The cold shower hits her back and a stroke of electricity passes through her body, she was sure that nothing bad could happen, but then suddenly as soon as she came out, she found the window open. All she could think about now was the winter breeze which was accompanied by pneumonia. If you have ever had pneumonia or come into contact with someone who does, you may have asked the question “is pneumonia contagious?”. That’s how a layman associates pneumonia, little does he know about the disease, but we are going to change that perception or you. Pneumonia is an inflammatory lung disease which is characterized by swelling of lung tissues in one or both lungs. The air sacs of the lungs are commonly affected by pneumonia which commonly is a consequence of infection.
These infections, resulting into pneumonia diagnosis are caused by bacteria, viruses or fungi or breathing foreign object (aspiration pneumonia) but according to the American Lung Association viruses are the most common cause of pneumonia in the US, responsible for more than one-third of the total cases.
Is Pneumonia Contagious?
The question “is pneumonia contagious?” is apt particularly when we already know that respiratory infections are mostly contagious. Yes, pneumonia is contagious which is a primary reason for many people getting infected by the disease.
However, not all the variants of the disease are contagious in nature. Amongst the contagious strains for pneumonia, some strains qualify as strongly contagious while others are either mildly contagious or not contagious. But, to discuss the spread of pneumonia further, it is important to be sure if what you suffer from is pneumonia or not.
Is It Pneumonia, Cold Or Influenza?
Comparing to the ability to spread from one person to another, pneumonia is less contagious than common cold or influenza. However, the contagious factor of pneumonia varies from one form to the other, attributing it to the causative agents. Out of the four probable causes of pneumonia, the bacterial and viral pneumonia are contagious in nature.
The streptococcus pneumoniae bacterium is contagious in nature but the development of resistance and immunity against this bacterium usually helps people fight the bacteria before the spread of the infection.
Bacterial pneumonia, viral pneumonia, mycoplasma pneumonia, MRSA (methicillin resistant staphylococcus aureus pneumonia), are all contagious because these pathogens are infectious in nature. Out of these types, mycoplasma pneumonia is a milder form of pneumonia.
- Severity of contagious pneumonia depends on the causative agent: Bacterial and viral pneumonia are contagious in nature. Mycoplasma pneumonia is a milder form of the pneumonia. Community acquired, hospital acquired pneumonia and aspiration pneumonia are contagious, but not as much as flu. On the contrary, pneumonia which is caused by the chemical fumes or other foreign agents; is not contagious.
As we talk about how the ability to be contagious of pneumonia is compared with that of common cold and influenza, it is also worth noting that the symptoms of these conditions may sometimes resemble. As many people have a tendency to confuse, the disease they have; it is important to know the primary symptoms of pneumonia, common cold and influenza.
Pneumonia symptoms can mimic common cold and flu, and the symptom manifestation varies from one case to another owing to the nature of causative agent. Typically, a person who suffers from pneumonia experiences laborious breathing which is characterized by tachypnea (abnormally rapid breathing) and dyspnea (difficult breathing). Similarly, the upper trunk is felt to be pushed back and forth as the person inhales and exhales.
In additional to this, the bacterial pneumonia is found to be accompanied by more symptoms which include chest pain, shaking chills, sweating, high degree fever, headache and a productive cough (cough with yellow or green sputum secretion).
On the other hand, viral pneumonia is characterized by fever, muscle pain, headache, fatigue and non-productive cough (dry cough without mucus secretion).
Thirdly, mycoplasma pneumonia, which is popularly known as walking pneumonia, is a mild form of pneumonia. Often, the person who suffers from mycoplasma pneumonia doesn’t even know that they suffer from this disease and it doesn’t require hospitalization.
- Pneumonia symptoms can mimic common cold and flu; and the symptom manifestation varies from one case to another owing to the nature of causative agent.
Exhibits its symptoms depending on the causative viral agent. These symptoms begin to manifest themselves two-three days after contracting the virus. Initiated by a sore throat, the irritability of the throat increases progressively and becomes painful. Usually, the sore throat mitigates after two to three days.
This is followed by thin mucus nasal discharge, which after a few days becomes thicker. Following this, the person who had caught cold experiences nasal blockage, which takes a couple of days to improve and at this point, cough is triggered which is productive in the beginning.
The cough becomes dry in next few days and depending on the causative virus of the cold, other symptoms like sneezing, headache, lacrimation (tearing eyes and flow of tears) and throat discomfort may also be experience.
- Common cold begins with a sore throat which progressively increases. Thin mucus nasal discharge turns thick in a few days, resulting in nasal blockage, followed by progressive cough which turns into dry cough in few days.
There are likely to overlap with the symptoms of common cold. But, to be better aware of your symptoms, subtle changes in the symptoms are required to be recorded by the patient. Influenza is marked by sudden onset which is soon followed by teary eyes and flowy nose.
Usually, this nasal discharge of influenza is watery and doesn’t become purulent (pus discharge) and thick, as it does in common cold. The person often experiences high degree fever which can be as high as 106o, unlike common cold.
Similarly, teary and red eyes, warm skin with blotchiness and patches of redness, are the symptoms of influenza but not commonly of common flu. The degree of discomfort, pain in the muscles and joints and feeling fatigued are also distinguishing factors between influenza and common cold, which are commonly characterized by influenza.
- Influenza is marked with teary eyes, runny nose, high degree fever, joint pain and muscle pain.
What Is The Incubation Period For Pneumonia Causing Pathogens?
- Incubation period can vary from one pathogen to the other, ranging from one day to a week.
This is the time, which a pathogen takes before symptom manifestation of the disease. The pathogen which has infected a person needs some time to multiple and replicate into a threshold number of cells before it can cause damage to the body.
The incubation period varies from one stain to another as the replication rate is different for all microorganisms. Apart from the replication rate of the microorganism involved, the age of the person who has contracted the infection and their state of health are also other determining factors for the incubation period of the pathogen.
For instance, if it is a small child with immature immunity or older adult with a weakened immunity, the body’s defense mechanism to fight out the pathogen is weak which leads to paced up multiplication of pathogenic cells in turn leading to early symptom manifestation.
The incubation period varies from day one to three over a stretch of a week, after which the symptoms at the beginning resemble that of common cold. However, as days pass, over the period of seven to 10 days, the pathogen strengthens, salient features of pneumonia begins to manifest themselves.
When Is Pneumonia Contagious?
- Depending on the pathogen, the period for which pneumonia stays contagious can range from one day to few weeks.
The answer to this question is a tricky one as the pathogen of pneumonia decides the degree and duration of infectious ability. Some are highly contagion, while others are not. Out of all the pathogens which are attributed to causing pneumonia, bacterial and viral pneumonias are said to be contagious in nature.
However, these strains differ in their contagion factor as well. Similarly, the approximate for a pathogen to become contagious also varies from one person to another and the time can range from one day to few weeks.
Before, we talk about all the pneumonia causing strains in detail, we need to understand, how the disease spreads from one person to another.
When Is Pneumonia Contagious? How Does The Pneumonia Pathogen Spread?
- It can spread from coming in contact with infected droplets, as the droplets are sneezed or coughed out. It can also spread from one lung to the other.
- In neonates, blood borne pneumonia is present as well.
Pneumonia causing pathogens are spread from one person to another, when the uninfected person comes in contact with the infected droplets expelled from the infected person, through coughing or sneezing. These droplets from the nasal secretions or mouth of the infected person contain the bacterial or viral strains of the disease and spread through air, as the contaminated air is inhaled by uninfected person.
These droplets can also travel through infected saliva and respiratory tract secretions like mucus. In additional to this, coming in contact with the infected person’s mouth also leads to the spread of pneumonia from one person to the other.
This spread can be termed as interpersonal transfer of pneumonia, which spreads from one individual to the other.
But, the spread of pneumonia can also take place at the cellular level of respiratory system. Once pneumonia develops in the lungs, it is likely to spread to the other lobes of the lung and upon aggravation; it may begin to spread to the uninfected lung.
In rare but severe cases, the pneumonia causing pathogens spread to other organs of the body and progressive damage to different organs can even lead to death, if it remains untreated.
Some pneumonia pathogens travel to the lung through aspiration which is also contagious in nature. This is the process when the food passes into the lungs instead of going into the digestive tract.
Furthermore, blood borne infection may also occur especially after birth in neonates. Moreover, inhalation of food or liquid, as occurs in the elderly or those with impaired gag reflex (stroke, Parkinson’s, cerebral palsy etc.) can also cause pneumonia (aspiration Pneumonia). Another type of pneumonia, caused by fungus, called the Pneumocystis carinii pneumonia (PCP) affects mainly the immunocompromised—like AIDS patients.
For How Long Does Pneumonia Stay Contagious?
- It can stay contagious up to 24- 48 hours after the first dose of antibiotics is taken and significantly reduced after this period.
- In viral pneumonia, it becomes less contagious as fever begins to drop.
The contagious nature of many pneumonia causing pathogens is alarming and it can pose a serious health threat. But thankfully so, the contagion potency of these strains begins to reduce significantly once diagnosis is made and proper medication is administered.
But, again the time for the pathogen to stay infectious depends upon the type of organism which is causing pneumonia.
The symptoms fever recession in viral pneumonia is an indication that the spread of pneumonia can be less. If we talk about bacterial pneumonia, its strength to infect others is reduced significantly when antibiotics are taken for 24 to 48 hours.
However, it does not mean that the pneumonia symptoms reduce simultaneously. The accompanied cough and fever may take several days to few weeks to completely end.
On the contrary, for viral pneumonia, the pathogenic strength to be contagious is greatly weakened as the primary symptom, that is fever begins to get better. This may take one to two days after the fever has fallen down to normal body temperature. The time, however, may vary if the pathogenic strains are different.
As mentioned above, for bacterial pneumonia, symptoms, it holds true for viral pneumonia as well. The symptoms can take weeks to completely normalize, however, the continuation of these symptoms do not mean that the infection is still contagious.
Types Of Pneumonia And Pathogens Involved
Pneumonia is caused by pathogens which include bacteria, viruses and fungi.
- Interestingly, most contagious pathogens cause milder cases of pneumonia, while weakly contagious pathogens lead to serious pneumonia cases.
Experts find that mycobacterium and mycoplasma organisms are highly contagious (but cause mild pneumonia), but other types, including pneumococcal pneumonia, require optimal conditions to spread to another person and are weakly contagious.
To understand the disease pathology better, given below are the pneumonia causing pathogen details
- Streptococcus pneumoniae and Haemophilus influenza are the most common causes of bacterial pneumonia in general population.
- Staphylococcus aureus is common cause of pneumonia in drug abusers, young children or adults with chronic health conditions.
As the name implies, it is caused by bacteria. These bacteria may infect one or both lungs; it may infect a small portion of the lung or spread across the lungs, entirely.
Once the bacteria enter the respiratory system, the pathogen causes inflammation of the air sacs.
As the bacteria invade the human system, the blood capillaries in the lungs become leaky and the protein-rich fluid enters the alveoli.The inflamed alveoli are filled with cellular debris, pus and other fluids. This leads towards reduced efficiency of oxygen-carbon dioxide exchange. As the patient becomes oxygen deprived, increased breathing rate is experienced as a result and breathlessness becomes a salient feature of the condition.
Simultaneously, the mucus production is intensified and the leaky capillaries lead towards mucus mixing with blood which further reduced the gas exchange in the air sacs of the lungs.
Bacterial pneumonia strains can be mild or serious. The severely affecting strains can lead towards death due to respiratory failure. The symptoms and condition deterioration depends on various factors, including the bacterial strain involved, the immunity strength of the patient and how readily the condition is diagnosed and treated.
Experts have categorized bacterial pneumonia into two categories, which are community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP).
CAP is caused by a bacterial pathogen which is contracted by bacterial exposure outside a healthcare facility. CAP contributes towards the most common cases of bacterial pneumonia. Although, many bacterial strains are likely to contribute towards pneumonia, which will be discussed later, some of the common ones include the following bacterial strains.
Streptococcus pneumoniae: In the US, the most common bacteria responsible for disease is Streptococcus pneumoniae (pneumococcus).
Pneumococcal disease is characterized by an infection caused by Streptococcus pneumoniae bacteria. This strain is responsible for many health conditions, which include ear infections, meningitis, sinusitis, blood infections in addition to pneumonia. The pathogen spread through the sneezing or coughing of the infected person. Similarly, making a close contact with an infected person also leads the uninfected person to catch the infection.
This bacterial pathogen lives in throat and nose of healthy people. As the bacterial cells replicate and grow in number, they enter the lungs through inhalation and also carry the ability to enter the blood stream through a wound or another infection. The person infected by this bacterial strain is observed to cough out rust-colored sputum.
Is Pneumonia Contagious? What Are Its Symptoms And Causes?
Pneumococcal disease is a global health hazard, but it particularly puts travelers, people living or working in crowded area and people of the developing countries where preventive shots are not routinely given; at a greater risk.
People over the age of 65 years and below the age of 2 years, and those with weakened immunity are also vulnerable to catch the disease.
However, to prevent yourself from catching pneumonia or other diseases through this bacterial pathogen, it is advised by the Centers for Disease Control and Prevention (CDC) that older adults and younger people, who suffer from other medical conditions or smoke, should get themselves vaccinated by 23-valent pneumococcal polysaccharide vaccine (PPSV23).
Children between the age of 6 to 18 and adults, who have been suffering from certain health conditions, should get a dose of 13-valent pneumococcal conjugate vaccine (PCV13).Children till the age of 5 are also recommended to receive 4 shots of PCV13.
These shots become increasingly important, if you are traveling from one region to the other which might have higher risk rate for pathogen contraction.
Haemophilus influenzae: This is the bacterial strain which resides in the upper respiratory tract and qualifies as the second most common cause of pneumonia. This bacterium does not cause harm to the person until they have a vulnerable immune system.
The strains of this genus are observed to produce green sputum.
This strain is found to be most common amongst pneumonia patients who are drug abusers, young children or adults with chronic health conditions. The bacterium resides on the surface or without the cells of pharynx or intestines.
This bacterium lives in the skin, digestive system and the mouth and it has the ability to affect people who have weakened defense system against foreign pathogens. If a person is infected with strains of klebsiella species, they are observed to produce red currant-jelly colored sputum.
Known also as Legionnaires’ disease and Pontiac fever, the bacterium was named after the 1976 outbreak which caused a new form of pneumonia. The bacterium grown in water systems and the contaminated water droplets when inhaled by people cause the disease.
At other and rather rare times, the spread of this bacterium can take place by aspiration of drinking water, which the water goes through the trachea into the lungs, instead of going into the digestive tract.
This is another bacterial strain which can lead to lung infections including such as pneumonia, it accounts for 2% to 5% of all CAP cases and it is the 2nd most common cause of respiratory infections, in general.
The infection may take place in the upper or lower respiratory tract and its incubation period ranges between 3 to 4 weeks, but it may not necessarily be this long. The infection is also reported to progress over time with a consistent cough and malaise experienced from several weeks to few months. The symptoms may continue even after the use of appropriate use of antibiotics.
Qualifying as CAP, this bacterium does not cause pneumonia in every person who is exposed to it. The small gram-negative strains from the Chlamydia genus, including Chlamydophilapneumoniae, Chlamydophilapsittaci and Chlamydiatrachomatis are commonly associated with pneumonia.
However, the disease caused by these strains is mild in nature and is prevalent in young adults and adolescents. On the contrary, in older adults severe cases of the disease are seen due to these strains because they have a weakened immunity.
The second category of bacterial pneumonia is the hospital acquired pneumonia (HAP), which infect a person in a span of two to three days of bacterial exposure in a hospital setting. These hospital acquired infections are also popularly known as nosocomial infections which are often resistant to antibiotics and surface disinfectants.
Thereby, due to their resistant nature, the HAP is often difficult to treat when compared with CAP. The most commonly present HAP includes Pseudomonasaeruginosa and methiclin-resistant Staphylococcus aureus (MRSA).
This bacterial strain plays an integral role in giving rise to hospital acquired infections in general. These infections are often severe in nature because they commonly show resistance antibiotics and are associated with high mortality rate. Similarly, the cases of pneumonia caused by this strain can lead to severe illness.
It is a gram-negative bacterium which particularly affects people with compromised immune system. If not timely treated, the condition caused by this pathogen can become life threating at times.
People who are exposed to the hospital environment for more than a week’s time, particularly the breathing machines, catheters and wounds are at higher risk of acquiring this pneumonia pathogen.
Staphyloccocus Aureus (MRSA)
Attributed to many infections, staphylococcus has turned into a doctor’s nightmare as it has evolved as superbug due to its methicillin resistance. As these strains are resistant to antibiotics, treating such cases of pneumonia is increasingly difficult. As HAP are becoming increasingly commonly, another term has been coined to classify pneumonia that is acquired by the use of ventilator.
Known, commonly as ventilator associated pneumonia, the infection develops in a person who has been on a ventilator, which is a breathing device to help ailing people with breathing by providing them with sufficient oxygen supply.
A tube is passed through the patient’s mouth, the nasal cavity or through a hole in the neck of the patient. The infection is likely to enter the system through the tube and as the people who are on ventilator for chronic illness have vulnerable immunity, they easily give in to the infection which increases the complications of the treatment.
However, to help minimize these pneumonia cases, CDC has released guidelines. These guidelines include thorough sterilization and disinfection of all the hospital equipment and devices, wet heat pasteurization and detailed equipment handling tips for healthcare management professionals and patients.
Other bacterial stains, which do not account for common cases of bacterial pneumonia, include the following strains.
Streptococcus Pyogenes: It is commonly spread through inhalation of bacteria contaminated droplets.
Sptreptococcus Agalactiae: It is spread from the inhalation of organisms which are passed down birth canal by neonates, causing pneumonia in new born babies.
Neisseria Meningitides: It is caused by inhalation of bacteria containing droplets and in past epidemics in the military recruits.
Moraxella Catarrhalis: It is another typical pneumonia causing bacterial strain which is contracted through inhalation of droplets which contain the pathogen.
Escherichia Coli: It is observed in pneumonia through aspiration (entering of food particles into the lungs) and it is seen in lung tissue death (necrosis) and neonatal pneumonia.
When Is Viral Pneumonia Contagious ?
- Most common cause of viral pneumonia is Influenza
The second most common type of pneumonia pathogens is viruses which are also contagious in nature as bacterial strains. However, the infectious factor varies from one strain to the other.
The viral pathogens attack the lungs and cause them to swell which blocks the flow of oxygen into the lungs and the symptom manifestation of the disease begins.
The symptoms of viral pneumonia are mild in the beginning and resemble flu, however in a few days period, the symptoms become severe. The most common pathogens are influenza and respiratory syncytial virus (RSV).
Influenza And Pneumonia
The influenza causing virus is the most common cause of viral pneumonia which develops its symptoms in three to five days. The respiratory signs like cyanosis (bluish skin coloration due to insufficient blood oxygenation) and dyspnea (laborious breathing) are observed in addition to other symptoms.
Human Metapneumovirus (HMPV)
The virus causes upper and lower respiratory diseases in people of all age groups, however those with vulnerable immunity have the highest tendency to get infected. The incubation period of this strain is three to six days and the duration of the illness depends on the severity of the illness. As the virus growth progresses, the symptom manifestation of pneumonia is seen which includes nasal congestion, fever, breathlessness and fever.
Human Parainfluenza Viruses (HPIVs)
The virus is responsible for upper and lower respiratory diseases which progress towards pneumonia. Affecting mainly infants and young children, the symptoms of the infection may take two to seven years to develop. In addition to the commonly associated symptoms with the disease, decreased appetite, ear pain and irritability may also be experienced.
Respiratory Syncytial Virus Pneumonia
It is the most common cause of lower respiratory tract infects in children and the second most common cause of viral pneumonia in adults. Fever, anorexia, dyspnea, pain in the ears, wheezing, rhonchi (rattling lung sounds) and dry cough are frequently observed symptoms.
Being resistant to many commonly used disinfectants, adenoviral pneumonia outbreaks are common in HAP cases, However, the symptoms are mild and do not require medical cares.
Other viruses like Chickenpox virus, Epstein-Barr virus and Coxsackie virus also lead to respiratory infections, which may lead to pneumonia.
What is Fungal Pneumonia? Is Fungal Pneumonia Contagious ?
- Rarely contagious in nature, fungal pneumonia affect people with weakened immunity. Pneumocystis jiroveciiis a common fungal pathogen which leads to other serious opportunistic infections.
These cases qualify for the third category of pneumonia which is rarely contagious. It is an infectious process in the lungs which is caused by one or more opportunistic or endemic fungi. Often inhalation fungal spores or reactivation of a latent infection in an immunosuppressant individual leads to fungal pneumonia.
These pneumonia cases are commonly seen in people with weakened immunity, amongst them the HIV positive people are commonly infected by fungal pneumonia.
Opportunistic fungal pathogens are likely to affect people who have congenital (from birth) or acquired defects in their immune system. These include Aspergillus species, Candida species and Mucor species.
Pneumocystis pneumonia (PCP) is caused by fungus Pneumocystisjirovecii which causes serious opportunistic infections. Those have vulnerable immunity, due to conditions like HIV/AIDS are at a risk of this infection.
The endemic fungal pathogens which include Histoplasma capsulatum, Sporothrix schenckii, Paracoccidioides brasiliensis, Coccidioides immitis, Cryptococcus neoformans and Blastomyces dermatitidis, cause pneumonia in healthy people and in those with weakened immunity as well. The prevalence in the geographical regions of American continents is higher; however it is present across the globe.
Is Atypical Pneumonia Contagious ?
- These cause mild forms of pneumonia and walking pneumonia is the most common.
It is milder form of pneumonia caused by the Mycoplasma pneumoniae, Chlamydia trachomatis, Coxiella burnetii and Legionella pneumophila.
Out of these, the most common form of atypical pneumonia is caused by mycoplasma pneumonia.
Commonly referred to as “Walking Pneumonia”, this is a mild form of pneumonia which often goes unnoticed by the person who has it. Experts say that out 1 to 10 out of every 50 patients of community acquired pneumonia is caused by this bacterium strain.
It is a common illness seen in young adults and school-going children. In other cases, the Mycoplasma pneumonia outbreaks result in crowded areas like military barracks, colleges and nursing homes.
Signs And Symptoms
The symptoms of pneumonia can range from mild to severe depending on the causative organism. However, the common symptoms are: The symptoms are similar to flu but they exceed from more than 7 to 10 days and then gradually become more severe. The commonly occurring symptoms of pneumonia include:
-Cough with phlegm or without sputum
-Fever and chills
-Chest pain or tightness
-Fatigue and malaise (discomfort)
-Nausea and vomiting
-Confusion, particularly in older adults
-Clammy skin and profuse sweating
In the older adults, clinical presentation may be atypical. The symptoms are less intense, with slight coughing, and mild to absent fever; chest pains are also less frequent. However, the progression of disease severity is more rapid in the older adults.
Pneumonia In Children
Pneumonia affects millions of children all over the world. Although it is a preventable disease, globally pneumonia causes the highest number of deaths in children less than 5 years of age; in 2015, this number reached 0.92 million. Due to its contagious nature, its spread is rapid however; there are instances too, where pneumonia can be caused by inspiration of foreign agents.
The children have bacteria stored in their nose. This is the ‘carriage’ but the spread is less likely because of the bacteria in nose, so the immunity is already there in the body against it.
In children the symptoms can include:
-Indrawing of chest during inhalation
-Refusal to take feed
-Loss of consciousness
-Cold body temperature (hypothermia) and even convulsions in severe disease
In children, the most common causes of pneumonia are age dependent.
In children below the age of 5 years: Pneumonia is frequently caused by viruses. In cases of bacterial pneumonia, Strep. pneumonia, Strep. aureus, and Strep. pyogenes are common.
In children above the age of 5 years: Most commonly occurring pneumonia is bacterial in nature, caused by M. pneumoniae, S. pneumoniae, or Chlamydia pneumonia.
How Does Bacterial Pneumonia Differ From Viral Pneumonia?
Consolidation, which is characterized by swelling or hardening of otherwise aerated soft lung tissues is a distinguishing feature of bacterial pneumonia. In this condition, the alveoli, which under normal functioning are hollow air spaces in the lungs, become solid due to accumulation of cellular debris and fluids.
On the contrary, for viral pneumonia do not have pulmonary consolidation. These pathogens result in infecting the alveolar walls and lung parenchyma. Similarly, pulmonary consolidation does not take place in walking pneumonia.
What Are The Salient Clinical Features Of Bacterial Pneumonia?
-Fever of 102F or above, while lower than 102F in older adults is observed
-Hypothermia, body temperature going below 35oC
-Moist and pale skin coloration
-Sudden onset of chills
-Cough with thick sputum secretion which may be yellow, green or have blood in it
-Chest pain which worsens with breathing or coughing
-Altered mental states
-Tachypnea or rapid breathing greater than 18 respirations/min
-Tachycardia (abnormally rapid heart rate) greater than 100 bpm or bradycardia lower than 60 bpm
Other physical signs may include:
-Wheezing, rhonchi, crackling sound while breathing
-Egophony, i.e. increased resonance of sounds heard from the lung, due to lung consolidation and fibrosis (scarring of lung tissue as a result of lung injury)
-Tracheal deviation due to unequal intrathoracic pressure in the chest
-Whispered pectoriloquy i.e. increased loudness of whispering observed through stethoscope
-Pleural friction rub
-Dullness of percussion due to pleural fluid, pleural scarring or consolidation
-Lymphadenopathy i.e. abnormal size, consistency or number of lymph node
In addition to these symptoms, periodontal disease (gum disease) may result as a result of polymicrobial or anaerobic infection. Decreased pharyngeal reflex or laryngeal spasm indicates infection contraction through aspiration.
Reduced heart rate (bradycardia) might and diarrhea indicate Legionella infections. Bullous myringitis that is eardrum’s infection may be an indication of Mycoplasma pneumonia.
Furthermore, rarely observed symptoms of mycoplasma pneumonia include neck lump, ear pain, skin rash and sore throat. And Chlamydia pneumonia is also differentiated from other strains of pneumonia by the presence of inflammation of the larynx, that is laryngitis resulted by painful coughing and rough breathing.
What Are The Salient Clinical Features Of Viral Pneumonia?
-Consistent fever of 102oF or more
-Blue lip coloration
-Wheezing and rattling noise in breathing
-Myalgia (muscle pain)
-Tachycardia or bradycardia
-Tachypnea and dyspnea
When Do You Need To See A Doctor?
You should see a doctor where your fever is accompanied by a productive (sputum-filled) cough. The sputum in this situation may range from green, yellow or brown coloration. You should not think of your illness as trivial and confuse it with common cold or flu.
Experiencing chest pain while breathing or coughing and/or shortness of breath with fever might be an indication to have an appointment with your doctor.
If you suffer from suppressed immunity like HIV, diabetes or other chronic illness then you should seek help immediately after the onset of mild pneumonia symptoms.
Similarly, if you are older than 65 years of age, if you have used breathing assistance device, if you have had a heart attack, if you smoke or if you have already been suffered from a chronic obstructive pulmonary disease (COPD), there it is wise to have a treatment.
Rapid breathing rate, a drop in your blood pressure or mental orientation in additional to the commonly observed symptoms also suggest that you should see a doctor.
Who Is At Risk Of Getting Pneumonia?
-Infants and children
-Children with immunosuppressant diseases, lung condition or sickle cell anemia
-Children with heart condition, spinal fluid leak or cochlear implants
-Adults with weakened immune system
-Adults who have HIV AIDS
-Older adults over the age of 65 years
-Adults who have suffered from COPD in the past
-Adults who use immunosuppressant drugs due to a health condition for long
-People between the age of 19 years to 64 years with a lung disease, heart condition or absent spleen
Pneumonia–What Increases Your Risk
Although anyone can get pneumonia, there are certain risk factors that make a person more susceptible to pneumonia. These include:
-Those who smoke, or those exposed to second hand smoke
-People with underlying lung disease—like COPD, cystic fibrosis or bronchiectasis.
-People with other chronic illness like heart disease, chronic liver disease, or diabetes
-People with recent viral respiratory infection like bronchitis or influenza
-People who have impaired gag reflex i.e. they have difficulty swallowing, for instance, those with Parkinson’s disease, or stroke or other conditions with neurological deficit.
-People who have undergone recent surgery or trauma
-Those with weakened immune system, these can include HIV patients, cancer patients and those with chronic illnesses.
-Children who are malnourished or undernourished, for example those who were not breast fed, or those with low birth weights
-Those living with indoor air pollution and crowded homes
Investigation Of Pneumonia
A thorough history and clinical examination are a part of diagnosing pneumonia. Apart from asking about your recent vaccination history, your doctor will inquire about recent traveling, exposure to individuals with pneumonia, any recent sickness (bronchopneumonia, bronchitis, lobe pneumonia, flu, interstitial pneumonia etc.), underlying medical disorder, smoking history and medication history.
As we discussed earlier, sputum coloration and texture are different for various pathogens which lead to a pneumonia diagnosis.
Mucopurulent sputum is often associated with bacterial pneumonia and further difference of color from rust to yellow and green are indicative of specific bacterial strains involved in causing the disease.
On the other hand, watery or scant mucus production indicated towards an atypical pneumonia causing strain involved.
Although, as we have mentioned about some sputum color differentiation between pathogens earlier, these colorations rarely help clinicians to make a definitive diagnosis and giving corresponding treatment because these striking distinction between sputum colorations are rarely observed in a clinical setting.
In addition to this, it is recommended that sputum gram staining and strain culture be carried out prior to administering antibiotic therapy for better treatment results.
Pneumonia has particular breath sounds (crackling sound) when heard with a stethoscope. Thereby, monitoring the breathing pattern and associated noises made can suggest of a disease, which is validated by carrying out further diagnostic tests.
Diagnostic Tests For Pneumonia
These can include:
Blood tests: Complete Blood Count and a Blood Culture is done to check white cell count as well as find bacteria in the blood.
Chest X-Ray: pneumonia makes a certain picture on the radiograph (consolidation).
Other Chest Imaging: Including chest ultrasonography, chest radiology and chest CT scans.
Sputum Culture: to find the causative organism.
Pulse Oximetry: to find the oxygen levels in the body.
Pleural Fluid Culture/Thoracentesis: fluid is taken from between the lung and the chest cavity space, and cultured to find the bacteria present in it.
High Resolution CT (HRCT): may be needed to assess lung function.
Bronchoscopy: is done in resistant strain cases, when medication is not working. The procedure evaluates lung tissues and bronchial washing specimens with the assistance of fiberoptic bronchoscope.
Arterial Blood Gases (ABGs): to find how much oxygen is being carried by the blood.
Pathogen-Specific Tests: Including immune serologic tests, serum, sputum or urinary antigen tests and urine assays.
A set of laboratory tests are carried out for pneumonia severity assessment, They include PSI/PORT which is the pneumonia severity index/Patient Outcomes Research Team score, APACHE abbreviated for acute physiology and chronic health evaluation and CURB-65 which translates into confusion, urea, respiratory rate blood pressure and age>65 years system.
In addition to this, serum lactate level, serum chemistry panel, venous blood gas determination, serum free cortisol value and arterial blood gas determination are also helpful in determining the severity of the disease.
Furthermore, diagnostic tests for viral pathogens of pneumonia include, laboratory studies which include:
-Serological test for accurate diagnosis
-Rapid antigen detection
-Cytologic evaluation including Intranuclear inclusions for DNA viruses and cytoplasmic inclusions for RNA viruses
-Polymerase Chain Reaction (PCR) assays for amplified the viral genome for strain identification
Treatment For Pneumonia
Pneumonia is treated according to its etiology. However the general guidelines according to the American Lung Association for treatment include:
-Plenty of rest
-Plenty of fluid
-Control of fever through over-the-counter aspirin of NSAIDs (like Ibuprofen). Giving Aspirin to children is not recommended.
-Avoiding cough suppressants
-Specific treatment for pneumonia includes:
Treatment For Bacterial Pneumonia
Once your doctor has diagnosed the type of pneumonia that you have, he/she will treat it accordingly. For bacteria-associated-pneumonia, antibiotic therapy is mainstay of treatment.
These antibiotics include first line drugs for Streptococcal pneumonia and second-generation Cephalosporins with or without Macrolides such as Azithromycin or erythromycin. For more serious patients, especially with an underlying disorder, Quinolones might be added.
Treatment is usually administered with oral antibiotics; however, these can be shifted to intravenous antibiotic if disease severity increases.
Chest physiotherapy, intravenous fluids, analgesia, oxygen supplements, respiratory therapy, ventilation with low tidal volumes, proper hydration and mobilization are also some more supportive measures which are used.
Treatment For Viral Pneumonia
This type of pneumonia does not need antibiotic therapy. An antiviral may be prescribed if deemed necessary; such type of pneumonia improves in 1-3 weeks.
More specifically, for influenza pneumonia, rimantadine hydrochloride and amantadine hydrochloride are recommended. For the treatment of PIV pneumonia, oral and aerosol form of ribavirin are recommended and for RSV pneumonia, treatment with ribavirin is given, however experts seem conflicted at the efficacy of this drug for treating this viral strain of pneumonia.
Oxygen may be needed by patients who have difficulty breathing and excessive coughing.
There can be possible complications seen in pneumonia that necessitate hospitalization and aggressive treatment. People who are likely to be hospitalized include:
-People with a serious underlying condition, like chronic liver disease or diabetes
-People at extremes of age
-Resistant disease that is not getting better with antibiotics at home
-Increased severity of symptoms
-People with decreased immunity
-Pneumonia can easily become complicated, and necessitate emergency management. The signs of an emergency include
-Cyanosis—bluing of lips and nails
-Increased heart rate
-Very high fever
-Increased breathing rate
-Loss of consciousness
The complications of pneumonia include:
- Sepsis:also known as bacteremia, this is a serious complication and includes the spread of bacteria or infection through the blood to other organs.
- Lung Abscess: bacteria that cause pneumonia can also cause pus to accumulate and form an abscess in the lung. Abscess can be treated with antibiotics, but sometimes invasive procedures may be needed to get rid of it.
- Pleural Effusion: pleural space is the space between the lungs and chest cavity with a tiny amount of lubricating fluid in it. Pneumonia can cause this fluid to become infected and this may need a plural tap to evacuate the fluid.
- Respiratory Failure: may occur when the body cannot get enough oxygen.
- Acute respiratory distress syndrome (ARDS): is a severe form of respiratory failure.
How To Prevent Spread Of Pneumonia?
Pneumonia can prove to be a life-threatening disease; it is important that measures be taken to prevent the disease.
Vaccination For Pneumonia
These vaccinations are particularly available for influenza virus, Haemophilus influenza and pneumococcal bacteria. It is worth noting that, although vaccines can’t ensure 200% protection against all pneumonia causing strains, it is observed that people who are vaccinated are less likely to be infected.
If they are infected by a causative agent, they experience milder symptoms of infections, reduced complications and their pneumonia tends to last for a shorter period of time as compared to those who do not get the shots.
Vaccination can be helpful in certain groups like:
-Those above the age of 65 years
-Children younger than 5 years
-Children/young adults with heart or lung conditions
-People with chronic liver disease
-People with immune disorders or chronic illness with weak immune system
Center for Disease Control and Prevention recommends two vaccines the Pneumococcal Conjugate Vaccine (PVC 13) followed by a period of one year by the Pneumococcal Polysaccharide Vaccine (PPSV23).
Observe proper hand washing with an antibacterial soap or sanitizer that kill germs and helps prevent disease spread. This is especially important for those around children, those taking care of the ill or those in healthcare settings.
Smoking causes irreversible lung damage, damage to the lining of the airways, increased mucus production and decreased immunity. It decreases the ability of the lungs to combat bacteria and contain the disease. Smoking not only increases chances of COPD, but also of acute bronchitis and pneumonia.
Keep Your Immune System Strong
If the defense system of the body is weak, it will become vulnerable to every kind of disease. The chronically ill, and those with weak immune system are not only susceptible to pneumonia but also to other bacterial and viral illnesses that other healthy individuals don’t get. One way to keep the immune system healthy is to eat healthy and follow a healthy lifestyle pattern with plenty of physical activity and exercise.
Avoid Exposure To The Disease
Limiting contact with those who have the disease can help prevent its spread. If you are taking care of someone with Pneumonia then you should observe the precautions mentioned above.
If you are someone with the disease then you should limit your exposure to other healthy individuals and decrease their risk of getting the disease.
WHO and UNICEF have integrated into GAPPD, the Global Action Plan for Pneumonia and Diarrhea, which aims to reduce prevalence of pneumonia in children by encouraging breast feeding in infants, adequate vaccination, reducing exposure to air pollution indoors, and ensuring that satisfactory treatment reaches every child—including antibiotics and oxygen if needed.
Nutrition In Pneumonia
Malnutrition is common in Pneumonia; it can be a consequence of increased energy expenditure due to difficulty breathing, as well as decreased appetite. This can have an effect of prolonging the disease, increasing recovery time and predisposing to disease-related complications.
Some nutrients like Vitamin C and Zinc as well as oregano oil and golden seal can help combat pulmonary illnesses like pneumonia. Light diet, but diet rich in vitamins and proteins is needed in pneumonia to improve the immune system yet prevent overtaxing the digestive system. Broth, egg white and whey can be given; intake of cold drinks and water are encouraged to promote the activity of the kidneys. However, saccharine and starchy food must be avoided.
Myths About Pneumonia
There are many myths regarding pneumonia. Many are stories inherited from our parents and prior generations. Pneumonia is often misunderstood. Know the facts about this serious disease. Pneumonia is a disease that involves the inflammation of the alveoli – the air sacs in the lungs where oxygen and carbon dioxide are exchanged.
Pneumonia Is like A Common Cold, Only Severe
Pneumonia should not be taken lightly! It is not a severe form of cold, rather a serious lung infection that can be fatal if left untreated. Proper antibiotic medication and even hospitalization is needed to combat Pneumonia.
Pneumonia Is A Disease Of The Aged
Statistics from around the world prove otherwise. Pneumonia can occur at any age, but its risk is increased in people with a weakened immune system—this includes not only the aged but young children and chronically ill as well. Young children suffer more because their immune system is not developed enough to deal with this disease, and as such, most casualties are seen in this age group.
Pneumonia Is Not Preventable
Not only is Pneumonia completely treatable, but also preventable. In children, it can be prevented by strengthening their immune system, for example by breast feeding them. Apart from children, it can be prevented in the elderly through immunization. Proper vaccination in vulnerable people can help prevent the disease or at least the most virulent forms of it.