophages in the patient’s blood serum, which they plan to use in the product.

Next, researchers n select the route of administration, dose and dosage form of the drug, which will ensure the maximum delivery of the required number of phages to the focus of infection and their long-term presence in the affected organ . The form of the drug can be any: tablets, liquid, ointment, sometimes intravenous administration is required.

To prevent bacteriophages from destroying beneficial bacteria in the patient’s body, scientists are conducting separate studies, similar to the study of the sensitivity of bacteriophage strains to “bad” bacteria. Useful microflora is taken based on the method of administration of the drug . Since most often these are pills, the patient’s feces are taken for examination.

Rare help

At least two factors hinder the widespread use of bacteriophages, said Konstantin Severinov, professor at the Skolkovo Institute of Science and Technology and Rutgers University (New Jersey, USA), head of laboratories at the Institute of Molecular Genetics and the Institute of Gene Biology, Russian Academy of Sciences.

– The first is in the complexity of manufacturing standardized preparations based on bacteriophages in large quantities – after all, these are in some sense living objects , – said the expert. – There is no such problem with antibiotics, that is, chemical compounds . They can be produced easily and in large quantities. Second, not a single bacteriophage-based drug has been clinically tested to prove the effectiveness of their use.

Photo: Izvestia / Kristina Kormilitsyna

However, there are isolated cases of their successful use for the treatment of specific people, but the task of scaling such stories is not for the near future , the scientist believes.

The use of bacteriophages is not included in clinical guidelines, Roman Komnov specified.

“However, you can always try, especially if the patient is in critical condition,” the specialist said.

If this method helps the patient, there will be no complaints, he concluded.

Pneumonia / State Budgetary Healthcare Institution of the Yamalo-Nenets Autonomous Okrug “Muravlenkovskaya City Hospital”

Pneumonia
Newsletter
November 2014
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Key facts
• Pneumonia is the leading infectious cause of death in children worldwide, accounting for 15% of all deaths among children under 5 years of age worldwide.
• In 2013, 935 thousand children under the age of 5 died of pneumonia.
• Viruses, bacteria and fungi can cause pneumonia.
• Pneumonia can be prevented through immunization, adequate nutrition, and elimination of environmental factors.
• Pneumonia due to bacteria can be treated with antibiotics, but only one third of children with pneumonia receive the antibiotics they need.
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Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. With pneumonia, the alveoli become filled with pus and fluid, making breathing painful and restricting oxygen supply.
Pneumonia is the single largest infectious cause of death in children worldwide. In 2013, 935 thousand children under the age of 5 died from pneumonia.It is responsible for 15% of all deaths in children under 5 years of age worldwide. Pneumonia is ubiquitous, but children and families are most affected by the disease in South Asia and sub-Saharan Africa. Pneumonia can be prevented with simple measures and can be treated with simple, inexpensive drugs with proper care.
Causes
Pneumonia is caused by a variety of infectious agents, including viruses, bacteria and fungi.The most common are:
• streptococcus pneumoniae – the most common cause of bacterial pneumonia in children;
• haemophilus influenzae type b (Hib) – the second most common cause of bacterial pneumonia;
• Respiratory syncytial virus is a common cause of viral pneumonia;
• Pneumocystis jiroveci is one of the most common causes of pneumonia in HIV-infected children. These microorganisms are responsible for at least one quarter of all pneumonia deaths in HIV-infected children.
Transmission
There are several ways pneumonia can spread. Viruses and bacteria that are commonly found in a baby’s nose or throat can infect the lungs if they are inhaled. They can also be spread by airborne droplets when you cough or sneeze. In addition, pneumonia can be transmitted through blood, especially during or immediately after childbirth. More research is needed to study the various pathogenic microorganisms that cause pneumonia and their transmission routes, as this is critical for treatment and prevention.
Symptoms
The symptoms of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia can be more varied than those of bacterial pneumonia.
In children under 5 years of age with symptoms of cough and / or shortness of breath, with or without a high fever, pneumonia is diagnosed if there is rapid breathing or retraction of the lower chest, if the chest is pulled in or retracted during inhalation (in a healthy a person’s chest expands when inhaling).Wheezing is more common with viral infections.
Very severe infants may be unable to eat or drink and may also experience loss of consciousness, hypothermia, and seizures.
Risk factors
Although most healthy children are able to cope with the infection with their own defenses, children with impaired immune systems are at greater risk of developing pneumonia. A child’s immune system can be weakened by inadequate or inappropriate nutrition.This is especially true for infants who are not exclusively breastfed.
Pre-existing illnesses such as symptomatic HIV infections and measles also increase the risk of pneumonia in children.
A child’s susceptibility to pneumonia is also increased by the following environmental factors:
• indoor air pollution caused by cooking and using biofuels (such as wood or dung) for heating;
• living in overcrowded dwellings;
• parental smoking.
Treatment
Pneumonia caused by bacteria can be treated with antibiotics. The preferred antibiotic is amoxicillin dispersible tablets. They are usually prescribed at a health center or hospital, but in the vast majority of cases, pneumonia in children can be effectively treated at home with inexpensive oral antibiotics. Hospitalization is recommended for children under 2 months of age and in very severe cases.
Prevention
Prevention of pneumonia in children is a key component of a strategy to reduce child mortality.Immunization against Hib, pneumococcus, measles and pertussis is the most effective way to prevent pneumonia.
Adequate nutrition, starting with exclusive breastfeeding during the first 6 months of life, is essential for enhancing the body’s defenses. It is also effective in preventing pneumonia and shortening the duration of illness.
Tackling environmental factors such as indoor air pollution (for example, by using affordable, environmentally friendly stoves) and creating hygienic conditions in crowded homes also reduce the number of children with pneumonia.
The antibiotic cotrimoxazole is given daily to HIV-infected children to reduce the risk of pneumonia.
Economic costs
The cost of antibiotic treatment for all children with pneumonia in the 66 countries that monitor maternal, newborn and child survival through the Countdown to 2015 Initiative is approximately US $ 109 million per year. The price of treatment includes the cost of antibiotics and pneumonia diagnostics.
What WHO does
WHO and UNICEF are working on the Global Plan of Action to Fight Pneumonia and Diarrhea. Its goal is to intensify the fight against pneumonia through combined action to protect children from pneumonia, prevent it and treat it, including the following:
• Protecting children from pneumonia, including promoting exclusive breastfeeding and handwashing, and reducing indoor air pollution premises;
• prevention of pneumonia through vaccination;
• Treating pneumonia: Providing the right treatment for every child, either with the help of a community health worker or, in the case of severe illness, in a health facility, and providing the antibiotics and oxygen needed to recover.
A number of countries, including Bangladesh, India, Uganda and Zambia, have developed regional, state and country-specific plans to accelerate action to tackle pneumonia and diarrhea.

Virologists describe the key difference between COVID-19 and other types of pneumonia

A large-scale study conducted by more than 100 scientists from Northwestern Medicine helped to identify the main difference between COVID-19 and other types of pneumonia. Its results were published by the journal Nature.

Known bacteria or viruses that cause pneumonia tend to spread over large areas of tissue within hours.The SARS-CoV-2 coronavirus, as it turned out, uses a different mechanism. By settling on many small areas of the lung, the COVID-19 pathogen acts like wildfire. It captures immune cells and uses them to spread, this process can last from several days to several weeks. The pathogen then slowly “moves” through the body, leaving damage in its path, continually fueling inflammation, lowering blood pressure, and causing damage to the kidneys, brain, heart, and other organs.

According to the authors of the work, it is the long course of the disease, and not the degree of its severity, that causes the complications of COVID-19.

A detailed comparison of the immune cells of patients with the novel coronavirus and other types of pneumonia has helped identify important points in the treatment of COVID-19, according to senior co-author of the study, assistant professor of pulmonary medicine and resuscitation Ben Singer.

Based on the data obtained, an experimental drug has been created that suppresses the inflammatory response of immune cells – macrophages and T-cells, which allows you to start the process of restoring damaged areas of the lung.

– COVID-19, like the flu, is unlikely to ever go away, even if most of the population is vaccinated. Already, scientists are investigating the mechanisms by which this rapidly mutating RNA virus can bypass vaccines. The results of our study could form the basis for treatments that reduce the severity of the disease so that it can be compared to a severe cold, Singer said.

Another study participant, Dr. Scott Badinger, noted that the death rate from the new coronavirus can be reduced by up to 20 percent if patients are carefully monitored and medical facilities are not overloaded.

90,000 Pneumonia: Types of pneumonia are divided depending on the area of ​​the lesion and the causative agents of the disease:, Causes of pneumonia, Symptoms of pneumonia in children

Many people doubt whether pneumonia is contagious. Inflammation of the lungs can be contagious in severe types of the disease caused by tuberculosis, Klebsiella, Mycoplasma and others. Pneumonia can be transmitted by airborne droplets from person to person. Most often, health workers who have long-term contact with patients are infected with pneumonia.This type of disease lasts a long time and with complications, complex treatment is prescribed.

Pneumonia in children occurs most often in infancy and is quite dangerous, since the child’s immunity has not yet matured and is prone to colds. Pneumonia kills 20% of babies under the age of 5 every year. It gives complications to the entire body, leading to disability and chronic diseases. Not every doctor can detect pneumonia in a child and hear the characteristic wheezing.Diagnosis is quite difficult at this age. Unlike pneumonia in an adult, it can be difficult to treat.

Types of pneumonia are divided depending on the area of ​​the lesion and the causative agents of the disease:

• Atypical – with this type, the disease is caused by dangerous microbes: mycoplasma, klebsiella, legionella and chlamydia. This type of pneumonia is spread from person to person.
• Typical – a common type of pneumonia, manifests itself in most cases in an adult.The disease is caused by pneumococci, Haemophilus influenzae, staphylococci and others.
• Aspiration – more common in children, occurs due to bacteria of foreign bodies in the respiratory tract. These can be food pieces or other items.
• Viral – occurs mainly in childhood due to various viruses.
• Bilateral – a disease in which inflammation affects both lungs.
• Right-sided and left-sided – the inflammatory process affects the right or left lung.
• Basal – with this type of pneumonia, inflammation occurs at the site of the pulmonary root.
• Focal – the inflammatory process extends to a small area of ​​the lung.

Depending on the severity of the disease, mild, moderate and severe forms of pneumonia are distinguished. The doctor determines the level of severity based on the severity of the signs and volumes of lung tissue affected.

Causes of pneumonia

Inflammation of the lungs can occur due to various microorganisms found on the mucous membranes of the nose, mouth and throat.Getting deep into the respiratory tract, viruses provoke the onset of pneumonia. With reduced immunity, the process spreads to new lung tissue and the disease becomes more severe. Most often, pneumonia can be caused by Klebsiella and pneumococci. They attack the lung tissue, causing inflammation.

The causes of pneumonia can be various pathological processes and diseases:

• colds and viral diseases;
• various diseases of internal organs, heart, kidneys, lungs;
• decreased immunity;
• long-term smoking;
• artificial lung ventilation;
• general anesthesia during operations;
• old age;
• various tumor processes in the body;
• alcoholism for many years;
• epilepsy and other disorders of the nervous system.

The main causative agents of pneumonia include:

• pneumococci, staphylococci;
• Haemophilus influenzae;
• viral organisms;
• Klebsiella;
• mycoplasma, legionella, chlamydia, forming a group of atypical pathogens;
• pneumocysts;
• Escherichia coli and Pseudomonas aeruginosa, enterobacteria.

Pneumonia symptoms

Among the main symptoms of pneumonia in an adult, a cough is distinguished, at first dry, constant, sometimes at the initial stages of the disease it can rarely appear.As the pneumonia progresses, the cough becomes moist, with a green discharge of mucus and purulent sputum. When you cough, there is an unpleasant pain that radiates to the chest area.

Another sign of pneumonia in an adult is a prolonged period of viral or colds. A viral illness usually lasts no more than a week. If the condition has deteriorated sharply after four days after the onset of a cold or flu, an inflammatory process of the lungs occurs in the body. The temperature rises sharply to 39-40 degrees, and with atypical pneumonia, it can fluctuate within 37.1-37.5 degrees.

Lung inflammation is confirmed if a person has a high body temperature, but antipyretic drugs do not help. There is pain in the chest when breathing and coughing, and taking a deep breath is not easy. Coughing fits and pain when inhaling are also referred to as symptoms of pneumonia. Outward signs include shortness of breath, pallor of the face, weakness of the whole body, increased sweating, fever, and decreased appetite.

Symptoms of pneumonia in children

There is a high temperature of 38 degrees and above, which lasts more than three days, does not get confused by antipyretic drugs, infants have a low temperature of up to 37 degrees.Symptoms of pneumonia in children are similar to poisoning: weakness, increased sweating, poor appetite, and lethargy. External signs of the disease appear, such as: blue lips and nails, pale skin of the face, protruding drops of sweat.

Among the signs of pneumonia in children, capricious and tearful behavior, lethargy and apathy, insomnia, and complete loss of appetite are noted. Diarrhea and vomiting may occur, and in infants, breast refusal and regurgitation. The throat begins to sore and a rare cough occurs, then it becomes dry and prolonged, aggravated by crying and feeding.Over time, the cough becomes wet, with expectoration of mucus.

Diagnosis of pneumonia

For a full diagnosis, the patient needs to undergo a general examination, consult a pulmonologist, conduct a general and biochemical blood test, sputum analysis, X-ray and computed tomography of the chest cavity, culture and subsequent blood examination, fibrobronchoscopy.

Treatment of pneumonia

Antibiotics are always prescribed for the treatment of pneumonia.For each type of disease, the doctor selects drugs that fight a particular virus. Together with antibiotics, the patient takes in a complex drugs that thin sputum, expand the bronchi and strengthen the body’s immunity. After the completed course of therapy, it is necessary to restore and strengthen the respiratory system.

Most often, patients are treated for pneumonia in a hospital. Bed rest and rest are prescribed. In order to diagnose the causes of the disease, sputum is cultured on nutrient media; it is difficult to see the whole picture of the disease from a smear.The patient takes antibiotics of the same type; in more severe forms of the disease, drugs can be combined. Typically, the course of treatment lasts from 10 days to two weeks. If the treatment does not help, another group of drugs is prescribed.

Treatment of pneumonia in children requires compulsory hospitalization in the clinic. The child is prescribed antibiotics depending on the age and severity of the disease. Most often, drugs are administered in the form of injections so that they are better absorbed by the body. The treatment process for childhood pneumonia takes two to four weeks, but can be longer and more difficult.If a child is in good health, he recovers in two weeks, weaker children respond to treatment and recovery much longer. After therapy, a course of rehabilitation procedures is prescribed.

Search in pharmacies in Kiev for drugs for the treatment of pneumonia can be done through our website in a special catalog of medicines.

Complications of pneumonia

In most cases, patients recover completely. In some cases, local pneumosclerosis is formed, which is an overgrowth of connective tissue and the process of compaction of certain areas of the lung.In the case of a small lesion, pneumosclerosis can be determined by x-ray. Pneumosclerosis does not affect the functioning of the lungs and does not manifest itself clinically.

Major pulmonary complications:

• inflammatory processes of the pleura;
• fusion of lung tissue with the formation of cavities with purulent masses of a localized nature;
• unrestricted process of extensive disintegration of lung tissue prone to inflammation;
• deviation of the process of air passage through the bronchi, which manifests itself through shortness of breath, difficulty breathing and a feeling of lack of air;
• acute respiratory failure.

Complications outside the lungs:

• shock of an infectious-toxic nature, the most severe form of extrapulmonary complications;
• inflammation of the heart muscles and the inner lining of the heart;
• inflammatory processes in the area of ​​tissues and membranes of the brain;
• deviations of mental functionality;
• decrease in the number of red blood cells and hemoglobin in the blood.

Prevention of pneumonia

Measures to prevent pneumonia include flu shots.They provide protection against pneumococcus, which is the most common cause of pneumonia. Vaccination is compulsory for young children, people in the elderly after 65 years, as well as for people with chronic diseases. Smokers need to quit the habit to protect their lungs from disease. In hazardous industries, workers must protect the respiratory tract with bandages or respirators.

The prevention of pneumonia includes hardening from an early age, avoiding hypothermia and dangerous sun, airing the room from dust and wet cleaning.It is necessary to treat colds and viral diseases in time in order to prevent a chronic form. Pneumonia can occur in patients with a sedentary lifestyle, they need to do massage, carry out therapeutic and respiratory gymnastics, and take antiplatelet agents.

Lung inflammation can be transmitted by airborne droplets, therefore it is necessary to limit communication with sick people, during periods of viral epidemics, do not visit large crowds of people. Medical staff caring for patients must follow the rules of work: always wear gloves, disinfect hands after contact, wear gauze bandages, keep the distance between themselves and the patient.Infectious patients are placed in separate rooms, isolated from each other.

Prevention of pneumonia in children is important from the very first years of life. For the first six months, the child needs nutrition exclusively with breast milk in order to strengthen the immune system and strengthen the general condition of the body. It contains essential amino acids and substances that are not found in artificial nutrition. In childhood, you can start gradual hardening, do gymnastics and spend more time in the fresh air. The child’s room should be well ventilated, especially before bedtime, regularly cleaned of dust and dirt.There should be no dampness in the house, as it is one of the dangerous factors in the development of pneumonia.

Scientists have found that zinc can reduce the risk of pneumonia in children. Foods containing zinc – red meat, legumes, seafood, cereals. Zinc can be taken in the form of special dietary supplements. Studies have shown that with the introduction of this mineral into the diet of children, the incidence of pneumonia decreased. The recommended dose of zinc per day for newborns is 5 milligrams per day, for children from one to four years old is 10 milligrams.It is not recommended to take minerals on your own without consulting your child’s doctor.

90,000 Bacteria are not to blame: most pneumonias are caused by viruses and cannot be cured with antibiotics

An international pneumonia research team has published a study on infections that cause severe pneumonia in children in developing countries. The results, published in the Lancet, show that, contrary to popular belief, only a minority of cases of this disease are caused by bacterial infections.The main culprit of pneumonia is viruses (more than 60% of cases). Another 10% of cases are fungal infections, processes involving tuberculosis pathogens (rickettsia) and diseases of an unknown nature.

Pneumonia is a serious illness that kills about a million children every year, mostly in developing countries. The inflammatory process in the lungs causes the accumulation of fluid in the pulmonary vesicles, which leads to the appearance of characteristic “wheezing”, which the doctor hears through the stethoscope.It is these wheezing in many cases that remain the only diagnostic sign of pneumonia. When they are found, the patient is usually prescribed antibiotics – substances that kill bacteria – since until recently it was believed that it was bacteria that were the main cause of pneumonia. Moreover, in some regions, including Russia, antibiotics are still often prescribed prophylactically, for severe colds and even before any signs of pulmonary infection are detected. Analysis of the specific causes of infection – the identification of a pathogenic microorganism – is extremely rare.

From the results published by scientists, it follows that the vast majority of cases of severe pneumonia are caused by viruses, among which the main culprit is the human respiratory syncytial virus (HRSV). He alone is the cause of about a third of cases, and the total pneumonia of a viral nature accounted for a little less than two-thirds of all cases of the disease. Antibiotics are not effective in treating viral infections. At the same time, modern diagnostic methods make it possible to identify the viral nature of the infection quickly and reliably.According to the researchers, the development of antiviral vaccines may become a promising direction in the fight against childhood pneumonia.

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On the other hand, the authors of the article note that if methods for diagnosing viral infections become more available in different regions of the world, this will allow doctors not to prescribe antibiotics in cases where they are known to be useless. This will drastically reduce unnecessary antibiotic use.

The widespread use of antibiotics without proper indications is one of the reasons for the proliferation of multi-resistant pathogenic bacteria in the world, the so-called “super microbes”.Mankind’s effective fight against bacterial infections requires the constant development of new and new antibiotics, but their introduction sooner or later leads to the emergence of resistance in bacteria. According to experts, today humanity is losing in this race. One reason is that the big-pharma economy is not conducive to companies investing in the development of new antibiotics. A number of American companies, including Allegran, Sanofi, Achaogen, have recently left the market.

Along with measures to stimulate the development and launch of new drugs on the market, the situation could be changed by a reduction in the unjustified use of antibiotics, including for the treatment of previously diagnosed pneumonia, and even more so for their prevention. In this way, the spread of antibiotic-resistant pathogens could be slowed down, scientists say. The results of this research could help change this practice and help humankind triumph in the race against super microbes.

90,000 Middle East pneumonia has also become Korean, but this is not a pandemic

text Sergei Netesov , Corresponding Member of the Russian Academy of Sciences, Novosibirsk State University

The danger of a Middle East Respiratory Syndrome (MERS) pandemic appears to be over. But the lessons of the epidemic have yet to be analyzed and reflected in biosafety regulations. Each group of similar deaths or serious illness should be investigated, its causes investigated by molecular epidemiological methods.In Russia, up to 6 thousand deaths from severe respiratory diseases are registered every year, in the world – more than 7 million. The more we know about their causes, the more lives we will save and even more deaths we will prevent.

Symptoms of MERS

Virus Disease

How did the epidemic begin

In 2012, Egyptian Ali Mohammed Zaki, who worked in the virology laboratory at Dr. Suleiman Fakih Hospital in Jeddah, Saudi Arabia, isolated a hitherto unknown virus from the lung tissue of a deceased patient.He initially described it and transferred it for further research to coronavirus specialists from Rotterdam.

Immediately after receiving the first data – September 15 – Dr. Zaki posted the results of joint research with the Dutch on the website www.promedmail.org, well known to microbiologists and virologists. In November of that year, they published a joint paper in the New England Journal of Medicine. The Saudi Arabian authorities, which, as it turned out, did not give permission for the export of biomaterials from the country, were angry that Dutch scientists had patented the genetic data on the virus, and Dr. Zaki was fired from the hospital.

Later that year, another patient was identified in Qatar and transferred to the UK for treatment. Both patients had similar symptoms: severe pneumonia and renal failure. As a result, both samples were analyzed under the guidance of Professor Ron Fouchier in the same laboratory in Rotterdam (Erasmus University Medical Center in Rotterdam). Their genomes turned out to be 99.5% similar. It also turned out that of all the coronaviruses that infect people, the closest to the new virus was the SARS virus, detected in 2003 in China.

However, the symptoms of the diseases they caused turned out to be significantly different: the new virus caused not only pneumonia, but also kidney dysfunction. Initially, there was no infection of medical personnel, although later such cases appeared quite a few.

A subsequent retrospective investigation led by Dr. Ziyad Memish of the University of Riyadh indicated that the virus infecting humans appears to have originated no later than 2007 as a result of at least 7 animal-to-human transmissions.At the same time, the strains identified in animals showed wide variability, while the strains isolated from humans were very close to each other in genome sequences.

What is coronavirus

The disease is named

So, for the first time, the Middle East Respiratory Syndrome virus was detected in Saudi Arabia as the cause of severe pneumonia. Most infected people develop acute respiratory syndrome with symptoms of fever, cough, difficulty breathing, and kidney damage.The mortality rate currently ranges from 15 to 40%.

The virus was also detected in other countries of the Middle East (Jordan, Qatar, UAE, Oman, Yemen, Iran, Turkey), North Africa (Algeria, Egypt, Tunisia) and Europe (Great Britain, Germany, Italy, France, Belgium, Austria, the Netherlands ), America (USA) and Asia (China, Malaysia, Philippines, Thailand, Republic of Korea).

A major outbreak of the virus continues this year in the Republic of Korea. The first patient arrived there from Saudi Arabia on May 20, and it all started with him.By early August, there were 186 laboratory-confirmed cases of MERS virus infection in Korea. Of these, 36 ended in death, 138 people recovered and 12 people were in the active phase of the disease, including three in critical condition. There was no one in quarantine, but 16693 people were quarantined earlier. According to the WHO criteria, after 2 periods of 21 days have passed after the recovery or death of the last patient, the epidemic in this place can be considered complete.

But no matter how you call this disease (in this case, in the nomenclature of the World Health Organization, it received the name MERS – Middle East Respiratory Syndrome), it remains what it is – pneumonia, or in Russian pneumonia of a viral nature.

Non-specific protection

Interferons are natural proteins, in the process of evolution they appeared in our body to protect against viruses, and regardless of the nature of the virus. In fact, these are signaling molecules that the body produces in response to any infection. They, in turn, cause the synthesis of about two hundred proteins (interferon-stimulated genes, ISG), which provide the body’s defense against the virus, and the defense is nonspecific.

This means that the effectiveness of such protection is equally high regardless of which virus enters the cell – influenza, HIV, measles or herpes.The proteins encoded by ISG interfere with the fusion of the viral and cell membranes, disrupt protein synthesis, bind viral components, preventing them from being transported to the desired parts of the cell, destroy viral RNA, i.e. interfere with the processes that are necessary for the normal process of viral growth.

In other words, interferons are the main link in nonspecific protection against viruses, and this is related to their use as antiviral drugs. The processes triggered by interferons in the cell make it possible to organize a quick and effective response to an infection, no matter what virus it is caused by, since they act on such targets that are necessary for viruses of all families.

The many-sided pneumonia

To date, more than 100 strains of infectious agents that cause pneumonia are known. But in fact, only a few of them are responsible for most cases of disease.

In addition, mixed viral-bacterial infections occur in approximately 45% of cases of pneumonia (VL) in children and in 15% of adults. And, what is important to remember, the pathogenic agent has so far been isolated and identified in only about half of the cases, despite careful research.True, until the 1970s, it was possible to identify only up to 20% of the pathogenic agents that cause pneumonia. So progress is evident.

In adults, the etiological agents causing VL are viruses in 30% of cases, in children – in about 15% of cases. The following viral agents commonly cause pneumonia: rhinoviruses, coronaviruses, influenza viruses, respiratory syncytial virus, adenovirus, parainfluenza viruses and, in some countries, hantaviruses.

In very rare cases, VL is caused by herpes viruses, mainly in newborns, cancer patients, organ transplant recipients and in patients with large areas of burns.People with organ transplants who are taking special medications to prevent organ rejection sometimes have pneumonia caused by cytomegalovirus.

Finally, patients with viral respiratory infections are much more likely than healthy people susceptible to bacterial infections, and then viral pneumonia becomes bacterial, the etiological agents of which are usually Streptococcus pneumoniae, Staphylococcus aureus or Haemophilus influenza. This often happens when patients have other health problems that affect the immune system.

For example, people with weakened immune systems, chronic lung disease, diabetes and kidney failure are at greatest risk for MERS virus disease.

At different times of the year, different viral infections causing pneumonia predominate; for example, during the seasons where influenza is most prevalent, these viruses can be responsible for more than half of all pneumonia cases.

From the above, it is clear that the problems of diagnosing pneumonia are still relevant.But progress in the field of identifying and studying the causative agents of pneumonia does not stop, and therefore, both the identification of the causative agent of Severe Acute Respiratory Syndrome (SARS), a new subgenus in the family of coronaviruses in 2003, and the discovery in 2012 of the Middle East Respiratory Syndrome (MERS) virus, are natural. which also belongs to coronaviruses.

How is the disease caused by the MERS

virus treated now?

Balancing on the brink of a pandemic

Genome sequencing data for Korean and first Chinese isolates of the virus were analyzed this summer, and new biosafety measures were introduced in patient care.The fact is that the virus, apparently, persists well on the surfaces of ordinary household items, and therefore the number of secondary cases of infection through household items and the surfaces of items in wards is so high. Similar cases have been reported previously for influenza virus.

The natural hosts of the MERS virus are most likely some species of tropical bats; camels also suffer from it. Apparently, its gradual evolution led to adaptation first to immunodeficient people, from whom the transmission of the virus to the human population began.

Head of Rospotrebnadzor Anna Popova announced that she recommends Russians to refrain from traveling to Korea and Saudi Arabia in the near future. This is a sound recommendation. Our epidemiologists use sound measures at the borders, but nevertheless, it is better to minimize the risks of bringing this infection into the country.

Whether the MERS virus will cause a major epidemic remains to be seen. But it is extremely important to extinguish the current outbreaks, especially since a vaccine against MERS has not yet been developed, although in principle it is quite possible.

Precautions for dealing with sick

Waiting for vaccine

Work on vaccines against coronavirus infections has been going on for a long time, because these viruses cause up to 20% of respiratory infections. But until 2003, mortality from them was negligible, so the world’s leading companies did not deal with them. With the emergence of SARS and MERS, infections with high mortality, the situation with the development of vaccines began to change.At the beginning of July, it was reported that the development of vaccines against MERS virus in Germany, and then in Russia, was successful.

In particular, a recent article in Medical News Today provides information on the development of a recombinant live vaccine against MERS at the Ludwig-Maximilian University in Munich based on the Ankara strain of vaccinia virus. This vaccine has been shown to be protective in mice as a model of MERS infection.

In my opinion, the development of a vaccine against common types of coronaviruses also makes sense, since they cause up to 5 million cases of respiratory infections in Russia per year, which is slightly less than for the influenza virus, vaccines against which are the subject of great concern and financial costs on the part Ministry of Health of Russia.And this is justified by the decrease in the number of diseases and deaths from this infection.

The name SARS is obsolete

Lung inflammation (LI), or pneumonia, is an inflammatory disease that affects the air sacs in the lungs called the alveoli. This disease is usually caused by viral or bacterial agents, less often by other microorganisms, certain chemicals, and sometimes is the result of autoimmune processes in the body.

Symptoms and signs usually include fever, chest pain, cough, and wheezing difficulty in breathing.VL is diagnosed using X-ray of the lungs, and the pathogenic agent is detected by culturing and subsequent analysis of sputum samples. Vaccines have been developed against some forms of pneumonia, and their use in the world is gradually expanding. Doctors usually think that VL is caused by bacteria and therefore prescribe antibiotics. In severe cases, patients are hospitalized with subsequent intensive symptomatic treatment.

VL in the world affects up to 450 million people per year (7% of the population), which currently leads to about 7 million deaths (2%).The introduction of antibiotic therapy and vaccination has dramatically increased the proportion of those who have recovered, and the above figures refer to our time. However, in developing countries, as well as among the elderly, infants and chronically ill, VL remains the leading cause of death.

It is almost impossible to distinguish viral and bacterial pneumonia by symptoms, however, there is a belief among doctors that if a whistle is heard while breathing, then this is a disease of a viral nature. It is diagnostically important to clearly distinguish between tuberculosis and other VL of a bacterial nature, because the methods of treating tuberculosis differ from methods of treating other bacterial respiratory infections.Currently, the main accurate diagnostic approaches are enzyme immunoassay for protein markers of infectious agents, antibodies produced by the body to them, and PCR diagnostics for the genetic material of pathogens.

Historically, cases of pneumonia have been symptomatically but very subjectively divided into “typical” and “atypical.