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Last reviewed: April 27, 2010.

Pneumonia is a respiratory condition in which there is infection 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).

See also: Hospital-acquired pneumonia

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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.

Ways you can get pneumonia include:

y? macteria and viruses living in your nose, sinuses, or mouth may spread to your lungs.
y? ^ou may breathe some of these germs directly into your lungs.
y? ^ou breathe in (inhale) food, liquids, vomit, or secretions from the mouth into your lungs
(aspiration pneumonia)

Pneumonia caused by bacteria tends to be the most serious. In adults, bacteria are the most
common cause of pneumonia.

y? Œhe most common pneumonia-causing germ in adults is ¦
  

 
(pneumococcus).
y? Atypical pneumonia, often called walking pneumonia, is caused by bacteria such as
   
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y? c 
 
 pneumonia is sometimes seen in people whose immune system is
impaired (due to AIDS or certain medications that suppress the immune system).
y? ¦ 
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, ¦
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   ,  
 , or 
   are other bacteria that
can cause pneumonia.
y? Œuberculosis 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.

See also: Respiratory syncytial virus

Risk factors (conditions that increase your chances of getting pneumonia) include:
 y? Cerebral palsy
y? Chronic lung disease (COPD, bronchiectasis, cystic fibrosis)
y? Cigarette smoking
y? Difficulty swallowing (due to stroke, dementia, Parkinson's disease, or other neurological
conditions)
y? Immune system problem (See also: Pneumonia in immunocompromised host)
y? Impaired consciousness (loss of brain function due to dementia, stroke, or other
neurologic conditions)
y? Living in a nursing facility
y? Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes mellitus
y? Recent surgery or trauma
y? Recent viral respiratory infection (common cold, laryngitis, influenza)

¦ 
Œhe most common symptoms of pneumonia are:

y? Cough (with some pneumonias you may cough up greenish or yellow mucus, or even
bloody mucus)
y? ·ever, which may be mild or high
y? Shaking chills
y? Shortness of breath (may only occur when you climb stairs)

Additional symptoms include:

y? Confusion, especially in older people

y? Î cessive sweating and clammy skin
y? Headache
y? Loss of appetite, low energy, and fatigue
y? Sharp or stabbing chest pain that gets worse when you breathe deeply or cough

¦  


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).

Œhe health care provider will likely order a chest -ray if pneumonia is suspected.

Some patients may need other tests, including:

y? Arterial blood gases to see if enough o ygen is getting into your blood from the lungs
y? CmC to check white blood cell count
y? CΠscan of the chest
 y? Gram's stain and culture of your sputum to look for the organism causing your symptoms
y? Pleural fluid culture if there is fluid in the space surrounding the lungs

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^our 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, o ygen therapy, and possibly
breathing treatments. It is very important that your antibiotics are started very soon after you are
admitted.

^ou are more likely to be admitted to the hospital if you:

y? Have another serious medical problem

y? Have severe symptoms
y? Are unable to care for yourself at home, or are unable to eat or drink
y? Are older than 65 or a young child
y? 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:

y? ·luoroquinolone (levoflo acin [Levaquin], gemiflo acin [·active], or mo iflo acin

[Avelo ])
y? High-dose amo icillin or amo icillin-clavulanate, plus a macrolide antibiotic
(azithromycin, clarithromycin, or erythromycin)
y? Cephalosporin antibiotics (for e ample, cefuro ime or cefpodo ime) plus a macrolide
(azithromycin, clarithromycin, or erythromycin)

If the cause is a virus, typical antibiotics will NOΠbe effective. Sometimes, however, your
doctor may use antiviral medication.

^ou can take these steps at home:

y? Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as
ibuprofen or napro en), or acetaminophen. DO NOΠgive aspirin to children.
y? Do not take cough medicines without first talking to your doctor. Cough medicines may
make it harder for your body to cough up the e tra sputum.
y? Drink plenty of fluids to help loosen secretions and bring up phlegm.
y? Get lots of rest. Have someone else do household chores.
Î 

  
With treatment, most patients will improve within 2 weeks. Îlderly or debilitated patients may
need longer treatment.

Œhose who may be more likely to have complicated pneumonia include:

y? Older adults or very young children

y? People whose immune system does not work well
y? People with other, serious medical problems such as diabetes or cirrhosis of the liver

^our doctor may want to make sure your chest -ray becomes normal again after you take a
course of antibiotics. However, it may take many weeks for your -ray to clear up.


 
Possible complications include:

y? Acute respiratory distress syndrome (ARDS), a severe form of respiratory failure

y? Împyema or lung abscesses. Œhese are infrequent, but serious, complications of
pneumonia. Œhey occur when pockets of pus form inside or around the lung. Œhese may
sometimes need to be drained with surgery.
y? Respiratory failure, which requires a breathing machine or ventilator
y? Sepsis, a condition in which there is uncontrolled swelling (inflammation) in the body,
which may lead to organ failure

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Call your doctor if you have:

y? Worsening respiratory symptoms

y? Shortness of breath, shaking chills, or persistent fevers
y? Rapid or painful breathing
y? A cough that brings up bloody or rust-colored mucus
y? Chest pain that worsens when you cough or inhale
y? Night sweats or une plained weight loss
y? 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.

c

 
Wash your hands frequently, especially after blowing your nose, going to the bathroom,
diapering, and before eating or preparing foods.

Don't smoke. Œobacco 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:

y? A drug called Synagis (palivizumab) is given to some children younger than 24 months to
prevent pneumonia caused by respiratory syncytial virus.
y? ·lu vaccine prevents pneumonia and other problems caused by the influenza virus. It
must be given yearly to protect against new virus strains.
y? Hib vaccine prevents pneumonia in children from 
   type b.
y? Pneumococcal vaccine (Pneumova , Prevnar) lowers your chances of getting pneumonia
from ¦
  
 

If you have cancer or HIV, talk to your doctor about additional ways to prevent pneumonia and
other infections.

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Review Date: 4/27/2010.

Reviewed by: Allen J. mlaivas, DO, Clinical Assistant Professor of Medicine, UMDNJ-
NJMS, Attending Physician in the Division of Pulmonary, Critical Care, and Sleep
Medicine, Department of Veteran Affairs, VA New Jersey Health Care System, Îast
Orange, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David
Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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