Dr. Schiffman received his B.S. degree with High Honors in biology from Hobart College in 1976. He then moved to Chicago where he studied biochemistry at the University of Illinois, Chicago Circle. He attended Rush Medical College where he received his M.D. degree in 1982 and was elected to the Alpha Omega Alpha Medical Honor Society. He completed his Internal Medicine internship and residency at the University of California, Irvine.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
What are some of the organisms that cause pneumonia? What is the treatment for pneumonia? Can pneumonia be prevented?
The most common cause of a bacterial pneumonia is Streptococcus pneumoniae. In this form of pneumonia, there is usually an abrupt onset of the illness with shaking chills, fever, and production of a rust-colored sputum. The infection spreads into the blood in 20%-30% of cases
(known as sepsis), and if this occurs, 20%-30% of these patients die.
Two vaccines are available to prevent pneumococcal disease: the pneumococcal conjugate vaccine (PCV13) and the pneumococcal polysaccharide vaccine (PPV23; Pneumovax). The pneumococcal conjugate vaccine is part of the routine infant immunization schedule in the U.S. and is recommended for all children < 2 years of age and children 2-4 years of age who have certain medical conditions. The pneumococcal polysaccharide vaccine is recommended for adults at increased risk for developing pneumococcal pneumonia including the elderly, people who have diabetes, chronic heart, lung, or kidney disease, those with alcoholism, cigarette smokers, and in those people who have had their spleen removed. This vaccination should be repeated every
five to seven years, whereas the flu vaccine is given annually.
Antibiotics often used in the treatment of this type of pneumonia include penicillin, amoxicillin and clavulanic acid (Augmentin, Augmentin XR), and macrolide antibiotics including erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone), azithromycin (Zithromax,
Z-Max), and clarithromycin (Biaxin). Penicillin was formerly the antibiotic of choice in treating this infection. With the advent and widespread use of broader-spectrum antibiotics, significant drug resistance has developed. Penicillin may still be effective in treatment of pneumococcal pneumonia, but it should only be used after cultures of the bacteria confirm their sensitivity to this antibiotic.
Mycoplasma pneumoniae is a type of bacteria that often causes a
slowly developing infection. Symptoms include fever, chills, muscle aches,
diarrhea, and rash. This bacterium is the principal cause of many pneumonias in
the summer and fall months, and the condition often referred to as "atypical
pneumonia." Macrolides (erythromycin, clarithromycin, azithromycin, and
fluoroquinolones) are antibiotics commonly prescribed to treat Mycoplasma
pneumonia.
Legionnaire's disease is caused by the bacterium Legionella pneumoniae
that is most often found in contaminated water supplies and air conditioners. It
is a potentially fatal infection if not accurately diagnosed. Pneumonia is part
of the overall infection, and symptoms include high fever, a relatively slow
heart rate, diarrhea, nausea, vomiting, and chest pain. Older men, smokers, and
people whose immune systems are suppressed are at higher risk of developing
Legionnaire's disease. Fluoroquinolones (see above) are the treatment of choice in this
infection. This infection is often diagnosed by a special urine test looking for
specific antibodies to the specific organism.
Mycoplasma, Legionnaire's, and another infection, Chlamydia pneumoniae,
all cause a syndrome known as "atypical pneumonia." In this syndrome, the chest X-ray shows diffuse abnormalities, yet the patient does not appear severely ill. In the past, this condition was referred to as "walking pneumonia," a term that is rarely used today. These infections are very difficult to distinguish clinically and often require laboratory evidence for confirmation.
Recently, a study performed in the Netherlands demonstrated that adding a steroid medication, dexamethasone
(Decadron), to antibiotic therapy shortens the duration of hospitalization. This medication should be used with caution in patients whom are critically ill or already have a compromised immune system.
Pneumocystis carinii (now known as Pneumocystis jiroveci) pneumonia is another form of pneumonia
that usually involves both lungs. It is seen in patients with a compromised
immune system, either from chemotherapy for cancer, HIV/AIDS, and those treated
with TNF (tumor necrosis factor), such as for rheumatoid arthritis. Once
diagnosed, it usually responds well to sulfa-containing antibiotics. Steroids
are often additionally used in more severe cases.
Viral pneumonias do not typically respond to antibiotic treatment. These
infections can be caused by adenoviruses, rhinovirus, influenza virus (flu),
respiratory syncytial virus (RSV), and parainfluenza virus (that also causes
croup). These pneumonias usually resolve over time with the body's immune system
fighting off the infection. It is important to make sure that a bacterial
pneumonia does not secondarily develop. If it does, then the bacterial pneumonia
is treated with appropriate antibiotics. In some situations, antiviral therapy is
helpful in treating these conditions. More recently, H1N1, swine-origin influenza A, has been associated with very severe pneumonia often resulting in respiratory failure. This disease often requires the use of mechanical ventilation for breathing support. Death is not uncommon when this infection involves the lungs.
Fungal infections that can lead to pneumonia include histoplasmosis,
coccidiomycosis, blastomycosis,
aspergillosis, and cryptococcosis. These are
responsible for a relatively small percentage of pneumonias in the United
States. Each fungus has specific antibiotic treatments, among which are
amphotericin B, fluconazole (Diflucan), penicillin, and sulfonamides.
Major concerns have developed in the medical community regarding the overuse
of antibiotics. Most sore throats and upper respiratory infections are caused by
viruses rather than bacteria. Though antibiotics are ineffective against
viruses, they are often prescribed. This excessive use has resulted in a variety
of bacteria that have become resistant to many antibiotics. These resistant
organisms are commonly seen in hospitals and nursing homes. In fact, physicians
must consider the location when prescribing antibiotics (community-acquired
pneumonia, or CAP, versus hospital-acquired pneumonia, or HAP).
The more virulent organisms often come from the health-care environment,
either the hospital or nursing homes. These organisms have been exposed to a
variety of the strongest antibiotics that we have available. They tend to
develop resistance to some of these antibiotics. These organisms are referred to
as nosocomial bacteria and can cause what is known as nosocomial pneumonia when
the lungs become infected.
Recently, one of these resistant organisms from the hospital has become quite
common in the community. In some communities, up to 50% of Staph aureus
infections are due to organisms resistant to the antibiotic methicillin. This
organism is referred to as MRSA (methicillin-resistant Staph aureus) and
requires special antibiotics when it causes infection. It can cause pneumonia
but also frequently causes skin infections. In many hospitals, patients with
this infection are placed in contact isolation. Their visitors are often asked
to wear gloves, masks, and gowns. This is done to help prevent the spread of
this bacteria to other surfaces where they can inadvertently contaminate
whatever touches that surface. It is therefore very important to wash your hands
thoroughly and frequently to limit further spread of this resistant organism. The situation with MRSA continues to evolve. The community-acquired strain of MRSA tends to be responsive to some of the more commonly used antibiotics whereas the hospital-acquired strains require stronger, more aggressive antibiotic therapies. As this evolution occurs, patients are arriving in the hospital with the community-acquired strains as well as a previous hospital-acquired strain. This further necessitates performing bacterial cultures to determine the best course of action.
Staphylococcus or Staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a Staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
MRSA (methicillin resistant Staphylococcus aureus) bacteria causes skin infections with the following signs and symptoms: cellulitis, abscesses, carbuncles, impetigo, styes, and boils. Normal skin tissue doesn't usually allow MRSA infection to develop. Individuals with depressed immune systems and people with cuts, abrasions, or chronic skin disease are more susceptible to MRSA infection.
HIV (human immunodeficiency virus) is the cause of AIDS (acquired immunodeficiency syndrome). HIV is a type of virus called a retrovirus, which infects humans when it comes in contact with a break in the skin or tissues such as those that line the vagina, anal area, mouth, or eyes.
Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis bacteria. Symptoms include weakness, fever, weight loss, night sweats and in worse cases, chest pain, shortness of breath, and coughing up blood. A person with an active infection (a positive TB skin test, abnormal chest x-ray and TB bacteria in their sputum) requires treatment with izoniazid, rifampin, ethambutol and pyrazinaide.
Chronic cough is a cough that does not go away and is generally a symptom of another disorder such as asthma, allergic rhinitis, sinus infection, cigarette smoking, GERD, postnasal drip, bronchitis, pneumonia, medications, and less frequently tumors or other lung disease. Treatment of chronic cough is dependant upon the cause.
Dengue fever is contracted from the bite of a striped Aedes aegypti mosquito. Symptoms of dengue include headache, fever, exhaustion, severe joint and muscle pain, rash, and swollen glands. Since dengue is caused by a virus, there is no specific medicine to treat it. Treatment instead focuses on relieving the symptoms.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Chest pain is a common complaint by a patient in the ER. Causes of chest pain include broken or bruised ribs, pleurisy, pneumothorax, shingles, pneumonia, pulmonary embolism, angina, heart attack, costochondritis, pericarditis, aorta or aortic dissection, and reflux esophagitis. Diagnosis and treatment of chest pain depends upon the cause and clinical presentation of the patient's chest pain.
Typhoid fever is an illness caused by the Salmonella typhi bacteria. The illness is contracted by ingesting the bacteria in contaminated water or food. Symptoms include headaches, fever, diarrhea, lethargy, aches and pains, and poor appetite. Treatment focuses on killing the Salmonella bacteria with antibiotics.
COPD (chronic obstructive pulmonary disease) is a disorder that persistently obstructs bronchial airflow. COPD mainly involves three related conditions, chronic bronchitis, chronic asthma, and emphysema. Symptoms of COPD include chronic cough, shortness of breath, frequent respiratory infections, wheezing, morning headaches, and pulmonary hypertension. Treatment of COPD is focused on the related condition(s).
Group B strep are bacteria called Streptococcus agalactiae that may sometimes cause infections both in a pregnant woman and her newborn. Symptoms include fever, seizures, heart rate abnormalities, breathing problems, and fussiness. Intravenous antibiotics are used to treat group B strep infections.
Laryngitis is an inflammation of the voice box (vocal cords). The most common cause of acute laryngitis is infection, which inflames the vocal cords. Symptoms may vary from degree of laryngitis and age of the patient. Common symptoms include croup, hoarse cough, fever, cold, runny nose, dry cough, and loss of voice. Chronic laryngitis generally lasts more than three weeks. Causes other than infection include smoking, excess coughing, GERD, and more. Treatment depends on the cause of laryngitis.
Whooping cough (pertussis) is highly contagious respiratory infection that is caused by the bacteria Bordetella pertussis. There are an estimated 300,000 plus deaths annually from whooping cough (pertussis). Whopping cough commonly affects infants and young children, but can be prevented with immunization with the vaccine. First stage whooping cough symptoms are a runny nose, sneezing, low-grade fever, a mild cough with the cough gradually becoming more severe. After one to two weeks, the second stage of whooping cough begins.
Emphysema is a progressive disease of the lungs. The primary cause of emphysema is smoking. Alpha 1-antitrypsin deficiency is a rare disorder that has a genetic predisposition to emphysema. Aging, IV drug use, immune deficiencies, and connect tissue illnesses are also risk factors for emphysema. Emphysema is a subtype of COPD (chronic obstructive pulmonary disease, COLD). Symptoms include shortness of breath and wheezing. Management of symptoms may be achieved with medications, quitting smoking, pulmonary rehabilitation, or surgery.
Influenza (flu) is a respiratory illness caused by a virus. Flu symptoms include fever, cough, sore throat, runny nose, headache, fatigue, and muscle aches. The flu may be prevented with an annual influenza vaccination.
Vancomycin-resistant enterococci (VRE) infection is the most common type of infection acquired by patients while hospitalized. Patients at risk for VRE are those who are already ill, and hospitalized, including individuals with diabetes, elderly, ICU patients, kidney failure patients, or patients requiring catheters. Enterococci can survive for months in the digestive tract and female genital tract. Other risk factors for acquiring VRE include those how have been previously treated with vancomycin and combinations of other antibiotics. Treatment of VRE is generally with other antibiotics other than vancomycin. Prevention of VRE can be achieved by proper hand hygiene.
Measles (rubeola) is a highly contagious disease that's caused by a virus. Symptoms include a rash, high fever, cough, runny nose, and red eyes. Treatment focuses on symptom relief. The disease can be prevented with the measles, mumps, and rubella vaccine.
Osteomyelitis is an infection of the bone. Potential causes include injections around the bone, fractures that puncture the skin, recent surgeries, and bacterial infections that travel from other areas of the body, spreading through the blood to the bone. Symptoms include pain, fever, chills, stiffness, and nausea. Treatment involves antibiotics and pain medications. Surgery is sometimes necessary.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
Chronic bronchitis is a cough that occurs daily with production of sputum that lasts for at least three months, two years in a row. Causes of chronic bronchitis include cigarette smoking, inhaled irritants, and underlying disease processes (such as asthma, or congestive heart failure). Symptoms include cough, shortness of breath, and wheezing. Treatments include bronchodilators and steroids. Complications of chronic bronchitis include COPD and emphysema.
Interstitial lung disease, is a term to describe a certain lung condition. Causes of interstitial lung disease include lung infection, exposure to toxins in the environment (asbestos for example), medications (chemotherapy), radiation therapy, and chronic autoimmune disorders. Common symptoms of interstitial lung disease include a dry cough and shortness of breath. Diagnosis and treatment depend upon the cause of the condition.
Coma is the inability to waken or react to the surrounding environment. The Glasgow Coma Scale is frequently used to measure the depth of coma. Causes of coma include trauma, bleeding, edema, lack of oxygen, poisoning, or hypoglycemia. Prognosis for a patient in a coma depends on the cause of the coma.
Bird flu (avian flu, avian influenza) infection in humans may result from contact with infected poultry. There is a vaccine to prevent human infection with the H5N1 strain of the avian flu virus.
Plague is an infectious disease caused by the Yersinia pestis bacteria, which is primarily found in rodents the fleas that feed off of them. The bacteria are passed to humans through flea or rodent bites. There are three forms of plague: bubonic, septicemic, and pneumonic. The symptoms and method of transmission vary with each form of plague. Plague can be treated with antibiotics.
Respiratory syncytial virus (RSV) is a highly contagious viral infection. Symptoms include fever and nasal congestion and discharge. Treatment focuses on supportive care.
Novel H1N1 influenza A virus infection (swine flu) is an infection that generally is transferred from an infected pig to a human, however there have been reported cases where infection has occured with no contact with infected pigs. Symptoms of swine flu are "flu-like" and include fever, cough, and sore throat. Treatment is generally with the antibiotics oseltamivir (Tamiflu) or zanamivir (Relenza).
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
Hiccups are a sudden, involuntary contraction of the diaphragm muscle. In general hiccups are just a temporary condition. Some of the causes of hiccups include certain medications, surgery, eating or drinking too much, spicy foods, diseases or conditions that irritate the nerves controlling the diaphragm, strokes, brain tumors, liver failure, and noxious fumes.
Group A streptococcal infections are caused by group A streptococcus, a bacteria that causes a variety of health problems, including strep throat, impetigo, cellulitis, erysipelas, and scarlet fever. There are more than 10 million group A strep infections each year.
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