Pneumonia

What is pneumonia?

Pneumonia is an infection in one or both of the lungs. It causes the air sacs of the lungs to fill up with fluid or pus. It can range from mild to severe, depending on the type of germ causing the infection, your age, and your overall health.

What causes pneumonia?

Bacterial, viral, and fungal infections can cause pneumonia.

Bacteria are the most common cause. Bacterial pneumonia can occur on its own. It can also develop after you've had certain viral infections such as a cold or the flu. Several different types of bacteria can cause pneumonia, including:

• Streptococcus pneumoniae
• Legionella pneumophila; this pneumonia is often called Legionnaires' disease
• Mycoplasma pneumoniae
• Chlamydia pneumoniae
• Haemophilus influenzae

Viruses that infect the respiratory tract may cause pneumonia. Viral pneumonia is often mild and goes away on its own within a few weeks. But sometimes it is serious enough that you need to get treatment in a hospital. If you have viral pneumonia, you are at risk of also getting bacterial pneumonia. The different viruses that can cause pneumonia include:

• Respiratory syncytial virus (RSV)
• Some common cold and flu viruses
• SARS-CoV-2, the virus that causes COVID-19

Fungal pneumonia is more common in people who have chronic health problems or weakened immune systems. Some of the types include:

• Pneumocystis pneumonia (PCP)
• Coccidioidomycosis, which causes valley fever
• Histoplasmosis
• Cryptococcus

Who is at risk for pneumonia?

Anyone can get pneumonia, but certain factors can increase your risk:

• Age; the risk is higher for children who are age 2 and under and adults age 65 and older
• Exposure to certain chemicals, pollutants, or toxic fumes
• Lifestyle habits, such as smoking, heavy alcohol use, and malnourishment
• Being in a hospital, especially if you are in the ICU. Being sedated and/or on a ventilator raises the risk even more.
• Having a lung disease
• Having a weakened immune system
• Have trouble coughing or swallowing, from a stroke or other condition
• Recently being sick with a cold or the flu

What are the symptoms of pneumonia?

The symptoms of pneumonia can range from mild to severe and include:

• Fever
• Chills
• Cough, usually with phlegm (a slimy substance from deep in your lungs)
• Shortness of breath
• Chest pain when you breathe or cough
• Nausea and/or vomiting
• Diarrhea

The symptoms can vary for different groups. Newborns and infants may not show any signs of the infection. Others may vomit and have a fever and cough. They might seem sick, with no energy, or be restless.

Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. Older adults who have pneumonia sometimes have sudden changes in mental awareness.

What other problems can pneumonia cause?

Sometimes pneumonia can cause serious complications such as:

• Bacteremia, which happens when the bacteria move into the bloodstream. It is serious and can lead to septic shock.
• Lung abscesses, which are collections of pus in cavities of the lungs
• Pleural disorders, which are conditions that affect the pleura. The pleura is the tissue that covers the outside of the lungs and lines the inside of your chest cavity.
• Kidney failure
• Respiratory failure

How is pneumonia diagnosed?

Sometimes pneumonia can be hard to diagnose. This is because it can cause some of the same symptoms as a cold or the flu. It may take time for you to realize that you have a more serious condition.

Your health care provider may use many tools to make a diagnosis:

• A medical history, which includes asking about your symptoms
• A physical exam, including listening to your lungs with a stethoscope
• Various tests, such as
  • A chest x-ray
  • Blood tests such as a complete blood count (CBC) to see if your immune system is actively fighting an infection
  • A Blood culture to find out whether you have a bacterial infection that has spread to your bloodstream

If you are in the hospital, have serious symptoms, are older, or have other health problems, you may also have more tests, such as:

• Sputum test, which checks for bacteria in a sample of your sputum (spit) or phlegm (slimy substance from deep in your lungs).
• Chest CT scan to see how much of your lungs is affected. It may also show if you have complications such as lung abscesses or pleural effusions.
• Pleural fluid culture, which checks for bacteria in a fluid sample that was taken from the pleural space
• Pulse oximetry or blood oxygen level test, to check how much oxygen is in your blood
• Bronchoscopy, a procedure used to look inside your lungs' airways

What are the treatments for pneumonia?

Treatment for pneumonia depends on the type of pneumonia, which germ is causing it, and how severe it is:

• Antibiotics treat bacterial pneumonia and some types of fungal pneumonia. They do not work for viral pneumonia.
• In some cases, your provider may prescribe antiviral medicines for viral pneumonia
• Antifungal medicines treat other types of fungal pneumonia

You may need to be treated in a hospital if your symptoms are severe or if you are at risk for complications. While there, you may get additional treatments. For example, if your blood oxygen level is low, you may receive oxygen therapy.

It may take time to recover from pneumonia. Some people feel better within a week. For other people, it can take a month or more.

Can pneumonia be prevented?

Vaccines can help prevent pneumonia caused by pneumococcal bacteria or the flu virus. Having good hygiene, not smoking, and having a healthy lifestyle may also help prevent pneumonia.

NIH: National Heart, Lung, and Blood Institute

Pneumocystis Infections

What is Pneumocystis jirovecii?

Pneumocystis jirovecii is a fungus that is common throughout the world. Many people have been exposed to it as children. Some people have the fungus in their lungs. If you are healthy, it usually will not make you sick. But it can make you sick if you have a weakened immune system, for example if you:

• Have HIV
• Have an autoimmune disease
• Have cancer
• Have a chronic (long-lasting) lung disease
• Had an organ or bone marrow transplant
• Take medicines which weaken your immune system, such as chemotherapy and steroids

How does Pneumocystis jirovecii spread?

Pneumocystis jirovecii can spread from person to person through the air. You can spread it to others even if it isn't making you sick.

What is pneumocystis pneumonia (PCP)?

The most common type of infection that Pneumocystis jirovecii causes is pneumocystis pneumonia (PCP). Pneumonia is an infection in one or both of the lungs. It causes the air sacs of the lungs to fill up with fluid or pus.

What are the symptoms of pneumocystis pneumonia (PCP)?

The symptoms of PCP can develop over several days or weeks. They may include:

• Fever
• Cough
• Trouble breathing
• Chest pain
• Chills
• Fatigue

Contact your healthcare provider if you have symptoms that you think are related to PCP. Since PCP can be life-threatening, it's important to get early treatment.

How is pneumocystis pneumonia (PCP) diagnosed?

To find out if you have PCP, your provider will take a sample of fluid or tissue from your lungs. You may cough up the sample (called sputum), have fluid collected during a bronchoalveolar lavage, or have tissue taken with a biopsy. They will send the sample to the lab to check for Pneumocystis.

What are the treatments for pneumocystis pneumonia (PCP)?

The treatment for PCP is with antibiotics, either by mouth or intravenously (by IV). You need to take them for about 3 weeks. If you have a severe case of PCP, you might need treatment in the hospital.

Can pneumocystis pneumonia (PCP) be prevented?

There is no vaccine to prevent PCP. Some people who are at high risk of getting PCP may need to take antibiotics to prevent it.

Centers for Disease Control and Prevention

Legionnaires' Disease

What is Legionnaires' Disease?

Legionnaires' disease is a serious type of pneumonia caused by Legionella bacteria. The disease got its name when a group of people at an American Legion convention became ill with this type of pneumonia.

Legionella is found naturally in freshwater, such as lakes and rivers. It can also be found in soil. But people usually only get sick from it when if it grows and spreads in man-made water systems. These systems can include hot tubs, fountains, and the plumbing systems of large buildings, such as hotels or nursing homes.

Legionella can also cause Pontiac fever. This is a milder, flu-like illness that doesn't infect your lungs.

What causes Legionnaires' disease?

You usually can't get infected by drinking water that contains the bacteria unless you aspirate it (accidentally breathe the water into your lungs). The bacteria don't spread from person to person. Disease outbreaks happen when many people are exposed to the same water source that contains the bacteria.

Who is more likely to develop Legionnaires' disease?

Most healthy people who come in contact with the bacteria do not become sick. You are more likely to develop an infection if you:

• Are over the age of 50
• Are a current or former smoker
• Have a chronic (long-lasting) disease such as diabetes or kidney failure
• Have a chronic lung disease such as COPD or emphysema
• Have a weakened immune system due to a disease such as HIV or cancer or are taking medicines that suppress your immune system
• Live in a long-term care facility
• Have recently stayed in a hospital or had surgery requiring anesthesia

What are the symptoms of Legionnaires' disease?

The symptoms usually show up 2 to 14 days after you were exposed to Legionella bacteria. Most of the symptoms are similar to those of other types of pneumonia. But Legionnaires' disease may also cause gastrointestinal symptoms and mental changes.

The symptoms of Legionnaires' disease may include:

• Cough
• High fever
• Chills
• Headache
• Chest pain
• Shortness of breath
• Fatigue
• Nausea and vomiting
• Diarrhea
• Confusion

What other problems can Legionnaires' disease cause?

Legionnaires' disease can cause life-threatening complications such as respiratory failure, kidney failure, and sepsis.

About 1 out of every 10 people who get sick with Legionnaires' disease will die from complications of the illness.

How is Legionnaires' disease diagnosed?

To find out if you have Legionnaires' disease, your health care provider will probably order a chest x-ray to see if you have pneumonia. If you do have it, lab tests such as a urine or sputum test can check for the Legionella bacteria. Your provider may also order a blood test to see if you have been exposed to the bacteria.

What are the treatments for Legionnaires' disease?

If you have Legionnaires' disease, you will likely need care in a hospital. The treatment is with antibiotics. Most people will recover, especially if they were healthy when they got the disease. Getting treatment early can increase the chances of getting better.

Can Legionnaires' disease be prevented?

You can lower your risk of getting Legionnaires' disease if you:

• Clean all your water-related devices regularly. This could include portable humidifiers, water heaters, air conditioners, and nasal rinses.
• If you haven't used your faucets and showerheads for a week or more, flush them by letting the hot and cold faucets run for at least two minutes before use.
• Avoid exposure to water sources such as decorative foundations or hot tubs if you don't know how well they are maintained.
• Use windshield cleaner in your wiper fluid tank in your car instead of water.
• Ask about how well your buildings' water systems are maintained.

Centers for Disease Control and Prevention

HIV and Infections

Having HIV/AIDS weakens your body's immune system. It destroys the white blood cells that fight infection. This puts you at risk for opportunistic infections (OIs). OIs are serious infections that take advantage of your weak immune system. These infections are less common and less severe in healthy people.

There are many types of OIs:

• Bacterial infections, including tuberculosis and a serious related disease, Mycobacterium avium complex (MAC)
• Viral infections, such as cytomegalovirus (CMV) and hepatitis C
• Fungal infections, like yeast infections, cryptococcal meningitis, pneumocystis carinii pneumonia (PCP) and histoplasmosis
• Parasitic infections, such as crypto (cryptosporidiosis) and toxo (toxoplasmosis)

Having HIV/AIDS can make infections harder to treat. People with HIV/AIDS are also more likely to have complications from common illnesses such as the flu.

You can help prevent infections by taking your HIV/AIDS medicines. Other things that can help include practicing safe sex, washing your hands well and often, and cooking your food thoroughly.

Smoking

What are the health effects of smoking?

There's no way around it; smoking is bad for your health. It harms nearly every organ of the body, even some that you would not expect. Cigarette smoking causes many cancers and other health problems. It is also the cause of nearly one in five deaths in the United States.

Some of the many health problems that smoking can cause include:

• Cancers. Smoking is the most common cause of lung and oral cancers. But it can also cause cancer in many other parts of your body, such as in your larynx (voice box), esophagus, throat, bladder, kidney, liver, stomach, pancreas, colon and rectum, and cervix. It can also cause acute myeloid leukemia (AML).
• Lung diseases. Smoking is the most common cause of COPD. It can also worsen asthma and raise your risk of pneumonia.
• Cardiovascular diseases. Smoking can damage your blood vessels and make them thicken and grow narrower. This makes your heart beat faster and raises your blood pressure. Smoking also increases your risk of blood clots and stroke.
• Vision problems. Smoking can raise your risk of cataracts and cause macular degeneration (AMD).

People who smoke while pregnant have a greater chance of certain pregnancy problems. Their babies are also at higher risk of dying of sudden infant death syndrome (SIDS).

Smoking also causes addiction to nicotine, a stimulant drug that is in tobacco. Nicotine addiction makes it much harder for people to quit smoking.

What are the health risks of secondhand smoke?

Your smoke is also bad for other people. If they breathe in your secondhand smoke, they can get many of the same problems as smokers do. These problems can include heart disease and lung cancer. Children exposed to secondhand smoke have a higher risk of ear infections, colds, pneumonia, bronchitis, and more severe asthma. People who breathe secondhand smoke while pregnant are more likely to have preterm labor and babies with low birth weight.

Are other forms of tobacco also dangerous?

Besides cigarettes, there are several other forms of tobacco. Some people smoke tobacco in cigars and water pipes (hookahs). These forms of tobacco also contain harmful chemicals and nicotine. Some cigars contain as much tobacco as an entire pack of cigarettes.

E-cigarettes often look like cigarettes, but they work differently. They are battery-operated smoking devices. Using an e-cigarette is called vaping. Researchers still have a lot to learn about the health effects of using e-cigarettes. We do know that they contain nicotine, which is highly addictive and is a health danger for pregnant people, their developing babies, children, and teens. And e-cigarettes also expose non-smokers to secondhand aerosols (rather than secondhand smoke), which contain harmful chemicals.

Smokeless tobacco, such as chewing tobacco and snuff, is also bad for your health. Smokeless tobacco can cause certain cancers, including oral cancer. It also increases your risk of getting heart disease, gum disease, and oral lesions.

Why should I quit?

Remember, there is no safe level of tobacco use. Smoking even just one cigarette per day over a lifetime can cause smoking-related cancers and premature death. Quitting smoking can reduce your risk of health problems and add years to your life. The earlier you quit, the greater the benefit. Some immediate benefits of quitting include:

• Lower heart rate and blood pressure
• Less carbon monoxide in the blood (carbon monoxide reduces the blood's ability to carry oxygen)
• Better circulation
• Less coughing and wheezing

Quitting smoking can be challenging, but it is so important for your health. Contact your health care provider if you need help quitting.