Pneumonia

What is pneumonia?

Pneumonia is a lung infection that can make you very sick. You may cough, run a fever, and have a hard time breathing. For most people,pneumonia can be treated at home. It often clears up in 2 to 3 weeks. But older adults, babies, and people with other diseases can become very ill. They may need to be in the hospital.

You can get pneumonia in your daily life, such as at school or work. This is called community-associated pneumonia. You can also get it when you are in a hospital or nursing home. This is called healthcare-associated pneumonia. It may be more severe because you already are ill. This topic focuses on pneumonia you get in your daily life.

What causes pneumonia?

Germs called bacteria or viruses usually cause pneumonia.

Pneumonia usually starts when you breathe the germs into your lungs. You may be more likely to get the disease after having a cold or the flu. These illnesses make it hard for your lungs to fight infection, so it is easier to get pneumonia. Having a long-term, or chronic, disease like asthma, heart disease, cancer, or diabetes also makes you more likely to get pneumonia.

What are the symptoms?

Symptoms of pneumonia caused by bacteria usually come on quickly. They may include:

• Cough. You will likely cough up mucus (sputum) from your lungs. Mucus may be rusty or green or tinged with blood.
• Fever.
• Fast breathing and feeling short of breath.
• Shaking and "teeth-chattering" chills. You may have this only one time or many times.
• Chest pain that often feels worse when you cough or breathe in.
• Fast heartbeat.
• Feeling very tired or feeling very weak.
• Nausea and vomiting.
• Diarrhea.

When you have mild symptoms, your doctor may call this "walking pneumonia."

Older adults may have different, fewer, or milder symptoms. They may not have a fever. Or they may have a cough but not bring up mucus. The main sign of pneumonia in older adults may be a change in how well they think. Confusion ordelirium is common. Or, if they already have a lung disease, that disease may get worse.

Symptoms caused by viruses are the same as those caused by bacteria. But they may come on slowly and often are not as obvious or as bad.

How is pneumonia diagnosed?

Your doctor will ask you about your symptoms and do a physical exam. He or she may order a chest X-ray and a blood test. This is usually enough for your doctor to know if you have pneumonia. You may need more tests if you have bad symptoms, are an older adult, or have other health problems. In general, the sicker you are, the more tests you will have.

What Is Syphilis? What Causes Syphilis?

Syphilis is one type of sexually transmitted disease. Syphilis is the result of a bacterial infection of the genital tract by the bacterium Treponema pallidum. Syphilis is passed from one person to another during direct sexual contact with a syphilis lesion that involves vaginal, oral, or anal sex. Syphilis can also be passed from an infected mother to her baby during pregnancy and result in stillbirth or serious birth defects. 

According to Medilexicon's medical dictionary:

Syphilis is an acute and chronic infectious disease caused by the bacterium Treponema pallidum and transmitted by direct contact, usually through sexual intercourse. After an incubation period of 12-30 days, the first symptom is a chancre, followed by slight fever and other constitutional symptoms (primary syphilis), followed by a skin eruption of various appearances with mucous patches and generalized lymphadenopathy (secondary syphilis), and subsequently by the formation of gummas, cellular infiltration, and functional abnormalities usually resulting from cardiovascular and central nervous system lesions (tertiary syphilis).

Any person that engages in sexual activity can contract and pass on syphilis. This includes heterosexual, homosexual and bisexual men and women. The more sexual partners a person has, the greater the risk of catching syphilis. Syphilis also increases the risk of HIV infection, which causes AIDS. About 12 million new cases of syphilis occur every year. More than 90% of them are in developing nations where congenital syphilis remains a leading cause of stillbirths and newborn deaths. In North America and Western Europe, syphilis is disproportionately common and rising among men who have sex with men and among persons who use cocaine or other illicit drugs. 

The name "syphilis" was coined by Hieronymus Fracastorius (Girolamo Fracastoro). Fracastorius on the temperature of wines, the rise of the Nile, poetry, the mind, and the soul; he was an astronomer, geographer, botanist, mathematician, philosopher and, last but not least in the present context, a physician. 

In 1530 he published the poem "Syphilis sive morbus gallicus" (Syphilis or the French Disease) in which the name of the disease first appeared. Perhaps more importantly, Fracastorius went on in 1546 to write "On Contagion" ("De contagione et contagiosis morbis et curatione"), the first known discussion of the phenomenon of contagious infection: a landmark in the history of infectious disease. 

What are the symptoms of Syphilis?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom while dilated pupils may be a sign. 

After becoming infected with syphilis, there is an incubation period between of 9 to 90 days (the average being around 21 days) before the first signs and symptoms of the disease appear. Each stage of syphilis has characteristic signs and symptoms but any particular sign or symptom may or may not be present.

Some people with syphilis don't have any signs of infection. In other people, the signs may be very mild. They might not even know they have it. But even if the signs of infection go away on their own, the germs are still alive. They can cause serious health problems many years later. 

The first (primary) stage involves the formation of the chancre. At this stage, syphilis is highly contagious. The primary stage can last one to five weeks. The disease can be transmitted from any contact with one of the ulcers, which are teeming with spirochetes. If the ulcer is outside of the vagina or on the scrotum, the use of condoms may not help in preventing transmission. Likewise, if the ulcer is in the mouth, merely kissing the infected individual can spread syphilis. Even without treatment, the early infection resolves on its own in most women. 

In men, the first sign of syphilis may be a sore on the penis. In women, the first sign may be a sore around or inside the vagina. One might not even notice the sore, because syphilis sores don't hurt. The sores go away after three to six weeks. 

Twenty five percent of cases will proceed to the secondary stage of syphilis, which lasts four to six weeks. This phase can include hair loss; a sore throat; white patches in the nose, mouth, and vagina; fever; headaches; and a skin rash. There can be lesions on the genitals that look like genital warts, but are caused by spirochetes rather than the wart virus. These wart-like lesions, as well as the skin rash, are highly contagious. The rash can occur on the palms of the hands, and the infection can be transmitted by casual contact. 

If syphilis is not treated early, it spreads from the sore into the bloodstream. When syphilis gets into blood, it can cause many problems. The most common sign is a rash. The rash may show up, often on the palms of the hands or the soles of the feet, from two weeks to two months after the sore appeared. Other signs of syphilis include fever, sore throat and swollen lymph glands. 

The third (tertiary) stage is the final stage of the disease involves the brain and heart, and is usually no longer contagious. At this point, however, the infection can cause extensive damage to the internal organs and the brain, and can lead to death.

After many years, people with syphilis who don't get treatment may begin to have problems in their brain and spinal cord. Syphilis may damage the heart and other organs, too.

What are the causes of Syphilis?

Syphilis is almost always passed through sexual contact. It also can be passed from an infected mother to her baby during pregnancy. 

Syphilis is caused by bacteria called Treponema pallidum. The bacteria can enter the body if you have close contact with an infected sore, normally during vaginal, anal or oral sex or by sharing sex toys. 

It may also be possible to catch syphilis if one is an injecting drug user and shares a needle with somebody who is infected. 

Pregnant women can pass the condition on to their unborn babies, which can cause stillbirth or death of the baby shortly after labor. 

It is extremely rare for syphilis to be spread through blood transfusions as almost all blood transfusions are routinely screened for syphilis.

Diagnosing Syphilis

A blood test can tell for sure if a person has syphilis. Sometimes other tests can show how far the syphilis has spread. For example, a doctor may want to look at spinal fluid to see if the syphilis bacteria have spread to the nervous system. 

Syphilis has several clinical manifestations, making laboratory testing a very important aspect of diagnosis. In North America, many unsuspected cases are discovered by laboratory testing. The etiological agent, Treponema pallidum, cannot be cultured, and there is no single optimal alternative test. 

Serological testing is the most frequently used approach in the laboratory diagnosis of syphilis.

What are the treatment options for Syphilis?

Primary and secondary syphilis can be successfully treated with a single dose of penicillin, which is given as an injection into the buttocks. If allergic, one will be prescribed anotherantibiotic alternative in tablet form. 

Later stages of the disease need to be treated with three penicillin injections, which are given at weekly intervals. 

Some of the antibiotics used to treat syphilis can adversely affect methods of contraception that contain the hormones oestrogen and progestogen, such as the combined pill or contraceptive patch. Tell a doctor or nurse if using these methods of contraception so they can advise on additional contraceptive methods to protect from pregnancy.

Preventing Syphilis

Prevention measures include seeking regular medical care throughout a lifetime. Regular medical care allows a health care professional to best evaluate a person's individual risks of catching syphilis and regularly test for the disease. These measures greatly increase the chances of catching and curing syphilis in its earliest stage before serious complications occur. 

Other preventive measures include abstaining from sexual activity or having sex only within a mutually monogamous relationship in which neither partner is infected with syphilis or another sexually transmitted disease. Latex condoms also provide some protection when used properly.

What Is Gonorrhea? What Causes Gonorrhea?

Gonorrhea (from Late Latin gonorrhoia where gonos means "seed" and rhoe means "flow") is a sexually transmitted bacterial infection that tends to attack the mucous membranes of the body. It is the second most common sexually transmitted diseasein the U.S.; the first being Chlamydia. The bacteria reside in the warm and moist body cavities of both men and women and are highly contagious. Gonorrhea is the most common cause of female infertility and is also known as "the clap" or "the drip". Only a fraction of women infected with the disease show any symptoms, leaving them unaware of their condition. If left untreated, gonorrhea patients can develop pelvic inflammatory disease or PID (women), or aninflammation of the epididymis, prostate gland, or urethral structure (men), all of which are far more difficult to treat.

What causes gonorrhea?

Gonorrhea is caused by the growth and proliferation of the bacteria Neisseria gonorrhoeae. The disease can survive in the eye, rectum, mouth, penis, throat, or vagina. This means that it can be transmitted through any variety of sexual contact. 
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Once infected, a person runs a high risk of spreading the bacteria to other parts of their body. For instance, someone with gonorrhea may rub his or her eye, inadvertently spreading the infection and elongating the treatment period. The infection can also be spread from mothers to babies during childbirth.

Who is at risk of getting gonorrhea?

Any sexually active person can become infected with gonorrhea. Rates of infection are highest among teenagers and young adults between the ages of 15 and 29. Those who have been diagnosed with and treated for gonorrhea in the past have no resistance to the bacteria.

What are the symptoms of gonorrhea?

Symptoms of gonorrhea, usually appearing between two and ten days after exposure, can take up to 30 days to occur and are sometimes so mild they are mistaken for something else. Most women with gonorrhea show no symptoms. In men, the symptoms include:

• Yellow, green, or white discharge from the penis
• Testicular swelling and/or pain
• Burning during urination

Women may experience:

• Yellow, green, or white vaginal discharge
• Pain or burning during urination
• Pain in the pelvic region
• Conjunctivitis (pink-eye)
• Irregular bleeding (between periods)
• Vulvitis (swelling of the vulva)
• Spotting after intercourse

The infection, if spread to the rectum, can cause anal itching, anal discharge, and painful bowel movements. Gonorrhea, as a result of oral sex, can also occur in the throat, characterized by burning sensations and swollen glands. Many women with gonorrhea interpret the symptoms as those of a yeast infection due to the vaginal discharge.

How is gonorrhea diagnosed?

If you suspect that you have gonorrhea, a professional health care worker can take a sample of discharge from the urethra (men) or cervix (women) and use it to conduct laboratory tests. Throat and anal cultures may also be taken if any symptoms suggest a spreading infection. Due to the large amount of cases in which the two occur together, the samples will be tested for both gonorrhea and Chlamydia in a laboratory. It often takes a few days for the test results to be reported. A urine test can also be done that checks for the presence of the bacteria responsible for gonorrhea.

How is gonorrhea treated?

Because gonorrhea is a bacterial infection, it can be treated with antibiotics. Antibiotics for the infection can be taken orally or via injection. It is important that the patient does not engage in sexual interactions until he/she has finished all of the prescribed treatment. Feeling better does not always mean that the infection is gone. Medical professionals will advise that any infected person notify everyone with whom they have had relations with in the past month about the infection.

How can gonorrhea be prevented?

Using a condom every time you have sex reduces your chance of contracting gonorrhea. Bacterial infections such as gonorrhea are more common among the promiscuous. If you have even the slightest inclination that you or your partner may be infected with gonorrhea, abstain from sex until consulting with a medical professional. 

What Is Tuberculosis? What Causes Tuberculosis?

Tuberculosis (TB) is an infectious disease that is caused by a bacterium calledMycobacterium tuberculosis. TB primarily affects the lungs, but it can also affect organs in the central nervous system, lymphatic system, and circulatory system among others. The disease was called "consumption" in the past because of the way it would consume from within anyone who became infected.

According to Medilexicon`s medical dictionary, tuberculosis is "A specific disease caused by infection withMycobacterium tuberculosis, the tubercle bacillus, which can affect almost any tissue or organ of the body, the most common site of the disease being the lungs."

When a person becomes infected with tuberculosis, the bacteria in the lungs multiply and cause pneumonia along with chest pain, coughing up blood, and a prolonged cough. In addition, lymph nodes near the heart and lungs become enlarged. As the TB tries to spread to other parts of the body, it is often interrupted by the body's immune system. The immune system forms scar tissue or fibrosis around the TB bacteria, and this helps fight the infection and prevents the disease from spreading throughout the body and to other people. If the body's immune system is unable to fight TB or if the bacteria breaks through the scar tissue, the disease returns to an active state with pneumonia and damage to kidneys, bones, and the meninges that line the spinal cord and brain. 

TB is generally classified as being either latent or active. Latent TB occurs when the bacteria are present in the body, but this state is inactive and presents no symptoms. Latent TB is also not contagious. Active TB is contagious and is the condition that can make you sick with symptoms. 

TB is a major cause of illness and death worldwide, especially in Africa and Asia. Each year the disease kills almost 2 million people. The disease is also prevalent among people with HIV/AIDS.

What causes tuberculosis?

Tuberculosis is ultimately caused by the Mycobacterium tuberculosis that is spread from person to person through airborne particles. It is not guaranteed, though, that you will become infected with TB if you inhale the infected particles. Some people have strong enough immune systems that quickly destroy the bacteria once they enter the body. Others will develop latent TB infection and will carry the bacteria but will not be contagious and will not present symptoms. Still others will become immediately sick and will also be contagious.

What are the symptoms of tuberculosis?

Most people who become infected with the bacteria that cause tuberculosis actually do not present symptoms of the disease. However, when symptoms are present, they include unexplained weight loss, tiredness, fatigue, shortness of breath, fever, night sweats, chills, and a loss of appetite. Symptoms specific to the lungs include coughing that lasts for 3 or more weeks, coughing up blood, chest pain, and pain with breathing or coughing.

How is tuberculosis diagnosed?

Tuberculosis diagnosis usually occurs after a combination of skin, blood, and imaging tests. 

A little talk about Tuberculosis

• Tuberculosis (TB) is an infection, primarily in the lungs (a pneumonia), caused by bacteria calledMycobacterium tuberculosis. It is spread usually from person to person by breathing infected air during close contact.
• TB can remain in an inactive (dormant) state for years without causing symptoms or spreading to other people.
• When the immune system of a patient with dormant TB is weakened, the TB can become active (reactivate) and cause infection in the lungs or other parts of the body.
• The risk factors for acquiring TB include close-contact situations, alcohol and IV drug abuse, and certain diseases (for example, diabetes, cancer, and HIV) and occupations (for example, health-care workers).
• The most common symptoms and signs of TB are fatigue, fever, weight loss, coughing, and night sweats.
• The diagnosis of TB involves skin tests, chest X-rays, sputum analysis (smear and culture), and PCRtests to detect the genetic material of the causative bacteria.
• Inactive tuberculosis may be treated with an antibiotic, isoniazid (INH), to prevent the TB infection from becoming active.
• Active TB is treated, usually successfully, with INH in combination with one or more of several drugs, including rifampin (Rifadin), ethambutol (Myambutol), pyrazinamide, and streptomycin.
• Drug-resistant TB is a serious, as yet unsolved, public-health problem, especially in Southeast Asia, the countries of the former Soviet Union, Africa, and in prison populations. Poor patient compliance, lack of detection of resistant strains, and unavailable therapy are key reasons for the development of drug-resistant TB.
• The occurrence of HIV has been responsible for an increased frequency of tuberculosis. Control of HIV in the future, however, should substantially decrease the frequency of TB.

Candida

Candida is a genus of yeasts. Many species are harmless commensals or endosymbionts of hosts including humans, but other species, or harmless species in the wrong location, can cause disease. Candida albicanscan cause infections (candidiasis or thrush) in humans and other animals, especially in immunocompromisedpatients. In winemaking, some species of Candida can create potential faults in wines.

Laboratory characteristics: Grown in the laboratory, Candida appears as large, round, white or cream (albicans is from Latin meaning 'whitish') colonies with a yeasty odor on agar plates at room temperature. C. albicans ferments glucose and maltose to acid and gas, sucrose to acid, and does not ferment lactose, which help to distinguish it from other Candida species.

Clinical characteristics: Candida are almost universal on normal adult skin and albicans is part of the normal flora of the mucous membranes of the respiratory, gastrointestinal, and female genital tracts which cause no disease.

But overgrowth of several species including albicans can cause superficial infections such as oropharyngeal candidiasis (thrush) and vulvovaginal candidiasis (vaginal candidiasis). Oral candidiasis is common in elderly denture wearers. In otherwise healthy individuals, these infections can be cured with topical or systemic antifungal medications (commonly over-the-counter treatments like miconazole or clotrimazole). In debilitated or immunocompromised patients, or if introduced intravenously, candidiasis may become a systemic disease producing abscess, thrombophlebitis, endocarditis, or infections of the eyes or other organs. Colonization of the gastrointestinal tract by C. albicans after antibiotic therapy usually causes no symptoms and may also result from taking antacids or antihyperacidity drugs.

Candida symptoms: Once Candida proliferates in the body, it wrecks havoc in many ways and is the initiator of many common maladies, conditions, syndromes and illnesses in our population.

Some of the most frequent Candida symptoms are:

• abdominal gas and bloating
• headaches
• migraines
• excessive fatigue
• cravings for alcohol
• anxiety
• vaginitis
• rectal itching
• cravings for sweets
• inability to think clearly or concentrate
• hyperactivity
• mood swings
• diarrhea
• constipation
• hyperactivity
• itching
• acne
• eczema
• depression
• sinus inflammation
• pre-menstrual syndrome
• dizziness
• poor memory
• persistent cough
• earaches
• low sex drive
• muscle weakness
• irritability
• learning difficulties
• sensitivity to fragrances and/or other chemicals
• cognitive impairment
• thrush
• athlete's foot
• sore throat
• indigestion
• acid reflux
• chronic pain

The brain is the organ that is most frequently affected by Candida Symptoms, but it also has profound negative effects on these systems:

• digestive
• nervous
• cardiovascular
• respiratory
• reproductive
• urinary
• endocrine
• lymphatic
• musculoskeletal

Candida symptoms can vary from one person to another and often move back and forth between systems within the same individual.  One day you may experience symptoms in the musculoskeletal system and the next day it could be the digestive system ,etc.

Alternative medicine therapies: Many practitioners of alternative medicine use the term Candida to refer to a complex with broad spectrum of symptoms, the majority of which center around gastrointestinal distress, rashes, sore gums and other miscellaneous symptoms. Candida is accorded responsibility for symptoms as specific as hay fever, as vague as "brain fog" and as common as weight gain or flatulence. These symptoms are attributed by some alternative medicine practitioners to the "overgrowth" of intestinal Candida albicans, which they claim leads to the spread of the yeast to other parts of the body via the digestive tract and bloodstream.

Use of the term Candida in alternative medicine to describe this complex is unassociated with its use in clinical medicine to refer to the fungus that causes vaginal yeast infections and thrush. This can be confusing for patients. No studies have proven that having intestinal candidiasis causes any symptoms of illness.

To treat what they refer to as Candida, some alternative medicine practitioners have recommended avoiding antibiotics, birth control pills, and foods that are high in sugar or yeast, ostensibly to "eliminate excess yeast" in the body. However, there is little clinically valid evidence that these "Candida cleanse" treatments treat intestinal candidiasis effectively, or cure any of the symptoms claimed by the proponents of the hypothesis.

The probiotic Saccharomyces boulardii has been shown to diminish levels of intestinal Candida in mice. This is therefore one of the specific probiotic strains often recommended by alternative medicine practitioners alongside a more general probiotic, for anyone on a "Candida cleanse" or "Candida diet".

A little talk about Pneumonia Part 4

What is the prognosis of pneumonia?

Pneumonia can be a serious and life-threatening infection. This is true especially in the elderly, children, and those who have other serious medical problems, such as COPD, heart disease, diabetes, and certain cancers. Fortunately, with the discovery of many potent antibiotics, most cases of pneumonia can be successfully treated. In fact, pneumonia can usually be treated with oral antibiotics without the need for hospitalization.

REFERENCES:

Hoare, Zara, and Wei Shen Lim. "Pneumonia: Update on Diagnosis and Management." BMJ 332 May 6, 2006: 1077-1079.

Meijvis, Sabine CA, et al. "Dexamethasone and Length of Hospital Stay in Patients With Community-Acquired Pneumonia: A Randomised, Double-Blind, Placebo-Controlled Trial." The Lancet. June 1, 2011. doi:10.1016/S0140-6736(11)60607-7.

United States. Centers for Disease Control and Prevention. "Seasonal Influenza (Flu)." June 3, 2011. <http://www.cdc.gov/flu/weekly/>.

A little talk about Pneumonia Part 3

What are some of the organisms that cause pneumonia? What is the treatment for pneumonia? Can pneumonia be prevented?

The most common cause of a bacterial pneumonia is Streptococcus pneumoniae. In this form of pneumonia, there is usually an abrupt onset of the illness with shaking chills, fever, and production of a rust-colored sputum. The infection spreads into the blood in 20%-30% of cases (known as sepsis), and if this occurs, 20%-30% of these patients die.
Two vaccines are available to prevent pneumococcal disease: the pneumococcal conjugate vaccine (PCV13) and the pneumococcal polysaccharide vaccine (PPV23; Pneumovax). The pneumococcal conjugate vaccine is part of the routine infant immunization schedule in the U.S. and is recommended for all children < 2 years of age and children 2-4 years of age who have certain medical conditions. The pneumococcal polysaccharide vaccine is recommended for adults at increased risk for developing pneumococcal pneumonia including the elderly, people who have diabetes, chronic heart, lung, or kidney disease, those with alcoholism, cigarette smokers, and in those people who have had their spleen removed. This vaccination should be repeated every five to seven years, whereas the flu vaccine is given annually.
Antibiotics often used in the treatment of this type of pneumonia include penicillin, amoxicillin and clavulanic acid (Augmentin, Augmentin XR), and macrolide antibiotics including erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), azithromycin (Zithromax, Z-Max), and clarithromycin (Biaxin). Penicillin was formerly the antibiotic of choice in treating this infection. With the advent and widespread use of broader-spectrum antibiotics, significant drug resistance has developed. Penicillin may still be effective in treatment of pneumococcal pneumonia, but it should only be used after cultures of the bacteria confirm their sensitivity to this antibiotic.
Klebsiella pneumoniae and Hemophilus influenzae are bacteria that often cause pneumonia in people suffering from chronic obstructive pulmonary disease (COPD) or alcoholism. Useful antibiotics in this case are the second- and third-generation cephalosporins, amoxicillin and clavulanic acid, fluoroquinolones (levofloxacin [Levaquin], moxifloxacin-oral [Avelox], and sulfamethoxazole/trimethoprim [Bactrim, Septra]).
Mycoplasma pneumoniae is a type of bacteria that often causes a slowly developing infection. Symptoms include fever, chills, muscle aches, diarrhea, and rash. This bacterium is the principal cause of many pneumonias in the summer and fall months, and the condition often referred to as "atypical pneumonia." Macrolides (erythromycin, clarithromycin, azithromycin, and fluoroquinolones) are antibiotics commonly prescribed to treat Mycoplasma pneumonia.
Legionnaire's disease is caused by the bacterium Legionella pneumoniae that is most often found in contaminated water supplies and air conditioners. It is a potentially fatal infection if not accurately diagnosed. Pneumonia is part of the overall infection, and symptoms include high fever, a relatively slow heart rate, diarrhea, nausea, vomiting, and chest pain. Older men, smokers, and people whose immune systems are suppressed are at higher risk of developing Legionnaire's disease. Fluoroquinolones (see above) are the treatment of choice in this infection. This infection is often diagnosed by a special urine test looking for specific antibodies to the specific organism.
Mycoplasma, Legionnaire's, and another infection, Chlamydia pneumoniae, all cause a syndrome known as "atypical pneumonia." In this syndrome, the chest X-ray shows diffuse abnormalities, yet the patient does not appear severely ill. In the past, this condition was referred to as "walking pneumonia," a term that is rarely used today. These infections are very difficult to distinguish clinically and often require laboratory evidence for confirmation.
Recently, a study performed in the Netherlands demonstrated that adding a steroid medication, dexamethasone (Decadron), to antibiotic therapy shortens the duration of hospitalization. This medication should be used with caution in patients whom are critically ill or already have a compromised immune system.
Pneumocystis carinii (now known as Pneumocystis jiroveci) pneumonia is another form of pneumonia that usually involves both lungs. It is seen in patients with a compromised immune system, either from chemotherapy for cancer, HIV/AIDS, and those treated with TNF (tumor necrosis factor), such as for rheumatoid arthritis. Once diagnosed, it usually responds well to sulfa-containing antibiotics. Steroids are often additionally used in more severe cases.
Viral pneumonias do not typically respond to antibiotic treatment. These infections can be caused by adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and parainfluenza virus (that also causes croup). These pneumonias usually resolve over time with the body's immune system fighting off the infection. It is important to make sure that a bacterial pneumonia does not secondarily develop. If it does, then the bacterial pneumonia is treated with appropriate antibiotics. In some situations, antiviral therapy is helpful in treating these conditions. More recently, H1N1, swine-origin influenza A, has been associated with very severe pneumonia often resulting in respiratory failure. This disease often requires the use of mechanical ventilation for breathing support. Death is not uncommon when this infection involves the lungs.
Fungal infections that can lead to pneumonia include histoplasmosis, coccidiomycosis, blastomycosis, aspergillosis, and cryptococcosis. These are responsible for a relatively small percentage of pneumonias in the United States. Each fungus has specific antibiotic treatments, among which are amphotericin B, fluconazole (Diflucan), penicillin, and sulfonamides.
Major concerns have developed in the medical community regarding the overuse of antibiotics. Most sore throats and upper respiratory infections are caused by viruses rather than bacteria. Though antibiotics are ineffective against viruses, they are often prescribed. This excessive use has resulted in a variety of bacteria that have become resistant to many antibiotics. These resistant organisms are commonly seen in hospitals and nursing homes. In fact, physicians must consider the location when prescribing antibiotics (community-acquired pneumonia, or CAP, versus hospital-acquired pneumonia, or HAP).
The more virulent organisms often come from the health-care environment, either the hospital or nursing homes. These organisms have been exposed to a variety of the strongest antibiotics that we have available. They tend to develop resistance to some of these antibiotics. These organisms are referred to as nosocomial bacteria and can cause what is known as nosocomial pneumonia when the lungs become infected.
Recently, one of these resistant organisms from the hospital has become quite common in the community. In some communities, up to 50% of Staph aureus infections are due to organisms resistant to the antibiotic methicillin. This organism is referred to as MRSA (methicillin-resistant Staph aureus) and requires special antibiotics when it causes infection. It can cause pneumonia but also frequently causes skin infections. In many hospitals, patients with this infection are placed in contact isolation. Their visitors are often asked to wear gloves, masks, and gowns. This is done to help prevent the spread of this bacteria to other surfaces where they can inadvertently contaminate whatever touches that surface. It is therefore very important to wash your hands thoroughly and frequently to limit further spread of this resistant organism. The situation with MRSA continues to evolve. The community-acquired strain of MRSA tends to be responsive to some of the more commonly used antibiotics whereas the hospital-acquired strains require stronger, more aggressive antibiotic therapies. As this evolution occurs, patients are arriving in the hospital with the community-acquired strains as well as a previous hospital-acquired strain. This further necessitates performing bacterial cultures to determine the best course of action.

A little talk about Pneumonia Part 2

How is pneumonia diagnosed?

Pneumonia may be suspected when the doctor examines the patient and hears coarse breathing or crackling sounds when listening to a portion of the chest with a stethoscope. There may be wheezing or the sounds of breathing may be faint in a particular area of the chest. A chest X-ray is usually ordered to confirm the diagnosis of pneumonia. The lungs have several segments referred to as lobes, usually two on the left and three on the right. When the pneumonia affects one of these lobes, it is often referred to as lobar pneumonia. Some pneumonias have a more patchy distribution that does not involve specific lobes. In the past, when both lungs were involved in the infection, the term "double pneumonia" was used. This term is rarely used today.

Sputum samples can be collected and examined under the microscope. Pneumonia caused by bacteria or fungi can be detected by this examination. A sample of the sputum can be grown in special incubators, and the offending organism can be subsequently identified. It is important to understand that the sputum specimen must contain little saliva from the mouth and be delivered to the laboratory fairly quickly. Otherwise, overgrowth of noninfecting bacteria from the mouth may predominate. As we have used antibiotics in a broader uncontrolled fashion, more organisms are becoming resistant to the commonly used antibiotics. These types of cultures can help in directing more appropriate therapy.

A blood test that measures white blood cell count (WBC) may be performed. An individual's white blood cell count can often give a hint as to the severity of the pneumonia and whether it is caused by bacteria or a virus. An increased number of neutrophils, one type of WBC, is seen in most bacterial infections, whereas an increase in lymphocytes, another type of WBC, is seen in viral infections, fungal infections, and some bacterial infections (like tuberculosis).


Bronchoscopy is a procedure in which a thin, flexible, lighted viewing tube is inserted into the nose or mouth after a local anesthetic is administered. Using this device, the doctor can directly examine the breathing passages (trachea and bronchi). Simultaneously, samples of sputum or tissue from the infected part of the lung can be obtained.
Sometimes, fluid collects in the pleural space around the lung as a result of the inflammation from pneumonia. This fluid is called a pleural effusion. If a significant amount of fluid develops, it can be removed. After numbing the skin with local anesthetic a needle is inserted into the chest cavity and fluid can be withdrawn and examined under the microscope. This procedure is called a thoracentesis. Often ultrasound is used to prevent complications from this procedure. In some cases, this fluid can become severely inflamed (parapneumonic effusion) or infected (empyema) and may need to be removed by more aggressive surgical procedures. Today, most often, this involves surgery through a tube or thoracoscope. This is referred to as video-assisted thoracoscopic surgery or VATS.

A little talk about Pneumonia Part 1

Pneumonia facts

• Pneumonia is a lung infection that can be caused by different types of microorganisms, including bacteria, viruses, and fungi.
• Symptoms of pneumonia include cough with sputum production, fever, and sharp chest pain on inspiration (breathing in).
• Pneumonia is suspected when a doctor hears abnormal sounds in the chest, and the diagnosis is confirmed by a chest X-ray.
• Bacteria causing pneumonia can be identified by sputum culture.
• A pleural effusion is a fluid collection around the inflamed lung.
• Bacterial and fungal (but not viral) pneumonia can be treated with antibiotics.

What is pneumonia?

Pneumonia is an infection of one or both lungs which is usually caused by bacteria, viruses, or fungi. Prior to the discovery of antibiotics, one-third of all people who developed pneumonia subsequently died from the infection. Currently, over 3 million people develop pneumonia each year in the United States. Over a half a million of these people are admitted to a hospital for treatment. Although most of these people recover, approximately 5% will die from pneumonia. Pneumonia is the sixth leading cause of death in the United States.

How do people "catch pneumonia"?

Some cases of pneumonia are contracted by breathing in small droplets that contain the organisms that can cause pneumonia. These droplets get into the air when a person infected with these germs coughs or sneezes. In other cases, pneumonia is caused when bacteria or viruses that are normally present in the mouth, throat, or nose inadvertently enter the lung. During sleep, it is quite common for people to aspirate secretions from the mouth, throat, or nose. Normally, the body's reflex response (coughing back up the secretions) and their immune system will prevent the aspirated organisms from causing pneumonia. However, if a person is in a weakened condition from another illness, a severe pneumonia can develop. People with recent viral infections, lung disease, heart disease, and swallowing problems, as well as alcoholics, drug users, and those who have suffered a stroke or seizure are at higher risk for developing pneumonia than the general population. As we age, our swallowing mechanism can become impaired as does our immune system. These factors, along with some of the negative side effects of medications, increase the risk for pneumonia in the elderly.

Once organisms enter the lungs, they usually settle in the air sacs and passages of the lung where they rapidly grow in number. This area of the lung then becomes filled with fluid and pus (the body's inflammatory cells) as the body attempts to fight off the infection.

What are pneumonia symptoms and signs?

Most people who develop pneumonia initially have symptoms of a cold (upper respiratory infection, for example, sneezing, sore throat, cough), which are then followed by a high fever (sometimes as high as 104 F), shaking chills, and a cough with sputum production. The sputum is usually discolored and sometimes bloody. Depending on the location of the infection, certain symptoms are more likely to develop. When the infection settles in the air passages, cough and sputum tend to predominate the symptoms. In some, the spongy tissue of the lungs that contain the air sacs is more involved. In this case, oxygenation of the blood can be impaired, along with stiffening of the lung, which results in shortness of breath. At times, the individual's skin color may change and become dusky or purplish (a condition known as "cyanosis") due to their blood being poorly oxygenated.

The only pain fibers in the lung are on the surface of the lung, in the area known as the pleura. Chest pain may develop if the outer aspects of the lung close to the pleura are involved in the infection. This pain is usually sharp and worsens when taking a deep breath and is known as pleuritic pain or pleurisy. In other cases of pneumonia, depending on the causative organism, there can be a slow onset of symptoms. A worsening cough, headaches, and muscle aches may be the only symptoms.

Children and babies who develop pneumonia often do not have any specific signs of a chest infection but develop a fever, appear quite ill, and can become lethargic. Elderly people may also have few symptoms with pneumonia.