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PubMed Health Home > Diseases and Conditions > Pneumonia Pneumonia Bronchopneumonia; Communityacquired pneumonia

Last reviewed: April 27, 2010. Pneumonia is a respiratory condition in which there is infection of the lung. Community-acquired pneumonia refers to pneumonia in people who have not recently been in the hospital or another health care facility (nursing home, rehabilitation facility).

 

See also: Hospital-acquired pneumonia Causes, incidence, and risk  factors Pneumonia is a common illness that affects millions of people each year in the United States. Germs called bacteria, viruses, and fungi may cause pneumonia. Ways you can get pneumonia include: •





Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs. You may breathe some of  these germs directly into your lungs. You breathe in (inhale) food, liquids, vomit, or secretions from the mouth into your lungs pneumonia)) (aspiration pneumonia

Pneumonia caused by bacteria tends to be the most serious. In adults,

 

bacteria are the most common cause of pneumonia. •

The most common pneumoniacausing germ in adults is Streptococcus pneumoniae (pneumococcus).





Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as Legionella pneumophila, Mycoplasma  pneumoniae , and Chlamydophila pneumoniae. Pneumocystis jiroveci pneumonia is

sometimes seen in people whose immune system is impaired (due to AIDS or certain medications that suppress the immune system). •

Staphylococcus aureus, Moraxella

 

catarrhalis, Streptococcus pyogenes, Neisseria meningitidis, Klebsiella pneumoniae, orHaemophilus influenzae are other bacteria that can cause pneumonia. •

Tuberculosis can cause pneumonia in some people, especially those with a weak immune system.

Viruses are also a common cause of  pneumonia, especially in infants and young children. See also: Respiratory syncytial virus Risk factors (conditions that increase your chances of getting pneumonia) include:  Cerebral palsy Chronic lung disease (COPD COPD,, bronchiectasis bronchiectasis,, cystic fibrosis)) fibrosis •





Cigarette smoking

 











Difficulty swallowing (due dementia, Parkinson' to stroke, stroke, dementia, s disease, disease, or other neurological conditions) Immune system problem (See also: Pneumonia in immunocompromised host) host) Impaired consciousness (loss of brain function due to dementia, stroke, or other neurologic conditions) Living in a nursing facility Other serious illnesses, such as heart disease, disease, liver cirrhosis, cirrhosis, or diabetes mellitus

Recent surgery or trauma Recent viral respiratory infection (common cold, laryngitis, laryngitis, influenza) influenza) Symptoms •



The most common symptoms of  pneumonia are:

 









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

Signs and tests

 

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: •







 Arterial blood gases to see if  enough oxygen is getting into your blood from the lungs  CBC to check white blood cell count  CT scan of the chest Gram's stain and culture of  your sputum to look for the

 

organism causing your symptoms  Pleural fluid culture if there is fluid in the space surrounding the lungs Treatment •

Your doctor must first decide whether you need to be in the hospital. If you are treated in the hospital, you will receive fluids and antibiotics in your veins, oxygen therapy, and possibly breathing treatments. It is very important that your antibiotics are started very soon after you are admitted. You are more likely to be admitted to the hospital if you: Have another serious medical problem •

• •

Have severe symptoms Are unable to care for yourself  at home, or are unable to eat or drink

 





Are older than 65 or a young child Have been taking antibiotics at home better and are not getting

However, many people can be treated at home. If bacteria are causing the pneumonia, the doctor will try to cure the infection with antibiotics. It may be hard for your health care provider to know whether you have a viral or bacterial pneumonia, so you may receive antibiotics. Patients with mild pneumonia who are otherwise healthy are sometimes treated with oral macrolide antibiotics clarithromycin,, (azithromycin, azithromycin,clarithromycin erythromycin). ). or erythromycin Patients with other serious illnesses, such as heart disease, disease, chronic obstructive pulmonary disease, disease, or emphysema, kidney disease, or

 

diabetes are often given one of the following: Fluoroquinolone (levofloxacin [Levaquin], gemif  loxacin [Factive], or moxifloxacin [Avelox]) High-dose amoxicillin or amoxi cillin-clavulanate, cillin -clavulanate, plus a macrolide antibiotic (azithromycin azithromycin,, clarithromycin clarithromycin,, •





or erythromycin) erythromycin) Cephalosporin antibiotics (for example, cefuroxime or cefpod oxime)) plus a macrolide oxime azithromycin,, clarithromycin clarithromycin,, (azithromycin erythromycin)) orerythromycin or

If the cause is a virus, typical antibiotics will NOT be effective. Sometimes, however, your doctor may use antiviral medication. You can take these steps at home: •

Control your fever with aspirin aspirin,, nonsteroidal anti-inflammatory drugs (NSAIDs, such

 

naproxen), as ibuprofen or naproxen), acetaminophen.. DO NOT oracetaminophen or 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. or debilitated patients may Elderly 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 becomes normal againchest after x-ray 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 Calling your health care provider •

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 or the area below thegrunting rib cage noises is retracting while breathing. Prevention

Wash your hands frequently, especially after blowing your nose, going to theeating bathroom, diapering, and before 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 byrespiratory byrespiratory syncytial virus.. virus  Flu vaccine prevents pneumonia and other problems caused by the influenza virus. It must be given yearly to protect against new virus strains.  Hib 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. References 1.

2.

3.

Higgins K, Singer M, Valappil T, Nambiar S, Lin D, Cox E. Overview of recent studies of  community-acquired pneumonia. Clin Infect Dis. 2008;47:S150-156. [PubMed [PubMed]] Van der Poll T, Opal SM. Pathogenesis, treatment, and prevention of pneumococcal pneumonia. Lancet . 2009;374:1543-1556. [PubMed PubMed]] Recommended Childhood and Adolescent Immunization Schedules -- United States, 2010. Committee on Infectious

 

4.

5.

6.

Diseases.Pediatrics. 2010;125:195-196. Advisory Committee on Immunization RecommendedPractices. adult immunization schedule: United States, 2010. Ann Intern Med . 2010. 152:36-39. Li JZ, Winston LG, Moore DH, Bent S. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a metaanalysis. Am J Med . 2007;120:783-790. [PubMed [PubMed]] Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of  America/American Thoracic Society consensus guidelines on the management of  community-acquired pneumonia in adults. Clin

 

Infect Dis. 2007 Mar 1;44 Suppl 2:S27-72. [PubMed [PubMed]] Review Date: 4/27/2010.

Reviewed by: Allen J. Blaivas, DO, Clinical Assistant Professor of Medicine, UMDNJ-NJMS, Attending Physician in the Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Veteran Affairs, VA New Jersey Health Care System, East Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. A.D.A.M., Disclaimer Copyright © 2011, A.D.A.M., Inc. In this Page •



 Causes, incidence, and risk factors  Symptoms

 







 Signs and tests  Treatment  Expectations (prognosis)









  Complications Calling your health care provider  Prevention  References Figures





Pneumococci organism Lungs



Pneumonia •



White nail syndrome Pneumococcal pneumonia

 

Respiratory system

























Read More  Mycoplasma pneumonia  Flu  Aspiration pneumonia  Atypical pneumonia  CMV - pneumonia  Hospital-acquired pneumonia  Legionnaire's disease  Pneumocystis jiroveci pneumonia  Pneumonia - weakened immune system  Viral pneumonia  Empyema



 Avian influenza

• •



 Pneumonia MedlinePlus.gov links to free, reliable, up-to-date health information from the National

 

Institutes of Health (NIH) and other trusted health organizations. Evaluating your options •



 Rheumatoid Arthritis Medicines: A Guide for Adults This guide can help you work with your doctor or nurse to find a medicine for rheumatoid arthritis (RA). It is a lifelong condition. RA causes inflammation (swelling, redness, and pain) that can damage the joints. No treatment can cure RA. But the drugs in this guide can slow down the disease and help you feel better. This guide is based on a government-funded review of  research about RA medicines. Besides helping you learn about what happens with RA, this guide explains the benefits, risks, and costs of RA drugs.  Comparing Targeted Immune Modulators

 

How do targeted immune modulators compare in arthritis? Drugs of interest •



 Erythromycin Erythromycin is an antibiotic used to treat certain infections caused by bacteria, such as bronchitis; diphtheria; Legionnaires' disease; pertussis (whooping cough); pneumonia; rheumatic fever; venereal disease (VD); and ear, intestine, lung, urinary tract, and skin infections. It is also used before some surgery or dental work to prevent infection. Antibiotics will not work for colds, flu, or other viral infections. This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.  Levofloxacin Levofloxacin is used to treat certain infections such as pneumonia chronic bronchitis and sinus, urinary

 

tract, kidney, prostate (a male reproductive gland), and skin infections. Levofloxacin is also used to prevent anthrax (a serious infection that may be spread on purpose as part of a bioterror attack) in people who may have been exposed to anthrax germs in the air. Levofloxacin is in a class of  antibiotics called fluoroquinolones. It



works by killing bacteria that cause infections. Antibiotics will not work for colds, flu, or other viral infections.  Amoxicillin Amoxicillin is used to treat certain infections caused by bacteria, such as pneumonia; bronchitis; gonorrhea; and infections of the ears, nose, throat, urinary tract, and skin. It is also used in combination with other medications to eliminate H. pylori, a bacteria that causes ulcers. Amoxicillin is in a class of 

 

medications called penicillin-like antibiotics. It works by stopping the growth of bacteria. Antibiotics will





not for colds, flu, and other viralwork infections.  Azithromycin Azithromycin is used to treat certain infections caused by bacteria, such as bronchitis; pneumonia; sexually transmitted diseases (STD); and infections of the ears, lungs, skin, and throat. Azithromycin is in a class of medications called macrolide antibiotics. It works by stopping the growth of bacteria. Antibiotics will not work for colds, flu, or other viral infections.  Clarithromycin Clarithromycin is used to treat certain infections caused by bacteria, such as pneumonia (a lung infection), bronchitis (infection of the tubes leading to the lungs), and infections of the ears, sinuses, skin,

 

and throat. It also is used to treat and prevent disseminated Mycobacterium avium complex (MAC) infection [a type of lung infection that often affects people with human immunodeficiency virus (HIV)]. It is used in combination with other medications to eliminate H. pylori, a bacteria that causes ulcers. Clarithromycin is in a class of  medications called macrolide antibiotics. It works by stopping the growth of bacteria. Antibiotics will not work for colds, flu, or other viral infections. See all...



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