What happens when pneumonia occurs

The lung inflammation and infection that makes breathing difficult is called pneumonia. Generally, pneumonia is easily treated at home and doesn't produce permanent lung damage. However, there are cases, in patients that are older than 65, in young children or in persons that suffer from other conditions, especially COPD – chronic obstructive pulmonary disease – that require hospitalization and careful medical monitoring. Walking pneumonia is a term attributed to the mild forms of pneumonia.

Pneumonia can be acquired anywhere: at school or at work – community based pneumonia – or in hospitals or nursing homes – nosocomial pneumonia.

After acquiring the condition, the symptoms may appear immediately or it can take up to 10 days until they will show. Here are some factors that will tell how severe the condition is:

• Age and overall health. People of old age, who are usually also sicker, encounter more severe cases and develop complications like bacteremia - the infection from the lungs enters the bloodstream, or septicemia – bacteria infection throughout the body.
• The bacterial or viral nature of the pneumonia. The viral forms are less severe than the bacterial ones.
• How soon it is discovered and treated.
• The immune system. People with an affected immune system will develop more severe forms of pneumonia then otherwise healthy people.

In of otherwise healthy people, the condition will show mild symptoms and will cure in 2-3 weeks. In old persons or people who already suffer from other conditions, pneumonia may take up to 6-8 weeks to cure and if the form is severe, hospitalization may be required.

• Most cases of pneumonia can be acquired anywhere: at school or at work – community based pneumonia. These forms of the condition do not require hospitalization.
• One third of the cases of community based pneumonia are represented by old people. Those cases require hospitalization more often than younger adults and their condition takes longer to heal. In many cases, complications may appear.

In the severe cases of pneumonia, the patient is hospitalized for a more adequate treatment with intravenous antibiotics and oxygen mask. However, the same result may be obtained with a home treatment consisting in oral antibiotics, especially if professional care can be obtained at home. Some cases require only a few days of hospital treatment and then home treatment until full recovery.

What will the doctor do

Diagnosis can be set based on the medical history, physical exam and X-ray test and the treatment may begin right away. Other tests are not necessary usually, but there are cases, however, when additional tests are taken depending on factors like the age of the patient, the overall health or the severity of the symptoms. A general rule is that the number of tests required increases together with the severity of the condition.

In many cases, an X-ray test will be taken to determine whether there are changes at pulmonary level and to look for other causes of the symptoms. The X-ray tests aren't always conclusive.

The X-ray test may:

• Show whether the pneumonia has complications.
• Determine the type of organism (bacterial, viral, or fungal) that causes the condition.
• Show conditions that may appear along with pneumonia (fluid in the chest cavity or lung failure).
• Discover another condition, like heart failure, lung cancer, or acute bronchitis.

The mucus from the lungs may also be examined to determine what organism caused the condition. This test is required only in severe cases or when other conditions (asthma or COPD) are present too.

• The Gram stain test requires a sample of mucus from the coughing which is treated with a material called Gram stain and examined under the microscope. This test helps the doctor establish the best treatment for the patient by revealing the type of organism that caused the infection.
• A sample of the mucus from the coughing will be placed in a container with substances that create a proper environment for the bacterium or fungus to grow. If they grow, they will be easier to identify and establish a correct treatment. This test is not too conclusive either because it is difficult to obtain mucus directly from the lung without being contaminated with mucus from the throat or mouth. Also, this test is not useful if an antibiotics treatment was started.

Other tests may be required, based on the severity of the condition. The immune system's functionality or other complications of the disease may be tested.

For the streptococcus pneumoniae and the legionella pneumophila bacteria, there is an additional urine test which shows the results in 15 minutes.

The urine test is very useful in revealing the legionella pneumophila but the doctors don't use it too often to determine the presence of the streptococcus pneumoniae. It is however used in adults with severe forms of pneumonia when the Gram stain test has shown no results.

In cases of people with affected immune system, pneumonia may have other causes including some types of fungi like pneumocystis jiroveci ( fungus that used to be called p. carinii). People suffering from AIDS are usually affected by this fungus. If the doctors believe that this fungus is the cause for pneumonia in a case, they may recommend an HIV test.