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Stages of Pneumonia and what you need to know about the infection.

In the following reading, we’ll review the stages of pneumonia and everything you need to know about this common respiratory infection. 

Pneumonia is a common, infectious condition that affects the lungs. Worldwide, it affects around 450 million people every year. Also, it is considered a significant cause of death since it’s accountable for approximately 4 million deaths every year. Everyone can get pneumonia, but it dramatically affects children under 5 years old and adults over 75 years old. In the United States, pneumonia is the 8th cause of death. 

Here, you will find the highlights of this condition. All the frequently asked questions, answered by a certified physician. And the best part is that is all put into simple word for your easy understanding. So, we invite you to keep reading if you want to learn more about pneumonia. 

What is pneumonia?

Pneumonia is an infectious disease of the lungs. It can be caused by multiple microorganisms like bacteria, viruses, and fungi. Pneumonia directly affects your alveoli (sac-like structures that make up your lung tissue).

When a person has pneumonia, your alveoli can fill with liquid or pus. This interferes with your lungs passing oxygen to your blood and carbon dioxide out to the environment. This will cause the typical respiratory symptoms of pneumonia, which we’ll discuss later. Also, this can cause difficulty breathing. 

File:Blausen 0994 Pneumonia.png

Pneumonia is a contagious disease since most of the microorganisms cause it to spread from person to person. You can get pneumonia from inhaling airborne droplets from a cough or a sneeze of an infected person. Also, you can get it by having contact with surfaces or objects contaminated with bacteria or viruses. 

Anyone can get pneumonia, but some people can be more affected by the disease than others. Pneumonia can cause mild symptoms to severe symptoms that will get you hospitalized. 

What microorganism causes it?

Pneumonia is an infection by multiple possible microorganisms. It is pretty common to assume that this illness is only by bacteria. But, no, it can be from bacteria, viruses, parasites, fungi, or even some particular bacterial species, “atypical bacteria,” which will be a matter of discussion further.

Although the most common cause of bacterial pneumonia is the classical bacteria, even more, just one bacterium causes the majority of those infections, the Streptococcus pneumoniae. But, pneumococcal pneumonia has seen a decrease throughout the years due to the implementation of a vaccine.

The thoughts on this illness being only a bacterial disease have changed over time. The most common cause of hospitalization due to pneumonia are viruses with rhinovirus and influenza virus as leading causes. Mostly in times of seasonal flu, the influenza virus would probably account for the vast majority of the cases. Nevertheless, there is an extensive list of the possible viruses, all of them similarly implicated in the common cold.

The classification taking into account where the illness arises is fundamental. Community-acquired pneumonia (CAP) includes all lung infections without any recent healthcare exposure by medical visits. It allows foreseeing which microorganism could be on the lung. In contrast, healthcare-associated pneumonia has its own possible set of probable harmful microorganisms.

CAP, when bacterial, typically comes from S pneumoniaeH influenza, and M catarrhalis infection. However, this is continuously changing with new technologies. These days, it es usual to find in 3 of every ten patients a co-infection between bacteria and viruses. On the contrary, healthcare-associated pneumonia has a significant cause, Pseudomonas aeruginosa.

What is healthcare-associated pneumonia?

Patients with close and constant contact with the healthcare system in many forms can develop different and more severe ways of pneumonia.

The close contact with the healthcare system includes any treatment through the vein in the last 30 days, living in a care facility for a long period, a recent visit to an acute-care facility within the precedent 90 days, or outpatient treatment in the preceding 30 days.

What are the risk factors for catching pneumonia?

Anyone can get pneumonia. However, like any other disease, some factors can increase your risk. Also, these factors are taken into account to calculate how likely you are to develop severe pneumonia. 

  • Age: The two groups with higher risk are the children under 2 years old and adults older than 65 years old. 
  • Being in a hospital: Even if you’re hospitalized for another condition, you can get pneumonia. This happens because hospitals are the home for many microorganisms. Usually, the microorganisms that will infect you in a hospital are different from those out of the hospital. Also, ICU patients connected to a ventilator similarly have a higher chance of developing pneumonia. 
  • Already having a respiratory or lung disease: Like chronic obstructive pulmonary disease (COPD).
  • Weakened immune system: Due to conditions like autoimmune disease or certain medications. A weakened immune system is not as effective in fighting infections.
  • People who can’t cough or swallow properly: For example, patients who have had a stroke. This occurs because of instead of swallowing, they can aspirate whatever they’re drinking or eating. When these foreign substances enter the airway, they cause lung infections. Doctors call this aspiration pneumonia. 
  • Certain lifestyle habits: Like smoking, directly affects your lungs. Also, patients with heavy alcohol abuse or malnourishment are more likely to develop all kinds of infections. 
  • Exposure to smoke, certain chemicals, and toxic fumes: All of these can make your airway inflamed and chronically affect your lungs. 

Does the person have an impaired immune system?

The particularity of the patients and their immune systems is critical. The propensity to CAP by any of the possible microorganisms varies, depending on which type of immunity isn’t well-functioning. This immunity susceptibility is a risk factor that requires attention.

For illustrating my point, if a child is less or more than two years, the microorganism causing CAP varies widely. This variation in microorganisms happens because of various immune system functionality changes at certain ages. Furthermore, adults over 65 years are also vulnerable to get CAP.

Patients with human immunodeficiency virus (HIV) that don’t take the medication would experience a T cell reduction within their body. Specifically, one subtype, T CD4+, this cell is core for maintaining the immune system function. Therefore, it is possible to see a classic CAP or another illness rare for the general population in these people but typical for these patients. Fungal pneumonia by Pneumocystis jiroveci, a fungus, is distinctive not only from HIV patients but also from other patients with suppression of their immunity, such as cancer patients receiving chemotherapy and patients with transplants receiving suppression treatment.

The same situation exists for persons who no longer have a spleen. They are keener to develop CAP by “encapsulated bacteria” due to a lack of immune system well-function. Humoral immunity is a critical component of human immunity. A large part of its functions occurs within the spleen. Humoral immunity is in exclusive dedication to producing a particular protein called antibodies that defend specifically from this type of bacteria; therefore, a weakened immune system would expose the patient to recurrent lung infection by this the encapsulated bacteria.

How the infection spreads from person to person?

The mechanisms by which CAP transmits are the same ones for a virus to spread. Both viral and bacterial germs have possibilities for transmission. It mainly occurs through the aspiration of airborne particles from infected people with germs in their nose and throat that cough or sneezes. Also, if people with CAP are in contact with surfaces, the germs can stick to them. And then, when healthy people touch those contaminated surfaces and afterward touch their nose or eyes, they acquire germs.

What are the stages of pneumonia?

There are 4 stages of pneumonia. They are separated by the changes that occur while the lung is infected and your immune system fights the infection. Also, each stage can have different symptoms.

  • Congestion or stage 1: In this stage, your lungs fill up with fluid or pus due to the infection. Thanks to this, you can experience mild symptoms of pneumonia-like coughing and a heavy chest feeling. 
  • Red hepatization or stage 2: Doctors call it like this because, during this stage, the lungs will acquire a red color. This results from the migration of red blood cells and immune cells that go to your lungs. They do this as a mechanism to fight the infection. In this stage, patients can experience worsening the symptoms like increased coughing, shortness of breath, and high fever.
  • Gray hepatization or stage 3: During this stage, symptoms can still persist. This happens because immune cells will stay in your lung tissue. However, red blood cells will already get disintegrated, causing the grayish color of the lungs.
  • Resolution or stage 4: By this time, symptoms will disappear thanks to your immune system and medical treatment. Commonly, the productive cough persists in cleaning your lungs from the excess fluid.

Pneumonia symptoms

The symptoms division would be in the typical and atypical presentation of CAP. Also, CAP can cause complications; therefore, its classification into complicated and non-complicated cases. The variation would utterly depend on the underneath microorganism and its relationship with the vulnerable person. Typically, an overall healthy adult with no exposition to the healthcare system and a well-built immune system, the bacteria acquired would develop a CAP without complications. Still, in rarer instances, this could go further.

Classically, CAP symptoms are high fever, cough, shortness of breath, rapid breathing, and malaise. Besides, the person could be coughing up mucus (of yellow or green color), chest pain, headache, abdominal pain, and signs of low oxygen in the blood due to lung misfunctions. However, this could vary upon the microorganism. These symptoms are the usual manifestation of patients with an uncomplicated CAP.

Get an infection by another bacteria, which is not that uncommon, like Staphylococcus aureus. Usually, a patient with this bacteria is in association with a worse presentation. The symptoms could be a lot worse, to the point of forming a giant abscess within the lung (a large mass of pus) that heightens the difficulty of breathing. The progression of the symptoms in this situation, and the alteration of basic vital signs such as heart and respiratory rate, usually lead the clinician to hospitalize the person for intravenous treatment.

Furthermore, pneumonia can manifest classically or as “atypical pneumonia.” This form of CAP doesn’t display nearly any symptoms, maybe just a mild elevation of the temperature and cough. This infection is by atypical bacteria, such as Mycoplasma pneumoniae. Given the lack of bothering symptoms on this condition, it is known as “walking pneumonia.”

What are the symptoms of walking pneumonia?

Walking pneumonia is a term used to describe mild, uncomplicated pneumonia. Patients with walking pneumonia will probably get outpatient treatment since there are no further complications. However, even complicated cases of pneumonia can have these initial symptoms, so keep an eye on them. The most common pneumonia symptoms include: 

  • Coughing: Most likely productive cough. This is a cough with phlegm or mucus production due to a respiratory infection
  • Fever: It can be high and accompanied by chills and sweating
  • Shortness of breath or breathing rapidly
  • Chest pain: It can typically worsen by coughing or extra effort breathing
  • Tiredness and fatigue
  • Loss of appetite 
  • Headaches

However, the symptoms may vary according to the microorganism causing the infection. For example, a patient can have pneumonia with no fever. This is what doctors call atypical pneumonia since it doesn’t drive all the typical symptoms.

For example, a viral infection can cause pneumonia, but the symptoms will be a little different. This also happens with the symptoms caused by fungal pneumonia. Even bacterial pneumonia can present itself differently according to what is causing it.

Typical pneumonia is mainly caused by a bacteria called streptococcus pneumoniae. In fact, the number one cause for pneumonia is a pneumococcal infection. On the other side, mycoplasma pneumoniae is another bacterium that causes pneumonia but has different symptoms. 

Can you have pneumonia without a fever?

Yes, atypical pneumonia can exist without fever and only mild symptoms like a cough. That is why a complete assessment, including auscultation by your medical doctor and a chest X-ray, is always a recommendation.

What color mucus is from pneumonia?

The color of phlegm or mucus may vary in different cases of pneumonia. The mucus present in pneumonia can go from clear to yellow/green or even brown or pink in some cases.

Sometimes, the color of the mucus can orientate the diagnosis to what’s causing the infection. So, don’t be shy to describe your mucus to your doctor. Most of the time, a clear mucus corresponds to viral infections. On the other side, yellow/green mucus is commonly seen in bacterial infections. Finally, pink phlegm can be this color because of the presence of blood in it. This can happen because of a severe infection or even lung cancer. 

Can a cold of flu turn into pneumonia?

The vast set of viruses implicated in the common cold similarly can cause CAP. It is unlikely to see a common cold progressing from the upper airway to the inferior part until it converts into a full pneumonia infection, though. What, indeed, is a very common case. It is to see after a viral infection like the common cold or the fluA new bacterial infection in the lungs produces bacterial pneumonia.

What are the complications of pneumonia?

Pneumonia can cause several complications if not treated early. Also, these complications are more common in patients with weakened immune systems and patients who suffer from chronic conditions. The most common pneumonia complications include: 

  • Pleural effusion: The pleura is a layer of tissue that covers and protects your lungs. Pleural effusion happens when there’s a fluid buildup between the pleura. This fluid can become infected and, if it’s too much, can impair your breathing. Some pleural effusions need to be drained with a tube coming out of your chest. 
  • Sepsis: Like any other infection, the infection can get to your bloodstream and cause organ failure without the proper treatment. 
  • Lung abscesses: Some microorganisms that cause pneumonia can also cause lung abscesses. These are collections of pus within the lung tissue. Sometimes they can require drainage or even surgery to resolve. 
  • Respiratory failure: Or acute respiratory distress syndrome that can end in death. 
Diagram showing a build up of fluid in the lining of the lungs (pleural effusion) CRUK 054.svg
Pleural effusion

Do you have to be hospitalized with pneumonia?

Not always. In fact, most of the patients can be treated with outpatient medical treatment. But, of course, this depends on the severity of the case. Also, if you have several risks factors for developing a severe case of pneumonia, you may get hospitalized. This ensures close medical surveillance. 

Moreover, you can be hospitalized if you have shortness of breath to receive oxygen. The hospitalized patient will receive antibiotics or treatment through an IV directly to your blood. Keep in mind that hospitalization can be very useful, not a sign of imminent death. 

What is considered severe pneumonia?

It is considered severe pneumonia when other organs like kidneys, heart, or the circulatory system have a high chance of failing. In order to stage the severity of pneumonia, doctors use a scale called CURB-65. This scale takes into account various factors and doctors use it to predict pneumonia severity and mortality. The parameters that CURB-65 uses are the following: 

  • Confusion: Or altered mental status
  • BUN greater than 19mg/dl
  • Respiratory rate of 30 breaths per minute or more
  • Blood pressure: less than 90/60 mmHg
  • Age 65 years or older

Each parameter equal to 1 point. The punctuation will determine how the patient is treated and their chance of developing complications and dying. 

From 0-1 points, the patient can have outpatient treatment. At 2 points, doctors should consider a short hospitalization for treatment and surveillance. And from 3 to 5 points, the patient needs hospitalization and a possible ICU hospitalization. A CURB-65 score of 3-5 is considered severe pneumonia. For this group of patients, the possibility of dying goes from 17% to more than 50%. 

What are the risks of having COPD and pneumonia?

COPD, or chronic obstructive pulmonary disease, is a major risk factor for developing pneumonia. Not only this, but it can also increase your chances of having severe pneumonia. COPD is a chronic inflammatory lung disease. With this condition, your airways become permanently inflamed. This causes an obstruction in the airflow, impairing it. This will only get worse if you develop pneumonia. The airflow is already impaired, and now you have an infection to make everything worse.

Furthermore, patients with COPD tend to get pneumonia from less common germs, making the diagnosis and treatment difficult. If you have COPD, you should suspect pneumonia if you experience a more productive cough than usual. You also find it harder to breathe during activities that you normally do. A patient with COPD is more likely to develop severe pneumonia. For this reason, they must get diagnosis and treatment as soon as possible. 

What is the connection between influenza and pneumonia?

Influenza is a virus that is responsible for causing many respiratory symptoms. Most of the time, these symptoms are mild. However, in some cases, influenza can be a causal agent of viral cases of pneumonia. It especially causes pneumonia in small children under 5 years old. Although influenza doesn’t cause pneumonia all the time, it can be very serious and difficult to treat once it occurs. The best way to prevent influenza pneumonia is through the flu vaccine. 

When should you suspect pneumonia?

You should suspect pneumonia if you have the symptoms that we described earlier. Anything from a high fever to productive cough and chest pain should be considered possible pneumonia. You can also suspect pneumonia if you experience flu-like symptoms which don’t completely resolve. Another possibility is that those flu-like symptoms get worse, and other symptoms appear. This should be suspected as pneumonia as well. 

How doctors diagnose the disease?

If you think you have pneumonia, you should go to the doctor. They will ask about the symptoms you’ve been having and your medical and family history. Also, they will perform a physical examination, focusing on your lungs.

Through physical examination, the doctor can listen to your lungs using a stethoscope. This way, they can listen to any abnormal noise. These abnormal noises can be useful in the diagnosis since doctors can determine which part of the lung has damage.

After this, they are likely to indicate some laboratory tests and some imaging studies. For pneumonia, a CBC (Complete Blood Count) can be useful to determine if the pneumonia is because of bacteria. Also, doctors will need imaging studies like a chest x-ray or a chest CT. This allows the doctors to see how big the infection is and even the presence of pleural effusion.

Sometimes determining which microorganism is causing the infection is hard. Most of the time, doctors will treat you for the most common pathogens. However, if they really need to know what’s causing pneumonia, they can ask for a sputum (phlegm) culture. 

How is it treated?

Since most of the time, pneumonia is caused by bacteria, the most common treatment is antibiotics. If you have a mild case of pneumonia, you can even have these antibiotics by mouth at home. Some other medications include NSAIDs to control fever and chest pain. However, if you have major risk factors or already have a moderate or severe case, you may be hospitalized.

In the hospital, you will probably receive oxygen and IV antibiotics. These antibiotics are usually standardized, assuming your pneumonia is caused by some of the most common germs. However, if you are not getting better, you can receive specific treatment for that microorganism. These can take several days until the result of the cultures come up.

On the other side, most viral types of pneumonia will not need any special treatment or hospitalization. This is because they rarely cause complications. However, it is not the case for the novel coronavirus. In the case of COVID-19 pneumonia, patients are more likely to present complications. Severe COVID-19 cases should always be hospitalized to get treatment and a better chance of surviving.

Finally, cases of pneumonia due to fungal infections can also be hospitalized. Typically, fungal pneumonias are more dangerous, and the patient must receive antifungal medication. 

Can you die from pneumonia?

Yes, pneumonia is the most deathly infectious disease in the world. It accounts for approximately 3,5 million deaths annually worldwide. Pneumonia deaths in the united states are in the top 10 causes of overall death, mostly in adults aging 65 to 79 years.

Is there a pneumonia vaccine?

Throughout the years, several vaccines for different microorganisms are used for preventing pneumonia.

The pneumococcal vaccine has been shown to reduce streptococcal pneumonia, complications, and deaths. Two vaccines are approved, and a recommendation depending on the age. The PCV13 is used in children from 6 weeks to 17 years and adults older than 50 years. The PPSV23 utilization is only for adults over 65 years and children two years or older that have a high risk of illness by this bacteria.

The annual influenza vaccination decreases the diagnosis and the severity of CAP by the influenza virus. This vaccine is a formal recommendation for all people aging for more than six months. However, some recommendations by the Centers for Disease Control and Prevention (CDC) about the many options available for vaccine types require assessment by a physician.

The special population with reduced immunity can benefit from these vaccines, including the Haemophilus vaccine that is also available.

Do you have symptoms similar to these ones?

This tool is a Pneumonia Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for the disease. Therefore, the tool will tell who uses it the likelihood that their symptoms are because of pneumonia.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.


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