# Pneumonia --- **Pneumonia** is an inflammation of the [[lungs|lung]] tissue, typically due to an [[infection]]. It can be bacterial, viral, fungal or even due to an aspiration of secretions or other material (in which case it is called "chemical pneumonia"). Pneumonia causes difficulty in [[pulmonary ventilation]] because it effectively blocks [[alveolar gas exchange]] and thus oxygenation. It's one of the leading causes of death by infectious disease. There are four types of pneumonia classifications, but a lot are overlaps. - **Community Acquired Pneumonia** or **CAP** is when pneumonia is acquired just out and about in the real world. For some reason it's typically associated with Gram positive bacteria. - **Health Care Associated Pneumonia** or **HCAP** is pneumonia that happens to someone who is not hospitalized but does have frequent contact with healthcare. - It it typically due to aspiration, and typically to immunocompromised patients. - **Hospital Acquired Pneumonia** or **HAP** is when pneumonia happens to someone currently hospitalized. - It is the second most common [[healthcare associated infection|HAI]] (second only to UTIs) - HAPs increase length of stay on average 4-9 days and have a 13-55% mortality. - **Ventilator Associated Pneumonia** or **VAP** is pneumonia acquired by someone who is on a [[ventilator]] ## Risk Factors - being [[mechanical ventilation|ventilator]] dependent - this increases the chances of acquiring pneumonia by 20 times - underlying conditions such as [[COPD]], [[heart failure]], [[cystic fibrosis]], or [[cancer]] - anything that makes you immunocompromised - age - older adults have many normal age-related changes that increase the chances of pneumonia, such as: - decreased amount of cilia which clear things from the respiratory tract - decreased elasticity in the alveoli, as well as thickened alveolar walls - weakened immune systems - weakened muscles used to clear the lungs - [[smoking]] - recent [[surgery]] - especially due to the effects of [[general anesthesia]], such as loss of the gag reflex, sleepy cilia, altered level of consciousness. ## Signs & Symptoms The signs and symptoms of pneumonia are all pretty much what you expect, coughing, shortness of breath, etc. These may not be clear in older adults though, and [[altered mental status]] might be the first sign for this population. ## Diagnostic Tests Pneumonia can be diagnosed with an X-ray, cultures, a CBC or even a bronchoscopy. Pneumonia on an X-ray looks like a cloudy area, where typically it's mostly black. ![[pneumonia.png]] >[!abstract]- Healthy lungs for reference ![[lung x-ray.png]] ## Prevention Preventing pneumonia is the most the is best done through the pneumonia [[vaccine]]. It is recommended for people age 65+ and for people with chronic illnesses. There are two similar but different pneumonia vaccines - **PCV13** protects against 13 different causative organisms - **PCV23** protects against 23 different causative organisms ___