Pneumonia - Adults (Community Acquired) : Causes, Incidence, and Risk Factors
Pneumonia - Adults (Community Acquired) : Causes, Incidence, and Risk Factors
Pneumonia is a breathing (respiratory) condition in which there is an infection of the lung. This article covers pneumonia in people who have not recently been in the hospital or another health care facility (nursing home or rehab facility). This type of pneumonia is called community-acquired pneumonia, or CAP. See also: Hospital-acquired pneumonia
Pneumonia caused by bacteria tends to be the most serious kind. In adults, bacteria are the most common cause of pneumonia. The most common pneumonia-causing germ in adults is Streptococcus pneumoniae (pneumococcus). Atypical pneumonia, often called walking pneumonia, is caused by certain other bacteria. Pneumocystis jiroveci pneumonia is sometimes seen in people whose immune system is not working well.
Many other bacteria can also cause pneumonia. Viruses are also a common cause of pneumonia, especially in infants and young children. Risk factors that increase your chances of getting pneumonia include: Chronic lung disease (COPD, bronchiectasis, cystic fibrosis) Cigarette smoking Dementia, stroke, brain injury, cerebral palsy, or other brain disorders Immune system problem (during cancer treatment or due to HIV/AIDS or organ transplant) Other serious illnesses, such as heart disease, liver cirrhosis, or diabetes mellitus Recent surgery or trauma Surgery to treat cancer of the mouth, throat, or neck
Symptoms
The most common symptoms of pneumonia are: Cough (with some pneumonias you may cough up greenish or yellow mucus, or even bloody mucus) Fever, which may be mild or high Shaking chills Shortness of breath (may only occur when you climb stairs)
Excess sweating and clammy skin Headache Loss of appetite, low energy, and fatigue Sharp or stabbing chest pain that gets worse when you breathe deeply or cough
Less often patients may need: Bronchoscopy--a flexible tube with a lighted camera on the end passed down to your lungs Thoracentesis--removing fluid from the space between the outside lining of the lungs and the chest wall
Treatment
Your doctor must first decide whether you need to be in the hospital. If you are treated in the hospital, you will receive: Fluids and antibiotics in your veins Oxygen therapy Breathing treatments (possibly)
It is very important that you are started on antibiotics very soon after you are admitted (unless you have viral pneumonia). You are more likely to be admitted to the hospital if you: Have another serious medical problem Have severe symptoms Are unable to care for yourself at home, or are unable to eat or drink Are older than 65 or a young child Have been taking antibiotics at home and are not getting better
However, many people can be treated at home. Your doctor may tell you to take antibiotics. Antibiotics help some people with pneumonia get better. Don't miss any doses. Take the medicine until it is gone, even if you start to feel better. Do NOT take cough medicine or cold medicine unless your doctor says it is okay. Coughing helps your body get rid of mucus from your lungs.
Breathing warm, moist (wet) air helps loosen the sticky mucus that may make you feel like you are choking. These things may help: Place a warm, wet washcloth loosely over your nose and mouth. Fill a humidifier with warm water and breathe in the warm mist.
Take a couple of deep breaths two or three times every hour. Deep breaths will help open up your lungs. Tap your chest gently a few times a day and lie with your head lower than your chest. This can help bring up mucus from the lungs.
Drink plenty of liquids (as long as your health care provider says it is okay): Drink water, juice, or weak tea Drink at least 6 to 10 cups a day Do NOT drink alcohol
Get plenty of rest when you go home. If you have trouble sleeping at night, take naps during the day.
Expectations (prognosis)
With treatment, most patients will improve within 2 weeks. Elderly or very sick patients may need longer treatment. Those who may be more likely to have complicated pneumonia include: Older adults or very young children People whose immune system does not work well People with other, serious medical problems such as diabetes or cirrhosis of the liver
In rare cases, more severe problems may develop, including: Life-threatening changes in the lungs that require a breathing machine Fluid around the lung (pleural effusion) Lung abscesses
Your doctor may want to make sure your chest x-ray becomes normal again after you are treated. However, it may take many weeks for your x-ray to clear up.
Prevention
Wash your hands often, especially after: Blowing your nose Going to the bathroom Diapering
Don't smoke. Tobacco damages your lung's ability to ward off infection. Vaccines may help prevent some types of pneumonia. They are even more important for the elderly and people with diabetes, asthma, emphysema, HIV, cancer, or other long-term conditions: Flu vaccine prevents pneumonia and other problems caused by the influenza virus. It must be given each year to protect against new virus strains. Pneumococcal vaccine (Pneumovax, Prevnar) lowers your chances of getting pneumonia from Streptococcus pneumoniae.
If you have cancer or HIV, talk to your doctor about ways to prevent pneumonia and other infections.
References
1. 2. 3. 4. Centers for Disease Control and Prevention. Recommended adult immunization schedule--United States, 2012. MMWR. 2012;61(4) Limper AH. Overview of pneumonia. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier;2011:chap 97. Niederman M. In the clinic. Community-acquired pneumonia. Ann Intern Med. 2009;151(7). Torres A, Menandez R, Wunderink R. Pyogenic bacterial pneumonia and lung abscess. In: Mason RJ, Broaddus VC, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 32.
Review Date: 5/29/2012. Reviewed 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. Health Solutions, Ebix, Inc.
A.D.A.M., Disclaimer PARA AORTIC LYMPHADENOPATHY The Para-aortic lymph nodes also known as Para-aortic, and Peri-aortic, are a group of lymph nodes that lie in front of the lumbar vertebral bodies near the aorta. Theselymph nodes receive drainage from the lower gastrointestinal tract and the pelvicorgans. Para-aortic Lymphadenopathy is an enlargement in the size of the lymph nodes which are near the aorta. The aorta is defined as the largest blood vessel. Its main function is to transports blood out of the heart to the rest of the body. There are many causes for Para-aortic lymphadenopathy. Para-aortic lymphadenopathy is a condition which can either be caused by inflammation of the aorta, infection in the aorta or cancer in the aorta cells. Generally cancers in the aorta are benign and the simplest way of treating them is surgery, which may include a heart transplant, as well as chemotherapy. Chemotherapy is the treatment of cancer with an anti-neoplastic drug or with a combination of such drugs into a standardized treatment regimen. Most commonly, chemotherapy acts by killing cells that divide rapidly, which is one of the main properties of most cancer cells. This means that it also harms cells that divide rapidly under normal circumstances such as cells in the bone marrow, digestive tract and hair follicles; this results in the most common side effects of chemotherapy: Myelosuppression, decreased production of blood cells, hence also immunosuppressant, mucositis, inflammation of the lining of the digestive tract, and alopecia hair loss. Inflammation of the aorta can be caused by an aortic aneurysm and is one of the conditions that gets a lot of media attention because they are asymptomatic until they burst. The treatment for this depends on the inflammation of the aorta. If it is bigger than a size of 5.5cm this typically requires surgery, dependent on other conditions. While below this point, treatment tends to be to simply monitor it as aortic aneurysms smaller than 5.5cm have a low incidence rate of rupture. Finally a person with Para-aortic lymphadenopathy should have no problem what so ever with conceiving, though it is advised that you discuss it with your doctor as in the long term it could have an effect on your condition.
What is ascites?
Ascites is the accumulation of fluid (usually serous fluid which is a pale yellow and clear fluid) in the abdominal (peritoneal) cavity. The abdominal cavity is located below the chest cavity, separated from it by the diaphragm. Ascitic fluid can have many sources such as liver disease, cancers,congestive heart failure, or kidney failure.
Ascites related to portal hypertension (cirrhosis, congestive heart failure, Budd-Chiari) is generally greater than 1.1.
may be legally considered "alcohol abuse," depending on local laws. Heavy alcohol abuse can cause physical damage and death. Amylase: An enzyme produced in the pancreas and salivary glands that helps in the digestion of starches. Elevation of blood amylase is common inpancreatitis. Analysis: A psychology term for processes used to gain understanding of complex emotional or behavioral issues. Anesthesia: Loss of feeling or awareness. A general anesthetic puts the person to sleep. A local anesthetic causes loss of feeling in a part of the body such as a tooth or an area of skin without affecting consciousness. Regional anesthesia numbs a larger part of the body such as a leg or arm, also without affecting consciousness. The term "conduction anesthesia" encompasses both local and regional anesthetic techniques. Many surgical procedures can be done with conduction anesthesia without significant pain. In many situations, such as a C-section, conduction anesthesia is safer and therefore preferable to general anesthesia. However, there are also many types of surgery in which general anesthesia is clearly appropriate. Ascites: Abnormal buildup of fluid in the abdomen. Ascites can occur as a result of a number of conditions, including severe liver disease and the presence of malignant cells within the abdomen. Bacteria: Single-celled microorganisms which can exist either as independent (free-living) organisms or as parasites (dependent upon another organism for life). See the entire definition of Bacteria