Notes

Pneumonia

See Pneumonia Klebsiella, Mycoplasma, Bronchial, Pneumocytis Carinii, and Bronchial Pneumonia programs. Always use Streptococcus Pneumoniae.LungEncyclopedia Entry for Pneumonia :Pneumonia, viral - respiratory syncytial virus (Paramyxovirus), CMV (Herpesvirus)Encyclopedia Entry for Pneumonia :Pneumonia - adults (community acquired). 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. In adults, bacteria are the most common cause of 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 fluids from the mouth into your lungs ( aspiration pneumonia ) Respiratory system Pneumonia can be caused by many types of germs. The most common type of bacteria is Streptococcus pneumoniae (pneumococcus). Atypical pneumonia , often called walking pneumonia, is caused by other bacteria. A fungus called Pneumocystis jiroveci can cause pneumonia in people whose immune system is not working well, especially people with advanced HIV infection. Viruses , such as the flu virus, are also a common cause of pneumonia. Risk factors that increase your chance of getting pneumonia include: Chronic lung disease ( COPD , bronchiectasis , cystic fibrosis ) Cigarette smoking Dementia, stroke, brain injury, cerebral palsy , or other brain disorders Immune system problem (during cancer treatment, or due to HIV/AIDS, organ transplant, or other diseases) Other serious illnesses, such as heart disease , liver cirrhosis , or diabetes mellitus Recent surgery or trauma Surgery to treat cancer of the mouth, throat, or neck.The most common symptoms of pneumonia are: Cough (with some pneumonias you may cough up greenish or yellow mucous, or even bloody mucus ) Fever , which may be mild or high Shaking chills Shortness of breath (may only occur when you climb stairs or exert yourself) Other symptoms include: Confusion , especially in older people Excess sweating and clammy skin Headache Loss of appetite , low energy, and fatigue Malaise (not feeling well) Sharp or stabbing chest pain that gets worse when you breathe deeply or cough White nail syndrome, or leukonychia White nail syndrome.The health care provider will listen for crackles or abnormal breath sounds when listening to your chest with a stethoscope. Tapping on your chest wall (percussion) helps the provider listen and feel for abnormal sounds in your chest. If pneumonia is suspected, the provider will likely order a chest x-ray. Other tests that may be ordered include: Arterial blood gases to see if enough oxygen is getting into your blood from the lungs. Blood and sputum cultures to look for the germ that may be causing the pneumonia. CBC to check white blood cell count. CT scan of the chest. Bronchoscopy. A flexible tube with a lighted camera on the end passed down to your lungs, in selected cases. Thoracentesis. Removing fluid from the space between the outside lining of the lungs and the chest wall.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 through your veins Oxygen therapy Breathing treatments (possibly) If you are diagnosed with a bacterial form of pneumonia, it is important that you are started on antibiotics very soon after you are admitted. If you have viral pneumonia, you will not receive antibiotics. This is because antibiotics do not kill viruses. You may receive other medicines, such as antivirals, if you have the flu. 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 Have been taking antibiotics at home and are not getting better Many people can be treated at home. If so, your doctor may tell you to take medicines such as antibiotics. When taking antibiotics: DO NOT miss any doses. Take the medicine until it is gone, even when you start to feel better. DO NOT take cough medicine or cold medicine unless your doctor says it is OK. Coughing helps your body get rid of mucus from your lungs. Breathing warm, moist (wet) air helps loosen the sticky mucus that may make you feel like you are choking. These things may help: Place a warm, wet washcloth loosely over your nose and mouth. Fill a humidifier with warm water and breathe in the warm mist. Take a couple of deep breaths 2 or 3 times every hour. Deep breaths will help open up your lungs. Tap your chest gently a few times a day while lying with your head lower than your chest. This helps bring up mucus from the lungs so that you can cough it out. Drink plenty of liquids, as long as your provider says it is OK. Drink water, juice, or weak tea Drink at least 6 to 10 cups (1.5 to 2.5 liters) a day DO NOT drink alcohol Get plenty of rest when you go home. If you have trouble sleeping at night, take naps during the day.With treatment, most people improve within 2 weeks. Older adults or very sick people may need longer treatment. Those who may be more likely to have complicated pneumonia include: Older adults People whose immune system does not work well People with other, serious medical problems such as diabetes or cirrhosis of the liver In all of the above conditions, pneumonia can lead to death, if it is severe. In rare cases, more serious problems may develop, including: Life-threatening changes in the lungs that require a breathing machine Fluid around the lung ( pleural effusion ) Infected fluid around the lung ( empyema ) Lung abscesses Your doctor may order another x-ray. This is to make sure your lungs are clear. But it may take many weeks for your x-ray to clear up. You will likely feel better before the x-ray clears up.Call your provider if you have: Cough that brings up bloody or rust-colored mucus Breathing (respiratory) symptoms that get worse Chest pain that gets worse when you cough or breathe in Fast or painful breathing Night sweats or unexplained weight loss Shortness of breath, shaking chills, or persistent fevers Signs of pneumonia and a weak immune system (for example, such as with HIV or chemotherapy) Worsening of symptoms after initial improvement.You can help prevent pneumonia by following the measures below. Wash your hands often, especially: Before preparing and eating food After blowing your nose After going to the bathroom After changing a baby's diaper After coming in contact with people who are sick DO NOT smoke. Tobacco damages your lung's ability to fight infection. Vaccines may help prevent some types of pneumonia. Be sure to get the following vaccines: Flu vaccine can help prevent pneumonia caused by the flu virus. Pneumococcal vaccine lowers your chances of getting pneumonia from Streptococcus pneumoniae. Vaccines are even more important for older adults and people with diabetes, asthma, emphysema, HIV, cancer, people with organ transplants, or other long-term conditions.Bronchopneumonia; Community-acquired pneumonia; CAP.Bronchiolitis - discharge Colds and the flu - what to ask your doctor - adult Colds and the flu - what to ask your doctor - child How to breathe when you are short of breath Oxygen safety Pneumonia in adults - discharge Pneumonia in children - discharge Using oxygen at home Using oxygen at home - what to ask your doctor When your baby or infant has a fever.Respiratory system Respiratory system Pneumonia Pneumonia White nail syndrome White nail syndrome.Ellison RT, Donowitz GR. Acute pneumonia.Encyclopedia Entry for Pneumonia :Pneumonia - children - community acquired. Viruses are the most common cause of pneumonia in infants and children. Ways your child can get CAP include: Bacteria and viruses living in the nose, sinuses, or mouth may spread to the lungs. Your child may breathe some of these germs directly into her lungs. Your child breathes in food, liquids, or vomit from her mouth into her lungs. Risk factors that increase a child's chance of getting CAP include: Being younger than 6 months of age Being born prematurely Birth defects, such as cleft palate Nervous system problems, such as seizures or cerebral palsy Heart or lung disease present at birth Weak immune system (this can occur due to cancer treatment or disease such as HIV/AIDS) Recent surgery or trauma.Common symptoms of pneumonia in children include: Stuffed up or runny nose, headaches Loud cough Fever , which may be mild or high, with chills and sweating Rapid breathing, with flared nostrils and straining of the muscles between the ribs Wheezing Sharp or stabbing chest pain that gets worse when breathing deeply or coughing Low energy and malaise (not feeling well) Vomiting or loss of appetite Symptoms common in children with more severe infections include: Blue lips and finger nails due to too little oxygen in the blood Confusion or very hard to arouse.The health care provider will listen to your child's chest with a stethoscope. The provider will listen for crackles or abnormal breath sounds. Tapping on the chest wall (percussion) helps the provider listen and feel for abnormal sounds. If pneumonia is suspected, the provider will likely order a chest x-ray. Other tests may include: Arterial blood gases to see if enough oxygen is getting into your child's blood from the lungs Blood culture and sputum culture to look for the germ that may be causing the pneumonia CBC to check white blood cell count CT scan of the chest Bronchoscopy -- a flexible tube with a lighted camera on the end passed down into the lungs (in rare cases) Removing fluid from the space between the outside lining of the lungs and the chest wall (in rare cases).The provider must first decide whether your child needs to be in the hospital. If treated in the hospital, your child will receive: Fluids, electrolytes, and antibiotics through the veins or mouth Oxygen therapy Breathing treatments to help open up the airways Your child is more likely to be admitted to the hospital if he: Has another serious medical problem Has severe symptoms Is unable to eat or drink Is less than 3 to 6 months old Has pneumonia due to a harmful germ Has taken antibiotics at home, but isn't getting better If your child has CAP caused by bacteria, he will be given antibiotics. Antibiotics are not given for pneumonia caused by a virus. This is because antibiotics do not kill viruses. Other medicines, such as antivirals, may be given if your child has the flu. Many children can be treated at home. If so, your child may need to take medicines such as antibiotics or antivirals. When giving antibiotics to your child: Make sure your child does not miss any doses. Make sure your child takes all the medicine as directed. Do not stop giving the medicine, even when your child starts feeling better. Do not give your child cough medicine or cold medicine unless your doctor says it is OK. Coughing helps the body get rid of mucus from the lungs. Breathing warm, moist (wet) air helps loosen the sticky mucus that may make your child feel like she is choking. These steps may help: Place a warm, wet washcloth loosely over your child's nose and mouth. Fill a humidifier with warm water and have her breathe in the warm mist. Have your child take a couple of deep breaths 2 or 3 times every hour. Deep breaths will help open up your child's lungs. Make sure your child drinks plenty of liquids, as long as the provider says it is OK. Drink water, juice, or weak tea Drink at least 6 to 10 cups a day Make sure your child gets plenty of rest when she goes home. Have her take naps, if needed.Most children improve in 7 to 10 days with treatment. Children who have severe pneumonia with complications may need treatment for 2 to 3 weeks. Children at risk for severe pneumonia include: Children whose immune system does not work well Children with lung or heart disease.In some cases, more serious problems may develop, including: Life-threatening changes in the lungs that require a breathing machine (ventilator) Fluid around the lung , which can become infected Lung abscesses Bacteria in blood (bacteremia) The provider may order another x-ray. This is to make sure that your child's lungs are clear. It may take many weeks for the x-ray to clear up. Your child may feel better for awhile before the x-rays are clear.Call the provider if your child has the following symptoms: Bad cough Difficulty breathing (wheezing, grunting, rapid breathing) Vomiting Loss of appetite Fever and chills Breathing (respiratory) symptoms that get worse Chest pain that gets worse when coughing or breathing in Signs of pneumonia and a weak immune system (such as with HIV or chemotherapy) Worsening symptoms after starting to get better.Teach older children to wash their hands often: Before eating food After blowing their nose After going to the bathroom After playing with friends After coming in contact with people who are sick Vaccines may help prevent some types of pneumonia. Be sure to get your child vaccinated with: Pneumococcal vaccine Flu vaccine Pertussis vaccine and Hib vaccine When infants are too young to be immunized, parents or caregivers can get themselves immunized against vaccine-preventable pneumonia.Bronchopneumonia - children; Community-acquired pneumonia - children; CAP - children.Pneumonia Pneumonia.Bradley JS, Byington CL, Shah SS, et al; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):617-630. PMID: 21890766 www.ncbi.nlm.nih.gov/pubmed/21890766. Byington CL, Bradley JS. Pediatric community-acquired pneumonia.Encyclopedia Entry for Pneumonia :Pneumonia - weakened immune system. People whose immune system is not working well are less able to fight off germs. This makes them prone to infections from germs that do not often cause disease in healthy people. They are also more vulnerable to regular causes of pneumonia , which can affect anyone. Your immune system may be weakened or not work well because of: Bone marrow transplant Chemotherapy HIV infection Leukemia , lymphoma, and other conditions that harm your bone marrow Autoimmune disorders Medicines (including steroids, and those used to treat cancer and control autoimmune diseases) Organ transplant (including kidney, heart, and lung).Symptoms may include: Cough (may be dry or produce mucus-like, greenish, or pus-like sputum) Chills with shaking Easy fatigue Fever General discomfort, uneasiness, or ill feeling ( malaise ) Headache Loss of appetite Nausea and vomiting Sharp or stabbing chest pain that gets worse with deep breathing or coughing Shortness of breath Other symptoms that may occur: Heavy sweating or night sweats Stiff joints (rare) Stiff muscles (rare).Your health care provider may hear crackles or other abnormal breath sounds when listening to your chest with a stethoscope. Decreased volume of breath sounds is a key sign. This finding may mean there is a buildup of fluid between the chest wall and lung ( pleural effusion ). Tests may include: Arterial blood gases Blood chemistries Blood culture Bronchoscopy (in certain cases) Chest CT scan (in certain cases) Chest x-ray Complete blood count Lung biopsy (in certain cases) Serum cryptococcus antigen test Serum galactomannan test Galactomannan test from bronchial alveolar fluid Sputum culture Sputum Gram stain Sputum immunofluorescence tests (or other immune tests) Urine tests (to diagnose Legionnaire disease or Histoplasmosis).Antibiotics or antifungal medicines may be used, depending on the type of germ that is causing the infection. Antibiotics are not helpful for viral infections. You may need to stay in the hospital during the early stages of the illness. Oxygen and treatments to remove fluid and mucus from the respiratory system are often needed.Factors that may lead to a worse outcome include: The pneumonia that is caused by a fungus. The person has a very weak immune system.Complications may include: Respiratory failure (a condition in which a patient can't take in oxygen and get rid of carbon dioxide without the use of a machine to deliver breaths.) Sepsis Spread of the infection Death.Call your provider if you have a weakened immune system and you have symptoms of pneumonia.If you have a weakened immune system, you may receive daily antibiotics to prevent some types of pneumonia. Ask your provider if you should receive the influenza (flu) and pneumococcal (pneumonia) vaccines. Practice good hygiene. Thoroughly wash your hands with soap and water: After being outdoors After changing a diaper After doing housework After going to the bathroom After touching body fluids, such as mucus or blood After using the telephone Before handling food or eating Other things you can do to reduce your exposure to germs include: Keep your house clean. Stay away from crowds. Ask visitors who have a cold to wear a mask or not to visit. DO NOT do yard work or handle plants or flowers (they can carry germs).Pneumonia in immunodeficient patient; Pneumonia - immunocompromised host; Cancer - pneumonia; Chemotherapy - pneumonia; HIV - pneumonia.Pneumococci organism Pneumococci organism Lungs Lungs The lungs The lungs Respiratory system Respiratory system.Chan KM, Gomersall CD. Pneumonia.Encyclopedia Entry for Pneumonia :Pneumonia in adults - discharge. In the hospital, your providers helped you breathe better. They also gave you medicine to help your body get rid of the germs that cause pneumonia. They also made sure you got enough liquids and nutrients.You will still have symptoms of pneumonia after you leave the hospital. Your cough will slowly get better over 7 to 14 days. Sleeping and eating may take up to a week to return to normal. Your energy level may take 2 weeks or more to return to normal. You will need to take time off work. For a while, you might not be able to do other things that you are used to doing.Breathing warm, moist air helps loosen the sticky mucus that may make you feel like you are choking. Other things that may also help include: Placing a warm, wet washcloth loosely over your nose and mouth. Filling a humidifier with warm water and breathing in the warm mist. Coughing helps clear your airways. Take a couple of deep breaths, 2 to 3 times every hour. Deep breaths help open up your lungs. While lying down, tap your chest gently a few times a day. This helps bring up mucus from the lungs. If you smoke, now is the time to quit. DO NOT allow smoking in your home. Drink plenty of liquids, as long as your provider says it is OK. Drink water, juice, or weak tea. Drink at least 6 to 10 cups (1.5 to 2.5 liters) a day. DO NOT drink alcohol. Get plenty of rest when you go home. If you have trouble sleeping at night, take naps during the day.Your provider may prescribe antibiotics for you. These are medicines that kill the germs that cause pneumonia. Antibiotics help most people with pneumonia get better. DO NOT miss any doses. Take the medicine until it is gone, even if you start to feel better. DO NOT take cough or cold medicines unless your doctor says it is OK. Coughing helps your body get rid of mucus from your lungs. Your provider will tell you if it is OK to use acetaminophen (Tylenol) or ibuprofen (Advil or Motrin) for fever or pain. If these medicines are OK to use, your provider will tell you how much to take and how often to take them.To prevent pneumonia in the future: Get a flu shot every year. Ask your provider if you need to get the pneumonia vaccine. Wash your hands often. Stay away from crowds. Ask visitors who have a cold to wear a mask.Your doctor may prescribe oxygen for you to use at home. Oxygen helps you breathe better. Never change how much oxygen is flowing without asking your doctor. Always have a back-up supply of oxygen at home or with you when you go out. Keep the phone number of your oxygen supplier with you at all times. Learn how to use oxygen safely at home. Never smoke near an oxygen tank.Call your provider if your breathing is: Getting harder Faster than before Shallow and you cannot get a deep breath Also call your provider if you have any of the following: Need to lean forward when sitting to breathe more easily Have chest pain when you take a deep breath Headaches more often than usual Feel sleepy or confused Fever returns Coughing up dark mucus or blood Fingertips or the skin around your fingernails is blue.Bronchopneumonia adults - discharge; Lung infection adults - discharge.Ellison RT, Donowitz GR. Acute pneumonia.Encyclopedia Entry for Pneumonia :Pneumonia in children - discharge. In the hospital, the providers helped your child breathe better. They also gave your child medicine to help get rid of the germs that cause pneumonia. They also made sure your child got enough liquids.Your child will probably still have some symptoms of pneumonia after leaving the hospital. Coughing will slowly get better over 7 to 14 days. Sleeping and eating may take up to a week to return to normal. You may need to take time off work to care for your child.Breathing warm, moist (wet) air helps loosen the sticky mucus that may be choking your child. Other things that may help include: Placing a warm, wet washcloth loosely over your child's nose and mouth Filling a humidifier with warm water and having your child breathe in the warm mist DO NOT use steam vaporizers because they can cause burns. To bring up mucus from the lungs, tap your child's chest gently a few times a day. This can be done as your child is lying down. Make sure everyone washes their hands with warm water and soap or an alcohol-based hand cleanser before they touch your child. Try to keep other children away from your child. DO NOT allow anyone to smoke in the house, the car, or anywhere near your child. Ask your child's provider about vaccines to prevent other infections, such as: Flu vaccine Pneumonia vaccine Also, make sure all your child's vaccines are up to date.Make sure your child drinks enough. Offer breast milk or formula if your child is younger than 12 months. Offer whole milk if your child is older than 12 months. Some drinks may help relax the airway and loosen the mucus, such as: Warm tea Lemonade Apple juice Chicken broth for children over age 1 Eating or drinking may make your child tired. Offer small amounts, but more often than usual. If your child throws up because of coughing, wait a few minutes and try to feed your child again.Antibiotics help most children with pneumonia get better. Your doctor may tell you to give antibiotics to your child. DO NOT miss any doses. Have your child finish all the antibiotics, even if your child starts to feel better. DO NOT give your child cough or cold medicines unless your doctor says it is OK. Your child's coughing helps get rid of mucus from the lungs. Your provider will tell you if it is OK to use acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for fever or pain. If these medicines are OK to use, your provider will tell you how often to give them to your child. Do not give aspirin to your child.Call your child's provider if your child has any of the following: Hard time breathing Chest muscles are pulling in with each breath Breathing faster than 50 to 60 breaths per minute (when not crying) Making a grunting noise Sitting with shoulders hunched over Skin, nails, gums, or lips are a blue or gray color The area around your child's eyes is a blue or gray color Very tired or fatigued Not moving around much Has a limp or floppy body Nostrils are flaring out when breathing Does not feel like eating or drinking Irritable Has trouble sleeping.Lung infection - children discharge; Bronchopneumonia - children discharge.Kelly MS, Sandora TJ. Community-acquired pneumonia.Encyclopedia Entry for Pneumonia :Pneumonia: Pneumonia has many possible causes, but it is usually an infection of the streptococcus or mycoplasma bacteria. These bacteria can live in the human body without causing infection for years, and only surface when another illness has lowered the person's immunity to disease. Streptococcus pneumoniae causes streptococcal pneumonia, the most common kind, which is more severe than mycoplasmal pneumonia. S. pneumoniae is responsible for more than 100,000 hospitalizations for pneumonia annually, as well as 6 million cases of otitis media and over 60,000 cases of invasive diseases such as meningitis.Encyclopedia Entry for Pneumonia :Pneumonia Walking. Caused by Pneumonia Mycoplasma. Also use Streptococcus Pneumoniae.Information from Marcello Allegretti.Encyclopedia Entry for Pneumonia :Pneumonia. Source of disease: multiple