Recognizing pneumonia

WEB EXCLUSIVE / OCTOBER 2005
POSTGRADUATE MEDICINE
Update of a handout originally published in April 1999

Download this Patient Note in PDF format

Pneumonia is an infection or inflammation of the lungs. There are more than 50 different kinds, but the most common are bacterial, viral, and a less typical kind called mycoplasmal pneumonia.

When you have pneumonia, the tiny air sacs in your lungs, called alveoli, fill with pus and other liquid. This fluid may block oxygen from reaching your blood. If your blood contains too little oxygen, your body's cells can't work properly and you become ill. Pneumonia can be dangerous if it is not recognized and treated early.

Pneumonia is contagious. The viruses or bacteria in the mouth or nose of infected persons can be spread to others through coughs and sneezes, shared drinking glasses and eating utensils, or used tissues or handkerchiefs.

Bacterial pneumonia: This is the most serious type of pneumonia, and it can affect anyone--from infants to the very old. People who already have a respiratory disease or weakened immune system are at greatest risk.

Bacteria that can cause pneumonia sometimes live in healthy throats without causing illness. If, however, the body's defenses are weakened by disease, malnutrition, AIDS, or other conditions, the bacteria can start to multiply. Infection may then spread quickly through the bloodstream.

Symptoms of bacterial pneumonia may occur slowly or very suddenly. In the most severe cases, bacterial pneumonia causes shaking chills, severe chest pain, and a cough that yields rust-colored or greenish mucus. Body temperature may rise as high as 105°F, and sweating, rapid breathing, deep coughs, and a fast pulse rate may occur. Sometimes, lips and nail beds appear blue because of a lack of oxygen.

Viral pneumonia: About half of all pneumonias are believed to be caused by viruses. The viruses usually attack the nose and throat, but some also infect the lungs, especially in children. Most of these pneumonias are not serious and last only a short time.

The influenza (flu) virus can also trigger pneumonia, which can be serious. In many cases, there are no signs that the lung tissue is filling up with fluid. Pregnant women as well as people who have heart or lung disease seem to be at the greatest risk for this type of pneumonia.

Symptoms of viral pneumonia are the same as those of flu and include fever, dry cough, headache, muscle pain, and weakness. After about 12 to 36 hours, breathlessness may develop and the cough may get worse. High fever and blue lips also are symptoms of viral pneumonia.

Mycoplasmal pneumonia: Mycoplasmas are the smallest free-living carriers of disease known. They resemble bacteria and viruses and can cause a mild but widespread pneumonia, particularly in older children and young adults. These organisms are responsible for about 20% of all pneumonias. Mycoplasmal pneumonia is sometimes called walking pneumonia.

The most prominent symptom of this type of pneumonia is a cough that tends to come in violent attacks. Chills and fever also are early symptoms, and some people have nausea and vomiting. Mycoplasmal pneumonia can leave you feeling weak and tired for a long time.

Treating the infection

Because pneumonia can have many causes, you should check with your doctor if you have cold or flu symptoms that don't improve within a few days. If pneumonia does develop, your chances for a fast recovery are best if it is caught early. The drugs used to treat pneumonia are determined by the type of organism causing it.

Treatment with antibiotics can cure most bacterial pneumonias and speed recovery from mycoplasmal pneumonia and some other types. However, some bacteria are able to resist the effects of antibiotics, making therapy less successful. Fewer medications are available for viral pneumonia, and they usually are given only in the most severe cases. Viral pneumonia almost always clears up on its own. Most people with pneumonia can be treated at home, but elderly patients often need to be hospitalized.

What should I do if I have symptoms of pneumonia?

There are several steps to take if you have symptoms of pneumonia:

• Call your doctor immediately. Even with the many effective medications now available, early diagnosis and treatment are important.
• Follow your doctor's advice.
• Continue to take the medicine your doctor prescribes until you have taken it all or are told to stop. This helps prevent relapses, which may be far more dangerous than the first attack.

Preventing pneumonia Because pneumonia is a common complication of influenza (flu), getting a flu shot every fall is good pneumonia prevention. The viruses that cause flu tend to change from year to year, and this year's shot is designed to fight this year's viruses. Physicians advise that people start receiving the flu vaccine at about age 50, since this timing seems to provide the best protection. People at risk for pneumonia--for example, those in nursing homes and other long-term care facilities--need the vaccine also. A vaccine is also available to prevent pneumococcal pneumonia, which is caused by bacteria. Risk of pneumococcal pneumonia tends to be greatest in people who: Have a serious chronic illness, such as lung disease, heart disease, a kidney disorder, sickle cell anemia, or diabetes Are recovering from severe illness Are in a nursing home or other healthcare facility Are age 65 years or older One pneumococcal shot usually lasts a lifetime. Vaccination is not recommended for pregnant women or for children under 2 years of age. The most important preventive measure is to be alert to any symptoms of breathing problems that last more than a few days. To increase your resistance to respiratory disease, eat a proper diet, practice good hygiene, get enough rest, don't smoke, drink plenty of fluids, and get regular exercise. These steps also help you recover more quickly if illness does occur.

This information is not a substitute for medical treatment.

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