Aspiration pneumonia

Aspiration pneumonia is inflammation of the lungs and airways to the lungs (bronchial tubes) from breathing in foreign material. Aspiration pneumonia occurs when foreign materials (usually food, liquids, vomit, or fluids from the mouth) are breathed into the lungs or airways leading to the lungs. This may lead to:

A collection of pus in the lungs (lung abscess) Swelling and inflammation in the lung A lung infection (pneumonia)

Causes Risk factors for aspiration or breathing in of foreign material into the lungs are:

Being less alert due to medicines, illness, or other reasons Coma Disorders of the esophagus, the tube that moves food from the mouth to the stomach (esophageal stricture, gastroesophageal reflux) Drinking large amounts of alcohol Medicine to put you into a deep sleep for surgery (general anesthesia) Old age Poor gag reflex in people who are not alert (unconscious or semi-conscious) after a stroke or brain injury Problems with swallowing

Acidic material that is breathed into the lungs can cause severe lung injury. However, it may not necessarily lead to pneumonia. Symptoms

Bluish discoloration of the skin caused by lack of oxygen Chest pain Cough o With foul-smelling phlegm (sputum) o With sputum containing pus or blood o With greenish sputum Fatigue Fever Shortness of breath Wheezing

Other symptoms that can occur with this disease:

Breath odor

Excessive sweating Swallowing difficulty

Exams and Tests A physical examination may reveal:

Crackling sounds in the lungs Decreased oxygen Rapid pulse (heart rate)

The following tests may also help diagnose this condition:

Arterial blood gas Blood culture Bronchoscopy Chest x-ray Complete blood count (CBC) CT scan of the chest Sputum culture Swallowing studies

Treatment Some people may need to be hospitalized. Treatment depends on the severity of the pneumonia. You may receive antibiotics, which treat bacteria. Some people may get special antibiotics to treat bacteria that live in the mouth. The type of bacteria that caused the pneumonia depends on:

Your health Where you live (at home or in a long-term nursing facility, for example) Whether you've recently been hospitalized Recent antibiotic use

You may need to have your swallowing function tested. Patients who have trouble swallowing may need to use other feeding methods to reduce the risk of aspiration. Outlook (Prognosis) The outcome depends on:

The severity of the pneumonia The type of bacteria causing the pneumonia How much of the lungs are involved

If acute respiratory failure develops, the patient may have a long-term illness or die. Many people who have aspiration pneumonia have other serious health problems, which may affect the outlook for recovery.

Possible Complications

Acute respiratory distress syndrome Low blood pressure Pneumonia with lung abscess Shock Spread of infection to the bloodstream (bacteremia) Spread of infection to other areas of the body

When to Contact a Medical Professional Call your health care provider, go to the emergency room, or call the local emergency number (such as 911) if you have:

Chest pain Chills Fever Shortness of breath Wheezing

Prevention

Avoid behaviors that may lead to aspiration, such as excessive alcohol use Become aware of the risk of aspiration

Alternative Names Anaerobic pneumonia; Aspiration of vomitus; Necrotizing pneumonia; Aspiration pneumonitis References Donowitz GR. Acute pneumonia. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 64. Torres A, Menndez R, Wunderink R. Pyogenic bacterial pneumonia and lung abscess. In: Mason RJ, Broaddus VC, Martin TR, et a. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 32. Update Date: 2/19/2011 Updated by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, Unviersity of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Atypical pneumonia
Atypical pneumonia refers to pneumonia caused by certain bacteria, including Legionella pneumophila,Mycoplasma pneumoniae, and Chlamydophila pneumoniae.

Pneumonia is a condition in which there is an infection of the lung. Causes Mycoplasma pneumonia is a type of atypical pneumonia. It is caused by the bacteria M. pneumoniae. It typically affects people younger than age 40. For more information on this type of pneumonia, see: Mycoplasma pneumonia Pneumonia due to chlamydia-related bacteria occurs year round and accounts for 5 - 15% of all pneumonias. It is usually mild. Pneumonia due to Legionella is seen more often in middle-aged and older adults, smokers, and those with chronic illnesses or a weak immune system. See also: Legionnaire's disease Symptoms Pneumonia due to mycoplasma and chlamydophila bacteria is usually mild.

Pneumonia due to Legionella pneumophila gets worse during the first 4 - 6 days, and then improves over 4 - 5 days. Even though symptoms will improve, it may take a while for them to go away completely.

The most common symptoms of pneumonia are:

Chills Cough (with Legionella pneumonia, you may cough up bloody mucus) Fever, which may be mild or high Shortness of breath (may only occur when you climb stairs)

Other symptoms include:

Chest pain that gets worse when you breathe deeply or cough Confusion, especially in older people or those with Legionella pneumonia Headache Loss of appetite, low energy, and fatigue Muscle aches and joint stiffness Sweating and clammy skin

Less common symptoms include:

Diarrhea (especially with Legionella pneumonia) Ear pain (with mycoplasma pneumonia) Eye pain or soreness (with mycoplasma pneumonia) Neck lump (with mycoplasma pneumonia) Rash (with mycoplasma pneumonia) Sore throat (with mycoplasma pneumonia)

Exams and Tests Persons with suspected pneumonia should have a complete medical evaluation. It may be hard for your health care provider to tell whether you have pneumonia or bronchitis, so you may need a chest x-ray. Depending on the severity of the illness, other tests may be done, including:

Complete blood count (CBC) Blood cultures Blood tests to identify the bacteria Bronchoscopy (rarely needed) CT scan of the chest Open lung biopsy (only done in very serious illnesses when the diagnosis cannot be made from other sources) Sputum culture

Urine tests or a throat swab may also be done. Treatment Take these steps at home:

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

Antibiotics are used to treat atypical pneumonia.

You may be able to take antibiotics by mouth at home. If you have severe atypical pneumonia, you will likely be admitted to a hospital, where you will be given antibiotics through a vein (intravenously), as well as oxygen. Antibiotics are used for 2 weeks or more

Antibiotics used to treat atypical pneumonia include:

Azithromycin Clarithromycin Erythromycin Fluoroquinolones and their derivatives (such as levofloxacin) Tetracyclines (such as doxycycline)

Outlook (Prognosis) Most patients with pneumonia due to mycoplasma or chlamydophila do well with the right antibiotic therapy.P.Legionella can be severe, leading to problems such as kidney failure, diabetes, COPD, a weak immune system, and death.

Possible Complications

Brain and nervous system infections, such as meningitis, myelitis, and encephalitis Hemolytic anemia, a condition in which there are not enough red blood cells in the blood because the body is destroying them Severe lung damage

When to Contact a Medical Professional Contact your health care provider if you develop fever, cough, or shortness of breath. There are numerous causes for these symptoms. The doctor will need to rule out pneumonia. Prevention Wash your hands often and have other people around you do the same. If your immune system is weak, stay away from crowds. Ask visitors who have a cold to wear a mask. Get a flu shot every year. Ask your doctor if you need a pneumonia vaccine. Alternative Names Walking pneumonia; Chlamydophila pneumoniae; Community-acquired pneumonia - atypical References Baum SG. Mycoplasma pneumoniae and atypical pneumonia. In: Mandell GL, Bennett JE, Dolin R, eds.Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 184. Update Date: 9/15/2010 Updated by: Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

CMV - pneumonia
Cytomegalovirus (CMV) pneumonia is an infection of the lungs that can occur in people who have a suppressed immune system. See also: Causes CMV esophagitis CMV gastroenteritis CMV retinitis CMV - immunocompromised host Congenital CMV

CMV pneumonia is caused by a member of a group of herpes-type viruses. Infection with CMV is very common. Most humans are exposed to CMV in their lifetime, but typically only individuals with weakened immune systems become ill from CMV infection Usually CMV produces no symptoms, but serious CMV infections can occur in people with weakened immune systems from conditions such as: AIDS Bone marrow transplant Organ transplant Chemotherapy or other treatments that suppress the immune system

In people who have had organ and bone marrow transplants, the risk of infection is greatest 5 - 13 weeks after the transplant. Symptoms Cough Fatigue Fever General discomfort, uneasiness, or ill feeling (malaise) Loss of appetite Muscle aches or joint pains Shortness of breath Shortness of breath on exertion Sweating, excessive (night sweats)

Low oxygen levels in the blood (hypoxemia) with CMV pneumonia often predicts death, especially in patients who need mechanical ventilation. Exams and Tests Arterial blood gas Blood culture Blood tests to detect and measure substances specific to CMV infection Bronchoscopy with biopsy Chest x-ray CT scan of chest Urine culture (clean catch)

Treatment The objective of treatment is to stop the virus from copying in the body through the use of antiviral drugs. Some people with CMV pneumonia will need to get medication through a vein (intravenously). Some people might initially need oxygen therapy and breathing support with a ventilator to maintain oxygen until the infection is brought under control. Outlook (Prognosis)

Antiviral medications stop the virus from copying itself, but do not destroy it. CMV itself suppresses the immune system, and may increase the risk of other infections due to the additional immunosuppression. Possible Complications Complications of CMV infection in people with AIDS include: CMV pneumonia Esophageal disease Intestinal disease Infectious, mononucleosis-like illness (CMV mononucleosis) Inflammation of the retina (CMV retinitis)

Complications of CMV pneumonia include: Kidney impairment (from drugs used to treat the condition) Low white blood cell count (from drugs used to treat the condition) Overwhelming infection that doesn't respond to treatment Return of infections

When to Contact a Medical Professional Call your health care provider if you have symptoms of CMV pneumonia. Prevention The following have been shown to help prevent CMV pneumonia in certain patients: Using organ transplant donors who don't have CMV Using CMV-negative blood products for transfusion Using CMV-immune globulin in certain patients

Preventing AIDS avoids opportunistic diseases, including CMV, that can occur in people who have a damaged or poorly functioning immune system. People with AIDS who have a CD4 count of less than 100 should consider taking preventive treatment for CMV. Alternative Names Pneumonia - cytomegalovirus; Cytomegalovirus pneumonia References Drew WL. Cytomegalovirus. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 399. Update Date: 12/1/2009 Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Mycoplasma pneumonia is an infection of the lungs from the bacteria Mycoplasma pneumoniae (M. pneumoniae). See also: Atypical pneumonia Viral pneumonia

Causes
Mycoplasma pneumonia is a type of atypical pneumonia. It is caused by the bacteria M. pneumoniae. This type of pneumonia usually affects people younger than 40. Various studies suggest that it makes up 15 - 50% of all pneumonia cases in adults and even more in school-aged children. People at highest risk for mycoplasma pneumonia include those living or working in crowded areas such as schools and homeless shelters, although many people who contract mycoplasma pneumonia have no identifiable risk factor.

Symptoms
The symptoms are generally mild and appear over a period of 1 to 3 weeks. They may become more severe in some people. Common symptoms include the following: Chest pain Chills Cough, usually dry and not bloody Excessive sweating Fever (may be high) Headache Sore throat

Less common symptoms include: Ear pain Eye pain or soreness Muscle aches and joint stiffness Neck lump Rapid breathing Skin lesions or rash

Exams and Tests

Persons with suspected pneumonia should have a complete medical evaluation, including a thorough physical exam and a chest x-ray -- especially because the physical exam may not always be able to tell pneumonia apart from acute bronchitis or other respiratory infections. Depending on the severity of illness, other tests may be done, including: Complete blood count (CBC)

Blood cultures Blood tests for antibodies to mycoplasma Bronchoscopy CT scan of the chest Open lung biopsy (only done in very serious illnesses when the diagnosis cannot be made from other sources) Sputum culture to check for mycoplasma bacteria

A urine test or a throat swab may also be done.

Treatment
Antibiotics that work against Mycoplasma include macrolides, quinolones, and tetracyclines. You can take these steps at home: Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen), or acetaminophen. DO NOT give aspirin to children. Do not take cough medicines without first talking to your doctor. Cough medicines may make it harder for your body to cough up the extra sputum. Drink plenty of fluids to help loosen secretions and bring up phlegm. Get a lot of rest. Have someone else do household chores.

Outlook (Prognosis)
Most people recover completely even without antibiotics, although antibiotics may speed recovery. In untreated adults, cough and weakness can persist for up to a month.

Possible Complications
Ear infections Hemolytic anemia Severe pneumonia Skin rashes

When to Contact a Medical Professional

Call for an appointment with your health care provider if you develop a fever, cough, or shortness of breath. While there are numerous causes for these symptoms, you will need to be checked for pneumonia. Also, call if you have been diagnosed with this type of pneumonia and your symptoms become worse.

Prevention
There is no known way to prevent atypical pneumonia. However, avoiding people who have the infection can help reduce your risk. Infants, and persons in poor health, especially those with weakened immune systems due to HIV, organ transplants, or other conditions should avoid contact with people who have mycoplasma pneumonia.

References

Baum SG. Mycoplasma pneumoniae and atypical pneumonia. In: Mandell GL, Bennett JE, Dolin R, eds.Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 184. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27-S72.

Update Date: 9/15/2010

Updated by: Denis Hadijiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

http://www.nlm.nih.gov/medlineplus/ency/article/000082.htm