Pneumonia

Pneumonia is an inflammation of the lungs caused by bacteria, viruses, or chemical irritants. It is a serious infection or inflammation in which the air sacs fill with pus and other liquid. Prior to the discovery of antibiotics, one-third of all people who developed pneumonia subsequently died from the infection.

• Lobar pneumonia affects one or more sections (lobes) of the lungs.
• Bronchial pneumonia (or bronchopneumonia) affects patches throughout both lungs.

Symptoms

The most common symptoms of pneumonia are:

·         Cough (with some pneumonias you may cough up greenish or yellow mucus, or even bloody mucus)

·         Fever, which may be mild or high

·         Shaking chills

·         Shortness of breath (may only occur when you climb stairs)

Additional symptoms include:

·         Confusion, especially in older people

·         Excessive sweating and clammy skin

·         Headache

·         Loss of appetite, low energy, and fatigue

·         Sharp or stabbing chest pain that gets worse when you breathe deeply or cough

Diagnosis

Diagnosis is usually made based on the season and the extent of the illness. Based on these factors, your physician may diagnose simply on a thorough history and physical examination, but may include the tests to confirm the diagnosis.

If you have pneumonia, you may be working hard to breathe, or breathing fast. Crackles are heard when listening to your chest with a stethoscope. Other abnormal breathing sounds may also be heard through the stethoscope or via percussion (tapping on your chest wall).

• The health care provider will likely order a chest x-ray if pneumonia is suspected.

Some patients may need other tests, including

• Blood tests - to analyze the amount of carbon dioxide and oxygen in the blood.
• Sputum culture - a diagnostic test performed on the material that is coughed up from the lungs and into the mouth. A sputum culture is often performed to determine if an infection is present.
• Pulse oximetry - an oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (such as a Band-Aid) is taped onto a finger or toe. When the machine is on, a small red light can be seen in the sensor. The sensor is painless and the red light does not get hot.

·         Pleural fluid culture if there is fluid in the space surrounding the lungs

Treatment for pneumonia:

Specific treatment will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include antibiotics for bacterial pneumonia. Antibiotics may also speed recovery from mycoplasma pneumonia and some special cases. There is no clearly effective treatment for viral pneumonia, which usually heals on its own.

Other treatment may include appropriate diet, oxygen therapy, pain medication, and medication for cough.

You can take these steps at home:

·         Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen), or acetaminophen. DO NOT give aspirin to children.

·         Do not take cough medicines without first talking to your doctor. Cough medicines may make it harder for your body to cough up the extra sputum.

·         Drink plenty of fluids to help loosen secretions and bring up phlegm.

·         Get lots of rest. Have someone else do household chores.

Expectations (prognosis)

With treatment, most patients will improve within 2 weeks. Elderly or debilitated patients may need longer treatment.
Those who may be more likely to have complicated pneumonia include:

·         Older adults or very young children

·         People whose immune system does not work well

·         People with other, serious medical problems such as diabetes or cirrhosis of the liver

Your doctor may want to make sure your chest x-ray becomes normal again after you take a course of antibiotics. However, it may take many weeks for your x-ray to clear up.

Complications

Possible complications include:

·         Acute respiratory distress syndrome (ARDS), a severe form of respiratory failure

·         Empyema or lung abscesses. These are infrequent, but serious, complications of pneumonia. They occur when pockets of pus form inside or around the lung. These may sometimes need to be drained with surgery.

·         Respiratory failure, which requires a breathing machine or ventilator

·         Sepsis, a condition in which there is uncontrolled swelling (inflammation) in the body, which may lead to organ failure

Call your doctor if you have:

·         Worsening respiratory symptoms

·         Shortness of breath, shaking chills, or persistent fevers

·         Rapid or painful breathing

·         A cough that brings up bloody or rust-colored mucus

·         Chest pain that worsens when you cough or inhale

·         Night sweats or unexplained weight loss

·         Signs of pneumonia and weak immune system, as with HIV or chemotherapy

Infants with pneumonia may not have a cough. Call your doctor if your infant makes grunting noises or the area below the rib cage is retracting while breathing.

Prevention

Wash your hands frequently, especially after blowing your nose, going to the bathroom, diapering, and before eating or preparing foods.
Don't smoke. Tobacco damages your lung's ability to ward off infection.
Vaccines may help prevent pneumonia in children, the elderly, and people with diabetes, asthma, emphysema, HIV, cancer, or other chronic conditions:

·         A drug called Synagis (palivizumab) is given to some children younger than 24 months to prevent pneumonia caused by respiratory syncytial virus.

·         Flu vaccine prevents pneumonia and other problems caused by the influenza virus. It must be given yearly to protect against new virus strains.

·         HIV vaccine prevents pneumonia in children from Haemophilus influenzae type b.

·         Pneumococcal vaccine (Pneumovax, Prevnar) lowers your chances of getting pneumonia from Streptococcus pneumoniae.

If you have cancer or HIV, talk to your doctor about additional ways to prevent pneumonia and other infections.