In the United States, more than 3 million people develop pneumonia each year, and about 17% of these receive treatment in a hospital. Most people with pneumonia recover, but about 5% will succumb to the condition.
NOTE;
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs (alveoli)—associated with fever, chest symptoms, and a lack of air space (consolidation) on a chest X-ray.Pneumonia is typically caused by an infection but there are a number of other causes.Infectious agents include: bacteria, viruses, fungi, and parasites.Typical symptoms include cough, chest pain, fever, and difficulty breathing.Diagnostic tools include x-rays and examination of the sputum. Vaccines to prevent certain types of pneumonia are available. Treatment depends on the underlying cause. Presumed bacterial pneumonia is treated with antibiotics.
WHAT CAUSES PNEUMONIA ?
Bacterials and viruses are the primary causes of pneumonia. When a person breathes pneumonia-causing germs into his lungs and his body's immune system cannot otherwise prevent entry, the organisms settle in small air sacs called alveoli and continue multiplying. As the body sends white blood cells to attack the infection, the sacs become filed with fluid and pus - causing pneumonia.Pneumonia has bacterial, viral, fungal, and other primary causes. A summary is provided below.
Bacterial
Streptococcus pneumoniae is the most common cause of bacterial pneumonia. People who suffer from chronic obstructive pulmonary disease (COPD) or alcoholism most often get pneumonia from Klebsiella pneumoniae and Hemophilus influenzae. Atypical pneumonia, a type of pneumonia that typically occurs during the summer and fall months, is caused by the bacteria Mycoplasma pneumoniae. People who have Legionnaire's disease caused by the bacterium Legionella pneumoniae (often found in contaminated water supplies and air conditioners) may also develop pneumonia as part of the overall infection. Another type of bacteria responsible for pneumonia is called Chlamydia pneumoniae. Pneumocystis carinii pneumonia is a form of pneumonia that usually affects both lungs and is found in patients with weakened or compromised immune systems from such conditions as cancer and HIV/AIDS and those treated with TNF (tumor necrosis factor) for rheumatoid arthritis.
Viral
Viral pneumonias are pneumonias that do not typically respond to antibiotic treatment (in contrast to bacterial pneumonias). Adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and parainfluenza virus are all potential causes of viral pneumonia.
Fungi
Fungal pneumonia is uncommon,but it may occur in individuals with weakened immune systems due to AIDS, immunosuppressive drugs, or other medical problems. The pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia. Fungal pneumonia is most often caused by Histoplasma capsulatum, blastomyces, Cryptococcus neoformans, Pneumocystis jiroveci, and Coccidioides immitis. Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis is most common in the southwestern United States.
Parasites
A variety of parasites can affect the lungs. These parasites typically enter the body through the skin or the mouth. Once inside the body, they travel to the lungs, usually through the blood. In parasitic pneumonia, as with other kinds of pneumonia, a combination of cellular destruction and immune response causes disruption of oxygen transportation. One type of white blood cell, the eosinophil, responds vigorously to parasite infection. Eosinophils in the lungs can lead to eosinophilic pneumonia, thus complicating the underlying parasitic pneumonia. The most common parasites causing pneumonia are Toxoplasma gondii, Strongyloides stercoralis, and Ascariasis.
Idiopathic
Idiopathic interstitial pneumonia or noninfectious pneumonia are a class of diffuse lung diseases. They include: diffuse alveolar damage, organizing pneumonia, nonspecific interstitial pneumonia, lymphocytic interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis interstitial lung disease, and usual interstitial pneumonia.
HOW IS PNEUMONIA DIAGNOSED?
Your doctor will ask you about your symptoms and do a physical exam. He or she may order a chest X-ray and a blood test. This is usually enough for your doctor to know if you have pneumonia. You may need more tests if you have bad symptoms, are an older adult, or have other health problems. In general, the sicker you are, the more tests you will have.
PATHOPHYSIOLOGY
Pneumonia fills the lung's alveoli with fluid, hindering oxygenation. The alveolus on the left is normal, whereas the one on the right is full of fluid from pneumonia.
Pneumonia frequently starts as an upper respiratory tract infection that moves into the lower respiratory tract.
Viral
Viruses invade cells in order to reproduce. Typically, a virus reaches the lungs when airborne droplets are inhaled through the mouth or nose. Once in the lungs, the virus invades the cells lining the airways and alveoli. This invasion often leads to cell death, either from damage to the cell by the virus or from a protective process called apoptosis in which the infected cell destroys itself before it can be used as a conduit for virus reproduction. When the immune system responds to the viral infection, even more lung damage occurs. White blood cells, mainly lymphocytes, activate certain chemical cytokines that allow fluid to leak into the alveoli. This combination of cell destruction and fluid-filled alveoli interrupts the normal transportation of oxygen into the bloodstream.As well as damaging the lungs, many viruses affect other organs and thus disrupt many body functions. Viruses can also make the body more susceptible to other bacterial infections; in this way bacterial pneumonia can arise as a co-morbid condition.
Bacterial
Bacteria typically enter the lung when airborne droplets are inhaled, but can also reach the lung through the bloodstream when there is an infection in another part of the body. Many bacteria live in parts of the upper respiratory tract, such as the nose, mouth, and sinuses, and can easily be inhaled into the alveoli. Once inside, bacteria may invade the spaces between cells and between alveoli through connecting pores. This invasion triggers the immune system to send neutrophils, a type of defensive white blood cell, to the lungs. The neutrophils engulf and kill the offending organisms, and also release cytokines, causing a general activation of the immune system. This leads to the fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation.
CONTAGIOUSNESS
The viruses and bacteria that cause pneumonia are contagious and usually found in fluid from the mouth or nose of someone who's infected. Illness can spread when an infected person coughs or sneezes on others, by sharing drinking glasses and eating utensils, and when someone touches the used tissues or handkerchiefs of an infected person.
PREVENTION
Some types of pneumonia can be prevented by vaccines. Kids usually receive routine immunizations against Haemophilus influenzae and pertussis (whooping cough) beginning at 2 months of age. (The pertussis immunization is the "P" part of the routine DTaP injection.)
Vaccines are now also given against the pneumococcus organism (PCV), a common cause of bacterial pneumonia.
Children with chronic illnesses, who are at special risk for other types of pneumonia, may receive additional vaccines or protective immune medication. The flu vaccine is strongly recommended for kids with chronic illnesses such as chronic heart or lung disorders or asthma, as well as otherwise healthy kids ages 6 months through 19 years.
Because they're at higher risk for serious complications, infants born prematurely may be given treatments that temporarily protect against RSV, which can lead to pneumonia in younger kids.
Doctors may give prophylactic (disease-preventing) antibiotics to prevent pneumonia in kids who have been exposed to someone with certain types of pneumonia, such as pertussis. Those with HIV infection might receive prophylactic antibiotics to prevent pneumonia caused by Pneumocystis carinii.
Antiviral medication is now available, too, and can be used to prevent some types of viral pneumonia or to make symptoms less severe.
In addition, regular tuberculosis screening is performed yearly in some high-risk areas because early detection will prevent active tuberculosis infection including pneumonia.
In general, pneumonia is not contagious, but the upper respiratory viruses and bacteria that lead to it are, so it is best to keep your child away from anyone who has an upper respiratory tract infection.
If someone in your home has a respiratory infection or throat infection, keep his or her drinking glasses and eating utensils separate from those of other family members, and wash your hands frequently, especially if you are handling used tissues or dirty handkerchiefs.
DIFFERENTIAL DIAGNOSIS
Several diseases can present similar to pneumonia, including: chronic obstructive pulmonary disease (COPD), asthma, pulmonary edema, bronchiectasis, lung cancer, and pulmonary emboli.[11] Unlike pneumonia, asthma and COPD typically present with wheezing, pulmonary edema presents with an abnormal electrocardiogram, cancer and bronchiectasis present with a cough of longer duration, and pulmonary emboli presents with acute onset sharp chest pain and shortness of breath.[11]
SYMPTOMS OF PNEUMONIA
Symptoms of pneumonia caused by bacteria usually come on more quickly than pneumonia caused by virus. Elderly persons and small children may actually have fewer or more mild symptoms than expected for such high risk groups. Most people with pneumonia begin with cold and flu symptoms and then develop a high fever, chills, and cough with sputum.
Although symptoms may vary greatly depending on other underlying conditions, common symptoms include:
-Cough
-Rusty or green mucus (sputum) coughed up from lungs
-Fever
-Fast breathing and shortness of breath
-Shaking chills
-Chest pain that usually worsens when taking a deep breath (pleuritic pain)
-Fast heartbeat
-Fatigue and feeling very weak
-Nausea and vomiting
-Diarrhea
-Sweating
-Headache
-Muscle pain
-Confusion or delirium
-Dusky or purplish skin color (cyanosis) from poorly oxygenated blood
CONVENTIONAL MEDICAL TREATMENT
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.
BACTERIAL PNEUMONIA TREATMENT OVERVIEW
Health care providers usually treat bacterial pneumonia with antibiotics. Although you may start to feel better shortly after beginning your medication, be sure to complete your entire course of antibiotics. Stopping medication too soon may cause your pneumonia to return. It also helps create strains of bacteria that are resistant to antibiotics - an increasingly serious problem in the United States.
PNEUMOCOCCAL BACTERIAL PNEUMONIA
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 under the age of 2 years 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 BACTERIAL PNEUMONIA
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 BACTERIAL PNEUMONIA
Mycoplasma pneumonia are treated with antibiotics. Even so, recovery may not be immediate. In some cases fatigue may continue long after the infection itself has cleared. Many cases of mycoplasma pneumonia go undiagnosed and untreated. The signs and symptoms mimic those of a bad chest cold, so some people never seek medical attention. 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.
LEGIONELLA BACTERIAL 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.
P. CARINII PNEUMONIA
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 PNEUMONIA
Viral pneumonias do not typically respond to antibiotic treatment, although a few viral pneumonias may be treated with antiviral medications. The recommended treatment is generally the same as for the flu which consists of rest and plenty of fluids. 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 PNEUMONIA
If your pneumonia is caused by a fungus, you will likely be treated with anti-fungal medications. 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.
ANTIBIOTIC CONCERNS
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, health care providers 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 are 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 percent 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.
OTHER TREATMENTS
In addition to these treatments, your health care provider may recommend over-the-counter (OTC) medications to reduce fever, treat your aches and pains, and soothe the cough associated with pneumonia. You do not want to suppress your cough completely, though, since coughing helps clear your lungs. If you must use a cough suppressant, use the lowest dose that helps you get some rest. If you have severe pneumonia, you will be hospitalized and treated with intravenous antibiotics and put on oxygen. If you do not need oxygen, you may recover as quickly at home with oral antibiotics as in the hospital, especially if you have access to qualified home health care. Sometimes you may spend three or four days in the hospital receiving intravenous antibiotics and then continue to recover at home with oral medication.
FOLLOW-UP CARE
Your health care provider will most likely schedule a follow-up X-ray and an office visit after your initial diagnosis and treatment. By that time your infection should have cleared, but it is important for your health care provider to see you, even if you are feeling better. Follow-up appointments and X-rays are especially important in smokers. If you are not feeling better, the follow-up visit is an opportunity for your health care provider to schedule tests to determine more specifically what is causing your symptoms.
HOME TREATMENT
If you have pneumonia, the following measures can help you recover more quickly and decrease your risk of complications:
- Fever, headaches, and body aches are typical pneumonia symptoms. If fever is uncomfortable, take acetaminophen or ibuprofen to lower it. You may also sponge your body with lukewarm water to reduce fever. Do not use cold water or ice. Lowering the fever will not make your symptoms go away faster, but it may make you more comfortable. If the fever is not causing discomfort, you may just want to watch for signs that it is going higher. A slight fever may help the body fight the virus. To relieve body aches and headache, take aspirin, acetaminophen, or ibuprofen. To avoid the risk of Reye's syndrome, do not give aspirin to anyone under age 20. Also, be aware that aspirin and ibuprofen can cause stomach upset, while acetaminophen does not.
- Get plenty of rest. Even when you start to feel better, be careful not to overdo it.
- Drink lots of fluids, especially water. Liquids keep you from becoming dehydrated and help loosen mucus in your lungs. Hot tea herbal teas with lemon, water, fruit juices, and broth-like soups are all good choices.
- Coughing is a common symptom associated with pneumonia. Some coughing is beneficial to break loose and expel mucus and fluids in the lungs. To help ease cough discomfort, try sucking on cough drops or plain, hard candy. Taking a non-prescription cough medicine that contains dextromethorphan may help you get some sleep. Ask your health care provider about taking cough remedies. Some products contain a high percentage of alcohol. Use them with caution, especially when giving them to children. Elevating your head at night with an extra pillow(s) may help if coughing keeps you awake and it eases breathing difficulties.
- Take the entire course of any prescribed medications. Stopping medication too soon can cause your pneumonia to come back and contributes to the development of antibiotic-resistant bacteria.
- Avoid smoking and breathing other people's smoke. This is good advice anytime, but it is especially important when you have a respiratory infection like a cold, the flu, or pneumonia.
- Keep all of your follow-up appointments. Even though you feel better, your lungs may still be infected. It is important to have your health care provider monitor your progress.
HOLISTIC & NUTRITIONAL RECOMMENDATIONS
CONSIDERATIONS
THE MAJOR IMPORTANT NUTRIENTS FOR FIGHTING INFECTION
- Vitamin A is necessary for maintaining the health of the lining of the respiratory passages. It promotes healing of lung tissue, helps the immune system and reduces the duration of illness. A deficiency of this vitamin increases susceptibility to respiratory infections, which in turn can lead to pneumonia. (See Nutritional Supplements on this page for supplement links.)
- Vitamin C, taken with bioflavonoids, is another powerful anti-pneumonia weapon. Bioflavonoids help the body absorb Vitamin C. Vitamin C is the most important supplement to help fight an infectious pneumonia and other inflammations. High dosages of vitamin C to bowel tolerance are recommended. A recommended dosage of Vitamin C, with bioflavonoids, is 1,000 mg every few hours. A major review of over 60 separate studies by Professor Harri Hemila, of the University of Helsinki, concluded that there is a substantial and consistent benefit from vitamin C. Intakes of more than 1 g/day (which is around 20 times the recommended daily allowance) have been proved to cut pneumonia rates almost in half, especially among the elderly - even in serious cases requiring hospitalization. For stubborn cases, intravenous vitamin C can work quickly and knock out the infection. (See Nutritional Supplements on this page for supplement links.)
- Zinc deficiency is known to be associated with weakened immune function and, thus, vulnerability to serious infectious disease. Zinc fortifies the immune system and also helps the body maintain adequate amounts of vitamin E, which does not stay in the body for long on its own. Many studies have shown that, in developing countries, giving children 20-30 mg/day of zinc will almost halve pneumonia rates. However, even in the developed world, children are often zinc-deficient. Agriculture practices, and food refining and processing have all conspired to reduce the average zinc intake in developed countries to about a third below the recommended daily minimum. In cases of pneumonia, zinc appears to work by reducing lung inflammation and obstruction to the airways. Signs of zinc deficiency include poor wound-healing, hair loss, skin rashes, night-blindness, and impaired taste and smell. A recommended dosage of zinc is 30-80 mg daily. Take with 3 mg copper to balance with Zinc. (See Nutritional Supplements on this page for supplement links.)
OTHER IMPORTANT NUTRIENTS
