Pneumonia is a serious infection of the lungs in which the air Bacterial pneumonia often develops when bacteria normally

sacs fill with fluid and pus, preventing the lungs from functioning present in the throat begin damaging tissue that is already
properly. The buildup of fluids prevents the lungs from weakened by a cold, sore throat, or the flu, Streptococcus
performing their two key jobs: to move inhaled oxygen to, and pneumoniae, commonly referred to as pneumococcus (plural,
eliminate carbon dioxide from, the blood stream. When the lungs pneumococci), is one such organism. Some studies suggest that
cannot function, the cells of the body cannot work properly, and up to 25 percent of healthy persons are carriers of pneumococci,
without treatment the patient may die. of which there are more than 80 known types. Staphylococci,
such as Staphylococcus aureus, are a common, and often
Pneumonia can be caused by a wide range of microorganisms. vicious cause of pneumonia in weakened patients who are
Whenever a bacterium or virus invades the lungs, the tissue already in the hospital. Hemophilus influenzae can cause
becomes inflamed and produces fluid in response to the serious pneumonia in children; Legionella pneumonophila, which
invaders. This fluid material—which is called exudate—fills the causes Legionnaires’ disease in middle-aged and elderly
smallest breathing tubes and air sacs of the lungs. When these persons, can also cause pneumonia in those individuals. Any
spaces are filled with fluid, the lungs are said to be congested. form of bacterial pneumonia can develop very rapidly, produce
fever as high as 105 °F (40.5 °C), and cause the patient to
Pneumonia is not a single illness but a large group of infections,
become confused or delirious. Among the possible
each caused by a different organism and featuring its own
complications are pleural effusion, where fluid fills the pleural
typical symptoms, course, and outcome. Most often the
cavity that surrounds the lungs; empyema, in which pus fills the
organism is breathed directly into the lungs, but it sometimes is
spaces surrounding the lungs; or an abscess, which is a self-
carried there by the blood flowing through the vessels of the
contained, or walled-off, cavity that is filled with pus. All of these
lungs. In other instances, the organism may arise from a nearby
complications cause problems, though an abscess in the lungs
infection—for example, an infection of the trachea or the chest
is particularly hard to eliminate.
wall. An infection of the pleura—the membrane covering the
lungs—can also reach the lungs themselves. Viral pneumonia probably accounts for half of all pneumonia
cases. Viral causes of pneumonia are increasingly being
Up to the mid-1930s pneumonia was the leading cause of death
identified, but most of these pneumonias last only a short time
in the United States. The discovery of penicillin, sulfa drugs, and
and have no serious after-effects. The influenza virus is an
other antibiotics did much to control the disease, but pneumonia
exception. It often produces severe pneumonia and has caused
and influenza together still rank as the sixth most common cause
large numbers of deaths in periodic epidemics. The measles
of death in the United States. About two million Americans
virus can also cause pneumonia, especially in poorly nourished
develop pneumonia each year, and between 40,000 and 70,000
children.
of them die as a result. Many of these are elderly persons or
patients with some serious underlying illness that makes them Other forms of pneumonia are caused by yeasts, protozoa, or
vulnerable to pneumonia. Many of those who die of pneumonia fungi such as Pneumocystis jiroveci (formerly known as P.
do so after contracting it in the hospital, where the infection can carinii), which is frequently seen in AIDS patients. Mycoplasma,
spread rapidly to the weakest patients, who are unable to fight it an organism in between a bacterium and virus, causes a specific
off. type of “walking pneumonia” in children where attacks of violent
coughing are accompanied by a sore throat and headaches. It
Cigarette smokers and those who abuse alcohol are at special
also is possible for pneumonia to develop without infection when
risk of getting pneumonia. The same is true for people with
a patient accidentally inhales, or aspirates, food, liquid, or dust
diabetes, heart failure, or chronic lung disease, which itself
into the lungs; this is called aspiration pneumonia.
makes it hard to get enough oxygen into the blood. Anyone who
is bedridden, unconscious, or paralyzed is at risk, as are patients To diagnose pneumonia, the doctor will usually take a chest X-
with conditions (such as AIDS) that weaken the immune system. ray of the patient, as well as a blood sample and a sputum or
Pneumonia can be a major problem in nursing homes and other mucus sample. In the blood sample, the doctor is looking for an
chronic care facilities. increased number of leukocytes, or white blood cells. The
sputum sample is cultured in an attempt to identify the organism
Depending on what organism causes pneumonia, the incubation
causing the illness. In up to half of all cases, however, the
period—that is, the time between actual infection and the first
organism is never identified. Early treatment with an effective
symptoms of the illness—can range from as little as 18 hours
antibiotic usually cures bacterial pneumonia within one to two
(for pneumonia caused by the influenza virus) to five to six days.
weeks, especially in younger and generally healthy patients.
Many patients suddenly become quite ill two to three days after
Some patients may need oxygen or anticough medication in
a cold or upper respiratory infection. The severity of the
addition. Antiviral drugs are available to treat those viral
symptoms depends on the type of infecting organism as well as
pneumonias that do not run their course. Some types of
the age and general condition of the patient. The amount of lung
pneumonia such as that caused by Mycoplasma pneumoniae
involvement is also a factor. Lobar pneumonia involves a single
may last as long as four to six weeks.
lobe (perhaps one-third) of one lung, whereas
bronchopneumonia, a more serious form, can affect small or The bacteria and viruses that cause pneumonia are contagious.
large areas throughout both lungs. Typically a patient develops They are spread from the mouth, nose, or throat of an infected
fever and chills, becomes short of breath with little effort, and person when sneezing or coughing, or by used tissues, drinking
begins coughing. The cough may be dry or it can produce thick, glasses, or eating utensils. Bacterial resistance to antibiotics is
yellow-green phlegm (sputum) or even blood. becoming an ever more serious problem. Some bacteria—
notably staphylococci, but others as well—develop a resistance
Children with pneumonia often make grunting or wheezing
to antibiotics and therefore are not killed by them. Researchers
sounds when they breathe. The rib muscles may draw inward
are continually working to develop new antibiotics to deal with
with each breath as the child desperately tries to get more
these highly adaptive bacteria.
oxygen. Loss of appetite, vomiting, and abdominal pain are
frequent symptoms. The lack of oxygen may give a bluish or Vaccines have been developed that can prevent many serious
gray color to the lips and fingernails. Some children, especially pneumonias, including childhood cases caused by Hemophilus
those with viral pneumonia, may have only a fever and rapid and the pneumococcal pneumonias that cause so many serious
breathing. and fatal cases in adults. All persons over age 60 and those
individuals with chronic lung disease are prime candidates to be
vaccinated.