1.) What is Pneumonia?

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air
sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus,
fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses
and fungi, can cause pneumonia. Pneumonia can range in seriousness from mild to life-
threatening. It is most serious for infants and young children, people older than age 65,
and people with health problems or weakened immune systems

The most common cause of pneumonia in adults > 30 years, in the absence of an ongoing
viral pandemic such as COVID-19, is

Bacterial infection
Streptococcus pneumoniae is still the most common pathogen in all age groups,
settings, and geographic regions. However, the incidence of S. pneumoniae infection has
been declining because of increasing rates of vaccination and development of herd
immunity. However, pathogens of every sort, from viruses to parasites, can cause
pneumonia. With the availability of sensitive molecular diagnostic methods, there is
increasing recognition of viruses as a cause of pneumonia.

The airways and lungs are constantly exposed to pathogens in the external
environment; the upper airways and oropharynx in particular are colonized with so-called
normal flora. Microaspiration of these pathogens from the upper respiratory tract is a
regular occurrence, but these pathogens are readily dealt with by lung host defense
mechanisms. Pneumonia develops when

 Defense mechanisms are compromised

 Macroaspiration leads to a large inoculum of bacteria that overwhelms normal
host defenses
 A particularly virulent pathogen is introduced
 Occasionally, infection develops when pathogens reach the lungs via the bloodstream
or by contiguous spread from the chest wall or mediastinum. Another recently identified
potential pathway of pneumonia development is dysbiosis in the resident microbiome of
the lung.

Upper airway defenses include salivary IgA, proteases, and lysozyme; growth
inhibitors produced by normal flora; and fibronectin, which coats the mucosa and inhibits
adherence.

Nonspecific lower airway defenses, including cough and mucociliary clearance,

prevent infection in airspaces. Specific lower airway defenses include various pathogen-
specific immune mechanisms, including IgA and IgG opsonization, antimicrobial
peptides, anti-inflammatory effects of surfactant, phagocytosis by alveolar macrophages,
and T-cell–mediated immune responses. These mechanisms protect most people against
infection.

Numerous conditions alter the normal flora (eg, systemic illness, undernutrition,
hospital exposure, antibiotic exposure) or impair these defenses (eg, altered mental status,
cigarette smoking, nasogastric or endotracheal intubation, disorders or drugs that
suppress the immune system). Pathogens that then reach airspaces can multiply and cause
pneumonia.

2.) What are the types of pneumonia?

Hospital-acquired pneumonia. You catch this type during a stay in a hospital. It can be
serious because the bacteria causing the pneumonia can be resistant to antibiotics.

You're more likely to get this type if:

 You're on a breathing machine
 You can't cough strongly enough to clear your lungs
 You have a tracheostomy (trach) tube to help you breathe
  Your immune system -- your body's defense against germs -- is weak from a
disease or treatment
Community-acquired pneumonia. This is a fancy way of saying you got infected
somewhere other than a hospital or long-term care facility. Community-acquired
pneumonia can be caused by bacteria, viruses, and fungi. Vaccines can help protect
against the flu virus and certain bacteria that can also cause pneumonia.

Community-acquired pneumonia also includes aspiration pneumonia, which

happens when you breathe food, fluid, or vomit into your lungs. It's more likely if you
have problems swallowing or coughing. If you can't cough up the material you took in,
bacteria can multiply in your lungs.

Bacterial Pneumonia. Bacteria cause most cases of community-acquired

pneumonia in adults. You can catch pneumonia when someone who is infected coughs or
sneezes. Bacteria-filled droplets get into the air, where you can breathe them into your
nose or mouth. If you have a weakened immune system, your chances of getting
pneumonia are higher. You're also more likely to get it if you have a condition like
asthma, emphysema, or heart disease.
Walking pneumonia is a less severe form of bacterial pneumonia. Sometimes,
doctors call it "atypical" pneumonia. Symptoms can be so mild that you don't know you
have it. You may feel well enough that you're able to go about your regular activities,
which is where the "walking" in the name comes from.
Viral Pneumonia. Viruses are the second most common cause of pneumonia.
Many kinds cause the disease, including some of the same viruses that bring on colds and
flu and the coronavirus that causes COVID-19.
Fungal Pneumonia. Fungi are a less common cause of pneumonia. You're not
likely to get fungal pneumonia if you're healthy. But you have a higher chance of
catching it if your immune system is weakened from:
 An organ transplant
 Chemotherapy for cancer
 Medicines to treat an autoimmune disease like rheumatoid arthritis
  HIV
You get fungal pneumonia by breathing in tiny particles called fungal spores.
People in certain jobs are more likely to come into contact with them, such as:
 Farmers who work around bird, bat, or rodent droppings
 Landscapers and gardeners who work with the soil
 Members of the military or construction workers who are around a lot of
dust

3.) What are the signs and symptoms?

The signs and symptoms of pneumonia vary from mild to severe, depending on
factors such as the type of germ causing the infection, and your age and overall health.
Mild signs and symptoms often are similar to those of a cold or flu, but they last longer.

Signs and symptoms of pneumonia may include:

 Chest pain when you breathe or cough

 Confusion or changes in mental awareness (in adults age 65 and older)
 Cough, which may produce phlegm
 Fatigue
 Fever, sweating and shaking chills
 Lower than normal body temperature (in adults older than age 65 and people with
weak immune systems)
 Nausea, vomiting or diarrhea
 Shortness of breath

Newborns and infants may not show any sign of the infection. Or they may vomit,
have a fever and cough, appear restless or tired and without energy, or have difficulty
breathing and eating.

Aspiration pneumonia happens when a person aspirates, or breaths a foreign

substance into their lungs. This happens most often with food or drink. When a person
swallows, a small amount of food or drink can go down the “wrong pipe,” into the lungs
rather than the stomach.
4.) What are the treatments for pneumonia?
Treatment for pneumonia involves curing the infection and preventing
complications. People who have community-acquired pneumonia usually can be treated
at home with medication. Although most symptoms ease in a few days or weeks, the
feeling of tiredness can persist for a month or more.

Specific treatments depend on the type and severity of your pneumonia, your age and
your overall health. The options include:

Antibiotics. These medicines are used to treat bacterial pneumonia. It may take time to
identify the type of bacteria causing your pneumonia and to choose the best antibiotic to
treat it. If your symptoms don't improve, your doctor may recommend a different
antibiotic.
Cough medicine. This medicine may be used to calm your cough so that you can rest.
Because coughing helps loosen and move fluid from your lungs, it's a good idea not to
eliminate your cough completely. In addition, you should know that very few studies
have looked at whether over-the-counter cough medicines lessen coughing caused by
pneumonia. If you want to try a cough suppressant, use the lowest dose that helps you
rest.
Fever reducers/pain relievers. You may take these as needed for fever and discomfort.
These include drugs such as aspirin, ibuprofen (Advil, Motrin IB, others) and
acetaminophen (Tylenol, others).

Hospitalization
You may need to be hospitalized if:

 You are older than age 65

 You are confused about time, people or places
 Your kidney function has declined
 Your systolic blood pressure is below 90 millimeters of mercury (mm Hg) or your
diastolic blood pressure is 60 mm Hg or below
  Your breathing is rapid (30 breaths or more a minute)
 You need breathing assistance
 Your temperature is below normal
 Your heart rate is below 50 or above 100

You may be admitted to the intensive care unit if you need to be placed on a
breathing machine (ventilator) or if your symptoms are severe.

Children may be hospitalized if:

 They are younger than age 2 months
 They are lethargic or excessively sleepy
 They have trouble breathing
 They have low blood oxygen levels
 They appear dehydrated

5.) What are the diagnostics for pneumonia?

Your doctor will start by asking about your medical history and doing a physical
exam, including listening to your lungs with a stethoscope to check for abnormal
bubbling or crackling sounds that suggest pneumonia.

If pneumonia is suspected, your doctor may recommend the following tests:

Blood tests. Blood tests are used to confirm an infection and to try to identify the type of
organism causing the infection. However, precise identification isn't always possible.
Chest X-ray. This helps your doctor diagnose pneumonia and determine the extent and
location of the infection. However, it can't tell your doctor what kind of germ is causing
the pneumonia.
Pulse oximetry. This measures the oxygen level in your blood. Pneumonia can prevent
your lungs from moving enough oxygen into your bloodstream.
Sputum test. A sample of fluid from your lungs (sputum) is taken after a deep cough and
analyzed to help pinpoint the cause of the infection.
 Your doctor might order additional tests if you're older than age 65, are in the
hospital, or have serious symptoms or health conditions. These may include:

CT scan. If your pneumonia isn't clearing as quickly as expected, your doctor may
recommend a chest CT scan to obtain a more detailed image of your lungs.
Pleural fluid culture. A fluid sample is taken by putting a needle between your ribs from
the pleural area and analyzed to help determine the type of infection.