PNEUMONIA

DEFINITION
An infection of the lungs that is caused by bacteria, viruses, fungi, or parasites. It is
characterized primarily by inflammation of the alveoli in the lungs or by alveoli that are filled
with fluid (alveoli are microscopic sacs in the lungs that absorb oxygen). A variety of organisms,
including bacteria, viruses and fungi, can cause pneumonia.
Pneumonia has four stages, namely consolidation, red hepatization, grey hepatization and
resolution.
Consolidation

Occurs in the first 24 hours

Cellular exudates containing neutrophils, lymphocytes and fibrin replaces the

alveolar air

Capillaries in the surrounding alveolar walls become congested

The infections spreads to the hilum and pleura fairly rapidly

Pleurisy occurs
Red Hepatization

Occurs in the 2-3 days after consolidation

At this point the consistency of the lungs resembles that of the liver

The lungs become hypeaemic

Alveolar capillaries are engorged with blood

Fibrinous exudates fill the alveoli

Grey Hepatization

Occurs in the 2-3 days after Red Hepatization

This is an avascular stage

The lung appears "gray-brown to yellow because of fibrinopurulent exudates,

disintegration of red cells, and hemosiderin"

The pressure of the exudates in the alveoli causes compression of the capillaries

"Leukocytes migrate into the congested alveoli"

Resolution

This stage is characterized by the "resorption and restoration of the pulmonary

architecture"

A large number of macrophages enter the alveolar spaces

Phagocytosis of the bacteria-laden leucocytes occurs

"Consolidation tissue re-aerates and the fluid infiltrate causes sputum"

CLASSIFICATIONS
Community-acquired pneumonia is the most common type of pneumonia. It occurs outside
of hospitals and other health care facilities, and may be caused by:

Bacteria, such as Streptococcus pneumoniae. Bacterial community-acquired pneumonia

can occur on its own or after having a cold or respiratory flu. This type of pneumonia often
affects one area (lobe) of the lung, a condition called lobar pneumonia.

Bacteria-like organisms, such as Mycoplasma pneumoniae, which typically produce

milder signs and symptoms than do other types of pneumonia. "Walking pneumonia," a term
used to describe pneumonia that isn't severe enough to require bed rest, may result from
Mycoplasma pneumoniae.

Viruses, including some that are the same type of viruses that cause colds and flu. Viruses
are the most common cause of pneumonia in children younger than 2 years. Viral pneumonia is
usually mild. But viral pneumonia caused by certain influenza viruses, such as sudden acute
respiratory syndrome (SARS), can become very serious.

Fungi, which can be found in soil and in bird droppings. This type of pneumonia is most
common in people with an underlying health problem or weakened immune system and in
people who have inhaled a large dose of the organisms.
Hospital-acquired pneumonia is a bacterial infection that occurs in people 48 hours or more
after being hospitalized for another condition. Hospital-acquired pneumonia can be serious
because the bacteria causing it may be more resistant to antibiotics.
People who are on a breathing machine (ventilator), often used in intensive care units, are at
higher risk of this type of pneumonia.
Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs.
This aspiration may happen if something disturbs your normal gag reflex, such as a brain injury,
swallowing problem, or excessive use of alcohol or drugs.
Pneumonia in the immunocompromised host involves infection and inflammation of the
lower respiratory tract. Regardless of the reason for altered immune function, pneumonia carries
a high mortality rate in immunocompromised patients. It is often caused by unusual pathogens.
Symptoms and signs depend on the pathogen. Diagnosis is based on blood cultures and
bronchoscopic sampling of respiratory secretions, sometimes with quantitative cultures.
Treatment depends on the host defect and pathogen.
RISK FACTORS
Pneumonia can affect anyone. But the two age groups at highest risk are:
Infants and children younger than age 2 years, because their immune systems are still
developing
People older than age 65
Other risk factors include:
Certain chronic diseases, such as asthma, chronic obstructive pulmonary disease and
heart disease
Weakened or suppressed immune system, due to factors such as HIV/AIDS, organ
transplant, chemotherapy for cancer or long-term steroid use
Smoking, which damages the body's natural defenses against the bacteria and viruses that
cause pneumonia
Being placed on a ventilator while hospitalized

SIGNS & SYMPTOMS

Fever, sweating and shaking chills
Lower than normal body temperature in people older than age 65, and in people with
poor overall health or weakened immune systems
Cough, which may produce thick, sticky fluid
Chest pain when breathing deeply or cough
Shortness of breath
Fatigue and muscle aches
Nausea, vomiting or diarrhea
Headache
COMPLICATIONS
Bacteria in the bloodstream (bacteremia). Bacteria that enter the bloodstream from the
lungs can spread the infection to other organs, potentially causing organ failure.
Lung abscess. An abscess occurs if pus forms in a cavity in the lung. An abscess is
usually treated with antibiotics. Sometimes, surgery or drainage with a long needle or
tube placed into the abscess is needed to remove the pus.
Fluid accumulation around your lungs (pleural effusion).Pneumonia may cause fluid to
build up in the thin space between layers of tissue that line the lungs and chest cavity
(pleura). If the fluid becomes infected, it may need to have it drained through a chest tube
or removed with surgery.
Difficulty breathing. If the pneumonia is severe or chronic underlying lung diseases, there
can be trouble breathing in enough oxygen.
DIAGNOSTIC STUDIES
Chest X-rays - to confirm the presence of pneumonia and determine the extent and
location of the infection.
Blood tests, to confirm the presence of infection and to try to identify the type of
organism causing the infection. Precise identification occurs in only about half of people
with pneumonia.
Pulse oximetry, to measure the oxygen level in the blood. Pneumonia can prevent the
lungs from moving enough oxygen into the bloodstream.
Sputum test. A sample of fluid from the lungs (sputum) is taken after a deep cough, and
analyzed to pinpoint the type of infection.
TREATMENT
Specific treatments depend on the type and severity of the pneumonia, and the age and overall
health. The options include:
Antibiotics, to treat bacterial pneumonia. It may take time to identify the type of bacteria
causing the pneumonia and to choose the best antibiotic to treat it. Symptoms often
improve within three days, although improvement usually takes twice as long in smokers.
If the symptoms don't improve, the doctor may recommend a different antibiotic.

Antiviral medications, to treat viral pneumonia. Symptoms generally improve in one to

three weeks.
Antipyretic such as aspirin or ibuprofen.
Cough medicine, to calm the cough to promote rest. Because coughing helps loosen and
move fluid from the lungs, it's a good idea not to eliminate the cough completely.