- 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 (Branchial p.), interfering with the uptake of oxygen.
- Fever >38.3(C or 100(F
- 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. Pseudemonas 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(F), 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 with activity
- Nausea, vomiting, Diarrhea
- Slow progression
- Low-grade fever
- Cough -- dry, violent runs of coughing
- 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 appetite
- 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
- Streptococcus Pneumonia is the most common cause of bacterial (Lobar) Pneumonia.
- Other bacteria include H. Influenza (winter
and 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
- 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 pleura covering 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, Measles.
- 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, kidney,
- Rickettsiae -- small organisms that cause diseases such as Rocky Mountain Spotted Fever. It may also have a mild to severe
effect on the lungs.
- Parasites -- ascariasis (round worm)
- 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)
- 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 airway).
- In PCP, an HIV test may be
needed -- CD4 cell count falls below 200 if HIV is
- Pictures of the lung are done
using --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.),
- 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 effusions and empyema.
- 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 natural defenses:
- Chemotherapy -- cancer killing drugs
- Chronic, obstructive lung disease
- Kidney failure
- Heart disease
- Diabetes Mellitus
- Overdose of drugs
- IVDA (intravenous drug abuse)
- Family members
- Mental hospitals
- Nursing homes
- Occupational -- farmers, infected birds (ducks, pet pigeons, parakeets), miners
- Depends on the type
- 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 after an operation.
- Avoid alcohol, drugs, NGT feeding
- Avoid smoking
- Avoid taking antibiotics for viral Pneumonias
- Foods high in vitamins, minerals, and other nutrients.
- 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 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 breath, respiratory support is provided via mechanical ventilation (machine breathes for you).
- A respiratory therapist may be needed to work with the patient.
- Follow up laboratory tests and X-Rays are done to check treatments.
- Medical follow up after discharge and a repeat X-Ray in 6-9 weeks.
Contact 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 1-212-315-8700.
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