Pneumonia: Symptoms, Diagnosis, Causes & Treatment

Last modified on January 2022
With inputs from Dr. Sreelekha Daruvuri

What is Pneumonia?

Pneumonia is an infection that causes inflammation in the air sacs of the lungs. Due to this, the lungs may fill up with liquid or pus. The infection can be life-threatening – especially to the vulnerable such as neonates, children, and those above the age of 65.

The condition affects the respiratory system leading to symptoms such as cough and difficulty in breathing. There are antibiotics that can help alleviate the infection and symptoms of pneumonia, however, there are vaccines that can help prevent some types of pneumonia.

This ultimate guide to Pneumonia will cover the following subjects.

Last modified on January 2022
With inputs from Dr. Sreelekha Daruvuri

What is Pneumonia?

Pneumonia is an infection that causes inflammation in the air sacs of the lungs. Due to this, the lungs may fill up with liquid or pus. The infection can be life-threatening – especially to the vulnerable such as neonates, children, and those above the age of 65.

The condition affects the respiratory system leading to symptoms such as cough and difficulty in breathing. There are antibiotics that can help alleviate the infection and symptoms of pneumonia, however, there are vaccines that can help prevent some types of pneumonia.

This ultimate guide to Pneumonia will cover the following subjects.

Chapter 1: Causes of Pneumonia

Viruses, bacteria, and fungi all cause Pneumonia.

Bacterial Pneumonia: The most common cause of bacterial pneumonia is Streptococcus pneumoniae. Other causes would include Mycoplasma pneumoniae, Legionella pneumophila, and Haemophilus influenzae.

Viral Pneumonia: The most common cause of viral pneumonia is respiratory viruses such as Influenza which causes the flu, rhinoviruses which causes the common cold, respiratory syncytial virus, human parainfluenza virus, human metapneumovirus, varicella-zoster virus which causes chickenpox, adenovirus, coronavirus, and SARS-CoV-2 which causes a COVID-19 infection.

Fungal Pneumonia: Fungal spores present in soil or bird excrements cause pneumonia and most commonly affect those with a vulnerable or weak immune system. Some fungi that cause pneumonia include Pneumocystis jirovecii, histoplasmosis, and cryptococcus.

When it comes to the common causes, these facts are helpful:

  • The most common cause of bacterial pneumonia in children is Streptococcus pneumonia
  • In infants diagnosed with HIV, the most common cause of pneumonia is Pneumocystis jiroveci
  • The most common viral cause of pneumonia is RSV (respiratory syncytial virus)
  • The second most common cause of bacterial pneumonia is Haemophilus influenzae type b (Hib)

Chapter 2: Symptoms of Pneumonia

The symptoms of pneumonia can range from mild to life-threatening. The symptoms of viral and bacterial pneumonia are similar but viral pneumonia most commonly has milder symptoms that can heal without antiviral treatment by 1-3 weeks.

The symptoms of pneumonia include:

  • Coughing with mucus or phlegm
  • Fever and chills
  • Chest pain worsening with breathing and/or coughing
  • Shortness of breath while resting or doing normal day-to-day activities
  • Fatigue and loss of appetite
  • Headaches, and nausea/vomiting
  • Pneumonia affects all ages, and these facts are important to remember:
  • Infants may not display symptoms of pneumonia, but some experience vomiting, and have challenges when eating or drinking
  • Children (>5 years of age) may present with increased breathing rate and/or wheezing
  • Adults above the age of 65 can experience bouts of confusion and lower body temperatures

Chapter 3: Pneumonia Transmission

Certain types of pneumonia are contagious and the infection is transmitted either through airborne droplets or through blood.

Chapter 4: Diagnosing & Tests of Pneumonia

Pneumonia diagnosis process includes:

  • Medical history
  • Risk assessment: how likely is the patient to have acquired a pneumonia infection
  • Timeline of symptoms
  • Physical exam: listening to lungs for abnormal sounds
  • Chest X-ray: to find signs of lung inflammation and its severity and location
  • Blood culture: to confirm a Pneumonia infection and the cause behind it
  • Sputum culture: to identify the cause of infection
  • Pulse oximetry: to confirm if the lungs are moving adequate oxygen to the blood
  • CT Scan: to visualize the lungs clearly
  • Fluid sample: If there is fluid in the chest’s pleural space, a sample is taken to identify the cause of the infection
  • Bronchoscopy: to visualize the airways of the lungs

Not all patients undergo all these tests – physicians evaluate the severity and risk of the patients suspected of Pneumonia, and their response to antibiotics. The classification of Pneumonia depends on the area of the lung that it affects. Bronchial pneumonia or bronchopneumonia affects tubes and surrounding areas of one or both lungs, whereas lobar pneumonia can affect one or more lobes of the lungs.

Chapter 5: Stages of Lobar Pneumonia

There are four stages of lobar pneumonia:

(1) Congestion: the lungs become congested because of accumulated fluid in the air sacs. In this stage the symptoms of pneumonia mentioned above are prevalent.
(2) Red hepatization: the body fights the infection in the lungs by way of red blood cells and immune cells. This stage causes the lungs to become red, along with the worsening of symptoms.
(3) Gray hepatization: during this stage, the red blood cells will break down resulting in the lungs becoming gray in color. The symptoms are still persistent in this stage as well.
(4) Resolution: the symptoms start to alleviate a bit, but a productive cough may remain as immune cells continue to work against the inflammation.

Chapter 6: Types of Pneumonia

Community-acquired pneumonia: this type of pneumonia results from a setting that doesn’t involve a hospital or any other medical care facility. In simple words, the patient becomes infected from somewhere else. Bacteria, viruses, and fungi cause community-acquired pneumonia – although bacteria is a common cause of community-acquired pneumonia.

Aspiration pneumonia: this occurs when an individual breathes in food, or fluid into their lungs. This causes symptoms such as coughing and difficulty in swallowing. Due to the aspirated material being in the lungs, bacteria easily multiply.

Healthcare-associated pneumonia: this type of pneumonia results from a hospital or healthcare facility. This can become serious if the bacteria causing this type of pneumonia is resistant to the antibiotics prescribed.

Ventilator-associated pneumonia: this type of pneumonia results after an individual acquires pneumonia after being on long-term breathing support through a ventilator.

Bacterial pneumonia: this type of pneumonia results from bacteria transmitted through infectious droplets from coughs or sneezes. Symptoms such as mucus-filled cough, fever of 100.4 F, shortness of breath, fatigue, and chest pain are common in bacterial pneumonia. The treatment of bacterial pneumonia includes prescription antibiotics. If the antibiotics are unable to alleviate the infection, hospitalization is required where antibiotics and fluids are given through IV, along with oxygen support.

Walking or atypical pneumonia: This pneumonia is a form of bacterial pneumonia that is less severe. Most commonly individuals are unaware that they have the infection because the symptoms can be incredibly mild and can go undetected. The symptoms, in fact, can present as a bad cold. Antibiotics treat walking pneumonia and the condition is likely to resolve in about 5-7 days while the cough may last a few days post that.

Viral pneumonia: This type of pneumonia is the second most common cause of the respiratory condition. There are various viruses (as mentioned above) that can cause viral pneumonia including the viruses that cause the common cold and flu. The symptoms of viral pneumonia can range from mild to severe and are similar to that of the flu such as fever and chills, dry cough or cough with mucus, congested nose, fatigue and weakness, etc. Antibiotics don’t treat viral pneumonia – the treatment is symptoms specific. The types of treatments include breathing support, fluid insertion, NSAIDs to alleviate pain and fevers, and antiviral medications if needed.

Fungal pneumonia: This is a less common cause of pneumonia and usually does not affect healthy individuals. Those that have a weak immune system can acquire fungal pneumonia easily. These include individuals that have had an organ transplant, have undergone chemotherapy, those diagnosed with autoimmune conditions, and those diagnosed with HIV.

This type of pneumonia results from the inhalation of fungal spores and its symptoms are similar to that of other types of pneumonia.

Understand more about the types of Pneumonia with this easy-to-read blog.

Chapter 7: Pneumonia Treatment

The treatment for pneumonia depends on the type of pneumonia, its severity, and the health of the patient. The different ways to treat pneumonia are as follows:
(1) Medications:
Prescription medications:
– Oral antibiotics treat bacterial pneumonia
– Antiviral medications treat viral pneumonia
– Antifungal medications treat fungal pneumonia
Over-the-counter (OTC) medications: This is for symptoms such as pain, fever, cough
– Aspirin
– Acetaminophen
– Ibuprofen
– Cough medicines

(2) Hospitalization: required if symptoms resist prescribed medications and/or are very severe. Hospital treatment includes:
– IV antibiotics
– Respiratory therapy to help with oxygenation
– Oxygenation therapy to help maintain oxygen levels.

(3) Home remedies do not treat pneumonia, however, some home remedies can help alleviate the symptoms of pneumonia.
– Cough alleviation: gargling of saltwater, drinking liquids such as warm dairy-free tea
– Fever alleviation: cold compress

Understand more about Pneumonia treat with this easy-to-read blog.

Chapter 8: Pneumonia Vaccines

Vaccination is preferably the first-line defense against pneumonia. There are various vaccines developed:
(1) Prevnar 13: protects against pneumonia, meningitis, and 13 types of pneumococcal bacteria. Recommended for children <2, those between the ages of 2-64 with an increased risk of developing pneumonia, and adults above the age of 65.
(2) Pneumovax 23: protects against pneumonia, meningitis, and 23 types of pneumococcal bacteria. Recommended for adults aged 65 or older, those between the ages of 19 – 64 with a history of smoking, and those between the ages of 2-64 with certain medical conditions and at an increased risk of developing pneumonia.
(3) Flu vaccine: recommended since pneumonia can result as a complication from the flu. Recommended for those above the age of 6 months – especially those individuals that have a higher risk of developing flu-related complications.
(4) Hib vaccine: Haemophilus influenzae B (Hib) causes pneumonia and meningitis. Recommended for those <5 years of age, unvaccinated individuals with chronic health conditions, and those that have undergone a bone marrow transplant.

Speak to a general care physician or a health care provider to understand which vaccines you should take and when you should take them. Pneumonia vaccines don’t protect against all types of pneumonia, but vaccinations lower the risk of complications associated with pneumonia.

Chapter 9: Pneumonia Risk Factors and Complications

Risk factors
Pneumonia can affect any individual, however, some individuals pose a higher risk of developing the illness. These include:

  • Infants and children less than 5 years
  • Adults that are 65 or older
  • Individuals with weak immune systems: pregnant women, HIV patients, patients on steroids and cancer drugs
  • Individuals with chronic conditions such as diabetes, cystic fibrosis (CF), COPD, asthma, malnourishment, HIV, etc
  • Individuals who have been hospitalized for a long period of time
  • Individuals who have been on ventilatory support for a long duration
  • Individuals who have suffered conditions that affect their ability to swallow or cough
  • Individuals exposed to pollution, toxic air, etc
  • Individuals living in crowded conditions such as healthcare facilities or nursing homes
  • Individuals who have a history of smoking, drinking, and drugs

Complications
There are various complications with pneumonia especially in those that are at a higher risk for developing the illness. The complications include:
– Exacerbation of existing medical health conditions such as emphysema, COPD, and congestive heart failure
– Lung abscess formation
– Breathing difficulties and impairment
– Bacteremia: bacteria can spread to the bloodstream resulting in low BP, septic shock, and in severe cases, organ failure.
– Pleural effusion:
– ARDS (Acute respiratory distress syndrome)
– Death

Chapter 10: Pneumonia and COVID-19 management

One of the causes of pneumonia is the SARS-CoV-2 virus which causes the COVID-19 infection. If you have been diagnosed with pneumonia or COVID-19, it is important to make sure to stick to a treatment plan given by your physician.

  • Ensure getting 8 hours of sleep
  • Maintain a healthy diet
  • Stay hydrated
  • Don’t ignore medical symptoms
  • Stay disciplined with your treatment

If you experience any COVID-19 symptoms, take an RT PCR test, a COVID blood test, or an HRCT chest scan to avoid complications and challenges.

Chapter 11: FAQ’s

Q. Is pneumonia contagious

A: Yes, there are types of pneumonia that are contagious. The medical condition results from bacterial, viral, or fungal infections – germs can be transmitted through air droplets and blood.
Understand more about Pneumonia transmissibility in this easy-to-read blog.

Q. How long can pneumonia last

A: Most types of pneumonia are healed in two-four weeks, although the cough it produces can linger within the chest for weeks after. Severe cases will take a longer time to completely heal.

Q. Can inhaling steam cause pneumonia

A: No, inhaling steam does not cause pneumonia. Although conditions that affect the nose like sinusitis can be caused by too much steam inhalation and can increase the risk of infections as there is damage to the mucosal barrier. Steam inhalation is used to relieve nasal congestion.

Q. What happens if you get the pneumonia vaccine twice

A: Pneumonia vaccines are recommended depending on the age groups and risk factors. It can be a single dose or two doses. If accidentally, two doses are taken within a short span or at a wrong interval, there can be mild side effects of the vaccine itself. But it’s best to inform the physician about the same.

Q. What are the side effects of the pneumonia vaccine

A: Just like all vaccines, certain side effects are expected with pneumonia vaccines. These include soreness in the injection site, fever, headache, muscle aches, loss of appetite, and fatigue.

Q. Can you die from pneumonia

A: The symptoms and severity of pneumonia can range from mild to life-threatening. If an infection is improperly treated, untreated or is accompanied with serious complications, it can be fatal.

Q. What to eat when you have pneumonia

A: Having a balanced diet and adequate hydration is important with a pneumonia diagnosis. This includes having an adequate amount of green veggies, protein, whole grains, probiotics, and fruits. Understand more about what to eat while diagnosed with Pneumonia in this easy-to-read blog.

Q. What does pneumonia look like on a CT scan

A: The most common CT findings are septal thickening, bronchial wall thickening, mosaic perfusion, bronchovascular bundle thickening, interstitial nodules, and honeycombing, and in a few cases, consolidation and nodular opacities are seen.

Q. What does pneumonia look like on an x-ray

A: The more common radiographical findings include segmental or lobar consolidations.
Other less common radiographical findings include mediastinal lymphadenopathy, pleural effusion, cavitation, and chest wall invasion.

Q. Bronchitis vs pneumonia: What is the difference

A: Bronchitis and pneumonia are both conditions that affect the lungs and present with similar symptoms. However, bronchitis affects the bronchial tubes that are responsible for carrying air to the lungs. Pneumonia affects the air sacs or alveoli, where oxygen passes into the blood.

Most individuals recover from pneumonia and respond well to treatment. The recovery time depends on the severity and type of pneumonia that is diagnosed along with the general state of your health. Should you have any severe respiratory symptoms such as mucus-filled cough, chest pain, difficulty breathing, fever, etc, consult with a general physician or a pulmonologist immediately. Diagnosing pneumonia in its early stages is key when it comes to treatment response and complication avoidance.

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