All about Pneumonia – Viral, Bacterial, Atypical/Walking. Am I at Risk?

shutterstock_112862059I have many patients who come to the urgent care this time of year due to cough and fever and they are worried about the possibility of pneumonia.  This is a valid concern, as pneumonia is a common illness and can lead to grave disability and even death.  Here are some questions they I often get asked and some information.  This is for informational use – please see a physician if you are worried about the possibility of pneumonia.

What is pneumonia?  Community acquired pneumonia as an illness with symptoms that might be present such as cough (sometimes with mucus), fever, shaking chills, shortness of breath (may only occur when climbing stairs), and occasionally with confusion (especially in the elderly), excess sweating and clammy skin, headache, loss of appetite, low energy, and sharp or stabbing chest pain that gets worse when you breath deeply or cough.

When I listen your lungs, I am listening for “crackles” which sound like scratchy sounds that sound similar to that produced by rubbing strands of hair together close to your ear. Sometimes I will order a blood test called a CBC to check white blood cell count, chest x-ray, CT  scan of the chest, and even a culture of the mucus you cough up to determine if there are bacteria present.

What causes pneumonia?  Pneumonia can be caused by viruses or bacteria.  The most common pneumonia-causing germ in adults and young kids is Streptococcus pneumonia (pneumococcus).  Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as Legionella pneumophila, Mycoplasma pneumonia and Chlamydophila pneumonia. Pneumocystis jiroveci pneumonia is sometimes seen in people whose immune system is not working well.

Viruses are also a common cause of pneumonia, especially in infants and young children.

What factors/conditions increase my chance of getting pneumonia?   Cerebral palsy, chronic lung disease (such as COPD, bronchiectasis, cystic fibrosis), cigarette smoking, difficulty swallowing (due to stroke, dementia, Parkinson’s disease, or other neurological condition), immune system problem, impaired consciousness, living in a nursing facility (such as a nursing home), other serious illnesses (such as heart disease, liver cirrhosis, or diabetes), recent surgery or trauma or recent cold, laryngitis or flu.

How do you decide whether I need antibiotics and which antibiotic to use?  The choice of antibiotic is often determined by multiple factors including the patients age (certain germs are found more commonly in certain age groups), findings on chest x-ray and symptoms of the patient.  Chest x-ray in typical bacterial pneumonia (ie. pneumococcus or Streptococcus pneumonia usually confirms lobar involvement.  In contrast, in atypical pneumonia, chest x-ray shows more diffuse involvement (source – http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2795279/).  If the pneumonia is caused by a virus, the antibiotic will obviously not affect the viral lung infection.

What is pneumoncoccus (Streptococcus pneumonia)?  In countries like the United States, pneumococcus remains the most common and important disease-causing organism in infants. Although exact numbers are difficult to obtain, it is estimated that pneumococcus infection is responsible for more than one million of the 2.6 million annual deaths due to acute respiratory infection in children younger than 5 years. Children younger than 5 years, particularly aged 2 years or younger are at an increased risk of disease. In addition, absence of breastfeeding, exposure to cigarette smoke, daycare attendance, and lack of immunization with the pneumococcal conjugate vaccine further increase the risk of disease.

Adults older than 55-65 years are the next most commonly affected age group worldwide.  As in the United States, the most common cause of Community Acquired Pneumonia (CAP) in Europe is S pneumoniae infection, affecting approximately 100 per 100,000 adults each year. Pneumococcus is usually treated with a medication such as penicillin/amoxicillin.

What is atypical pneumonia (walking pneumonia)?  Atypical pneumonia refers to pneumonia caused by certain bacteria including Legionella, Mycoplasma and Chlamydophila.  Atypical pneumonia is most common in young adults and children.  Pneumonia due to mycoplasma and chlamydophila bacteria is usually mild.  The antibiotics used to treat atypical pneumonia include:  Azithromycin, Clarithromycin, Erythromycin, Fluroquinolones and Tetracyclines.

What are the most common bacteria causing pneumonia in children?  That depends on the age of the child.

1)    Newborns (0 – 30 days):  Group B Streptococcus, Listeria, E-Coli, Klebsiella pneumonia

2)    Young infant (1 – 3 months):  S. pneumonia, S. aureus, and H. influenza

3)    Infants, toddlers and preschool-aged children:  Viruses remain the most common cause for approximately 90% of all pneumonias.  RSV(Respiratory Syncytial Virus) is the most common viral pathogen.

4)    School-aged children and young adolescents:  Mycoplasma pneumonia is the most frequent cause among older children.

5)    Older adolescents:  Mycoplasma pneumonia is the most common cause of community-acquired pneumonia during the teenage and young adult years.

6)    Immunocompromised children: Children with cystic fibrosis are especially prone to develop infections with S. aureus, P. aeruginosa, B. cepacia and other multi-drug resistant organisms.

How is pneumonia spread?  Most of the time the infection is carried in the upper respiratory tract of the person infected.  It is spread by airborne or direct exposure to respiratory droplets from the infected person.  Illness among casual contacts is infrequent.

How soon after exposure do symptoms occur?  The incubation period may vary, but is generally 1 to 3 days.

Is there a vaccine to help prevent infections?  Yes, there are two different vaccines.  One primarily for adults and one for children.  The vaccine for adults had been available for many years and is called Pneumovax.  The pediatric vaccine is called Prevnar and is only for use in children under 5 years of age.

Who should receive the  adult vaccine?  All adults 65 years of age or older.  All persons 2 years of age or older with:  chronic illness such as diabetes, heart or lung diseases, anatomic or functional asplenia, immunocompromised conditions (due to disease, cancer, chemotherapy or steroids), HIV infected individuals.

Who should receive the childhood vaccine?  All children less than 24 months of age.  All children aged 2 to 5-6 yrs with high risk medical conditions.

This document is for informational purposes only, and should not be considered medical advice for any individual patient.  If you have questions please contact your medical provider.

 

I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, DO

Blog: https://doctorrennie.wordpress.com

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