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Pneumonia – Know Your Enemy !!

Pneumonia is the 7th leading cause of mortality in the US causing over 900,000 deaths annually especially in patients older than 65. Risk factors include smoking, COPD and Alcoholism. Pneumonia can be caused by Bacteria, Viruses or fungi. recent studies gave conflicting results, one study showed that viruses are more common than Bacteria while the other study showed the opposite. The lung tissue is normally sterile or has no bacteria and lung infection or pneumonia occurs usually when the bacteria and other pathogens that reside in the non-sterile mouth and throat descend to the lung tissue and trigger intense inflammatory reaction that causes the classic symptoms of pneumonia: Fever, purulent cough, shortness of breath and chest pain (from irritating the lung cover known as the Pleura that is quite rich with pain receptors nerve endings in contrast to the lung tissue that has none). A strong cough reflex is our main defense mechanism against these descending microbial invaders and all conditions that can weaken cough will increase the risk of developing Pneumonia such as old age, muscular fatigue, malnutrition and altered mental status (nursing home patients). Pneumonia is usually diagnosed by exam and lungs auscultation (50% sensitivity) or by chest X-Rays (near 100% sensitivity) that is why a chest X-Rays is recommended whenever Pneumonia is suspected.  
Samer Nasry MD

Determining the exact bacteria or virus causing Pneumonia was limited in the past to ICU patients but now with the emergence of PCR testing we can test patient’s sputum for a long list of common pathogens to determine the exact cause quite rapidly however this test is expensive and unwarranted at this time since empiric treatment (treatment that targets the common pathogens) is effective.

When diagnosing Pneumonia, the doctor has to determine if the patient may be treated safely with oral antibiotics at home or he should be referred for in hospital IV antibiotics. The age, the vital signs, the hydration status and the presence of chronic debilitating diseases all play a role in the decision making.

In our urgent care we can offer you a physical exam, a chest X-Rays, antibiotic injections, establish the Pneumonia diagnosis,start the proper treatment and refer when necessary to the hospital.

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