Pneumonia - causes, symptoms, diagnosis, treatment
Pneumonia is a bacterial or viral infection of the lungs. Symptoms can include fever, chills, shortness of breath, coughing that produces phlegm, and chest pain. Pneumonia can usually be treated successfully at home with antibiotics but hospitalisation may be required in some cases. In New Zealand, pneumonia has a mortality rate of between five and 10 per cent.
Pneumonia is an infection of the air sacs in the lungs and is caused by bacteria, viruses or, rarely, fungi. Most cases of pneumonia are caused by bacteria, most commonly bacteria called streptococcus pneumonia but viral pneumonia is more common in children.
The lungs are made up of separate lobes – three in the right lung and two in the left lung. Pneumonia can affect only one lobe of the lungs or it may be widespread in the lungs. The condition can be classified by the area of the lung affected and by the cause of the infection.
Anyone can develop pneumonia but some groups are at greater risk:
- Babies and toddlers - particularly those born prematurely
- People who have had a recent viral infection - such as a cold or flu
- People with chronic lung conditions
- People with suppressed immune systems
- People who drink excessive alcohol
- Patients in hospital
- People who have had strokes.
Pneumonia can develop when a person breathes in small droplets that contain pneumonia-causing organisms. It can also occur when bacteria or viruses that are normally present in the mouth, nose and throat, enter the lungs.
Signs and symptoms
Viral pneumonia tends to develop slowly over a number of days, whereas bacterial pneumonia usually develops quickly, often over a day.
Most people who develop pneumonia initially have a viral infection such as a cold or ‘flu, which produces symptoms such as headache, muscle aches and fever. If pneumonia develops, symptoms commonly include:
- High fever
- Shortness of breath
- Increased breathing rate
- A worsening cough that may produce discoloured or bloody sputum (phlegm)
- Sharp chest pains – caused by inflammation of the membrane that lines the lungs.
In babies and children, symptoms may be less specific and they may not show clear signs of a chest infection. Commonly they will have a high fever, appear very unwell, and become lethargic. they may also have noisy or rattly breathing, have difficulty with feeding and make a grunting sound with breathing.
It is also possible for the skin, lips and nail beds to become dusky or bluish. This is a sign that the lungs are unable to deliver enough oxygen to the body. If this occurs it is vital to seek medical assistance straight away.
If pneumonia is suspected it is important to seek medical attention promptly so that an accurate diagnosis can be made and appropriate treatment given.
The doctor will take a medical history and will conduct a physical examination. During the examination the doctor will listen to the chest with a stethoscope. Coarse breathing, crackling sounds, wheezing and reduced breath sounds in a particular part of the lungs can indicate pneumonia.
In order to confirm the diagnosis a chest x-ray is usually taken. The x-ray will show the area of the lung affected by the pneumonia.
Blood tests may also be taken and a sample of the sputum may be sent to the laboratory for testing.
Most cases of pneumonia can be treated at home. However babies, children, and people with severe pneumonia may need to be admitted to hospital for treatment.
Pneumonia is usually treated with antibiotics, even if viral pneumonia is suspected as there may be a degree of bacterial infection as well. The type of antibiotic used and the way it is given will be determined by the severity and cause of the pneumonia.
If able to be treated at home, treatment usually includes:
- Antibiotics - given by mouth as tablets or liquid
- Pain relieving medications
- Paracetamol to reduce fever
If treatment in hospital is required, treatment usually includes:
- Antibiotics given intravenously (via a drip into a vein)
- Oxygen therapy - to ensure the body gets the oxygen it needs
- Intravenous fluids - to correct dehydration or if the person is too unwell to eat or drink
- Physiotherapy - to help clear the sputum from the lungs.
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Pneumonia may take several weeks to fully recover from. The cough may continue for a period of time until the sputum has been cleared from the lungs. This is a part of the recovery process. Fatigue and a reduced tolerance to exercise may also be experienced.
If the cough worsens or recovery is taking longer than several weeks, it is important to see a doctor for further assessment. Smokers should have a chest x-ray after six weeks to confirm complete clearance of the lungs.
Further information and support
For further information and support about pneumonia contact your GP, practice nurse, or contact:
Freephone: 0800 611 116 (operates 24 hours a day, 7 days a week)
Freephone: 0800 933 922 (operates 24 hours a day, 7 days a week)
Anderson, K. N., Anderson, L. E. & Glanze, W. D. (Eds.) (2006) Mosby’s Medical, Nursing and Allied Health Dictionary. (6th ed.) St. Louis: The C.V. Mosby Company
Crompton, G. K., Haslett, C., Chilvers, E. R. (1999). Diseases of the respiratory system. In C. Haslett, E.R. Chilvers, J.A.A. Hunter & N.A. Boon (eds.) Davidson’s Principles and Practice of Medicine (18th ed.) Edinburgh: Churchill Livingstone
Kidshealth (2010) Pneumonia. Paediatric Society of New Zealand and Starship Foundation. www.kidshealth.org.nz/pneumonia
MedicineNet (2007) Pneumonia. San Clememte, Ca. MedicineNet, Inc.
Veale, A. Respiratory and Sleep Physician. Personal communication (2009).
Last Reviewed – November 2012
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