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Pneumonia

Pneumonia is an acute or chronic inflammation of the parenchyma of the lung. Most cases are due to infection by bacteria or viruses, a few to inhalation of chemicals, fungi, parasites or trauma. Pneumonia is most commonly classified by the area of lung affected: lobar pneumonia, bronchial pneumonia and interstitial pneumonia. The signs and symptoms of pneumonia vary from mild to severe. The most common symptoms of pneumonia include productive cough, fever, dyspnea and chest pain.


Presentation

Individuals with infectious pneumonia generally have a productive cough, sharp pain in between breaths, fever accompanied with shaking chills and an increased respiratory rate. For the elderly, confusion is often the most prominent sign [6]. In children under 5, the typical signs and symptoms are fever, fast or difficult breathing and cough.

Fever is not a specific symptom because it occurs in many other illnesses and may be absent in with more severe conditions or malnutrition. Again, children less than two months old do not present with cough. In severe cases, other symptoms to expect include a blue-tinged skin, decreased thirst, convulsions, constant vomiting, decreased levels of consciousness and temperature always at the extremes.

Both bacterial and viral cases of pneumonia have similar symptoms.

Some causative agents are linked with classic but often non-specific characteristics. For instance pneumonia caused by Klebsiella may have the “currant jelly” symptom or bloody sputum, pneumonia caused by Streptococcus pneumonia is linked with rusty and coloured sputum while Legionella-cuased pneumonia is associated with abdominal pain, diarrhea or confusion.

Cough
  • This will shake the mucus and pus pocket loose so your child can cough it up. Encourage coughing during this time. Cough medicine – do not suppress the cough during the day. Your child needs to cough it up.[askdrsears.com]
  • 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, which may only occur when you climb stairs Additional[lung.org]
  • Wet cough iStock/lisafx A persistent cough is common with a URI. (Related: Find out these natural cough remedies .) Eventually, that cough becomes productive and allows for the body to push out mucus.[rd.com]
  • Talk to a doctor before using cough medicine. Cough medicine allows the body to be less irritated by mucus, but this inhibits the body from coughing the mucus and getting it out of your system.[plushcare.com]
  • Rhythmic breathing and coughing helps you loosen and cough up secretions by tapping on the chest, then deep breathing and coughing forcefully.[livestrong.com]
Dry Cough
  • The initial symptoms of viral pneumonia are the same as influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness.[lung.org]
  • Early symptoms are similar to flu symptoms, which include: Fever Dry cough Headache Sore throat Loss of appetite Muscle pain Additional symptoms about a day later: High fever Cough with mucus Shortness of breath Next: Management and Treatment Cleveland[my.clevelandclinic.org]
  • The hacking, dry cough can be very persistent.[patient.info]
  • If your pneumonia is caused by a virus, the symptoms will be flu-like for the first few days: dry cough, fever, headache, shaking chills, extreme fatigue, a poor appetite, and muscle pain and weakness.[fox17online.com]
  • They may not feel ill enough to demand a day of school, but they could be tired, suffering from headaches, a minor feever or a dry cough. Mycoplasma pneumoniae is responsible for up to 20 per cent of adult pneumonia cases.[thesun.co.uk]
Productive Cough
  • The most common symptoms of pneumonia include productive cough, fever, dyspnea and chest pain.[symptoma.com]
  • Patients with pneumonia usually report a gradual onset of difficulty breathing, along with fever and chills, a productive cough and chest pain associated with the cough.[ems1.com]
  • Many other bacteria may cause bacterial pneumonia including: Group B streptococcus Staphylococcus aureus Group A streptococcus Bacterial pneumonia may have a quick onset and the following symptoms may occur: Productive cough Pain in the chest Vomiting[stanfordchildrens.org]
  • Read more on WA Health website Pneumonia symptoms - myDr.com.au The symptoms of pneumonia usually depend on the cause of the pneumonia, but some symptoms are common, such as dry or productive cough, chest pain, fever or chills and breathlessness.[healthdirect.gov.au]
  • Fever, productive cough, pleuritic chest pain and dyspnea are the most common symptoms. Pregnant women may be at greater risk for morbidity and mortality due to pneumonia because of the immunologic and physiologic changes of pregnancy.[clinicaladvisor.com]
Dyspnea
  • The clinical signs included 106 rectal temperature and extreme dyspnea with open-mouth breathing.[ksvdl.org]
  • The most common symptoms of pneumonia include productive cough, fever, dyspnea and chest pain.[symptoma.com]
  • Fever, productive cough, pleuritic chest pain and dyspnea are the most common symptoms. Pregnant women may be at greater risk for morbidity and mortality due to pneumonia because of the immunologic and physiologic changes of pregnancy.[clinicaladvisor.com]
Rales
  • Physical exam: Rales and pulmonary changes such as dullness are often absent despite disease. Chest X-ray patterns seen with bacterial CAP are generally areas of consolidation in one lobe or multilobar. Pleural effusions are uncommon.[clinicaladvisor.com]
Fever
  • There may be a high fever and there may be blueness of the lips. What Causes Pneumonia? Many different germs can cause pneumonia.[lung.org]
  • Manage Fever Symptoms To help keep a fever from getting worse or a high fever from causing further complications, here are tips that you can implement at home: Suck on ice cubes or make homemade ice pops to prevent dehydration .[draxe.com]
  • Fever iStock/KatarzynaBialasiewicz You may develop a low-grade fever with an upper respiratory infections (URI); it’s not common, but also not impossible.[rd.com]
  • A fever spikes. You get chills and begin to shake. These are all signs of pneumonia, a serious lung infection that claims the lives of hundreds of thousands of people around the world each year.[fox17online.com]
Chills
  • Chills iStock/George Clerk Patients with pneumonia often report teeth-chattering chills that cannot be remedied. Chills are a sign of fever and that the body is working overtime to regulate temperature.[rd.com]
  • : an acute disease that is marked by inflammation of lung tissue accompanied by infiltration of alveoli and often bronchioles with white blood cells (such as neutrophils) and fibrinous exudate , is characterized by fever, chills, cough, difficulty in[merriam-webster.com]
  • In bacterial-based pneumonia, a very high fever is often accompanied by sweating, chills, and occasionally a sense of delirium or confusion in the patient.[news-medical.net]
  • Symptoms include cough, shortness of breath, fevers, chills, chest pain, headache, sweating, and weakness. Definition (CSP) inflammation of the lungs with consolidation and exudation.[fpnotebook.com]
Malaise
  • The elderly may present with mainly systemic complaints of malaise, fatigue, anorexia and myalgia. Young children may present with nonspecific symptoms or abdominal pain.[patient.info]
  • Initially, these patients experience fever with chills, cough, shortness of breath, headache, muscle pain, and malaise , all of which may subside in a day if there is no further exposure.[britannica.com]
  • These patients may present with fever, cough, headache, malaise and erythema nodosum.[clinicaladvisor.com]
  • The following may also occur: dyspnoea sharp chest pain worsening cough fever/chills Tachycardia pleuritic chest pain headaches malaise muscle pains cyanosis due to poorly oxygenated blood loss of appetite rapid breathing wheezing or grunting during breathing[physio-pedia.com]
  • Some people develop a mild flu-like syndrome with low-grade fever, malaise, headache , and muscle aches. In extremely rare cases, some may develop the neurologic syndrome known as Guillain-Barré syndrome.[emedicinehealth.com]
Hypoxemia
  • Additional tests that may be helpful include pulse oximetry to indicate hypoxemia even in a well appearing pregnant woman.[clinicaladvisor.com]
Anorexia
  • The elderly may present with mainly systemic complaints of malaise, fatigue, anorexia and myalgia. Young children may present with nonspecific symptoms or abdominal pain.[patient.info]
Vomiting
  • Vomiting – not just vomiting from a big coughing fit, but vomiting even in between coughing fits. Blue color around the lips and face – from lack of oxygen.[askdrsears.com]
  • They may seem weak, vomit, or have diarrhea. Less common symptoms include abdominal pain and a stiff neck.[babycenter.com]
  • Aspiration pneumonia Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs.[mayoclinic.org]
  • Symptoms may include: Fever Chest or stomach pain Decrease in appetite Chills Breathing fast or hard Vomiting Headache Not feeling well Fussiness The symptoms of pneumonia may resemble other problems or medical conditions.[stanfordchildrens.org]
Loss of Appetite
  • Early symptoms are similar to flu symptoms, which include: Fever Dry cough Headache Sore throat Loss of appetite Muscle pain Additional symptoms about a day later: High fever Cough with mucus Shortness of breath Next: Management and Treatment Cleveland[my.clevelandclinic.org]
  • Fever, sweating and shivering, loss of appetite and a rapid heartbeat are all also symptoms. Less common symptoms include coughing up blood, headaches, tiredness, feeling or being sick, wheezing, muscle pain and confusion.[thesun.co.uk]
  • […] of appetite, low energy, and fatigue Confusion, especially in older people Symptoms also can vary, depending on whether your pneumonia is bacterial or viral.[lung.org]
  • Other symptoms include shortness of breath, rapid-shallow breathing, chest pain, headache, excessive fatigue, and/or loss of appetite.[craighospital.org]
  • Patients with pneumonia also experience fevers, nausea, diarrhea, loss of appetite, fatigue, and shortness of breath—the severity of which can vary depending on the causative agent and the patient’s overall level of health.[news-medical.net]
Diarrhea
  • They may seem weak, vomit, or have diarrhea. Less common symptoms include abdominal pain and a stiff neck.[babycenter.com]
  • UNICEF, One is too many: Ending child deaths from pneumonia and diarrhea , UNICEF, New York, 2016.[data.unicef.org]
  • Patients with pneumonia also experience fevers, nausea, diarrhea, loss of appetite, fatigue, and shortness of breath—the severity of which can vary depending on the causative agent and the patient’s overall level of health.[news-medical.net]
  • In Honduras, pneumonia treatment is part of a national, integrated community child care program that trains community volunteers to monitor children's growth, provide health education, and treat pneumonia and diarrhea.[pbs.org]
  • […] other bacteria may cause bacterial pneumonia including: Group B streptococcus Staphylococcus aureus Group A streptococcus Bacterial pneumonia may have a quick onset and the following symptoms may occur: Productive cough Pain in the chest Vomiting or diarrhea[stanfordchildrens.org]
Abdominal Pain
  • Less common symptoms include abdominal pain and a stiff neck. Streptococcus pneumoniae is the usual cause, but other bacteria (such as Staphylococcus aureus or Mycoplasma pneumoniae) can cause pneumonia, too.[babycenter.com]
  • For instance pneumonia caused by Klebsiella may have the “currant jelly” symptom or bloody sputum, pneumonia caused by Streptococcus pneumonia is linked with rusty and coloured sputum while Legionella-cuased pneumonia is associated with abdominal pain[symptoma.com]
  • Young children may present with nonspecific symptoms or abdominal pain. Signs: tachypnoea, bronchial breathing, crepitations, pleural rub, dullness with percussion.[patient.info]
  • Sometimes a child's only sign may be rapid breathing and often when pneumonia exist in the lower part of the lungs, no breathing problems may be present but rather fever, abdominal pain or vomiting.[physio-pedia.com]
Chest Pain
  • pain No chest pain or only mild pain No sore throat Sore throat How pneumonia is diagnosed Pneumonia can be difficult to diagnose because the symptoms are very similar to bronchitis, a bad cold or asthma.[beta.nhs.uk]
  • If they are severe symptoms such as chest pain, seek urgent medical attention. It can be tough to diagnose because its symptoms are similar to common conditions such as colds and asthma.[thesun.co.uk]
  • […] that is marked by inflammation of lung tissue accompanied by infiltration of alveoli and often bronchioles with white blood cells (such as neutrophils) and fibrinous exudate , is characterized by fever, chills, cough, difficulty in breathing, fatigue, chest[merriam-webster.com]
  • Symptoms include cough, shortness of breath, fevers, chills, chest pain, headache, sweating, and weakness. Definition (CSP) inflammation of the lungs with consolidation and exudation.[fpnotebook.com]
  • See your doctor promptly if you Have a high fever Have shaking chills Have a cough with phlegm that doesn't improve or gets worse Develop shortness of breath with normal daily activities Have chest pain when you breathe or cough Feel suddenly worse after[medlineplus.gov]
Cyanosis
  • […] that usually worsens when taking a deep breath, known as pleuritic pain fast heartbeat fatigue and weakness nausea and vomiting diarrhea sweating headache muscle pain confusion or delirium, especially in older adults dusky or purplish skin color, or cyanosis[medicalnewstoday.com]
  • The following may also occur: dyspnoea sharp chest pain worsening cough fever/chills Tachycardia pleuritic chest pain headaches malaise muscle pains cyanosis due to poorly oxygenated blood loss of appetite rapid breathing wheezing or grunting during breathing[physio-pedia.com]
  • At times, the individual's skin color may change and become dusky or purplish (a condition known as cyanosis) due to their blood being poorly oxygenated.[emedicinehealth.com]
Myalgia
  • The elderly may present with mainly systemic complaints of malaise, fatigue, anorexia and myalgia. Young children may present with nonspecific symptoms or abdominal pain.[patient.info]
Arthralgia
  • Arthralgia and myalgia are often reported. Severe complications include pancreatitis, peritonitis, pericarditis, myocarditis, endocarditis and glomerulonephritis. Signs Vital signs should be checked.[patient.info]
Confusion
  • A patient's mental state may be confused or delirious. The initial symptoms of viral pneumonia are the same as influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness.[lung.org]
  • If the infections progresses quickly, the lips may turn a bluish color and confusion or delirium may occur due to a lack of oxygen. Possible Complications We often hear that pneumonia itself is a complication of a cold or the flu.[verywell.com]
  • Seek urgent medical attention if you're experiencing severe symptoms, such as rapid breathing, chest pain or confusion. Who's affected? In the UK, pneumonia affects around 8 in 1,000 adults each year. It's more widespread in autumn and winter.[nhs.uk]
  • He or she also will look for confusion and a purplish hue in your lips, fingernails or hands because these symptoms can indicate that you have low levels of oxygen in your blood.[drugs.com]
Headache
  • The initial symptoms of viral pneumonia are the same as influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness.[lung.org]
  • If you add fever, body aches and headache that come on quickly, it could be you have the flu. Pneumonia is usually a complication of cold or flu, when the illness lodges in the lungs.[fox17online.com]
  • Headache affects the majority of symptomatic sufferers. Fever is relatively unusual. Symptoms may drag on for weeks or months, despite a course of appropriate antibiotics.[patient.info]
Seizure
  • A depressed gag reflex, such as from alcohol intoxication, overdose, head injury, stroke or seizure increases the risk of aspiration pneumonia [3] .[ems1.com]
  • People with recent viral infections, lung disease, heart disease , and swallowing problems , as well as alcoholics, drug users, and those who have suffered a stroke or seizure are at higher risk for developing pneumonia than the general population.[emedicinehealth.com]
  • This can happen when you have had a medical condition that affects your ability to swallow, such as a seizure or a stroke. A healthy person's nose and throat often contain bacteria or viruses that cause pneumonia.[uwhealth.org]
Grunting
  • The following may also occur: dyspnoea sharp chest pain worsening cough fever/chills Tachycardia pleuritic chest pain headaches malaise muscle pains cyanosis due to poorly oxygenated blood loss of appetite rapid breathing wheezing or grunting during breathing[physio-pedia.com]
  • In children, symptoms may depend on age: In infants younger than 1 month of age, symptoms may include having little or no energy (lethargy), feeding poorly, grunting, or having a fever.[uwhealth.org]
Cerebellar Ataxia
  • Extra-respiratory features include rashes such as erythema multiforme, erythema nodosum and urticaria; neurological complications like Guillain-Barré syndrome, transverse myelitis, cerebellar ataxia and aseptic meningitis; haematological complications[patient.info]

Workup

Physical examinations and imaging studies are the chief methods of diagnosis [7].

Diagnosis for pneumonia is often based on a combination of physical signs and a chest X-ray. The underlying cause however can be difficult to confirm as there is often no definitive test for distinguishing between pneumonia of bacterial origin and pneumonia of other origins. In children, the WHO guideline defines pneumonia clinically as decreased level of consciousness, chest indrawing, rapid respiratory rate, difficulty in breathing and/or cough.

Pleural Rub
  • Signs: tachypnoea, bronchial breathing, crepitations, pleural rub, dullness with percussion.[patient.info]
  • Pleural rub Chest X-ray usually done to confirm the diagnosis Sputum samples and blood tests done to diagnose the type of pneumonia that is present sputum test is done to determine whether it is a fungal or bacterial infection blood test is done to examine[physio-pedia.com]

Treatment

Pneumonia is often treated with antibiotics. Most of the cases require the intake of oral antibiotics and these are often prescribed at any health care centre [8]. The average case of pneumonia can be treated with inexpensive oral antibiotics at the community level by trained community health workers. Hospitalisation is only recommended for severe cases of pneumonia and for cases of pneumonia in infants younger than 2 months of age.

Prognosis

The prognosis is generally positive as most kinds of bacterial pneumonia stabilises with a week. Most symptoms get resolved within a week. Findings in X-ray clear within four weeks and mortality is generally low [5]. People with other lung conditions and the elderly may recover after a longer period of time (as long as 3 months).

Etiology

Pneumonia arises due to infections caused primarily by bacteria or viruses. In less common cases, fungi and parasites can bring about pneumonia. Even though over 100 types of infectious agents have been recorded, only a few of these cause the majority of pneumonia cases [2]. In 45% of infections in children, both viruses and bacteria may be responsible for the condition. In adult pneumonia infections, the figure is placed at 15%. Despite careful testing, it is possible to not isolate any causative agent in 50% of pneumonia cases.

Epidemiology

Pneumonia is a very common condition that affects around 450 million people around the world. It is equally a major cause of death amongst people of all age groups as it results in over 4 million deaths. This accounts for more than 7% of the total deaths recorded around the world each year. The rates are at their peak in children who are less than five years old and in adults who are older than the age of 75. Every year, more than 1.1 million children with the condition die every year [3]. The occurrence is 5 times lower in the developed world when compared to the developing world. In the United States for example, pneumonia is the 8th leading cause of deaths.

Sex distribution
Age distribution

Pathophysiology

Viral cases

The Viruses can enter the lung via different routes. For instance, respiratory syncytial virus is often contacted when individuals touch contaminated objects before touching their eyes or nose while other forms of viral infections occur when contaminated airborne droplets get inhaled through the mouth or nose. As soon as they get into the upper airway, the viruses will move to the lungs where the cells lining the airways, lung parenchyma and the alveoli get invaded [4].

Bacterial cases

The bacteria get into the lungs through small aspirations of organisms that reside in the throat or nose. Most normal people have these aspirations while asleep. Although the throat contains bacteria always, the potentially infectious ones are found there only at certain periods and under specific conditions. Contaminated airborne droplets are responsible for the deposition of Mycobacterium tuberculosis and Legionella pneumophilia. The bacteria can also spread via the blood. As soon as the bacteria is in the lungs, the spaces between cells and alveoli are invaded and the neutrophils and macrophages attempt to get rid of the bacteria. The resultant combination brings about the image seen in X-ray.

Prevention

The prevention of pneumonia is one of the most important strategies to reduce the incidence of child mortality. The most effective way to prevent pneumonia is immunization against measles,pertussis, Pneumococcus and Haemophilus influenzae type B.

Adequate nutrition is also important in improving the natural defences of a child beginning with exclusive breastfeeding for the first six months of life. In addition to being effective in the prevention of pneumonia, the length of periods of illness in a child is reduced greatly [9].

The number of people who fall ill with pneumonia can also be prevented by encouraging good hygiene in crowded homes and addressing of environmental factors such as indoor pollution.

For children who are infected with HIV, daily intake of cotrimoxazole is required so as to decrease the risk of contracting pneumonia.

Summary

Pneumonia is an acute respiratory infection of the lungs [1]. The lungs are filled with small sacs called alveoli. These fill when a healthy individual breathes in. In an individual with any form of pneumonia, the sac get s filled with pus and fluid and this makes breathing painful, thereby limiting the individual’s ability to take in oxygen.

Patient Information

Pneumonia is a condition that affects the air sacs in either one lung or both. Cough producing phlegm or pus, difficulty in breathing, chills and fever are common symptoms of this condition and this happens when the affected air sac gets filled with fluid or pus. 

There are different types of organisms that can cause pneumonia. This includes bacteria, viruses and fungi. 

The level of seriousness of this condition varies greatly but it is the most serious amongst infants, young children and people older than 65 years of age. People with underlying health conditions or weakened immune systems also get more serious cases of pneumonia. 

The chances of recovery from pneumonia is high though as there are several antiviral medications for treating it. 

References

Article

  1. Guidelines for the management of community acquired pneumonia in adults; British Thoracic Society (2009), Thorax Vol 64 Sup III
  2. Durrington HJ, Summers C; Recent changes in the management of community acquired pneumonia in adults. BMJ. 2008 Jun 21;336(7658):1429-33.
  3. Guidelines for the management of adult lower respiratory tract infections, European Respiratory Society and European Society of Clinical Microbiology and Infectious Diseases (September 2011)
  4. Chest infections - adult, Prodigy (August 2007)
  5. Bartlett JG; Is activity against "atypical" pathogens necessary in the treatment protocols for Clin Infect Dis. 2008 Dec 1;47 Suppl 3:S232-6.
  6. Rudan I, Boschi-Pinto C, Biloglav Z, et al. Epidemiology and etiology of childhood pneumonia. Bull World Health Organ 2008; 86:408.
  7. Harris M, Clark J, Coote N, et al. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax 2011; 66 Suppl 2:ii1.
  8. Margolis P, Gadomski A. The rational clinical examination. Does this infant have pneumonia? JAMA 1998; 279:308.
  9. Fiore AE, Shay DK, Broder K, et al. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2009. MMWR Recomm Rep 2009; 58:1.
  10. Jokinen C, Heiskanen L, Juvonen H, et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 1993; 137:977.

Symptoms

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