Sputum samples can be collected and examined under the
What is pneumonia?
Pneumonia is an infection of one or both lungs which is usually
caused by bacteria, viruses, or fungi. Prior to the discovery of
antibiotics, one-third of all people who developed pneumonia
subsequently died from the infection. Currently, over 3 million
people develop pneumonia each year in the United States. Over
a half a million of these people are admitted to a hospital for
treatment. Although most of these people recover,
approximately 5% will die from pneumonia. Pneumonia is the
sixth leading cause of death in the United States.
How do people "catch pneumonia"?
Some cases of pneumonia are contracted by breathing in small
droplets that contain the organisms that can cause pneumonia.
These droplets get into the air when a person infected with
these germs coughs or sneezes. In other cases, pneumonia is
caused when bacteria or viruses that are normally present in the
mouth, throat, or nose inadvertently enter the lung. During
sleep, it is quite common for people to aspirate secretions from
the mouth, throat, or nose. Normally, the body's reflex response
(coughing back up the secretions) and immune system will
prevent the aspirated organisms from causing pneumonia.
However, if a person is in a weakened condition from another
illness, a severe pneumonia can develop. 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.
Once organisms enter the lungs, they usually settle in the air
sacs of the lung where they rapidly grow in number. This area of
the lung then becomes filled with fluid and pus as the body
attempts to fight off the infection.
What are pneumonia symptoms and signs?
Most people who develop pneumonia initially have symptoms of
a cold which are then followed by a high fever (sometimes as
high as 104 degrees Fahrenheit), shaking chills, and a cough
with sputum production. The sputum is usually discolored and
sometimes bloody. People with pneumonia may become short of
breath. The only pain fibers in the lung are on the surface of the
lung, in the area known as the pleura. Chest pain may develop if
the outer pleural aspects of the lung are involved. This pain is
usually sharp and worsens when taking a deep breath, known as
pleuritic pain.
In other cases of pneumonia, there can be a slow onset of
symptoms. A worsening cough, headaches, and muscle aches
may be the only symptoms. In some people with pneumonia,
coughing is not a major symptom because the infection is
located in areas of the lung away from the larger airways. 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.
Children and babies who develop pneumonia often do not have
any specific signs of a chest infection but develop a fever,
appear quite ill, and can become lethargic. Elderly people may
also have few symptoms with pneumonia.
How is pneumonia diagnosed?
Pneumonia may be suspected when the doctor examines the
patient and hears coarse breathing or crackling sounds when
listening to a portion of the chest with a stethoscope. There may
be wheezing, or the sounds of breathing may be faint in a
particular area of the chest. A chest x-ray is usually ordered to
confirm the diagnosis of pneumonia. The lungs have several
segments referred to as lobes, usually two on the left and three
on the right. When the pneumonia affects one of these lobes it
is often referred to as lobar pneumonia. Some pneumonias have
a more patchy distribution that does not involve specific lobes.
In the past, when both lungs where involved in the infection, the
term "double pneumonia" was used. This term is rarely used
today.
microscope. If the pneumonia is caused by bacteria or fungi, the
organisms can often be detected by this examination. A sample
of the sputum can be grown in special incubators, and the
offending organism can be subsequently identified. It is
important to understand that the sputum specimen must
contain little saliva from the mouth and be delivered to the
laboratory fairly quickly. Otherwise, overgrowth of noninfecting
bacteria may predominate.
A blood test that measures white blood cell count (WBC) may be
performed. An individual's white blood cell count can often give
a hint as to the severity of the pneumonia and whether it is
caused by bacteria or a virus. An increased number of
neutrophils, one type of WBC, is seen in bacterial infections,
whereas an increase in lymphocytes, another type of WBC, is
seen in viral infections.
Bronchoscopy is a procedure in which a thin, flexible, lighted
viewing tube is inserted into the nose or mouth after a local
anesthetic is administered. The breathing passages can then be
directly examined by the doctor, and specimens from the
infected part of the lung can be obtained.
Sometimes, fluid collects in the pleural space around the lung as
a result of the inflammation from pneumonia. This fluid is called
a pleural effusion. If the amount of this fluid that develops is
large enough, it can be removed by inserting a needle into the
chest cavity and withdrawing the fluid with a syringe in a
procedure called a thoracentesis. In some cases, this fluid can
become severely inflamed (parapneumonic effusion) or infected
(empyema) and may need to be removed by more aggressive
surgical procedures.
What are some of the organisms that cause pneumonia, and
how are they treated?
The most common cause of a bacterial pneumonia is
Streptococcus pneumoniae. In this form of pneumonia, there is
usually an abrupt onset of the illness with shaking chills, fever,
and production of a rust-colored sputum. The infection spreads
into the blood in 20%-30% of cases, and if this occurs, 20%-30%
of these patients die.
Two vaccines are available to prevent pneumococcal disease;
the pneumococcal conjugate vaccine (PCV7; Prevnar) and the
pneumococcal polysaccharide vaccine (PPV23; Pneumovax). The
pneumococcal conjugate vaccine is part of the routine infant
immunization schedule in the U.S. and is recommended for all
children < 2 years of age and children 2-4 years of age who
have certain medical conditions. The pneumococcal
polysaccharide vaccine is recommended for adults at increased
risk for developing pneumococcal pneumonia including the
elderly, people who have diabetes, chronic heart, lung, or kidney
disease, those with alcoholism, cigarette smokers, and in those
people who have had their spleen removed.
Antibiotics often used in the treatment of this type of pneumonia
include penicillin, amoxicillin and clavulanic acid (Augmentin,
Augmentin XR), and macrolide antibiotics including
erythromycin, azithromycin (Zithromax, Zmax), and
clarithromycin (Biaxin). Penicillin was formerly the antibiotic of
choice in treating this infection. With the advent and widespread
use of broader-spectrum antibiotics, significant drug resistance
has developed. Penicillin may still be effective in treatment of
pneumococcal pneumonia, but it should only be used after
cultures of the bacteria confirm their sensitivity to this antibiotic.
Klebsiella pneumoniae and Hemophilus influenzae are bacteria
that often cause pneumonia in people suffering from chronic
obstructive pulmonary disease (COPD) or alcoholism. Useful
antibiotics in this case are the second- and third-generation
cephalosporins, amoxicillin and clavulanic acid, fluoroquinolones
(levofloxacin [Levaquin], moxifloxacin-oral [Avelox], gatifloxacin-
oral [Tequin], and sulfamethoxazole and trimethoprim [Bactrim,
Septra]).
Mycoplasma pneumoniae is a type of bacteria that often causes
a slowly developing infection. Symptoms include fever, chills,
muscle aches, diarrhea, and rash. This bacterium is the principal
cause of many pneumonias in the summer and fall months, and
the condition often referred to as "atypical pneumonia."
Macrolides (erythromycin, clarithromycin, azithromycin, and
fluoroquinolones) are antibiotics commonly prescribed to treat
Mycoplasma pneumonia.
Legionnaire's disease is caused by the bacterium Legionella
pneumoniae that is most often found in contaminated water
supplies and air conditioners. It is a potentially fatal infection if
not accurately diagnosed. Pneumonia is part of the overall
infection, and symptoms include high fever, a relatively slow
heart rate, diarrhea, nausea, vomiting, and chest pain. Older
men, smokers, and people whose immune systems are
suppressed are at higher risk of developing Legionnaire's
disease. Fluoroquinolones are the treatment of choice in this
infection. This infection is often diagnosed by a special urine test
looking for specific antibodies to the specific organism.
Mycoplasma, Legionnaire's, and another infection, Chlamydia
pneumoniae, all cause a syndrome known as "atypical
pneumonia." In this syndrome, the chest x-ray shows diffuse
abnormalities, yet the patient does not appear severely ill.
These infections are very difficult to distinguish clinically and
often require laboratory evidence for confirmation.
Pneumocystis carinii pneumonia is another form of pneumonia
that usually involves both lungs. It is seen in patients with a
compromised immune system, either from chemotherapy for
cancer, HIV/AIDS, and those treated with TNF (tumor necrosis
factor), such as for rheumatoid arthritis. Once diagnosed, it
usually responds well to sulfa-containing antibiotics. Steroids are
often additionally used in more severe cases.
Viral pneumonias do not typically respond to antibiotic
treatment. These infections can be caused by adenoviruses,
rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV),
and parainfluenza virus (that also causes croup). These
pneumonias usually resolve over time with the body's immune
system fighting off the infection. It is important to make sure
that a bacterial pneumonia does not secondarily develop. If it
does, then the bacterial pneumonia is treated with appropriate
antibiotics. In some situations, antiviral therapy is helpful in
treating these conditions.
Fungal infections that can lead to pneumonia include
histoplasmosis, coccidiomycosis, blastomycosis, aspergillosis,
and cryptococcosis. These are responsible for a relatively small
percentage of pneumonias in the United States. Each fungus has
specific antibiotic treatments, among which are amphotericin B,
fluconazole (Diflucan), penicillin, and sulfonamides.
Major concerns have developed in the medical community
regarding the overuse of antibiotics. Most sore throats and
upper respiratory infections are caused by viruses rather than
bacteria. Though antibiotics are ineffective against viruses, they
are often prescribed. This excessive use has resulted in a variety
of bacteria that have become resistant to many antibiotics.
These resistant organisms are commonly seen in hospitals and
nursing homes. In fact, physicians must consider the location
when prescribing antibiotics (community-acquired pneumonia,
or CAP, versus hospital-acquired pneumonia, or HAP).
The more virulent organisms often come from the health-care
environment, either the hospital or nursing homes. These
organisms have been exposed to a variety of the strongest
antibiotics that we have available. They tend to develop
resistance to some of these antibiotics. These organisms are
referred to as nosocomial bacteria and can cause what is known
as nosocomial pneumonia when the lungs become infected.
Recently, one of these resistant organisms from the hospital has
become quite common in the community. In some communities,
up to 50% of Staph aureus infections are due to organisms
resistant to the antibiotic methicillin. This organism is referred to
as MRSA (methicillin-resistant Staph aureus) and requires
special antibiotics when it causes infection. It can cause
pneumonia but also frequently causes skin infections. In many
hospitals, patients with this infection are placed in contact
isolation. Their visitors are often asked to wear gloves, masks,
and gowns. This is done to help prevent the spread of this
bacteria to other surfaces where they can inadvertently
contaminate whatever touches that surface. It is therefore very
important to wash your hands thoroughly and frequently to limit
further spread of this resistant organism.
Conclusions
Pneumonia can be a serious and life-threatening infection. This
is true especially in the elderly, children, and those that have
other serious medical problems, such as COPD, heart disease,
diabetes, and certain cancers. Fortunately, with the discovery of
many potent antibiotics, most cases of pneumonia can be
successfully treated. In fact, pneumonia can usually be treated
with oral antibiotics without the need for hospitalization.
Pneumonia At A Glance
• Pneumonia is a lung infection that can be caused by
different types of microorganisms, including bacteria,
viruses, and fungi.
• Symptoms of pneumonia include cough with sputum
production, fever, and sharp chest pain on inspiration
(breathing in).
• Pneumonia is suspected when a doctor hears abnormal
sounds in the chest, and the diagnosis is confirmed by
a chest x-ray.
• Bacteria causing pneumonia can be identified by
sputum culture.
• A pleural effusion is a fluid collection around the
inflamed lung.
• Bacterial and fungal (but not viral) pneumonia can be
treated with antibiotics.
Medications
• amoxicillin, Amoxil, Dispermox, Trimox
• erythromycin, E-Mycin, Eryc, Ery-Tab, Pce, Pediazole,
Ilosone
• SULFAMETHOXAZOLE WITH TRIMETHOPRIM-ORAL
SUSPENSION, Septra
• SULFAMETHOXAZOLE WITH TRIMETHOPRIM- ORAL,
Bactrim, Bethaprim, Cotrim, Septra
Gastroenteritis
Also called: Stomach flu
Have you ever had the "stomach flu?" What you probably had
was gastroenteritis - not a type of flu at all. Gastroenteritis is an
inflammation of the lining of the intestines caused by a virus,
bacteria or parasites. Viral gastroenteritis is the second most
common illness in the U.S. It spreads through contaminated food
or water, and contact with an infected person. The best
prevention is frequent hand washing.
Symptoms of gastroenteritis include diarrhea, abdominal pain,
vomiting, headache, fever and chills. Most people recover with
no treatment.
The most common problem with gastroenteritis is dehydration.
This happens if you do not drink enough fluids to replace what
you lose through vomiting and diarrhea. Dehydration is most
common in babies, young children, the elderly and people with
weak immune systems.
What is viral gastroenteritis?
Gastroenteritis means inflammation of the stomach and small
and large intestines. Viral gastroenteritis is an infection caused
by a variety of viruses that results in vomiting or diarrhea or
children and adults can also be affected. Norwalk and
both. It is often called the "stomach flu," although it is not
Noroviruses are more likely to cause diarrhea in older children
caused by the influenza viruses.
and adults.
What causes viral gastroenteritis?
How is viral gastroenteritis diagnosed?
Many different viruses can cause gastroenteritis, including
Generally, viral gastroenteritis is diagnosed by a physician on
rotaviruses, noroviruses, adenoviruses, type 40 or 41,
the basis of the symptoms and medical examination of the
sapoviruses, and astroviruses. Viral gastroenteritis is not caused
patient. Rotavirus infection can be diagnosed by laboratory
by bacteria (such as Salmonella or Escherichia coli) or parasites
testing of a stool specimen. Tests to detect other viruses that
(such as Giardia), or by medications or other medical conditions,
cause gastroenteritis are not in routine use, but the viral
although the symptoms may be similar. Your doctor can
gastroenteritis unit at CDC can assist with special analysis upon
determine if the diarrhea is caused by a virus or by something
request.
else.
What are the symptoms of viral gastroenteritis?
How is viral gastroenteritis treated?
The main symptoms of viral gastroenteritis are watery diarrhea
and vomiting although one or the other symptom may The most important of treating viral gastroenteritis in children
predominate. The affected person may also have headache, and adults is to prevent severe loss of fluids (dehydration). This
fever, and abdominal cramps ("stomach ache"). In general, the treatment should begin at home. Your physician may give you
symptoms begin 1 to 2 days following infection with a virus that specific instructions about what kinds of fluid to give. CDC
causes gastroenteritis and may last for 1 to 10 days, depending recommends that families with infants and young children keep
on which virus causes the illness; however, most episodes last a supply of oral rehydration solution (ORS) at home at all times
from 1-3 days. and use the solution when diarrhea first occurs in the child. ORS
is available at pharmacies without a prescription. Follow the
Is viral gastroenteritis a serious illness? written directions on the ORS package, and use clean or boiled
water. Medications, including antibiotics (which have no effect
For most people, it is not. People who get viral gastroenteritis on viruses) and other treatments, should be avoided unless
almost always recover completely without any long-term specifically recommended by a physician.
problems. Gastroenteritis is a serious illness, however, for
persons who are unable to drink enough fluids to replace what Can viral gastroenteritis be prevented?
they lose through vomiting or diarrhea. Infants, young children, Persons can reduce their chance of getting infected by frequent
and persons who are unable to care for themselves, such as the handwashing, prompt disinfection of contaminated surfaces with
disabled or elderly, are at risk for dehydration from loss of fluids. household chlorine bleach-based cleaners, and prompt washing
Immune compromised persons are at risk for dehydration of soiled articles of clothing. If food or water is thought to be
because they may get a more serious illness, with greater contaminated, it should be avoided. Immunity to noroviruses is
vomiting or diarrhea. They may need to be hospitalized for short-term, lasting only a few months, so it is possible to be
treatment to correct or prevent dehydration. reinfected. To complicate matters more, however, some
Is the illness contagious? How are these viruses spread? individuals presumably immune because of high levels of
antibodies to the norovirus may still be susceptible to infection.
Yes, viral gastroenteritis is contagious. Outbreaks (in which Since there are many strains of noroviruses and immunity is
many people are affected) occur primarily from eating or specific for each strain, it is possible to have an episode of
drinking contaminated foods or beverages. The viruses that gastroenteritis immediately after another if the infecting strains
cause gastroenteritis also are spread through close contact with are different; however, this probably occurs infrequently.
infected persons through contamination with stool or vomitus. Overall, the status of immunity to the viruses causing
gastroenteritis--particularly as it relates to susceptibility to
How does food get contaminated by gastroenteritis viruses?
infection--is incomplete.
Food may be contaminated by food preparers or handlers who
Is there a vaccine for viral gastroenteritis?
have viral gastroenteritis, especially if they do not wash their
hands regularly after using the bathroom. Shellfish may be Currently there is a licensed rotavirus vaccine available that
contaminated by sewage, and persons who eat raw or protects against severe diarrhea from rotavirus infection in
undercooked shellfish harvested from contaminated waters may infants and young children. Studies into a norovirus vaccine are
get diarrhea. Drinking water can also be contaminated by underway.
sewage and be a source of spread of these viruses.
Where and when does viral gastroenteritis occur?
Viral gastroenteritis affects people in all parts of the world. Each
virus has its own seasonal activity. For example, in the United
States, rotavirus and astrovirus infections occur during the
cooler months of the year (October to April), whereas
adenovirus infections occur throughout the year. Norovirus
outbreaks can occur in institutional settings, such as schools,
child care facilities, and nursing homes, and can occur in other
group settings, such as banquet halls, cruise ships, dormitories,
and campgrounds. Although gastroenteritis occurs as outbreaks
among groups that have a common source, for example, on
cruise ships, it also may occur sporadically in individuals.
Who gets viral gastroenteritis?
Anyone can get it. Viral gastroenteritis occurs in people of all
ages and backgrounds. However, some viruses tend to cause
diarrheal disease primarily among people in specific age groups.
Rotavirus infection is the most common cause of diarrhea in
infants and young children under 5 years old. Adenoviruses and
astroviruses cause diarrhea mostly in young children, but older