Pneumonia: What You Need to Know

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Overview

Pneumonia is a common lung infection caused by germs like bacteria, viruses, or fungi. It can also be a complication of the flu. It causes air sacs in your lungs to inflame and fill with mucus or other liquid, which causes fever, coughing, and difficulty breathing. (1)

While most people recover from pneumonia in anywhere from a week to a month, certain groups are at higher risk for catching it and at higher risk of having complications.

Symptoms of pneumonia can vary widely, from mild to severe. In some cases, it can be life-threatening. Fortunately, pneumonia can be prevented with some simple precautions.

Here’s what you need to know.

How Common Is Pneumonia?

Every year in America, one million people are hospitalized for pneumonia, and another 4 million tough it out at home. It kills 50,000 people each year. (2) Pneumonia can affect anyone, but some groups of people have a higher risk than others. Children under the age of 2 and adults over 65 are most at risk, as well as people of any age who have conditions that cause a weakened immune system. These can include cancer, organ transplant, or certain medications. (3)

What Causes Pneumonia?

There are several different types of pneumonia, each with its own symptoms and causes. (4)

Community-acquired Pneumonia

When pneumonia occurs outside of a hospital or healthcare facility, it is called community-acquired pneumonia. It is the most common form of pneumonia and has several potential causes.

Bacteria

This is most commonly caused by the bacterium Streptococcal pneumoniae. It often comes on after a cold or flu, but it can happen on its own as well. When it affects only one lobe of the lung, it is called lobar pneumonia. When it affects patches of both lungs, it is known as bronchial pneumonia (or bronchopneumonia). (5)

Bacterial pneumonia is the most serious type of pneumonia.

Bacteria-like Organisms

This is often called walking pneumonia or atypical pneumonia. It is caused by the bacterium Mycoplasma pneumoniae. It usually causes milder symptoms, sometimes so mild that you may not know that you have it. It most commonly occurs in military personnel or others living in crowded conditions and adults under 40.

Fungi

This is caused by an inhaled fungus found in bird droppings or soil. It occurs most commonly in people with weakened immune systems or chronic medical problems. It occurs when a person inhales large doses of the fungus. The organism responsible varies from one geographical location to another.

Viruses

This is the most common cause of pneumonia in children, but it can occur in people of any age. It is caused by the same viruses that cause cold and flu, which can sometimes turn into pneumonia. This type of pneumonia is usually mild, but not always.

You may be more susceptible to bacterial pneumonia if you have had viral pneumonia. (5)

Hospital-acquired Pneumonia

This is a more serious type of pneumonia that is caught during a hospital stay. It is often caused by bacteria that are resistant to antibiotics, making it harder to treat. People in intensive care units and on machines to help them breathe are especially susceptible to this type. In that situation, it is called ventilator-acquired pneumonia.

Healthcare-acquired Pneumonia

This is similar to hospital-acquired pneumonia, but it happens in long-term facilities such as nursing homes. It can also occur in outpatient facilities such as dialysis centers. Like hospital-acquired pneumonia, it’s caused by antibiotic-resistant organisms.

What are the Symptoms of Pneumonia?

The symptoms of pneumonia can vary widely depending on your age, general health, and the type of pneumonia you have. (5)

Bacterial

Some symptoms you may experience include:

  • Bluish color to lips and fingertips.
  • Confusion or change in mental status in older adults.
  • Coughing with yellow, green, or bloody mucus.
  • Fever.
  • Sweating or clammy skin.
  • Loss of appetite.
  • Fatigue.
  • Rapid breathing.
  • Rapid pulse.
  • Shaking chills.
  • Chest pain with breathing or coughing.
  • Shortness of breath.

Viral

All of the above, which may be followed by:

  • Headache.
  • Worsening shortness of breath.
  • Muscle pain.
  • Weakness.
  • Worsening cough.

Cold, Influenza, or Pneumonia?

Sometimes the symptoms of pneumonia can begin with a cold or mimic the flu. So how do you tell the difference? Generally, influenza symptoms come on suddenly, while pneumonia symptoms are usually more gradual. Pneumonia, however, usually causes higher fevers that rise rapidly. See the chart below for a complete comparison of symptoms. (6)

Symptom

Cold

Flu

Pneumonia

Fever

Rare

High – over 101°, lasts 3 to 4 days

High – up to 105°, rises quickly

Headache

Rare

Yes

Usually no

Muscle aches

Slight

Usually, can be severe

Occasional

Fatigue

Mild

Early, can last 2 to 3 weeks

Occasional

Stuffy and/or runny nose

Common

Sometimes

Usually no

Sore or scratchy throat

Common

Sometimes

Usually no

Chest discomfort or pain

Mild to moderate

Common

Common

Cough

Common

Usually dry and hacking

Moist cough, may be productive of rust-colored sputum or pus

Onset of symptoms

Gradual

Rapid

Gradual

If you have any chronic health problems such as heart, kidney, liver, or lung disease, it’s especially important that you see your doctor as soon as you notice symptoms.

Is Pneumonia Contagious?

It depends on the type of pneumonia you have. Bacterial pneumonia can be contagious, as bacteria is transferred from person to person. Viral pneumonia can also be contagious, as can mycobacterium (walking) pneumonia. Pneumonia caused by fungi is generally not contagious.

Are There any Risk Factors for Pneumonia?

You are at higher risk for pneumonia if you have one of the following conditions:

  • Asthma.
  • Cystic fibrosis.
  • Chronic obstructive pulmonary disease (COPD).
  • A weakened immune system from an organ transplant or diseases like HIV or cancer.
  • Diabetes.
  • Are very young or an older adult.
  • Alcohol abuse.
  • Smoking.
  • A physical disability.
  • Recent surgery.

What Are the Complications of Pneumonia?  (5)

Most people recover fully from pneumonia, but in some cases it can be very serious and even fatal. Young children and older adults are more likely to have complications. If you have a condition that compromises your immune system, you are also at higher risk for complications.

Complications can include:

  • Acute respiratory distress syndrome (ARDS). This is a condition where fluid leaks into your lungs and causes respiratory failure.
  • Lung abscesses. These are cavities of pus inside or around a lung. Surgery is needed to drain the cavities.
  • Respiratory failure that requires a breathing machine or ventilator.
  • Sepsis. This is when an infection gets into your blood and causes an inflammatory reaction. It can lead to organ failure.

How is Pneumonia Diagnosed?

There are several things your provider will use to identify the type of pneumonia you have, including your medical history, a physical exam, and a chest x-ray or CT scan. (7)

They may also do blood work or use a bronchoscope to look at your lungs. They may take a biopsy from your lungs or a sample of the fluid surrounding them to find out which bacterium you are infected with. (8)

What is the Treatment for Pneumonia?

After your provider determines which type of pneumonia you have, he or she may treat you with antibiotics (if it’s bacterial). Most viral pneumonias will get better on their own, but sometimes antivirals are given. (8)

In most cases, you will be treated at home. You should increase fluids, rest, and use fever reducers, pain medication, and cough suppressants if needed.

In severe cases, you may need oxygen therapy and/or hospitalization.

What is the Outlook for Recovering from Pneumonia?

Most people recover fully from pneumonia. You should begin to feel better after you start taking antibiotics, but you probably will not return to normal for several weeks. If you are not feeling better after two to three days or feel worse, call your provider. (8)

It’s very important that you take all of the antibiotics your doctor prescribed. Don’t stop even if you feel better.

How Can Pneumonia be Prevented?

There are simple things you can do to prevent your risk of contracting pneumonia.

What You Can Do at Home (7)

  • Wash your hands often. Use soap and water or sanitizing gel. This helps to prevent spreading the bacteria that cause pneumonia.
  • Don’t smoke. Smoking hampers your lungs’ ability to filter out germs. There are many resources available to help you quit smoking. Ask your provider.
  • Protect your immune system. Eat a healthy diet and get plenty of rest and exercise.
  • Get yearly flu vaccines. This is important because some people come down with pneumonia after having the flu. Vaccines are usually available from your doctor from September through November of each year.

Pneumonia Vaccines (9)

There are two types of pneumonia vaccine. They are the pneumococcal conjugate vaccine (PCV13 or Prevnar 13) and the pneumococcal polysaccharide vaccine (PPSV23 or Pneumovax 23). These are sometimes referred to as the 13-valent and the 23-valent vaccines.

According to the CDC (10), you should not get both vaccines at the same time. If you need both, you should get the Prevnar 13 first and a dose of Pneumovax 23 at another visit. Your provider can tell you how long you should wait between vaccinations.

Who Should Get Vaccinated?

The CDC recommends the Prevnar 13 vaccine for:

  • children younger than two.
  • most adults age 65 and older.
  • adults ages 19 through 64 who:
  • have chronic illness, including heart disease, liver disease, kidney disease, or lung disease (including chronic obstructive pulmonary disease, emphysema, and asthma), diabetes, or alcoholism.
  • have any condition that weakens the immune system (cancer, HIV/AIDS, or damaged or missing spleen).
  • have cerebrospinal fluid (CSF) leaks.
  • have cochlear implants.
  • are smokers.

The CDC recommends the Pneumovax 23 vaccine for:

  • most adults over age 65.
  • people ages 2 through 64 who:
    • have HIV infection, sickle cell disease, diabetes, nephrotic syndrome, immune compromising conditions.
    • have chronic heart, lung, kidney, or liver disease.
    • have cochlear implants.
    • have cerebrospinal fluid (CSF) leaks.
  • adults ages 19 through 64 who smoke.

Who Should Not Get Vaccinated? (9)

Prevnar 13

  • Anyone who has had a life-threatening allergic reaction.
  • Anyone who has had an allergic reaction to any of the following:
  • a dose of this vaccine.
  • an earlier pneumococcal conjugate vaccine called PCV7 (or Prevnar).
  • any vaccine containing diphtheria toxoid (for example, DTaP).
  • any of the component of PCV13. (Your provider can tell you what these are.)
  • Anyone who has been ill recently.

Pneumovax 23

  • Anyone who has had a life-threatening allergic reaction.
  • Anyone who has had an allergic reaction to any of the following:
  • a dose of this vaccine.
  • any of the components of this vaccine. (Your provider can tell you what these are.)
  • Anyone who is pregnant.
  • Anyone who has been ill recently.

You should ask your provider about the best plan for your specific health situation.

Vaccine Effectiveness

The CDC (9) reports that pneumonia vaccines can’t prevent all cases, but overall they work well to protect against pneumococcal pneumonia.

  • At least one dose of pneumococcal conjugate (Prevnar 13) vaccine protects: (11)
    • at least 80% of babies.
    • 75% of adults 65 years or older.
    • 45% of adults 65 years or older.
  • One dose of pneumococcal polysaccharide (Pneumovax 23) vaccine protects between 50% and 85% of healthy adults. (12)

Vaccine Side Effects

Side effects to these vaccines are usually mild and go away in just a day or two. The most common side effects are redness, swelling, and tenderness in the area where the shot was given, fever, loss of appetite, irritability, tiredness, headache, and chills. Muscle aches may also occur with the Pneumovax 23 vaccine.

Where Can I Get My Vaccine?

Both forms of the pneumococcal vaccine are widely available at pharmacies, community health clinics, and health departments. They are sometimes available at workplaces, schools, and religious centers as well. (9)

Medicare and most insurance plans cover pneumonia vaccines at 100%.

Conclusion

While it’s true that pneumonia can be fatal in certain circumstances, it’s also true that there are some simple precautions you can take to significantly lower your risk of contracting pneumonia. Practice good handwashing, eat a healthy diet, get plenty of exercise, and get your flu and pneumonia vaccines.

Works Cited

(1) “Pneumonia.” American Lung Association. https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/pneumonia/. Accessed 6/20/2019.

(2) “6 Things You Need to Know About Pneumonia.” University of Michigan. https://healthblog.uofmhealth.org/wellness-prevention/6-things-you-need-to-know-about-pneumonia. 9/13/2016. Accessed 6/20/2019.

(3) “Pneumonia Outlook/Prognosis.” Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4471-pneumonia/outlook–prognosis. Updated 4/29/2016. Accessed 6/20/2019.

(4) “Pneumonia?” Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204. Accessed 6/20/2019.

(5) “Pneumonia: What is Pneumonia?” Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/pneumonia.  Accessed 6/20/2019.

(6) “Is it a Cold, Flu, or Pneumonia?” University of Northern Coloradohttps://www.unco.edu/student-health-center/health-topics/cold-flu-pneumonia.aspx. Updated 8/2/2018. Accessed 6/20/2019.

(7) “Pneumonia.” National Heart, Lung, and Blood Institute (NHLBI)https://www.nhlbi.nih.gov/health-topics/pneumonia. Updated 4/27/2018. Accessed 6/20/2019.

(8) “Pneumonia.” Michigan Medicine, University of Michigan. https://www.uofmhealth.org/health-library/hw63868. Updated 9/5/2018. Accessed 6/20/2019.

 

(9) “Pneumococcal Vaccination: What Everyone Should Know.” Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html. Updated 12/6/2017. Accessed 6/20/2019.

(10) “Adults: Protect Yourself with Pneumococcal Vaccines.” Centers for Disease Control and Prevention. https://www.cdc.gov/features/adult-pneumococcal/index.html. Updated 9/17/2018. Accessed 6/20/2019.

(11) Moore MR, Link-Gelles R, Schaffner W, et al. Effectiveness of 13-valent pneumococcal conjugate vaccine for prevention of invasive pneumococcal disease in children in the USA: A matched case-control studyLancet Respir Med. 2016;4(5):399–406.

(12) Bonten MJ, Huijts SM, Bolkenbaas M, et al. Polysaccharide conjugate vaccine against pneumococcal pneumonia in adultsN Engl J Med. 2015;372(12):1114–25.