PNEUMONIA

Pneumonia is an inflammation of the lungs caused by infection. Bacteria, viruses, fungi or parasites can cause pneumonia. Pneumonia is a particular concern if you're older than 65 or have a chronic illness or weak immune system. It can also occur in young, healthy people.

Pneumonia can range in seriousness from mild to life-threatening. Pneumonia often is a complication of another condition, such as the flu. Antibiotics can treat most common forms of bacterial pneumonias, but antibiotic-resistant strains are a growing problem. The best approach is to try to prevent infection.

SYMPTOMS

Pneumonia often mimics the flu, beginning with a cough and a fever, so you may not realize you have a more serious condition. Symptoms can vary depending on your age and general health.

The signs and symptoms of pneumonia may include:

• Fever
• Lower-than-normal body temperature in older people
• Cough
• Shortness of breath
• Sweating
• Shaking chills
• Chest pain that fluctuates with breathing (pleurisy)
• Headache
• Muscle pain
• Fatigue

Chest x ray

DIAGNOSIS

• Physical exam. During the exam, your doctor listens to your lungs with a stethoscope to check for abnormal bubbling or crackling sounds (rales) and for rumblings (rhonchi) that signal the presence of thick liquid.
• Chest X-rays. X-rays can confirm the presence of pneumonia and determine the extent and location of the infection.
• Blood and mucus tests. You may have a blood test to measure your white cell count and look for the presence of viruses, bacteria or other organisms. Your doctor also may examine a sample of your mucus or your blood to help identify the particular microorganism that's causing your illness.

TREATMENT

Typically, oral antibiotics, rest, simple analgesics, and fluids suffice for complete resolution.However, those with other medical conditions, the elderly, or those with significant trouble breathing may require more advanced care. If the symptoms worsen, the pneumonia does not improve with home treatment, or complications occur, hospitalization may be required.Worldwide, approximately 7–13% of cases in children result in hospitalization.while in the developed world between 22 and 42% of adults with community-acquired pneumonia are admitted.The CURB-65 score is useful for determining the need for admission in adults.If the score is 0 or 1 people can typically be managed at home, if it is 2 a short hospital stay or close follow-up is needed, if it is 3–5 hospitalization is recommended. In children those with respiratory distress or oxygen saturations of less than 90% should be hospitalized.The utility of chest physiotherapy in pneumonia has not yet been determined.Non-invasive ventilation may be beneficial in those admitted to the intensive care unit. Over-the-counter cough medicine has not been found to be effective nor has the use of zinc in children.There is insufficient evidence for mucolytics.

Bacterial

Antibiotics improve outcomes in those with bacterial pneumonia.Antibiotic choice depends initially on the characteristics of the person affected, such as age, underlying health, and the location the infection was acquired. In the UK, empiric treatment with amoxicillin is recommended as the first line for community-acquired pneumonia, with doxycycline or clarithromycin as alternatives.In North America, where the "atypical" forms of community-acquired pneumonia are more common, macrolides (such as azithromycin or erythromycin), and doxycycline have displaced amoxicillin as first-line outpatient treatment in adults.In children with mild or moderate symptoms amoxicillin remains the first line. The use of fluoroquinolones in uncomplicated cases is discouraged due to concerns about side effects and generating resistance in light of there being no greater clinical benefit.The duration of treatment has traditionally been seven to ten days, but increasing evidence suggests that shorter courses (three to five days) are similarly effective.Recommended for hospital-acquired pneumonia include third- and fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, and vancomycin.These antibiotics are often given intravenously and used in combination.In those treated in hospital more than 90% improve with the initial antibiotics.

Viral

Neuraminidase inhibitors may be used to treat viral pneumonia caused by influenza viruses (influenza A and influenza B).No specific antiviral medications are recommended for other types of community acquired viral pneumonias including SARS coronavirus, adenovirus, hantavirus, and parainfluenza virus.Influenza A may be treated with rimantadine or amantadine, while influenza A or B may be treated with oseltamivir, zanamivir or peramivir.These are of most benefit if they are started within 48 hours of the onset of symptoms.Many strains of H5N1 influenza A, also known as avian influenza or "bird flu," have shown resistance to rimantadine and amantadine.The use of antibiotics in viral pneumonia is recommended by some experts as it is impossible to rule out a complicating bacterial infection.The British Thoracic Society recommends that antibiotics be withheld in those with mild disease. The use of corticosteroids is controversial.

Aspiration

In general, aspiration pneumonitis is treated conservatively with antibiotics indicated only for aspiration pneumonia.The choice of antibiotic will depend on several factors, including the suspected causative organism and whether pneumonia was acquired in the community or developed in a hospital setting. Common options include clindamycin, a combination of a beta-lactam antibiotic and metronidazole, or an aminoglycoside.Corticosteroids are sometimes used in aspiration pneumonia, but there is limited evidence to support their effectiveness.