Ask the Doctors

Dear Doctor: My husband was recently hospitalized for pneumonia "of undetermined origin" and treated with IV antibiotics. Does that mean they don't know whether it was viral or bacterial? Are antibiotics used for both? I'm also worried that he might have a relapse.

Dear Reader: The word "pneumonia" refers to inflammation of the lungs, specifically the small air sacs, called alveoli, which sit in clusters at the far edges of the bronchial tree. These air sacs provide the surface area for the oxygen that you inhale to move from the lungs into the bloodstream and throughout the body.

When the air sacs become inflamed, they fill with fluid. People with pneumonia can often hear a crackling sound deep within their lungs as they draw a breath. The presence of that fluid not only makes it hard to breathe, it also prevents adequate oxygen from getting to all parts of the body. Additional symptoms include high fever, cough and chills.

Most often, pneumonia occurs due to some type of infection. The agent can be viral, as in influenza, or bacterial, as with Staph or Strep. More rarely the cause can be fungi, or chemical agents. Pneumonia can affect one or both lungs, and can be asymptomatic, which means you don't even realize you have it. That's commonly referred to as "walking pneumonia."

Differentiating between a virus and a bacterium as the cause of pneumonia can be a challenge. We go by a review of each patient's vital signs and symptoms, the results of chest X-rays, nasal swabs to look for flu viruses and sputum cultures to check the secretions in the lungs. Then we weigh all the evidence to arrive at the best determination.

Since your husband was treated with IV antibiotics, it means that his care team concluded the cause of his pneumonia was bacterial. Antibiotics are not used to treat viral pneumonia. Instead, the approach is supportive care -- rest, fluids, nutrition and time.

When we treat bacterial pneumonia, we don't always find the specific bug that's the cause. If we're lucky, we can pinpoint it through a blood culture or sputum sample. But in many cases, we choose the antibiotic we think will be most effective and monitor its progress.

More than 900,000 people in the United States become ill with pneumococcal pneumonia each year, which is the most common type of bacterial pneumonia. To help combat the Streptococcus (pneumococcus) bacteria, the American Lung Association recommends that children younger than 5 and adults over 65 receive a pneumococcal vaccination series.

Pneumonia in and of itself isn't contagious. However, as with a cold or the flu, a cough or sneeze by someone with pneumonia can spread the organisms that caused it. If your husband is feeling better after the course of antibiotics is complete, then they have done their work.

Should he relapse, which is known as recurrent pneumonia, his care team will likely want to evaluate further. In older patients, we always worry about cancer. And recurrent pneumonia can be a sign of a weakened immune system. In any case, an important part of his recovery is taking things slow for a few weeks, even when he feels like he's back to normal.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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