E33: Pneumonia: Types, Diagnosis and Treatment
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.
There are more than 30 different causes of pneumonia, and they’re grouped by the cause. The main types of pneumonia are bacterial, viral, and mycoplasma pneumonia.
- Bacterial pneumonia. This type is caused by various bacteria. The most common is Streptococcus pneumoniae. It usually occurs when the body is weakened in some way, such as by illness, poor nutrition, old age, or impaired immunity, and the bacteria are able to work their way into the lungs. Bacterial pneumonia can affect all ages, but you are at greater risk if you abuse alcohol, smoke cigarettes, are debilitated, have recently had surgery, have a respiratory disease or viral infection, or have a weakened immune system.
- Viral pneumonia. This type is caused by various viruses, including the flu (influenza), and is responsible for about one-third of all pneumonia cases. You may be more likely to get bacterial pneumonia if you have viral pneumonia.
- Mycoplasma pneumonia. This type has somewhat different symptoms and physical signs and is referred to as atypical pneumonia. It is caused by the bacterium Mycoplasma pneumoniae. It generally causes a mild, widespread pneumonia that affects all age groups.
Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.
The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of germ causing the infection, and your age and overall health. Mild signs and symptoms often are similar to those of a cold or flu, but they last longer.
Common Signs and Symptoms of Pneumonia
The following are clinical presentations of pneumonia that the patients experience
- Bluish color to lips and fingernails
- Confused mental state or delirium, especially in older people
- Cough that produces green, yellow, or bloody mucus
- Heavy sweating
- Loss of appetite
- Low energy and extreme tiredness
- Rapid breathing
- Rapid pulse
- Shaking chills
- Sharp or stabbing chest pain that’s worse with deep breathing or coughing
- Shortness of breath that gets worse with activity
Newborns and infants may not show any sign of the infection. Or they may vomit, have a fever and cough, appear restless or tired and without energy, or have difficulty breathing and eating.
Diagnosis of Pneumonia
Diagnosis is usually made based on your recent health history (such as surgery, a cold, or travel exposures) and the extent of the illness. Based on these factors, your healthcare provider may diagnose pneumonia simply on a thorough history and physical exam. The following tests may be used to confirm the diagnosis:
- Chest X-ray. This test takes pictures of internal tissues, bones, and organs, including the lungs.
- Blood tests. This test may be used to see whether infection is present and if infection has spread to the bloodstream (blood cultures). Arterial blood gas testing checks the amount of oxygen in your bloodstream.
- Sputum culture. This test is done on the material that is coughed up from the lungs and into the mouth. It’s often used to see if there’s an infection in the lungs.
- Pulse oximetry. An oximeter is a small machine that measures the amount of oxygen in the blood. A small sensor is taped or clipped onto a finger. When the machine is on, a small red light can be seen in the sensor. The test is painless and the red light does not get hot.
- Chest CT scan. This imaging procedure uses a combination of X-rays and computer technology to produce sharp, detailed horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than regular X-rays.
- Bronchoscopy. This is direct exam of the bronchi (the main airways of the lungs) using a flexible tube (called a bronchoscope). It helps to evaluate and diagnose lung problems, assess blockages, and take out samples of tissue and/or fluid for testing,
- Pleural fluid culture. In this test, a sample of a fluid sample is taken from the pleural space. This is the space between the lungs and chest wall. A long, thin needle is put through the skin between the ribs and into the pleural space. Fluid is pulled into a syringe attached to the needle. It is sent to the lab where it’s tested to find out which bacteria is causing the pneumonia.
See your doctor if you have difficulty breathing, chest pain, persistent fever of 102 F (39 C) or higher, or persistent cough,
Treatment and Management of Pneumonia
Treatment depends on the type of pneumonia you have. Antibiotics are used for bacterial pneumonia. It may also speed recovery from mycoplasma pneumonia and some special cases. Most viral pneumonias don’t have a specific treatment and just get better on their own.
Other treatment may include a healthy diet, more fluids, rest, oxygen therapy, and medicine for pain, cough, and fever control.
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Most people with pneumonia respond well to treatment, but pneumonia can cause serious lung and infection problems. It can even be deadly.