Host-directed therapies for infectious diseases: current status, recent progress, and future prospects

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A Patient's Guide To Pneumonia: Causes, Treatment And Prevention

Pneumonia — an infection of one or both of your lungs — can leave you coughing, feverish and feeling miserable.…

Pneumonia — an infection of one or both of your lungs — can leave you coughing, feverish and feeling miserable. And sometimes, it can land you in the hospital struggling to breathe.

While the rate of pneumococcal infections has been decreasing since the introduction of pneumococcal conjugate vaccines in 2000, more than 40% of the bacteria that cause pneumonia are resistant to one or more antibiotics, according to the Centers for Disease Control and Prevention.

In October 2024, the CDC reported an increase in pneumoniae infections among children ages 2 to 17 in the United States. This rise in pneumonia cases is largely being caused by the bacteria Mycoplasma pneumoniae. M. Pneumoniae infections are generally mild and mostly present as a chest cold but may also present as pneumonia. When an M. Pneumoniae infection progresses to pneumonia, it's typically a less severe form of bacterial pneumonia commonly referred to as "walking pneumonia."

[READ: How to Get Rid of a Cold and the Flu]

What Is Pneumonia?

Pneumonia affects the air sacs of the lungs, called alveoli. As these air sacs become inflamed and infected, they fill with fluid, making breathing more difficult and reducing the flow of oxygen throughout your body.

Pneumococcal infections are more common in the winter and early spring.

Cases range from fairly mild to dangerously severe. According to the CDC, about 1 million people in the U.S. Are hospitalized from pneumonia each year. It kills about 41,000 people in the U.S. Yearly, most of them older adults and children under 5 years old.

"The danger with pneumonia is more related to the host, or the person experiencing the pneumonia, and their other medical conditions," says Dr. Laraine Washer, a clinical professor in infectious diseases at the University of Michigan Medical School. "People who are more likely to have severe pneumonias are those of older age, those who have emphysema or other lung diseases and patients who perhaps have decreased immune systems, for various reasons."

Having a history of stroke or other chronic illnesses also makes people more vulnerable to pneumonia, adds Washer, who is also the hospital epidemiologist for the University of Michigan Health System. Smokers are more likely to develop pneumonia.

A variety of bacteria, viruses and fungi cause different types of pneumonia. These germs enter the respiratory tract though your mouth or nose. There are several ways you can become infected:

— If an infected person coughs or sneezes on you

— If you breathe in the germs

— If you touch a contaminated surface and then touch your face

[READ: 10 Signs of Strep Throat]

Types

Experts break down pneumonia into two broad categories, depending on where you contract the infection:

Community-Acquired pneumonia

Group settings, such as college dorms, schools, workplaces, day care, public transit and anywhere people gather, are prime sources of contagion.

With community-acquired pneumonia, "It's people who've just been living their day-to-day lives," says Dr. David LaFon, a pulmonologist and an assistant professor in the Division of Pulmonary, Allergy and Critical Care Medicine at the Heersink School of Medicine at University of Alabama at Birmingham.

Certain kinds of bacteria — streptococcus, pneumococcus and H. Influenzae — are commonly responsible for community-acquired pneumonia, LaFon says. "Those tend to cause the typical signs of pneumonia, like fever, cough and difficulty breathing."

Having the flu can be a direct cause of pneumonia, he adds, or it can predispose people to eventually develop a bacterial infection. Walking pneumonia is a milder type of community-acquired pneumonia.

[READ: The Differences Between RSV, COVID and the Flu Symptoms]

Hospital-Acquired pneumonia

This is also called nosocomial pneumonia, meaning it originated or occurred in the hospital. Nursing home-acquired pneumonia is similar, although it's contracted in a long-term care facility rather than a hospital. Nursing-home acquired pneumonia is one of top causes of hospital readmissions for residents.

If people with pneumonia have recently been exposed to a health-care or nursing-home setting, certain bacteria may be suspected, LaFon says. These can include antibiotic-resistant bacteria like MRSA and organisms called gram-negative bacteria.

Causes

The following are the main categories of organisms that cause pneumonia:

Bacterial pneumonia

Most cases of pneumonia are bacterial in origin, with Streptococcus pneumoniae the leading cause of bacterial pneumonia globally.

Bacterial pneumonia includes:

— Pneumococcal pneumonia. This common type of bacterial pneumonia is caused by Streptococcus pneumoniae.

— Mycoplasma pneumoniae.

— Staph pneumonia. Staph pneumonioa is caused by Staphylococcus aureus. MRSA is an antibiotic-resistant form of S. Aureus bacteria.

— H. Influenzae pneumonia. Although similar-sounding, Haemophilus influenzae bacteria are not related to the flu virus.

— Gram-negative pneumonia. This is pneumonia caused by bacteria such as E. Coli, Klebsiella or Pseudomonas. (They're called gram-negative because of how they respond to a chemical staining process in the lab.) This type of pneumonia is more common in health care facilities than in the community.

Viral pneumonia

Viral pneumonia includes these types:

— Influenza pneumonia caused by influenza (flu) viruses A and B.

— RSV pneumonia (respiratory syncytial virus). RSV is more common in children.

— Adenoviruses, rhinoviruses and human metapneumovirus are less common causes of viral pneumonia.

Walking pneumonia

Mycoplasma pneumonia is also called atypical or walking pneumonia. Caused by bacteria called Mycoplasma pneumoniae

, it's milder than typical bacterial pneumonia. M. Pneumoniae infections can occur at any age, but they most often occur among children ages 5 to 17 years and young adults.

Fungal pneumonia

Pneumonia can develop from diseases that are caused by breathing in airborne fungal spores. Fungal pneumonia is less common than viral or bacterial types.

In addition to contagion from outsides sources, your nose can be "colonized" with bacteria without you realizing it. That bacteria may stay there indefinitely or become invasive and actually cause infection, Washer explains.

[READ: Flu vs. The Common Cold.]

Symptoms

It can be hard to tease out whether symptoms you're experiencing are due to a common cold or pneumonia, and if you need to be seen by a doctor. The time frame provides a clue, says Dr. Heather Alden, a family medicine physician in Sandy, Utah.

"Most patients start getting concerned when they have maybe an illness, like a cold, that's lasting much longer than they expect," Alden says. "A lot of patients come in and say, 'It's been almost two weeks and I'm still having fevers.' So it's the length of symptoms, the persistence of fever or new symptoms. They're having chills; they're coughing more mucus and thick phlegm. These are usually reasons why people eventually come into the office."

Pneumonia symptoms:

— Cough with or without phlegm

— Blood-tinged phlegm

— Fever and chills

— Wheezing

— Breathing difficulty or shortness of breath

— Night sweats

— Nasal flaring and rapid breathing in infants

— Chest pain when breathing or coughing

— Decreased energy

— Appetite loss

— Low blood oxygen levels

Older adults may experience weakness, confusion or a lower-than normal temperature instead of a fever. Sometimes babies may vomit, appear restless or have low energy, or show signs of breathing problems.

Diagnosis

Even with milder symptoms, such as low-grade fever,

an ongoing cough, feeling tired or loss of appetite, you might need an examination from your primary care provider.

"I usually tell patients: If you're having cold symptoms 7 to 10 days and things still aren't getting better, that's when you should go see your doctor," Alden says.

To diagnose pneumonia, health care providers evaluate your symptoms, listen to your lungs with a stethoscope and possibly order a chest X-ray or other imaging tests. The extent of testing varies depending on whether your infection is likely community-acquired or hospital-based, your age and medical history and the severity of your symptoms.

Patients admitted to the hospital typically get blood work done and sometimes have sputum samples taken to isolate a particular bacteria causing the pneumonia, LaFon adds.

Treatment

Pneumonia that's treated at home typically involves oral medication and supportive measures.

Antibiotics

Bacterial pneumonia is treated with antibiotics.

"Over time, we have found shorter courses are equally effective as longer courses," Washer says. "Currently, for most patients, five days of antibiotics are sufficient. There's a lot of good data that suggests that, in fact, longer courses are probably worse for the patients."

Antibiotics may cause side effects, particularly GI symptoms, including nausea, abdominal pain, diarrhea or just decreased appetite, Alden notes. Taking antibiotics with food can help prevent these symptoms, she says, and an over-the-counter probiotic supplement or simply eating yogurt may also help.

"I would encourage anybody who is prescribed antibiotics for anything to ask the prescriber what side effects to look out for, or if there are any interactions with other medications that they need to watch for," LaFon says. Your doctor or pharmacist can go over your current medications to make sure they're compatible with a newly prescribed antibiotic.

Experts emphasize the importance of taking antibiotics as prescribed and finishing the entire course, notifying your health care provider if you have any side effects. Completing your antibiotics helps prevent any remaining bacteria from becoming drug-resistant.

"Within 48 hours of antibiotics, you should start feeling a lot better, but don't expect to be fully 100% back," says Alden, who tells patients to give themselves 7 to 14 days to recuperate.

[Read: Getting Your Probiotic Fix When Taking Antibiotics.]

Antivirals

Viral pneumonia does not respond to antibiotics. For influenza-related pneumonia, antiviral medications like oseltamivir (brand name Tamiflu) may be prescribed.

"In most of the viral illnesses, specific antiviral treatment isn't indicated for otherwise healthy people," Washer says.

Supportive care

While you're recovering from pneumonia at home, these supportive measures can help:

— Your primary care provider or pediatrician may suggest an over-the-counter medication such as ibuprofen (Advil or Motrin) or acetaminophen (Tylenol) to reduce fever.

— Stay hydrated by drinking as much water and other fluids as possible.

— You may need help with a troublesome cough. "Coughing, in itself, is not necessarily a bad symptom," Alden says. "It's your body trying to get rid of the excess mucus and phlegm and clear your lung out a little bit." However, she adds, some people may cough so excessively that they can pull muscles in their chest. Sleep can also suffer. "If it's keeping them up at night and they're not getting good rest, I usually will prescribe a cough suppressant for patients."

— Rest to recuperate. Avoid the temptation to jump back into your daily routine as soon as you start feeling a little better. It's usually OK to return to activities like exercising once antibiotics are done, Alden says, although you might have to reduce the rigor or intensity at first, then gradually ramp up.

Complications

"The good news is that most pneumonias are fairly easy to treat, as far as noncomplicated, community-acquired pneumonia," Alden says. "They're very receptive to antibiotics. However, in certain situations, people can have complications such as sepsis."

Sepsis, a systemic complication of infection, can lead to plunging blood pressure and organ failure, and can be lethal.

For pneumonia severe enough to hospitalize a patient, treatment is more aggressive. Intravenous (IV) antibiotics and fluids are more likely to be given at first. Supplemental oxygen may be needed for patients with trouble breathing.

If supplemental oxygen is not enough, patients may require intubation, or insertion of a tube, and mechanical ventilation to help them breathe until the pneumonia resolves.

Empyema is the development of infected fluid (pus) in the space around the lungs. In addition to IV antibiotics, a patient might need a drainage procedure with a chest tube to treat this infection, Washer says.

Permanent damage to lung tissue may occur with severe pneumonia, possibly resulting in decreased lung capacity from scarring. In very serious cases, damaged sections of the lung may also need to be removed to help prevent pneumonia from happening again.

Prevention

Pneumonia, or pneumococcal, immunization programs in recent years have led to a substantial reduction in infection caused by strains of pneumococcal bacteria.

Vaccines

There are two types of pneumonia vaccines recommended by the CDC:

— Pneumococcal conjugate vaccine 13 (PCV13) for children younger than 5 years old, adults 65 years or older and people 6 years or older with certain risk factors

— Pneumococcal polysaccharide vaccine (PPSV23) for adults 65 years or older and high-risk people 2 through 64 years old

It is now recommended that all people with asthma and anyone exposed to tobacco smoke also receive the pneumonia vaccine.

Discuss the pneumonia vaccine with your doctor, as some groups should receive both shots. What most people don't realize is that this vaccine also protects against sinus infections and ear infections, as it's the same bacteria that causes pneumonias.

Minimizing exposure

You can take steps at home to prevent pneumonia from affecting your family.

— Avoid exposure to people whom you know are sick .

— Wash your hands frequently, either with soap and water or an alcohol-based hand sanitizer, to keep you from transferring viruses or bacteria from your hands to your face, nose or mouth.

— If you have pneumonia, avoid infecting others when you are contagious. "Typically, contagiousness can occur a day or so prior to the onset of symptoms," Washer says. "As a rule of thumb, if you're coughing or feverish, certainly you're likely to be most contagious at that time."

Health Care Providers

What Causes Pneumonia In Elderly? Know Symptoms, Prevention Tips And Treatment For This Fatal Infection

Pneumonia is a deadly infection wherein the tiny air sacs in your lungs (alveoli) tend to get inflamed causing symptoms such as cough and shortness of breath. Pneumonia is not only common in youngsters but even older population. It is known to cause higher morbidity and mortality rates in patients. Older pneumonia, often overlooked in discussions regarding respiratory health, is a serious lung infection that can affect some older adults. This age group tends to have weakened immune systems and underlying conditions, making them more vulnerable to pneumonia complications. Unlike other young patients who might be experiencing normal symptoms like pain in the chest and a high fever, older patients seem to present with confusion or even a sudden loss of mobility and may need to be hospitalised.

The causes:

When we spoke to Dr Samir Garde, Director of Dept of Pulmonology and Lung Transplant, Gleneagles Hospital, Parel, he said that pneumonia in the elderly stems from a myriad of underlying factors such as a weak immune function as people age, chronic health conditions such as chronic obstructive pulmonary disease (COPD), diabetes, or heart disease, lifestyle factors such as poor nutrition or lack of physical activity can lead to weakened lung function and reduced capacity for recovery.

The symptoms:

The symptoms of this condition are cough, fever and chills, chest pain, fatigue, shortness of breath, and rapid breathing. These symptoms can steal one's peace of mind and interfere with one's ability to perform daily activities with ease. Elderly people should consult the doctor in case they have additional symptoms such as confusion, gasping to breathe, abnormal body temperature, and unbearable chest pain.

The diagnosis:

This condition can be detected with the help of blood tests, CT scans, and X-rays to confirm the diagnosis. It is essential to follow the instructions given by the doctor to enhance the quality of life.

The treatment:

The treatment should be all-inclusive. This means antibiotics, antiviral drugs, as well as supportive care, which entails hydration, monitoring spo2 levels, resting adequately, as well as pulmonary rehabilitation. Such treatment within the shortest time possible will prevent complications, for instance, respiratory failure, lung abscess, sepsis, fluid accumulation in the lungs, and eventually death in elderly patients.

Tips to prevent pneumonia in the elderly:

Getting the pneumococcal vaccine and influenza vaccine, washing hands regularly, maintaining personal hygiene, wearing a mask, disinfecting frequently touched surfaces, avoiding crowded places or being around sick people, quitting smoking, eating a balanced diet, exercising daily, getting a sound sleep regularly and ensuring proper hydration to keep the lungs healthy is key to prevent pneumonia.

ALSO READ: Pneumonia risk increases up to 10 times in children from milk bottlesKnow details

COPD Patient Receives World's First Robotic Double Lung Transplant

A 57-year-old woman with chronic obstructive pulmonary disease (COPD) has received the world's first fully robotic double lung transplant. Photo by NYU Langone Health/HealthDay News

A 57-year-old woman with COPD has received the world's first fully robotic double lung transplant.

The breakthrough surgery was performed in October at NYU Langone Health in New York City by Dr. Stephanie Chang. Just a month before, Chang performed a fully robotic single lung transplant -- the nation's first.

"This latest innovation is a watershed moment in lung transplantation surgery worldwide and just the beginning of a new era in patient care," said Dr. Ralph Mosca, chair of cardiothoracic surgery at NYU Grossman School of Medicine, in New York City.

Chang and her team use a da Vinci Xi robot to perform the minimally invasive transplants.

They make small incisions between the ribs, then use the robot to remove and replace the damaged lungs.

The groundbreaking double transplant was performed on Oct. 22, four days after patient Cheryl Mehrkar was added to the transplant list after months of careful evaluation.

"For a long time, I was told I wasn't sick enough for a transplant," she recalled in an NYU news release.

"I'm so grateful to the donor and their family for giving me another chance at life," Mehrkar added. "And I'm so grateful to the doctors and nurses here for giving me hope."

Mehrkar, a volunteer emergency medical technician with the Union Vale Fire Department in Dutchess County, N.Y., inherited a genetic risk for lung disease.

She was 43 when she was diagnosed with COPD in 2010. A bout with COVID-19 in 2022 made her COPD worse.

Until her health relegated her to the sidelines, Mehrkar traveled the world as a scuba divemaster and, with her husband, Shahin, earned a black belt in karate. For many years, they owned a dojo, where she taught martial arts.

Mehrkar said she looks forward to being more active once again and praised her transplant team for making her quality of life a priority.

Surgical director of the lung transplant program at NYU Langone Transplant Institute, Chang was assisted in performing the double transplant by Dr. Travis Geraci and Dr. Eugene Grossi.

"It is one of the greatest privileges to be able to help patients return to a healthy quality of life," Chang said. "By using these robotic systems, we aim to reduce the impact this major surgery has on patients, limit their postoperative pain and give them the best possible outcome."

More information

Johns Hopkins Medicine has more about lung transplantation.

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