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Pneumonia

Pneumonia is a general term for inflammation of the lungs. It is usually caused by a bacterial or viral infection but can also result from damage to the lungs from toxic substances (such as poisonous gases) or from injury. Less frequently, pneumonia is caused by fungi, yeasts, or other microscopic organisms. Pneumonia is a common complication of a variety of disorders, including upper respiratory tract infections such as the flu (see page 649) or acute bronchitis (see page 655). Pneumonia can also be a complication of a chronic disease such as congestive heart failure, cancer, stroke, or emphysema. In people who have these diseases, pneumonia is often given as the cause of death.

Pneumonia is very common in people who smoke or who have chronic lung infections and in people who cannot cough up phlegm forcefully enough to clear their lungs (such as people who are very sick or weak). It is especially common in people who are taking drugs that suppress the immune system (such as after an organ transplant to prevent rejection) or whose immune system is impaired because of an illness such as AIDS (see page 909).

Pneumonia has many different medical names, usually depending on the location of the inflammation in the lung (such as interstitial pneumonia or lobar pneumonia), on the virus or bacterium that caused the pneumonia (such as pneumococcal pneumonia), or on how the pneumonia was contracted (aspiration pneumonia or hospital-acquired pneumonia). Atypical pneumonia is pneumonia caused by microorganisms other than bacteria (bacterial pneumonias are more common). Walking pneumonia usually refers to milder forms of pneumonia that do not require hospitalization.

Symptoms

The symptoms of pneumonia depend on the cause of the infection and on a person’s general health. No single symptom is characteristic of all types of pneumonia. In general, you should consider the possibility that you have pneumonia if you have a respiratory illness with coughing, fever with chills, sweating, chest pains, muscle aches, fatigue, headache, nausea and vomiting, a bluish tinge to the lips or skin (from lack of oxygen), or green or blood-stained phlegm. You may also have mental confusion or shortness of breath. The severity of symptoms depends on how much of the lung is affected.

How quickly symptoms begin varies with the infection. Some symptoms can start within hours of exposure to the disease-causing organism, some in a few days, and some up to 10 days after exposure. An especially strong strain of bacteria can be quickly fatal for a person who has an impaired immune system. In a healthy young adult, pneumonia from a mild respiratory tract infection may cause symptoms that are no worse than those of a severe cold. See your doctor immediately if you suddenly become feverish with shortness of breath, if your chest hurts when you breathe, if you have a temperature over 101°F with chills, or if you cough up blood-stained phlegm.

Diagnosis

If you have symptoms of pneumonia, your doctor will examine you, listen to your lungs with a stethoscope, and tap your chest with his or her fingers to listen to (and interpret) the sounds produced by the tapping. Your doctor may recommend that you have a chest X-ray and may take blood and phlegm samples to examine them for the presence of microorganisms that could cause pneumonia. He or she may need to take a tissue sample from your lungs for examination and evaluation (biopsy) using a procedure called bronchoscopy (see below).

Treatment

The treatment of pneumonia depends on a number of factors, including the type of bacterium or other microorganism that is causing it and the person’s general health. For example, pneumonia caused by a virus does not respond to antibiotics, which are effective only against bacteria. However, even in cases of viral pneumonia, a doctor may prescribe antibiotics to help prevent a bacterial infection from developing and causing more severe symptoms.

Bronchoscopy

Bronchoscopy is a procedure that allows a doctor