infection, or lobar pneumonia
- The cells in the body need oxygen
to survive. When one breathes in oxygen-rich air, it travels
through the nose or mouth and into the lungs via a system of
pipelike air canals known as bronchi.
- The left and the right lungs are
spongy organs located underneath the rib cage on either side
of the chest cavity.
- In Pneumonia,
inflammation (irritation, swelling) or infection of the
lungs causes fluid and pus to fill a section (Lobar p.) or
form patches in both lungs (Bronchial p.), interfering with
the uptake of oxygen.
- Fever: > 38.3 degrees Celsius or 100 degrees Fahrenheit
- Chills -- sudden onset
- Cough -- dry
- Cough -- productive with sputum
that has a rusty color. It may be thick and have a pinkish
tone or blood specks (Streptococcus p.). In Aspiration p.
sputum may be foul- smelling and green. Pseudomonas p. may
produce greenish sputum. In Klebsiella p., sputum will
look like current jelly.
- Chest pain -- sharp, especially
upon inhalation (pleurisy)
- Rapid shallow breathing
- Shortness of breath (SOB) --
especially with activity
- Headache, nausea, vomiting, Diarrhea, and
weakness may occur with all types, but more often is due
to Legionella p.
- Abdominal pain
- Starts with upper respiratory symptoms such as a dry cough, low-grade fever (< 100 degrees Fahrenheit), headache, Nasal Congestion,
sore throat, along with muscle and joint aches
- Skin rash may appear as in measles
- Cough -- dry, can have sputum
- Chest pain -- especially with
breathing, and on one side
- Shortness of breath, especially
- Nausea, vomiting, Diarrhea
- Slow progression
- Low-grade fever
- Cough -- dry, violent runs of
- Nasal Congestion
- Sore throat
- Muscle and joint pain
- Wheezing sound when breathing
- Often first presentation in HIV Infection or AIDS
- Symptoms may develop suddenly.
- Cough with white -- clear sputum
- Shortness of breath -- at first
only with activity, but then advancing to SOB at rest
- Weight loss
- Loss of
Pneumonia is not a single disease.
- Bacteria (B.P.) or wet p. -- when the body's resistance is lowered due to certain conditions (i.e., age, disease, alcohol, Malnutrition) the
normal bacteria of the mouth and the throat multiply and
invade one or all of the 5 sections (lobes) of the
lungs. The infected lobe (or lobes) then fills with
fluid and pus (Consolidation), in turn interfering with
the lung's normal oxygen exchange.
- The infection can spill into the
blood stream and invade the whole body. Bacteria can
also enter the lungs from the air or from other sites in
the body. Infections can either be acquired from the
community at large or while in the hospital.
- Streptococcus Pneumonia is the most common cause of bacterial (Lobar) Pneumonia.
- Other bacteria include H. Influenza (winter
early spring), Staphylococcus aureus (Intravenous drug abusers -- IVDA), Chlamydia,
Moraxella catarrhalis (smokers), Legionella (summer and
fall in water delivery systems, air conditioning units),
and gram-negative bacteria such as Pseudomonas aeruginosa,
Klebsiella, and anaerobes.
- Aspiration p. occurs when stomach contents get into the lungs. Aspiration takes place when the normal swallowing mechanism is impaired while unconscious (e.g., seizure, Stroke, overdose), and from acid Reflux or vomiting
(alcoholics). Multiple types of bacteria can infect
the lungs in these ways.
- Empyema -- refers to the pus in between the layers of the
pleura (the covering over the lungs)
- Viruses -- are usually acquired by inhaling air borne infected virus droplets from someone sneezing or coughing. Viruses are responsible for 50% of all Pneumonias, usually causing upper respiratory illness (air ways near the throat and mouth), but can work their way down to the lower lungs and produce a patchy type of Pneumonia that
usually resolves on its own. Some of the viruses include Influenza (A, B, C -- most common in adults), RSV (most common in infants), paraInfluenza (1,2,3,4), adenovirus, CMV, Chicken Pox, EBV,
- Mycoplasma Pneumoniae (i.e., walking Pneumonia) --
classified as a small organism between a virus and a bacteria, it causes Pneumonia with a
nagging dry cough that comes in violent
- Pneumocystis carinii (PCP) -- believed to be a fungus, it often causes Pneumonia in patients with AIDS or decreased body
- Tuberculosis (TB) --
caused by the organism known as Mycobacterium Tuberculosis (i.e.,
M. bovis and M. africanum). It is contagious, and
can infect the lungs and other organs (brain, spine,
- Rickettsiae -- small organisms
that cause diseases such as Rocky Mountain spotted
fever. It may also have a mild to severe effect on
- Parasites -- ascariasis (round worm) in
- Others -- substances can get into the lungs and cause a
blockage of the air passages, promoting bacterial overgrowth
or directly inflaming the lung tissue.
- Food -- vomiting or swallowing a
small object, like a pea
- Gases -- furniture polish
- Dust -- usually dust, fungus, or
mold inhalation in farmers, mushroom pickers, or miners
- Liquids -- gasoline, kerosene
- Foreign body (e.g., swallowing a
coin or tooth)
Varies with type of Pneumonia
- Skin may show a rash, cyanosis
- Increased heart and respiration
rate (number of breaths per minute)
- Blood pressure may be low
- There may be fever
- The chest (rib cage) may expand
- There may be decreased breath
sounds or abnormal sounds (friction rub, rales, crackles,
wheezing) due to destruction of lung tissue, narrowing of
airways, or presence of fluid and pus.
- Changes in mentation -- confusion, Anxiety
- Sputum samples may be collected
and sent for microscopic analysis using special stains to
reveal the particular bacteria.
- Sputum may be sent for cultures
grown in order to identify the organism type, along with
sensitivity to antibiotics.
- Cultures may take anywhere from 48
hours (bacteria) to several weeks (TB).
- Viral cultures can be done as
- Blood may also be collected and
sent for bacterial cultures (positive in 8-20% of B .p).
- Blood may show high ESR (viral), white blood cell count (may be normal in elderly and low in Viral p.), low oxygen levels (hypoxia), low Sodium levels (empyema or lung Abscess), high LDH
(PCP), and acidity (acidosis).
- Blood can also be screened for presence of specific Proteins called
- In Mycoplasma p., 1-2 weeks after
infection there are high levels of IgM antibodies in
almost 80% of patients.
- One can look for organisms such as viruses (herpes, Influenza, RSV) by
doing a throat swab using a sterile Q-tip and swabbing the
throat; or by performing tracheal aspiration (suction tube
used to suck secretions from the trachea, i.e. the main
- In PCP, an HIV test may be needed
-- CD4 cell count falls below 200 if HIV is present.
- Pictures of the lung are done
- Chest X-Ray -- may
show infection in one or more lobes of the lungs (B. p.),
diffuse pattern of infection (PCP, V. p., M. p.), and
- CAT scan or MRI is rarely necessary unless cancer or Abscess is
suspected; or when preparing for a procedure.
- Your doctor may consult with an
infectious diseases specialist, or a pulmonologist (lung
- The pulmonologist may
- Bronchoscopy --
flexible tube with a camera at its tip is passed through
the mouth to the lungs, taking a sample of secretions for
culture or biopsy (taking a tiny piece).
- Thoracentesis is
performed by inserting a needle between the ribs and
removing fluids for analysis. This is done in
- Recent viral infections
- Tube feeding
- Mechanical ventilation
- Antibiotic use
- Age -- extremes of age, i.e., infants
and elderly (> 65)
- Weakened immune system or body's
- Chemotherapy -- cancer killing
- Chronic, obstructive lung disease
- Kidney failure
- Heart disease
- Diabetes mellitus
- Overdose of drugs
- IVDA (intravenous drug
- Family members
- Mental hospitals
- Nursing homes
- Occupational -- farmers, infected
birds (ducks, pet pigeons, parakeets),
- Depends on the type
- May need admission to hospital if patient has a high
fever, shortness of breath, or in shock.
- If treated on outpatient basis, one needs to be
monitored closely afterward to make sure he is improving.
- Bed rest, plenty of fluids, and Tylenol for pain are
usually sufficient for mild uncomplicated cases.
- Antibiotic pills may be started if the patient does not
appear too sick.
- General antibiotics (e.g., erythromycin) may be given
until the cultures come back from the lab, then changed to
the appropriate antibiotic.
- Antibiotics are not given for virus infections.
- Antivirus medications such as Amantadine (Influenza A and B) or
Ribavirin (RSV, hanta virus) and Ganciclovir (CMV, herpes)
are available and only given to those whose infections have
been identified and typed.
- If the patient is very sick, he or she should be
admitted to the hospital.
- Intravenous (IV) fluids started.
- Oxygen given if levels are low.
- IV antibiotics started.
- If one has TB or other dangerous forms of Pneumonia, isolate
from other patients.
- If unable to breathe, respiratory support is provided
via mechanical ventilation (machine breathes for you).
- A respiratory therapist may be needed to work with the
- Follow up laboratory tests and X-Rays are done to check
- Medical follow up after discharge and a repeat X-Ray in 6-9
your doctor immediately. If you have difficulty breathing,
call 911. Further Information can be obtained from the
American Lung Association in the U.S. by calling
- Reduce risk factors
- Vaccination -- against measles, Influenza, Pneumococcal p., especially in
those over age 65 and other diseases
- Bed-ridden individuals -- avoid prolonged bed rest,
perform exercises in bed, breathing and coughing exercises
before and after an operation.
- Avoid alcohol, drugs, NGT feeding
- Avoid smoking
- Avoid taking antibiotics for viral Pneumonias
- Foods high in vitamins, minerals, and other
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