Differentiating Viral From Bacterial Pneumonia
Carl Heneghan, Annette Pluddemann and Kamal R. Mahtani
On behalf of the Oxford COVID-19 Evidence Service TeamCentre for Evidence-Based Medicine, Nuffield Department of Primary Care Health SciencesUniversity of Oxford
VERDICTA severe complication of COVID-19 is viral pneumonia. Distinguishing viral pneumonia from bacterial pneumonia is difficult in the community. In some cases, they could co-exist, increasing the chance of a more unfortunate outcome. However, there may be important clues in the history and the examination that can help differentiate the two. Recent guidance from NICE will support clinicians in this process.
BACKGROUNDCommunity-acquired pneumonia can be caused by viruses, bacteria and fungi .
Viral pneumonia is a common complication of influenza-like illnesses and is a complication of SARS-COV-2. Viral pneumonia may clear up on its own however, when severe, it can be life-threatening. Viruses are generally not as common a cause of CAP as some bacteria. However, as well as being a primary pathogen, viruses can be a co-pathogen with bacteria, particularly in those with severe illness requiring admission to ICU and in ventilator-associated pneumonia.
Coronavirus has also been shown to occur with CAP. In a 2010 case-control study conducted in Israel , coronaviruses were identified in 24 patients with CAP, compared with 17 in control subjects.
Those more at risk include:
Differentiating viral and bacterial pneumonia
Who Is Most At Risk For Getting Pneumonia
People who have an increased risk of pneumonia include:
- People over the age of 65 and infants under age 2. The weakening immune system of older people makes them less able to fight off illnesses. Similarly, the immune system of infants is still developing and not at full-strength, making them more susceptible to infection.
- People with a health-caused weakened immune system. Examples include:
- People who are receiving chemotherapy
- Transplanted organ recipients
- People who have HIV/AIDS
- People with autoimmune disease and who are taking medications that suppress the immune system.
When To See A Doctor
You should see your GP if:
- you feel very unwell or your symptoms are severe
- your symptoms are not improving
- you feel confused, disorientated or drowsy
- you have chest pain or difficulty breathing
- you cough up blood or blood-stained phlegm
- your skin or lips develop a blue tinge
- you’re pregnant
- you’re very overweight and have difficulty breathing
- you think a child under five has a chest infection
- you have a weakened immune system
- you have a long-term health condition
- you have a cough that has lasted more than 3 weeks
Your GP should be able to diagnose you based on your symptoms and by listening to your chest using a stethoscope .
In some cases, further tests such as a chest X-ray, breathing tests and testing phlegm or blood samples may be necessary.
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How Do You Treat Pneumonia
The only way to tell the difference between pneumonia and other respiratory illnesses is by getting a chest X-ray, which will show whether fluid and inflammation are present in the lungs, explains Dr. Dass. While the presence of fluid around the lungsin addition to the above symptomslikely indicates pneumonia, the fluid can also be a potential sign of heart or liver complications, kidney disease, or it could possibly be a side effect of certain cancers, according to Yale Medicine. “If you pneumonia, you should see your doctor as soon as possible to make the diagnosis and start treatment early,” says Dr. Dass.
Both Dr. Dass and Dr. Patel note that treatment depends on the cause and severity of pneumonia. Some people begin to feel better with 10-14 days of antibiotics, while others may need to be hospitalized and receive intravenous antibiotics and fluid replacement, explains Dr. Dass. That’s why getting to your doctor early is critical: “Most of the time, if caught early, it will mean less downtime, fewer complications, and a better prognosis,” explains Dr. Patel.
Key Points About Pneumonia
Pneumonia is an infection of one or both of the lungs caused by bacteria, viruses, or fungi.
There are more than 30 different causes of pneumonia, and theyre grouped by the cause. The main types of pneumonia are bacterial, viral, and mycoplasma pneumonia.
A cough that produces green, yellow, or bloody mucus is the most common symptom of pneumonia. Other symptoms include fever, shaking chills, shortness of breath, low energy, and extreme tiredness.
Pneumonia can often be diagnosed with a thorough history and physical exam. Tests used to look at the lungs, blood tests, and tests done on the sputum you cough up may also be used.
Treatment depends on the type of pneumonia you have. Antibiotics are used for bacterial pneumonia. It may also speed recovery from mycoplasma pneumonia and some special cases. Most viral pneumonias dont have a specific treatment and just get better on their own. Other treatment may include a healthy diet, more fluids, rest, oxygen therapy, and medicine for pain, cough, and fever control.
Most people with pneumonia respond well to treatment, but pneumonia can cause serious lung and infection problems. It can even be deadly.
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Whats The Outlook For People With Pneumonia
The time that it takes to recover from pneumonia can vary by individual. Some may find that they can go back to their normal routine in about a week. Others may need some additional time to recover. Sometimes tiredness and fatigue can linger for several weeks.
Illness may also be more severe in at-risk groups like young children, older adults, and people with underlying conditions. These groups often require hospitalization and close monitoring through their treatment and recovery.
What about the different causes of pneumonia? The time until symptoms improve can also depend on whats causing your infection.
In bacterial pneumonia, you may begin to feel better after several days of antibiotic treatment. Viral pneumonia typically improves in while fungal pneumonia may require taking antifungal medications for weeks or even months.
what to do while recovering
Remember, the germs that cause pneumonia can be contagious. While youre recovering, be sure to do the following:
- limit contact with others
- cover your nose and mouth when you cough
- wash your hands frequently
- throw away any used tissues promptly in a covered container
Be sure to speak to your doctor about when you can go back to your normal activities. Your doctor may also want to schedule a follow-up chest X-ray to make sure that your infection has completely cleared.
Incubation Period And Symptoms Of Pneumonia
The incubation period is the time from when you pick up the pneumonia virus to when you actively display symptoms. Many variables affect this, including the type of pneumonia, your general health, and your age. You may assume that you have a cold or the flu when symptoms begin because they are quite similar. However, they last longer and become more severe with time instead of less.
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When Would I Need To Be Hospitalized For Pneumonia
If your case of pneumonia is more severe, you may need tostay in the hospital for treatment. Hospital treatments may include:
- Fluids, antibiotics and other medicines given through an IV
- Breathing treatments and exercises to help loosen mucus
People most likely to be hospitalized are those who are most frail and/or at increased risk, including:
- Babies and young children
- People with weakened immune systems
- People with health conditions that affect the heart and lungs
It may take six to eight weeks to return to a normal level of functioning and well-being if youve been hospitalized with pneumonia.
Questions About Your Symptoms
Bacterial pneumonia, which is the most common form, tends to be more serious than other types of pneumonia, with symptoms that require medical care. The symptoms of bacterial pneumonia can develop gradually or suddenly. Fever may rise as high as a dangerous 105 degrees F, with profuse sweating and rapidly increased breathing and pulse rate. Lips and nailbeds may have a bluish color due to lack of oxygen in the blood. A patient’s mental state may be confused or delirious.
The symptoms of viral pneumonia usually develop over a period of several days. Early symptoms are similar to influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within a day or two, the symptoms typically get worse, with increasing cough, shortness of breath and muscle pain. There may be a high fever and there may be blueness of the lips.
Symptoms may vary in certain populations. Newborns and infants may not show any signs of the infection. Or, they may vomit, have a fever and cough, or appear restless, sick, or tired and without energy. Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. Older adults who have pneumonia sometimes have sudden changes in mental awareness. For individuals that already have a chronic lung disease, those symptoms may worsen.
When to call a doctor
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How Do I Know If I Have Pneumonia
Pneumonia symptoms may present within 24 hours after infection or come on slowly. Common symptoms of pneumonia sometimes resemble cold- or flu-like symptoms including coughing, fever, and trouble breathing.
The cough itself may be wet or productive, meaning you cough up yellow, green, or even brown mucus from the lungs. Hemoptysis and coughing at night can also occur during a bout of pneumonia.
A high fever, upward of 105 degrees, can be a reaction to the body fighting an infection associated with pneumonia. If youre feverish, you may experience chills, sweating, and shaking.
Difficulty breathing may feel like shortness of breath, or feeling like you cant catch your breath. Chest pains, including sharp or stabbing feelings when coughing or trying to take a deep breath, are common once pneumonia develops. Furthermore, cyanosis may occur, causing your lips, fingertips, or skin to turn blue from a lack of oxygen.
Additional symptoms of pneumonia can include a loss of appetite, diarrhea, nausea, and vomiting.
It Might Feel Like A Cold
Walking pneumonia is how some people describe a mild case of pneumonia. Your doctor might call it âatypical pneumoniaâ because itâs not like more serious cases.
A lung infection is often to blame. Lots of things can cause it, including:
- Inhaled food
Walking pneumonia usually is due to bacteria called Mycoplasma pneumoniae.
You probably wonât have to stay in bed or in the hospital. You might even feel good enough go to work and keep up your routine, just as you might with a cold.
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How To Prevent The Spread Of Pneumonia
To reduce your risk of getting or spreading pneumonia, you should do the following:
- Practice good hygiene.Wash your hands with soap and water for at least 20 seconds after touching frequently used public surfaces. In addition, coughing into your elbow and not your hands can help of pathogens that cause pneumonia.
- Boost your immune system. To keep your immune system strong and protect yourself against illness, you should exercise regularly and eat a healthy diet full of fruits and vegetables. Read more about how to boost your immune system.
- Don’t smoke. Smoking damages your lungs and reduces their ability to defend against germs. A 2016 analysis of 27 studies examining the effect of tobacco smoke on developing pneumonia found that smokers older than 65 are at a 64% increased risk for pneumonia.
How Is Walking Pneumonia Different
Walking pneumonia, also known as atypical pneumonia, is caused by mycoplasma pneumoniae bacteria. It usually causes cold-like symptoms, in addition to a fever and a hacking cough. It is most common in school-aged children and young adults, says Annette Cameron, MD, a Yale Medicine pediatrician.
Because this type of pneumonia typically causes milder symptoms, it may go undiagnosed for a while, especially if the child is able to participate in normal activities and isnt as visibly sick as he or she would be with other forms of pneumonia. And thats why its called walking pneumonia, Dr. Cameron says. It might just be a little bit of malaise. Sometimes you can have community-acquired, or bacterial pneumonia, along with walking pneumonia, in which case we would just treat both of them.
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Is Pneumonia Contagious Yes When It’s Caused By Bacteria Or Viruses
- Most types of pneumonia are contagious.
- When pneumonia is caused by a virus or bacteria as it usually is it can spread from person to person through respiratory droplets.
- To prevent the spread of pneumonia, you should practice good hygiene, work to boost your immune system, refrain from smoking, and get the necessary vaccines.
Pneumonia is an infection that causes the air sacs in one or both lungs to fill with fluid or pus. Each year, more than 250,000 Americans are hospitalized with pneumonia, and about 50,000 die from the disease.
Signs and symptoms of pneumonia can vary depending on the type and severity, but they typically include:
- Difficulty breathing
There are many different types of pneumonia and most of them can be contagious. Here’s what you need to know about the types of pneumonia, how they spread, and how to protect yourself.
Other Viral Pneumonia Causes
Viral pneumonia can be caused by influenza virus, respiratory syncytial virus , and herpes or varicella viruses as well as those that cause the common cold .
Depending on which virus is involved, the symptoms, severity, and treatment vary.
- Influenza A and B usually occur in the winter and spring. In addition to the respiratory symptoms, you can get headache, fever, and muscle aches. Your chance of catching the flu decreases significantly if you get immunized every year.
- Respiratory syncytial virus is most common in the spring. It usually infects children and can cause outbreaks in day-care centers and hospital nurseries.
- Herpes, or varicella, pneumonia is rare unless you are infected with chickenpox. This tends to be a more common complication in adults who get chickenpox.
- Adenovirus and parainfluenza viral pneumonias are often accompanied by cold symptoms such as runny nose and pinkeye .
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Caring For Your Symptoms At Home
Many chest infections aren’t serious and get better within a few days or weeks. You won’t usually need to see your GP, unless your symptoms suggest you have a more serious infection .
While you recover at home, you can improve your symptoms by:
- getting plenty of rest
- drinking lots of fluid to prevent dehydration and to loosen the mucus in your lungs, making it easier to cough up
- treating headaches, fever and aches and pains with painkillers such as paracetamol or ibuprofen
- drinking a warm drink of honey and lemon to relieve a sore throat caused by persistent coughing
- raising your head up with extra pillows while you’re sleeping to make breathing easier
- using an air humidifier or inhaling steam from a bowl of hot water to ease your cough
- stopping smoking
Avoid cough medicines, as there’s little evidence they work, and coughing actually helps you clear the infection more quickly by getting rid of the phlegm from your lungs.
Antibiotics aren’t recommended for many chest infections, because they only work if the infection is caused by bacteria, rather than a virus.
Your GP will usually only prescribe antibiotics if they think you have pneumonia, or you’re at risk of complications such as fluid building up around the lungs .
If there’s a flu outbreak in your local area and you’re at risk of serious infection, your GP may also prescribe antiviral medication.
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So A Common Cold Or Flu Can Turn Into Pneumonia
The short answer is: yes. “A cold and the flu are usually caused by a viral infection,” explains Dr. Patel. “Symptoms of cold and flu, such as a runny nose, sneezing, congestion, and cough, are an immune response to the virus invading the body and its attempt to fight it.”
If your body can’t fight the infection on its own, “the bacteria can further invade the system, causing more severe bacterial infections and high fevers, chills, and worsening bacterial infections such as pneumonia,” says Dr. Patel.
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How Long Is Pneumonia Contagious
Pneumonia may be contagious for 2-14 days. Usually, the goal of medications given for pneumonia is to limit the spread of the disease. A person with bacterial pneumonia will stop being contagious within two days of taking antibiotics. However, rarely, the treatment may have to be administered for at least two weeks or more before a person is no longer contagious, depending upon which type of bacteria has caused the disease. Individuals with viral pneumonia are less contagious after symptoms have subsided.