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Denver children's natural health - pediatric pneumonia
Pneumonia is a respiratory condition in which there is inflammation of the lung.
Community-acquired pneumonia refers to pneumonia in people who have not recently been in the hospital or another health care facility (nursing home, rehabilitation facility).
Pneumonia is a common illness that affects millions of people each year in the United States. Germs called bacteria, viruses, and fungi may cause pneumonia.
Bacteria and viruses living in your nose, sinuses, or mouth may spread to your lungs.
You may breathe some of these germs directly into your lungs.
You breathe in (inhale) food, liquids, vomit, or secretions from the mouth into your lungs (aspiration
Pneumonia caused by bacteria tends to be the most serious. In adults, bacteria are the most common cause of pneumonia.
The most common pneumonia-causing germ in adults is Streptococcus pneumoniae
Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as Legionella
, Mycoplasma pneumoniae
, and Chlamydophila pneumoniae
pneumonia is sometimes seen in people whose immune system is impaired
(due to AIDS or certain medications that suppress the immune system).
, Moraxella catarrhalis
, Streptococcus pyogenes
, Neisseria meningitidis
, or Haemophilus influenzae
are other bacteria that can cause pneumonia.
Tuberculosis can cause pneumonia in some people, especially those with a weak immune system.
Viruses are also a common cause of pneumonia, especially in infants and young children.
Risk factors (conditions that increase your chances of getting pneumonia) include:
Recent viral respiratory infection (common cold, laryngitis, influenza)
Difficulty swallowing (due to stroke, dementia, Parkinson's disease, or other neurological conditions)
Chronic lung disease (COPD, bronchiectasis, cystic fibrosis)
illnesses, such as heart disease, liver cirrhosis, or diabetes mellitus
Impaired consciousness (loss of brain function due to dementia, stroke, or other neurologic
Immune system problem (See also: Pneumonia in immunocompromised host)
The most common symptoms of pneumonia are:
Cough (with some pneumonias you may cough up greenish or yellow mucus, or even bloody mucus)
Shortness of breath (may only occur when you climb stairs)
Sharp or stabbing chest pain that gets worse when you breathe deeply or cough
Loss of appetite, low energy, and fatigue
Confusion, especially in older people
Exams and Tests
If you have pneumonia, you may be working hard to breathe, or breathing fast.
Crackles are heard when listening to your chest with a stethoscope. Other abnormal breathing sounds may also be heard through the stethoscope or via percussion (tapping on your chest wall).
The health care provider will likely order a chest x-ray if pneumonia is suspected.
Some patients may need other tests, including:
Arterial blood gases to see if enough oxygen is getting into your blood from the lungs
Gram's stain and culture of your sputum to look for the organism causing your symptoms
Pleural fluid culture if there is fluid in the space surrounding the lungs
Your doctor must first decide whether you need to be in the hospital. If you are treated in the hospital, you will receive fluids and antibiotics in your veins, oxygen therapy, and possibly breathing treatments. It is very important that your antibiotics are started very soon after you are admitted.
You are more likely to be admitted to the hospital if you:
Have another serious medical problem
Are unable to care for yourself at home, or are unable to eat or drink
Have been taking antibiotics at home and are not getting better
However, many people can be treated at home. If bacteria are causing the pneumonia, the doctor will try to cure the infection with antibiotics. It may be hard for your health care provider to know whether you have a viral or bacterial pneumonia, so you may receive antibiotics.
Patients with mild pneumonia who are otherwise healthy are sometimes treated with oral macrolide antibiotics (azithromycin, clarithromycin, or erythromycin).
Patients with other serious illnesses, such as heart disease, chronic obstructive pulmonary disease, or emphysema, kidney disease, or diabetes are often given one of the following:
Fluoroquinolone (levofloxacin (Levaquin), sparfloxacin (Zagam), gemifloxacin (Factive), or
High-dose amoxicillin or amoxicillin-clavulanate, plus a macrolide antibiotic (azithromycin,
Cephalosporin antibiotics (for example, cefuroxime or cefpodoxime) plus a macrolide (azithromycin,
If the cause is a virus, typical antibiotics will NOT be effective. Sometimes, however, your doctor may use antiviral medication.
Drink plenty of fluids to help loosen secretions and bring up phlegm.
Get lots of rest. Have someone else do household chores.
Do not take cough medicines without first talking to your doctor. Cough medicines may make it
harder for your body to cough up the extra sputum.
Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or
naproxen), or acetaminophen. DO NOT give aspirin to children.
With treatment, most patients will improve within 2 weeks. Elderly or debilitated patients may need longer treatment.
Those who may be more likely to have complicated pneumonia include:
People whose immune system does not work well
People with other, serious medical problems such as diabetes or cirrhosis of the liver
Your doctor may want to make sure your chest x-ray becomes normal again after you take a course of antibiotics. However, it may take many weeks for your x-ray to clear up.
Respiratory failure, which requires a breathing machine or ventilator
Empyema or lung abscesses. These are infrequent, but serious, complications of pneumonia. They
occur when pockets of pus form inside or around the lung. These may sometimes need to be drained with surgery.
Sepsis, a condition in which there is uncontrolled swelling (inflammation) in the body, which may lead
Acute respiratory distress syndrome (ARDS), a severe form of respiratory failure
When to Contact a Medical Professional
Shortness of breath, shaking chills, or persistent fevers
A cough that brings up bloody or rust-colored mucus
Chest pain that worsens when you cough or inhale
Night sweats or unexplained weight loss
Signs of pneumonia and weak immune system, as with HIV or chemotherapy
Infants with pneumonia may not have a cough. Call your doctor if your infant makes grunting noises or the area below the rib cage is retracting while breathing.
Wash your hands frequently, especially after blowing your nose, going to the bathroom, diapering, and before eating or preparing foods.
Don't smoke. Tobacco damages your lung's ability to ward off infection.
Vaccines may help prevent pneumonia in children, the elderly, and people with diabetes, asthma, emphysema, HIV, cancer, or other chronic conditions:
Pneumococcal vaccine (Pneumovax, Prevnar) lowers your chances of getting pneumonia from
Flu vaccine prevents pneumonia and other problems caused by the influenza virus. It must be given
yearly to protect against new virus strains.
Hib vaccine prevents pneumonia in children from Haemophilus influenzae
A drug called Synagis (palivizumab) is given to some children younger than 24 months to prevent
pneumonia caused by respiratory syncytial virus.
If you have cancer or HIV, talk to your doctor about additional ways to prevent pneumonia and other infections.
Bronchopneumonia; Community-acquired pneumonia
Higgins K, Singer M, Valappil T, Nambiar S, Lin D, Cox E. Overview of recent studies of community-acquired pneumonia. Clin Infect Dis
Centers for Disease Control and Prevention. Recommended Immunization Schedule for Ages 0 - 6 Years. United States, 2009.
Centers for Disease Control and Prevention. Recommended Immunization Schedule for Ages 7 - 18 Years. United States, 2009.
Centers for Disease Control and Prevention. Recommended Immunization Schedule for Adults. United States, 2009.
Li JZ, Winston LG, Moore DH, Bent S. Efficacy of short-course antibiotic regimens for community-acquired pneumonia: a meta-analysis. Am J Med
Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis
. 2007 Mar 1;44 Suppl 2:S27-72.
Update Date: 6/9/2009
Updated by: David A. Kaufman, MD, Section Chief, Pulmonary, Critical Care & Sleep Medicine, Bridgeport Hospital-Yale New Haven Health System, and Assistant Clinical Professor, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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