Treatment

Prior to the discovery of penicillin antibiotics, bacterial pneumonia was almost always fatal. Today,
antibiotics, especially given early in the course of the disease, are very effective against bacterial
causes of pneumonia. Erythromycin and tetracycline improve recovery time for symptoms of
mycoplasma pneumonia. They, do not, however, eradicate the organisms. Amantadine and
acyclovir may be helpful against certain viral pneumonias.
A newer antibiotic named linezolid (Zyvox) is being used to treat penicillin-resistant organisms
that cause pneumonia. Linezolid is the first of a new line of antibiotics known as oxazolidinones.
Another new drug known as ertapenem (Invanz) is reported to be effective in treating bacterial
pneumonia.

Prognosis
Prognosis varies according to the type of organism causing the infection. Recovery following
pneumonia with Mycoplasma pneumoniae is nearly 100%. Staphylococcus pneumoniae has a
death rate of 30-40%. Similarly, infections with a number of gram negative bacteria (such as
those in the gastrointestinal tract which can cause infection following aspiration) have a death
rate of 25-50%. Streptococcus pneumoniae, the most common organism causing pneumonia,
produces a death rate of about 5%. More complications occur in the very young or very old
individuals who have multiple areas of the lung infected simultaneously. Individuals with other
chronic illnesses (including cirrhosis of the liver, congestive heart failure, individuals without a
functioning spleen, and individuals who have other diseases that result in a weakened immune
system, experience complications. Patients with immune disorders, various types of cancer,
transplant patients, and AIDS patients also experience complications

Books
Beers, Mark H., MD, and Robert Berkow, MD., editors. "Pneumonia." In The Merck Manual of
Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

chest tube (chest drain or tube thoracostomy) is a flexible plastic tube that is inserted
through the side of the chest into the pleural space. It is used to remove air
(pneumothorax) or fluid (pleural effusion, blood, chyle), or pus (empyema) from the
intrathoracic space. It is also known as a Bülau drain or an intercostal catheter.

The free end of the tube is usually attached to an underwater seal, below the level of the
chest. This allows the air or fluid to escape from the pleural space, and prevents anything
returning to the chest. Alternatively, the tube can be attached to a flutter valve. This
allows patients with pneumothorax to remain more mobile.

DEFINITION

Pneumonia (pronounced noo-MOAN-ya) is an infection of the lung. It can be caused by a

great many different agents, including bacteria, viruses, fungi, and parasites. In the
United States, pneumonia is the sixth most common disease leading to death. It is also the
most common fatal infection acquired by patients in hospitals. In developing countries,
pneumonia is one of the two most common causes of death. Diarrhea is the other.

DESCRIPTION

The healthy human lung is normally free of disease-causing microorganisms, such as

bacteria and viruses. The body has immune system (a complex defense system) is
designed to keep it that way. For example, hairs in the nose trap large particles carried
along by the air we breathe in. The epiglottis is a kind of trapdoor in the larynx
(windpipe; pronounced LAYR-inx) that keeps food and other swallowed substances from
entering the lungs. Mucus, a thick liquid, is produced throughout the respiratory
(breathing) system to capture dust, bacteria, and other organisms. Cilia (pronounced SIL-
ee-uh) are hairlike projections along the lining of the respiratory system that also trap and
remove foreign objects from the body. Special types of white blood cells, called
macrophages (pronounced MAK-ruh-faj), are also part of this defensive system. They are
produced when foreign bodies enter the body to attack and destroy those bodies.

This system of defenses does not work perfectly, however. Sometimes organisms that can
cause infection get into the lungs. For example, a person may be exposed to large
amounts of smoke. There may be too many smoke particles for the body's defense system
to remove. In such a case, the lungs may become infected and pneumonia can develop.
the airways.

The list of organisms that can cause pneumonia is very long. It includes bacteria, viruses,
fungi, and parasites. Some examples include:

• Viruses are the most common cause of pneumonia in young children. These
viruses also cause other infections of the respiratory system, such as influenza
(see influenza entry), tonsillitis (see tonsillitis entry), and the common cold (see
common cold entry).
• Bacteria are the primary cause of pneumonia in older children and adults. The
most common of these bacteria are Streptococcus pneumoniae, (pronounced
STREP-tuh-coc-us noo-MOHN-ee-ay) Haemophilus influenzae, (pronounced
HEE-mof-uh-lus in-floo-EN-zay) and Staphylococcus aureus (pronounced
STAFF-lo-coc-us or-ee-us).
• An organism called Mycoplasma pneumoniae affects older children and adults.
The organism is somewhat similar to both bacteria and viruses. It produces a form
of pneumonia known as "walking pneumonia."
• A protozoan (one-celled organism) called Pneumocystis carinii causes a form of
pneumonia in people with weakened immune systems. The condition,
pneumocystis carinii pneumonia (PCP), is one of the most serious medical
problems for people with HIV or AIDS. It also affects people whose immune
systems have been weakened by chemotherapy or cancer.
 • An organism known as Chlamydia psittaci causes a form of pneumonia
sometimes known as "bird pneumonia." The disease is quite rare and was once
observed only in humans who came into contact with bird droppings. People
infected with HIV are also susceptible to the infection.
• In 1976, a new form of pneumonia was discovered. It broke out among a large
group of people attending an American Legion convention. The infection was
caused by a previously unknown organism. Subsequently named Legionella
pneumophila, it causes what is now called Legionnaires' disease. The organism
was eventually traced to the air conditioning units at the hotel where the
convention took place.

Pneumonia can be caused by microorganisms, irritants and unknown causes. When

pneumonias are grouped this way, infectious causes are the most common type.

The symptoms of infectious pneumonia are caused by the invasion of the lungs by
microorganisms and by the immune system's response to the infection. Although more
than one hundred strains of microorganism can cause pneumonia, only a few are
responsible for most cases. The most common causes of pneumonia are viruses and
bacteria. Less common causes of infectious pneumonia are fungi and parasites.

Viruses
Main article: Viral pneumonia

Viruses invade cells in order to reproduce. Typically, a virus reaches the lungs when
airborne droplets are inhaled through the mouth and nose. Once in the lungs, the virus
invades the cells lining the airways and alveoli. This invasion often leads to cell death,
either when the virus directly kills the cells, or through a type of cell controlled self-
destruction called apoptosis. When the immune system responds to the viral infection,
even more lung damage occurs. White blood cells, mainly lymphocytes, activate certain
chemical cytokines which allow fluid to leak into the alveoli. This combination of cell
destruction and fluid-filled alveoli interrupts the normal transportation of oxygen into the
bloodstream.

As well as damaging the lungs, many viruses affect other organs and thus disrupt many
body functions. Viruses can also make the body more susceptible to bacterial infections;
for which reason bacterial pneumonia often complicates viral pneumonia.

Viral pneumonia is commonly caused by viruses such as influenza virus, respiratory

syncytial virus (RSV), adenovirus, and metapneumovirus. Herpes simplex virus is a rare
cause of pneumonia except in newborns. People with weakened immune systems are also
at risk of pneumonia caused by cytomegalovirus (CMV).
Bacteria
Main article: Bacterial pneumonia

Bacteria typically enter the lung when airborne droplets are inhaled, but can also reach
the lung through the bloodstream when there is an infection in another part of the body.
Many bacteria live in parts of the upper respiratory tract, such as the nose, mouth and
sinuses, and can easily be inhaled into the alveoli. Once inside, bacteria may invade the
spaces between cells and between alveoli through connecting pores. This invasion
triggers the immune system to send neutrophils, a type of defensive white blood cell, to
the lungs. The neutrophils engulf and kill the offending organisms, and also release
cytokines, causing a general activation of the immune system. This leads to the fever,
chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils, bacteria,
and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen
transportation.

The bacterium Streptococcus pneumoniae, a common cause of pneumonia,

photographed through an electron microscope.

Bacteria often travel from an infected lung into the bloodstream, causing serious or even
fatal illness such as septic shock, with low blood pressure and damage to multiple parts of
the body including the brain, kidneys, and heart. Bacteria can also travel to the area
between the lungs and the chest wall (the pleural cavity) causing a complication called an
empyema.

The most common causes of bacterial pneumonia are Streptococcus pneumoniae, Gram-
positive bacteria and "atypical" bacteria. The terms "Gram-positive" and "Gram-
negative" refer to the bacteria's color (purple or red, respectively) when stained using a
process called the Gram stain. The term "atypical" is used because atypical bacteria
commonly affect healthier people, cause generally less severe pneumonia, and respond to
different antibiotics than other bacteria.

The types of Gram-positive bacteria that cause pneumonia can be found in the nose or
mouth of many healthy people. Streptococcus pneumoniae, often called "pneumococcus",
is the most common bacterial cause of pneumonia in all age groups except newborn
infants. Another important Gram-positive cause of pneumonia is Staphylococcus aureus,
with Streptococcus agalactiae being an important cause of pneumonia in newborn babies.
Gram-negative bacteria cause pneumonia less frequently than gram-positive bacteria.
Some of the gram-negative bacteria that cause pneumonia include Haemophilus
influenzae, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and
Moraxella catarrhalis. These bacteria often live in the stomach or intestines and may
enter the lungs if vomit is inhaled. "Atypical" bacteria which cause pneumonia include
Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila.

Fungi
Main article: Fungal pneumonia

Fungal pneumonia is uncommon, but it may occur in individuals with immune system
problems due to AIDS, immunosuppresive drugs, or other medical problems. The
pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia.
Fungal pneumonia is most often caused by Histoplasma capsulatum, blastomyces,
Cryptococcus neoformans, Pneumocystis jiroveci, and Coccidioides immitis.
Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis
in the southwestern United States.

Parasites
Main article: Parasitic pneumonia

A variety of parasites can affect the lungs. These parasites typically enter the body
through the skin or by being swallowed. Once inside, they travel to the lungs, usually
through the blood. There, as in other cases of pneumonia, a combination of cellular
destruction and immune response causes disruption of oxygen transportation. One type of
white blood cell, the eosinophil, responds vigorously to parasite infection. Eosinophils in
the lungs can lead to eosinophilic pneumonia, thus complicating the underlying parasitic
pneumonia. The most common parasites causing pneumonia are Toxoplasma gondii,
Strongyloides stercoralis, and Ascariasis.

Idiopathic
Main article: Idiopathic interstitial pneumonia

Idiopathic interstitial pneumonias (IIP) are a class as diffuse lung diseases. In some types
of IIP, e.g. some types of usual interstitial pneumonia, the cause, indeed, is unknown or
idiopathic. In some types of IIP the cause of the pneumonia is known, e.g. desquamative
interstitial pneumonia is caused by smoking, and the name is a misnomer.
Pneumonia fills the lung's alveoli with fluid, keeping oxygen from reaching the
bloodstream. The alveolus on the left is normal, while the alveolus on the right is full of
fluid from pneumonia.