Pneumonia.

Pneumonia is more likely when you have a fever above 38°C, breathlessness, focal chest pain, or oxygen saturation below 95%. Bronchitis causes cough and chest tightness but usually keeps oxygen saturation normal and lung exam clear. A chest X-ray is the single best way to tell them apart — pneumonia shows a new infiltrate, bronchitis does not.

Most healthy adults with mild outpatient pneumonia feel meaningfully better in 5-7 days and return to normal activity in 2-3 weeks. Fatigue and reduced exercise tolerance often last 4-6 weeks. Older adults and those hospitalized for severe pneumonia commonly need 8-12 weeks for full recovery, and the chest X-ray can take 6-12 weeks to clear.

The infection itself is not the same as a cold, but the pathogens that cause pneumonia spread by respiratory droplets and close contact. Influenza, RSV, SARS-CoV-2, Mycoplasma, and pneumococcus can pass between people. Risk drops sharply after 48 hours of effective antibiotic therapy for bacterial pneumonia and after the febrile period ends for viral pneumonia.

Bacterial pneumonia requires antibiotics. Viral pneumonia does not respond to antibiotics, but it is difficult to be certain about cause clinically, so most patients receive empirical antibiotics until viral PCR and procalcitonin results return. Influenza-specific antivirals are added when influenza is confirmed.

Walking pneumonia is a colloquial term for mild atypical pneumonia, usually caused by Mycoplasma pneumoniae or Chlamydophila pneumoniae. Patients feel ill enough to notice but well enough to stay on their feet. Symptoms include low-grade fever, headache, dry cough, and fatigue lasting weeks. Treatment is a macrolide or doxycycline.

Go to the emergency department if you have a respiratory rate above 30, oxygen saturation below 92%, confusion, low blood pressure, chest pain at rest, or persistent vomiting that prevents oral antibiotics. Children with grunting, retractions, or bluish lips need urgent care. Otherwise, primary care or urgent care is usually appropriate for evaluation.

Adults 65 and older should receive PCV20 alone, or PCV15 followed by PPSV23 a year later. Adults 19-64 with chronic heart, lung, liver, or kidney disease, diabetes, smoking, immunocompromise, or cochlear implants should also receive a pneumococcal vaccine on the same schedule. The CDC ACIP recommendations are the operational reference.

Most uncomplicated pneumonia leaves no permanent damage. Severe pneumonia, ARDS, or necrotizing pneumonia can leave scarring, bronchiectasis, or reduced lung function. Older adults and those with underlying COPD are most at risk. Pulmonary function testing at 8-12 weeks helps quantify any residual loss.

Bacterial pneumonia tends to cause higher fevers, productive purulent sputum, focal lobar consolidation on imaging, and elevated procalcitonin. Viral pneumonia more often causes diffuse interstitial infiltrates, lower procalcitonin, and prominent extrapulmonary symptoms such as muscle aches and sore throat. The distinction matters because only bacterial pneumonia responds to antibiotics.

Diagnosis combines symptoms (fever, cough, breathlessness), focal findings on lung exam, and a new infiltrate on chest X-ray or CT. Pulse oximetry, CBC, procalcitonin, and lactate quantify severity. Sputum culture, blood cultures, urinary antigens, and respiratory viral PCR identify the causative organism in hospitalized or severe cases.

Yes. Pneumonia is one of the leading infectious causes of death in children under five worldwide. Warning signs in children include fast breathing, chest indrawing, grunting, nasal flaring, and bluish lips. RSV, influenza, pneumococcus, and Mycoplasma are common causes. Vaccination, breastfeeding, and avoidance of indoor smoke are key prevention measures.

Yes. Recurrent pneumonia in the same lobe within a year suggests obstruction such as a tumor, foreign body, or bronchiectasis and warrants CT and bronchoscopy. Recurrent pneumonia in different lobes suggests immunodeficiency, aspiration, or chronic structural lung disease. Both patterns should trigger pulmonology referral.

COVID-19 can cause viral pneumonia when SARS-CoV-2 infects the alveoli and produces bilateral ground-glass infiltrates and hypoxemia. Most COVID-19 infections do not progress to pneumonia, but those that do can become severe and may require oxygen, corticosteroids, and remdesivir or nirmatrelvir-ritonavir.

Aspiration pneumonia follows inhalation of oropharyngeal or stomach contents into the lung. It typically affects dependent lung segments and involves anaerobic and Gram-negative bacteria. Risk factors include stroke, dementia, seizures, alcohol use, dysphagia, and post-anesthesia states. Treatment includes antibiotics covering anaerobes and management of the underlying aspiration risk.

Aging weakens cough strength, alveolar macrophage function, and antibody response. Chronic diseases such as heart failure, COPD, and diabetes compound the risk. US adults 65 and older carry roughly 8 times the working-age hospitalization rate, and pneumonia is among the top five causes of death in this group.

Adjunctive corticosteroids reduce 28-day mortality in severe community-acquired pneumonia requiring ICU support, based on the 2023 CAPE COD trial. They are not recommended for mild or moderate pneumonia. Patients with influenza pneumonia should generally avoid steroids unless ARDS or another indication is present.

For uncomplicated community-acquired pneumonia that has stabilized clinically by day 3, the 2019 ATS/IDSA guideline recommends 5 days of antibiotics. Severe pneumonia, complicated pneumonia with empyema or abscess, hospital-acquired pneumonia, and infections with Pseudomonas or MRSA require longer courses of 7-14 days or more.

Yes, substantially. The pneumococcal vaccine, annual influenza vaccine, updated COVID-19 vaccine, smoking cessation, dental hygiene, and treatment of chronic lung and heart disease together lower pneumonia hospitalization risk by roughly 40-60% in older adults. Vaccination is the single most effective measure.

CURB-65 is a five-point clinical score used to predict 30-day mortality in pneumonia. One point each for confusion, urea above 7 mmol/L, respiratory rate at least 30 per minute, low blood pressure, and age 65 or older. Scores of 0-1 are typically outpatient, 2 admit, and 3 or higher signal severe disease.

Routine follow-up X-rays in healthy adults under 50 are usually unnecessary if symptoms resolve. A repeat X-ray at 6-8 weeks is recommended in smokers over 50, patients with persistent symptoms, recurrent pneumonia in the same lobe, or any concern for an underlying mass. Persistent abnormality at 12 weeks warrants CT chest.

Yes. Pneumonia triggers myocardial infarction, atrial fibrillation, heart failure exacerbation, or stroke in 10-30% of hospitalized older adults during the admission or the following 90 days. This is one reason pneumonia hospitalization is independently associated with increased one-year cardiovascular mortality.