Lobar Pneumonia: What Is It, Causes, Symptoms & Treatment
Introduction
Did you know that pneumonia, a respiratory infection causing inflammation in your lungs, is one of the leading causes of hospitalisation and death in the world1,2?
It is important to remember that early identification of your infection can lead to complete recovery with minimal complications3.
What Is Lobar Pneumonia?
Pneumonia is an infection of the lung tissue causing inflammation in the air sacs (alveoli) of your lungs2,3. Lobar pneumonia is a type of pneumonia in which there is a rapid involvement of an entire section or lobe of your lung by the inflammatory process. However, clinically, the involvement may not always include the entire lobe and may be seen as patchy areas to confluent consolidation (replacement of air with fluid/pus cells in lungs).Typically caused by the bacterium Streptococcus pneumoniae, the condition usually presents in a severe form with a greater possibility of complications4,5.
Note: Lobar pneumonia is a type of pneumonia according to an earlier classification system used for infections of the lower respiratory tract based on X-ray patterns. The current clinical classifications, however, are usually based on the aetiology (causative organism) or whether the infection is community or hospital acquired4.
Causes of Lobar Pneumonia
Are you wondering what causes lobar pneumonia? The causative agents include1,5:
Bacteria: Pneumonia can be caused by gram positive, gram negative, and atypical bacteria1,5.
Gram negative bacteria: Haemophilus influenzae, Klebsiella pneumoniae, and Escherichia coli
Atypical bacteria: Mycoplasma pneumoniae, Chlamydophila pneumoniae, or Legionella species. Results in a patchy or interstitial infiltration but not true lobar consolidation in most cases6.
Viruses: This includes Influenza Type A virus, RSV (Respiratory Syncytial Virus), SARS-CoV-2 (COVID-19) and adenovirus1.
Fungi: While fungal causes of lobar pneumonia are less common than bacterial or viral causes, they mainly occur in immunocompromised individuals. Common organisms include Cryptococcus neoformans, Histoplasma capsulatum, Blastomyces dermatiditis, and Aspergillus fumigatus1.
Persistent cough with or without sputum (Bloody sputum is a classic sign of lobar pneumonia caused by Streptococcus pneumoniae)
High-grade fever with chills
Confusion or delirium
Pleuritic chest pain (sharp pain in your chest which worsens during deep inspiration due to pleural involvement).
Shortness of breath
Vomiting
Abdominal pain
Tiredness or fatigue
Complications such as acute heart failure, shock and meningitis can occur in patients with lobar pneumonia and mortality is also higher4. Thus. if you are facing any of the above-mentioned symptoms, it is ideal to seek medical care and get prompt lobar pneumonia treatment.
Who Is More Likely to Get Lobar Pneumonia?
You are more likely to develop pneumonia if you are8,9,10:
Suffering from any chronic conditions such as diabetes, chronic lung disease, heart disease, etc.
Smoking regularly as smoking impairs your mucociliary clearance and damages epithelial defences.
Consuming alcohol regularly as this is associated with impaired cough reflex, aspiration, and neutrophil dysfunction.
Immunocompromised due to HIV / AIDS or bone marrow transplant.
Exposed to metal fumes (for ex: welder) as this inhalable fume may cause damage to lung defences or the iron in the fume may facilitate the growth of the microorganisms.
Under 5 years of age or above 65 years of age. (Although a study reported men between 40-50 to be more susceptible to lobar pneumonia)4
These risk factors also indicate a higher likelihood of developing lobar pneumonia when you are exposed to causative organisms like Streptococcus pneumoniae.
Congestion (Initial stage): In this stage, the lung becomes swollen and heavy due to an increased blood flow and fluid accumulation. Microscopically, this condition involves vascular engorgement with the alveoli containing proteinaceous fluid, few bacteria and some immune cells.
Red Hepatisation: Due to capillary damage, your red blood cells and white blood cells called neutrophils leak into the alveolar spaces. The lung becomes firm like liver due to the increased neutrophils, fibrinous exudate, and red blood cells. Hence, this stage is referred to as hepatisation (liver-like).
Grey Hepatisation: The characteristic grey appearance in this stage is due to the breakdown of the red blood cells and the accumulation of fibrin, neutrophils and special immune cells known as macrophages.
Resolution (Recovery): The body starts to clean up the infection. The macrophages are the main cells in this stage and help to remove the leftover debris. The lung may return to normal, however, in some cases, a small amount of scar tissue remains.
Diagnosis of Lobar Pneumonia
To diagnose lobar pneumonia, your doctor may suggest3,11:
Chest X-ray: Key diagnostic tool for lobar pneumonia. Your chest X-ray may show segmental, homogenous consolidation of one or more lobes with visible air bronchogram (air-filled bronchi visible within the consolidated lung)1.
Computed Tomography: Helpful in cases which are unclear.
Blood Tests: These include:
Complete blood count: Elevated creatinine and white blood cells count indicates infection. Elevated erythrocyte sedimentation rate and C-reactive protein suggest inflammation. Although these are non-specific markers and cannot confirm pneumonia, they can support the diagnosis when elevated.
Arterial blood gases: Useful in severe cases such as hypoxia (low oxygen supply to tissues) and respiratory acidosis (acidic blood due to the presence of carbon dioxide).
Sputum Culture: Maybe advised in severe or hospitalised cases to identify the bacteria causing your illness. However, it is not always reliable, and confirmation of pneumonia requires correlation with clinical history and gram staining.
Liver function tests: Abnormal liver function tests are common in cases of community acquired pneumonia12.
Urinary Antigen Test: Can help to identify Streptococcus pneumoniae and Legionella pneumophila, the main causative organisms of lobar pneumonia13.
Gram Staining: To identify the causative organism. For example: Gram positive cocci may indicate Streptococcus pneumoniae, whereas gram-negative bacilli may indicate Haemophilus influenzae.
Respiratory Viral Panel: A secondary bacterial infection is common following a viral infection. This test is done by collecting a sample from your respiratory tract (nasopharyngeal swab) and helps to check for viral pathogens such as influenza, RSV or SARS-CoV-2.
A timely and accurate diagnosis of lobar pneumonia is necessary to guide appropriate treatment.
Treatment Options
The main treatment for lobar pneumonia involves the use of antibiotics.
For healthy individuals without any underlying health issues, the commonly prescribed antibiotics include3,11:
Amoxicillin(preferred for Streptococcus pneumoniae)
Doxycycline and macrolides may be preferred for atypical pathogens such as Mycoplasma pneumoniae, Chlamydophila pneumoniae and Legionella species.
For individuals with chronic conditions, such as diabetes or heart disease, the treatment often involves3,11:
Combination of beta lactam antibiotic (high dose amoxicillin or amoxicillin-clavulanate, cefuroxime) along with a macrolide (such as azithromycin or clarithromycin) or doxycycline
Alternatively, your doctor may recommend a single stronger antibiotic like respiratory fluoroquinolone (such as levofloxacin or moxifloxacin). While respiratory fluoroquinolones are acceptable alternatives, it is important to note that overuse may lead to resistance and increased risk of Clostridium difficile infection14.
For hospitalized patients with moderate illness, doctors may recommend3,11:
A beta lactam antibiotic (such as ceftriaxone) along with a macrolide (such as azithromycin).
Your doctor may alternatively suggest the use of a single respiratory fluoroquinolone (such as levofloxacin).
If you are admitted to the hospital and your pneumonia is severe, your treatment will be more intensive and usually includes3,11:
A beta lactam antibiotic plus a macrolide
Empirical treatment may also require coverage for Methicillin Resistant Staphylococcus aureus (MRSA) or pseudomonas. In these cases, adding vancomycin or linezolid for suspected MRSA or anti-pseudomonal beta-lactams for high-risk patients15.
Alternatively, your doctor may recommend a beta lactam antibiotic along with a respiratory fluoroquinolone.
Note: Macrolide monotherapy is not recommended in areas with high macrolide-resistant Streptococcus pneumoniae.
Timeline for Recovery
Most people with lobar pneumonia symptoms start to show signs of recovery within 5 to 7 days, if they respond well to treatment (fever is gone for 2-3 days, no longer need oxygen, and their breathing and blood pressure have returned to normal)16.
However, depending on the causative agent, you may require a longer treatment time. For example, your lobar pneumonia is generally severe when caused by Legionella pneumonia, so you would require approximately 10-14 days to recover. Similarly for Staphylococcus aureus infection, a longer treatment duration of 14-21 days approx. will be required, especially in cases of MRSA infection16.
Moreover, if you develop any complications such as fluid buildup in your lungs (empyema), lung abscess, or lung tissue damage (necrosis), your treatment may take longer to complete. Hence, your total treatment time and recovery is dependent on how fast your symptoms improve, the causative organism and any complications3,11.
Managing Lobar Pneumonia at Home
Home management of pneumonia is appropriate for non-severe, stable patients. If pneumonia follows a viral infection like influenza or due to a pathogen with potential spread like Mycoplasma, it might be ideal to isolate from early on. Simple self-care measures that you can follow to manage lobar pneumonia at home include2:
Getting plenty of rest: Try to stay and rest at home and avoid contact with other people, and if you do not feel well enough.
Staying hydrated: It is important to drink plenty of fluids and stay hydrated.
Following good hygiene practices: Wash your hands regularly with warm water and soap, throw used tissues in the bin, and cover your mouth while sneezing or coughing.
Isolating yourself: Following social distancing or isolating early in the course of illness can be helpful in preventing spread especially if pneumonia is associated with a viral infection or due to an atypical organism.
Using over-the-counter pain relievers: You may take paracetamol or ibuprofen if you are having pain or a very high temperature. But ideally consult your doctor before prolonged use, particularly if you have any condition where the renal function may be affected.
Taking medications: Use your medications exactly as prescribed by your doctor.
If your symptoms worsen or do not improve after a few days of treatment, consulting your doctor is important2.
Lobar Pneumonia in the Elderly
Lobar pneumonia in elderly individuals can be a serious condition as they have a higher risk of complications due to age-related weakening of immune system and chronic medical conditions.
Moreover, elderly individuals may not even show symptoms or have atypical ones like increasing confusion, loss of consciousness, and low blood pressure along with high-grade fever and increased heart rate. Hence, it is important to promptly and correctly diagnose pneumonia in these individuals and start treatment early, following medical guidelines closely to reduce further complications.
Simple steps, such as getting vaccinated against pneumonia, flu, and quitting smoking, can help to lower the risk and reduce the severity of infection in elderly people17.
Prevention Strategies
Prevention strategies to reduce your risk of pneumonia include3,11,18,19:
Get Vaccinated:
Pneumococcal vaccination: PCV 15/PCV20 are conjugate vaccines while PPSV23 is a polysaccharide vaccine. It provides vaccination against Streptococcus pneumoniae, the main aetiological agent of lobar pneumonia. It is recommended in all children under 5 years of age, and in individuals with chronic conditions like diabetes, chronic lung disease, etc.In immunocompetent adults above 65 years or adults with comorbidities, vaccination with either a single dose of PCV20 or PCV15 is recommended, followed by PPSV23 after 1 year20,21.
Pertussis vaccination (DTaP / Tdap Vaccination): The pertussis vaccine helps to protect against pertussis, a highly contagious bacterial infection that causes severe coughing fits24.
Good hand hygiene practices Follow simple steps like regularly washing your hands with warm water and soap.
Avoiding smoking By smoking you not only damage your lungs but also weaken your immune system, thereby increasing your risk of lobar pneumonia.
Management of chronic conditions such as asthma, diabetes, or heart disease by ensuring prompt medical care and taking medications as directed.
Strengthening your immune system by staying physically active and following a healthy diet.
Avoiding close contact with sick individuals, avoiding crowds and practicing sneezing or coughing into a tissue or your elbow.
By following these steps, you can reduce your risk of developing lobar pneumonia.
When to See a Doctor
You should visit your doctor if you are experiencing cough for more than three weeks, or if you have shortness of breath which is getting worse, or if you are coughing up blood or if you are experiencing chest pain (especially increased pain when you breathe or cough)2.
Early diagnosis and treatment of lobar pneumonia are important to reduce complications and support recovery2.
Conclusion
Lobar pneumonia is a serious lung infection that can affect an entire lobe of your lung. Early recognition and timely treatmentare essential to avoid complications. Simple measures like vaccination, good hygiene, and managing chronic conditions can reduce your risk of developing lobar pneumonia. If your symptoms worsen or persist, you should seek prompt medical attention.
Frequently Asked Questions (FAQs)
What are the complications of lobar pneumonia?
Lobar pneumonia can cause complications such as pleural effusion (fluid around the lungs), empyema (pus in the pleural space), lung abscess (pus-filled cavity), or respiratory failure. In severe cases, it may lead to spread of infection to other organs1.
What is the difference between lobar pneumonia and bronchopneumonia?
Lobar pneumonia affects an entire lobe of the lung with uniform consolidation, while bronchopneumonia involves patchy inflammation around the bronchi and may affect multiple lobules of your lungs9.
Is lobar pneumonia more common in any specific season?
Yes, lobar pneumonia is more common during the winter and early spring seasons. Respiratory infections are more common during this season and presence of crowds increases the risk of transmission8.
Can lobar pneumonia be contagious?
Yes, as lobar pneumonia is caused by bacteria or viruses that spread through inhalation of infected respiratory droplets from coughing, sneezing, or close contact with an infected person25.
References
Franquet T. Imaging of Community-acquired Pneumonia. Journal of Thoracic Imaging [Internet]. 2018 Sep;33(5):282–94. Available from: https://pubmed.ncbi.nlm.nih.gov/30036297/
Zinserling VA, Swistunov VV, Botvinkin AD, Stepanenko LA, Makarova AE. Lobar (croupous) pneumonia: old and new data. Infection [Internet]. 2021 Sep 1;50. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8409273/
Bradley SF. Alcohol Use Disorder and Risk of Pneumonia. JAMA Network Open [Internet]. 2019 Jun 7 [cited 2019 Oct 17];2(6):e195179. Available from: https://pubmed.ncbi.nlm.nih.gov/31173114/
Pahal P, Rajasurya V, Sharma S. Typical Bacterial Pneumonia [Internet]. National Library of Medicine. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534295/
Jinks MF, Kelly CA. The pattern and significance of abnormal liver function tests in community-acquired pneumonia. European Journal of Internal Medicine [Internet]. 2004 Nov 1;15(7):436–40. Available from: https://www.ejinme.com/article/S0953-6205(04)00191-8/pdf
Kim P, Deshpande A, Rothberg MB. Urinary Antigen Testing for Respiratory Infections: Current Perspectives on Utility and Limitations. Infection and Drug Resistance [Internet]. 2022 Apr;Volume 15:2219–28. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9058651/
Shea KM, Hobbs ALV, Jaso TC, Bissett JD, Cruz CM, Douglass ET, et al. Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection. Antimicrobial Agents and Chemotherapy [Internet]. 2017 Jun;61(6). Available from: https://journals.asm.org/doi/10.1128/aac.00125-17
VanEperen AS, Segreti J. Empirical therapy in Methicillin-resistant Staphylococcus Aureus infections: An Up-To-Date approach. Journal of Infection and Chemotherapy [Internet]. 2016 Jun 1;22(6):351 Available from: https://pubmed.ncbi.nlm.nih.gov/27066882/
Dimitra Dimopoulou, Moschopoulos CD, Konstantina Dimopoulou, Dimopoulou A, Berikopoulou MM, Ilias Andrianakis, et al. Duration of Antimicrobial Treatment in Adult Patients with Pneumonia: A Narrative Review. Antibiotics [Internet]. 2024 Nov 12;13(11):1078–8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC11591184/
National Heart, Lung, and Blood Institute. Pneumonia: What needs to be considered in older people? [Internet]. NCBI. Institute for Quality and Efficiency in Health Care (IQWiG); 2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525776/
Gilsdorf JR. Hib Vaccines: Their Impact on Haemophilus influenzae Type b Disease. The Journal of Infectious Diseases [Internet]. 2021 Sep 30;224(Supplement_4):S321–30. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8482018/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
Pneumonia in the Elderly: Causes, Symptoms, Treatment, and Prevention
Introduction
As people get older, they become more susceptible to infections, and a common one is the lung infection called pneumonia. It happens when bacteria, viruses, fungi or other uncommon germs enter the lungs. In the elderly, the body’s defence system becomes weak, so germs can easily enter the airways1,2. This leads to infection in the lungs where a thick fluid called inflammatory exudate, made up of immune cells, proteins and germs build up in the air spaces, causing trouble in breathing and symptoms like cough and chest pain2,3.
It is a serious concern in older people because the illness can get worse quickly, and recovery becomes more difficult. They are more likely to get a severe form of pneumonia and need hospital admission4. There are chances of death also, seen in about 5 to 15% of people admitted to the hospital, and it can rise to 30 to 50% in those who are seriously ill and need intensive care1.
But it can be managed better if we know about symptoms of pneumonia in elderly, how it is treated, and how it can be prevented, which we will discuss further in this blog5.
Types of Pneumonia in the Elderly
Pneumonia in elderly is grouped based on where and how they catch the infection. The common types are:
Community-acquired pneumonia: This happens outside hospitals, when bacteria or viruses spread through coughing or sneezing. It could also include places like old age homes, rehab centres, or other care facilities. In some elderly people, it may also occur when food, drink, or saliva accidentally enters the lungs instead of the stomach (known as aspiration pneumonia).
Hospital-acquired pneumonia: When pneumonia is seen in a person has after they have stayed in a hospital or healthcare setting for at least 2 days, it is called hospital-acquired pneumonia. This means the infection started in the hospital and was not present when the person was first admitted.
Ventilator-associated pneumonia: This develops in patients who are put on a breathing support machine like a ventilator. If pneumonia starts 48 hours or more after the tube is placed into the windpipe, it is called ventilator-associated pneumonia.
All these types of pneumonia in elderly may be caused by either a bacterium, a virus, a fungus, or a parasite that has infected the lungs2,6. Let us see what causes these types of pneumonia in the next section.
What Causes Pneumonia in the Elderly?
Bacteria are the most common cause of pneumonia in elderly population. It can happen mainly in two ways: • By accidentally breathing in food or stomach contents (aspiration pneumonia) • By catching the infection from air or people around (airborne pneumonia)
Here is a table that shows what causes pneumonia in elderly and how they spread6,7:
Among these, Streptococcus pneumoniae is the most common bacteria seen in elderly patients.
Some elderly people may get infected with strong germs that do not respond to certain antibiotics. These are hard to treat and are often seen in those who had pneumonia earlier, are admitted to the hospital often, or received injectable antibiotics in the last 90 days6.
There are other risk factors that make elderly people more likely to get pneumonia, which will be discussed in detail in the next section.
Risk Factors for Pneumonia in the Elderly
As the body ages, the immune system becomes slower, and other health issues and some medicines can increase the risk of pneumonia, as given below:
Weak immune system: With age, the body can’t make strong immune cells to fight infections. At risk are those with weak immunity, those having cancer, kidney problems, or taking medicines that lower immunity, or those without a spleen (typically due to Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis)5,8.
Health issues: Problems like COPD, heart disease, liver issues, or diabetes can make the lungs weak. In COPD, damaged airways, excess mucus, and changes in lung bacteria make it easier for infections to grow5,9.Liver disease alters the immune system and affects the body’s ability to clear lung infections. In heart disease, fluid gets built-up in the lungs, which may slow down the removal of bacteria and affect the lung’s defence system10,11.
Lifestyle: Being male, poor diet, not drinking enough water, pollution, alcohol, smoking, or staying in old-age homes can add to the risk.
Medicines: Drugs for mental health, sleep, acidity, allergy, or steroids can raise the risk. Some mental health medicines (like antipsychotics) and sleeping pills (like opioids or benzodiazepines) can make the body slow down and increase the chance of food or fluid entering the lungs. This can lead to a type of lung infection called aspiration pneumonia. Acidity medicines like PPIs (e.g., omeprazole, lansoprazole) may also weaken the body’s defence by affecting immune cells, making it harder to fight infections5,12.
Elderly people who lie flat for long periods, have trouble swallowing, use feeding tubes, are very drowsy, or have poor mouth hygiene are at risk of getting aspiration pneumonia. Tumours in the mouth or airways can also raise the risk5.
Symptoms of Pneumonia in the Elderly
Symptoms of pneumonia in elderly individuals may not always be typical, and only some may have common signs like:
Cough
Breathing difficulty
Mild fever (occasionally)
Others may just show vague symptoms. These include:
Sometimes, other signs like sudden falls may be seen. These are not direct symptoms of pneumonia, but when the infection spreads in the body, it can cause weakness, dizziness, or low blood pressure, leading to falls.
In people with existing heart or lung conditions, pneumonia can make those illnesses worse, even if they are not symptoms of pneumonia itself5,15.
If such symptoms appear, doctors may suspect pneumonia. A fast breathing rate (over 25 per minute) or low oxygen (below 90%) may suggest infection. However, low oxygen is not specific to pneumonia, it shows that the lungs are not working properly, and the illness may be severe. To confirm, imaging tests like X-ray or CT scan and blood tests may be done. Treatment will be started early5,13.
Treatment for Pneumonia in the Elderly
Treatment for pneumonia in older people is planned based on how severe the condition is and where the person is being treated, either at home or in the hospital. The table below shows common treatments depending on the patient’s condition5,13.
Patient Condition
Medicines Commonly Given
Treated at home with no other health problems
Antibiotics like amoxicillin are commonly used, especially if Streptococcus pneumoniae is expected. Azithromycin or doxycycline may also be used, but azithromycin alone is not preferred in areas where resistance is high.
Treated at home but has other health issues
Combination of two antibiotics like amoxicillin with azithromycin can be given. Or a single broad antibiotic like levofloxacin may also be given.
Admitted to hospital but not in ICU
Same as above but given through a vein (IV) and under close watch. Usually a beta-lactam antibiotic like ceftriaxone with azithromycin, or just a strong one like levofloxacin.
Admitted to ICU but no risk of severe infections
Strong antibiotics like ceftriaxone or cefepime, with azithromycin or levofloxacin. Doctors also check if any resistant organisms like MRSA or Pseudomonas are possible.
Lungs have pus or fluid buildup like abscess or empyema
Strong antibiotics or special ones like clindamycin may be added, especially if food or fluid accidentally entered the lungs.
Along with antibiotics, in severe cases, steroids are given to calm the immune system. Oxygen and IV fluids help with breathing and hydration. Patient is watched closely to see if they get better or have any issues. Recovery depends on how well they respond to the treatment5,13.
Recovery from Pneumonia in the Elderly
Recovery from pneumonia in older people is often slower compared to younger people. If the treatment for pneumonia in elderly is in the hospital, it may take up to 8 weeks or longer to fully recover, while people treated at home may feel better sooner. Even after the person feels better, the chest X-ray may still show signs of infection. This is common in older people and does not always mean the pneumonia is still active13.
Avoid smoke or wood fires, as they can irritate the lungs.
Do breathing exercises as advised by doctor. Chest physiotherapy is usually recommended only in people with lung conditions like COPD or when it is hard to clear mucus1,3.
Recovery also depends on the person’s ability to do daily activities. Those who are weak or have other health issues may take longer to recover and may face complications1,13.
Complications of Elderly Pneumonia
In people who are very old and frail and have other diseases like heart or kidney problems, pneumonia recovery can be hard, and complications may occur.
The infection can spread and cause sepsis, which could be seen as one of first signs of pneumonia in elderly
Lung damage such as pus collection (empyema) or severe tissue damage (necrotizing pneumonia) or abscess can occur
Heart failure or clots in the legs/ lungs can occur due to low oxygen, poor movement, or inflammation
Some may eat less and face a nutritional drop
These problems are common in elderly pneumonia when not treated early. Symptoms like confusion or delirium may lead to poor outcomes2,6.
How to Prevent Pneumonia in Older Adults
Pneumonia in elderly individuals can be dangerous with complications, but by preventing it, you can make sure you’re ageing healthily and maintain your quality of life. Here are some ways how to prevent pneumonia in elderly:
Vaccines: Get vaccinated against pneumococcal bacteria, flu virus, and COVID-19. Flu vaccine is for all ages, but people above 65 should take it every year. Pneumococcal vaccine (PCV) may be given to people above 65 as either one shot (PCV20) or two shots (PCV15 followed by PPSV23).
Lifestyle changes: Quit alcohol and smoking. Take care of problems like trouble swallowing, poor nutrition, and oral hygiene. Also, get your medicines checked to see if they increase pneumonia risk. Do breathing exercises and keep your body moving as physical activity helps reduce risk.
Good hygiene: Wash your hands with soap and water regularly. Cover your mouth and nose while coughing or sneezing.
Manage ongoing health problems: Conditions like COPD, heart failure, and diabetes should be treated well to prevent pneumonia3,15.
So, by getting vaccines, following infection control, and managing chronic illnesses, you can reduce the risk of pneumonia.
When Should You See a Doctor?
The following symptoms of pneumonia in elderly people require medical attention:
Fever
Cough
Breathing difficulty
Chest pain
Feeling confused or very tired
Signs like trouble breathing, bluish lips, or low blood pressure need urgent care.
Especially those who have heart disease, diabetes, or kidney problems should not wait but see the doctor early so they can avoid complications and recover faster3,16.
Conclusion
Pneumonia in older people can be serious and even life-threatening if not treated early. However, with the right medicines, along with good nutrition, proper care for existing health problems, and support for any complications, pneumonia in elderly can show good recovery. Closely watch for symptoms like cough, fever, breathing trouble, or confusion. So, knowing the signs and risks helps you visit the doctor in time and start appropriate treatment to avoid any complications of pneumonia from occurring.
Frequently Asked Questions (FAQs)
If I do not brush properly, can I get pneumonia?
If you are older and have poor dental hygiene, you may be at risk of getting pneumonia. When you do not brush properly, bacteria can build up in the mouth. These bacteria can accidentally enter the lungs and cause pneumonia6.
Is my nutrition affected when I get pneumonia?
Yes, pneumonia can affect your nutrition. The illness causes your body to use up nutrients faster, and many people eat less when they are sick. This can lead to poor nutrition, which may slow recovery and lead to worse outcomes6.
Why do some older people get aspiration pneumonia?
People who have trouble swallowing, lie down for long hours, use feeding tubes or oxygen, take painkillers, or have poor mouth hygiene are more likely to get aspiration pneumonia5.
What does a geriatrician do for an older person with pneumonia?
Yes, a geriatrician checks for problems that can make pneumonia worse, like poor nutrition, weakness, memory loss, or confusion. They address these issues early, give the right support and medical care, and help reduce the risk of getting pneumonia6.
References
Chebib N, Cuvelier C, Malézieux-Picard A, Parent T, Roux X, Fassier T, et al. Pneumonia prevention in the elderly patients: The other sides. Aging Clinical and Experimental Research. 2019 Dec 31;33(1). https://link.springer.com/article/10.1007/s40520-019-01437-7
Li W, Ding C, Yin S. Severe pneumonia in the elderly: a multivariate analysis of risk factors. International Journal of Clinical and Experimental Medicine [Internet]. 2015 Aug 15;8(8):12463. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4612842/
Restrepo MI, Sibila O, Anzueto A. Pneumonia in Patients with Chronic Obstructive Pulmonary Disease. Tuberculosis and Respiratory Diseases [Internet]. 2018;81(3):187–97. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6030662/
Xu L, Ying S, Hu J, Wang Y, Yang M, Ge T, et al. Pneumonia in patients with cirrhosis: risk factors associated with mortality and predictive value of prognostic models. RESPIRATORY RESEARCH. 2018 Dec;19(1). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6280505/
Shen L, Jhund PS, Anand IS, Bhatt AS, Desai AS, Maggioni AP, et al. Incidence and Outcomes of Pneumonia in Patients With Heart Failure. Journal of the American College of Cardiology [Internet]. 2021 Apr 27 [cited 2021 Sep 18];77(16):1961–73. Available from: https://pubmed.ncbi.nlm.nih.gov/33888245/
Manian FA, Hsu F, Huang D, Blair A, Mosarla R, Mulugeta W, et al. Coexisting Systemic Infections in Patients Hospitalized Because of a Fall: Prevalence and Risk Factors. The Journal of Emergency Medicine. 2020 May;58(5):733–40. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0736467920300214
Antje Häder, Nilay Köse-Vogel, Schulz L, Lucja Mlynska, Hornung F, Hagel S, et al. Respiratory Infections in the Aging Lung: Implications for Diagnosis, Therapy, and Prevention. Aging and Disease. 2024 Jan 1;14(4):1091–104. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10389836/#sec11
Institute for Quality and Efficiency in Health Care. Pneumonia: What needs to be considered in older people? [Internet]. Nih.gov. Institute for Quality and Efficiency in Health Care (IQWiG); 2018. Available from: https://www.ncbi.nlm.nih.gov/books/NBK525776/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
1
Is Pneumonia Contagious? Causes, Transmission, Symptoms & Treatment
Introduction
Did you know that you have an increased risk of developing pneumonia if you are above 65 years of age or under 2 years of age1? Pneumonia is one of the leading causes of death worldwide2.
While pneumonia itself is not contagious, the causative agents (bacteria, virus) generally are. Understanding how pneumonia spreads, what causes it, how to recognise whether your infection is contagious and knowing about the right treatment are essential to protect yourself1.
What Is Pneumonia?
Pneumonia is a serious infection that can affect either one or both of your lungs, causing the air sacs of your lungs or alveoli to be filled with fluid or pus3,4.
Pneumonia is a clinical syndrome with multiple aetiologies and classifications, which include5:
Community-Acquired Pneumonia: Pneumonia acquired outside of hospital settings or in a community setting.
Hospital-Acquired Pneumonia: Pneumonia acquired 48 hours or more of admission in any hospital.
Ventilator-associated Pneumonia: Pneumonia acquired more than 48 hours after endotracheal intubation.
What Causes Pneumonia?
Pneumonia is the inflammation of alveoli in your lungs mostly caused by bacteria, viruses or fungi. These include6,7,8:
Bacterial Pneumonia: Bacteria are a common cause of pneumonia in adults. The most commonly noticed bacterium is Streptococcus pneumoniae while others like Haemophilus influenzae, Bordetella pertussis etc may also be the cause. Atypical bacteria such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, or Legionella are also causes of pneumonia, especially in younger individuals.
Viral Pneumonia: Viruses such as influenza virus, SARS-CoV-2, respiratory syncytial virus (RSV), and rhinovirus can also cause pneumonia.
Fungal Pneumonia: Not as common as bacterial and viral pneumonia, but fungi such as Pneumocystis jirovecii, cryptococcus, histoplasma and blastomyces may also lead to the development pneumonia, especially in individuals with weak immune systems.
Aspiration Pneumonia is one subtype of pneumonia, which occurs when food, liquids, or vomit are inhaled into the lungs, and is not caused by infectious organisms per se9.
Understanding the cause of pneumonia can help to identify whether it is contagious and prevent its spread.
Is Pneumonia Contagious?
This depends upon the underlying cause of pneumonia. Certain types can be contagious based on the causative organism, while others may not spread directly6.
Contagious pneumonia is generally caused by bacteria or viruses, which can be transmitted through respiratory droplets when an infected person coughs, sneezes, or talks6.
Non-contagious pneumonia does not spread from person-to-person. This type of pneumonia occurs due to inhalation of foreign substances (aspiration pneumonia) and is not caused by an infectious agent so cannot spread to others9.
Another type of pneumonia that is less likely to be contagious is that caused by fungal infections, which typically affect people with weakened immune systems. While these are not transmitted between individuals, they can occur in clusters due to shared environmental exposure10,11.
Let’s have a look at the contagious ones in detail.
Which Pneumonia Types are Contagious?
Are you wondering which pneumonia is contagious? Well, as mentioned, not all pneumonias are contagious. Some can spread from person to person, while others do not.
Bacterial pneumonia: Bacteria such as Streptococcus pneumoniae can cause infections that can spread through cough, sneezes, or close contact.
Atypical pneumonia: Some bacteria may cause pneumonia with different symptoms which are usually milder that those in typical pneumonia (referred to as walking pneumonia or atypical pneumonia). This is mostly caused by Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumophila and generally affects younger populations. This is contagious and spreads through inhalation of infected respiratory droplets or aerosolised contaminated water.
Viral pneumonia: Viruses such as influenza virus, RSV, or SARS-CoV-2 are also highly contagious and spread similarly via airborne droplets or contact with contaminated surfaces.
Fungal pneumonia: These are acquired from environmental exposure, and person-to-person transmission is exceedingly rare or non-existent, except sometimes in transplant settings (e.g., organ donation from infected donor)12.
How Does Pneumonia Spread?
Pneumonia can spread in several ways, which includes9,10:
Airborne Droplets: This occurs when an individual affected with pneumonia coughs, sneezes or talks. This causes the release of respiratory droplets (infectious as they may contain bacteria or viruses). When you inhale these droplets, you may develop pneumonia.
Contact with Contaminated Surfaces: When an individual touches a surface that is contaminated with bacteria and viruses, and then touches their nose or mouth, they may develop pneumonia.
Aerosols or water droplets: Some organisms which cause pneumonia (such as Histoplasma, Blastomyces, Legionella) are present in the aerosolised soil particles or contaminated water droplets. Hence, when an individual is exposed to these factors, they may inhale an infectious organism and develop pneumonia.
Aspiration: This is not actually a mode for person-to-person transmission, rather a mechanism of entry of oropharyngeal or gastric contents into the lungs. It is a non-infectious event, though it can lead to secondary infection.
Despite these, developing pneumonia depends on host factors, virulence, and exposure dose. Not everyone exposed develops pneumonia. Certain factors may increase risk of pneumonia such as a weakened immune system (this includes HIV, or any chronic diseases like asthma, diabetes, etc). It’s important to be especially vigilant of pneumonia symptoms if you have any preexisting conditions8.
How Long is Pneumonia Contagious?
The contagious period can vary based on the type of pneumonia you are suffering from. The table below lists when pneumonia is contagious6,9:
Type of Pneumonia
Contagious Period
Bacterial Pneumonia
Contagious for approximately 48 hours after starting antibiotics and until fever reduces
Walking Pneumonia
Contagious for several weeks (2-4 weeks before your first symptoms appear and until symptoms resolve)
Viral Pneumonia
Several days to over a week (until fever reduces and symptoms subside)
Fungal Pneumonia
Generally, not contagious
Aspiration Pneumonia
Not contagious
Is Pneumonia Contagious After Antibiotics?
An individual infected with bacterial pneumonia is said to be contagious for approximately 48 hours after starting effective antibiotics, while viral pneumonia may remain contagious longer (several weeks). You are likely to be contagious until your symptoms subside and fever resolves. It is always best to consult your doctor and follow instructions to reduce the spread of infection6.
Symptoms of Pneumonia
The signs and symptoms of pneumonia may include4,13,14:
Fever and chills
Headache
Chest pain (pleuritic pain, which is a sharp pain on breathing and coughing)
Muscle pain or myalgia
Productive cough (may be associated with greenish, yellow or even bloody mucus)
If you are facing any of these symptoms, consult your doctor and seek immediate medical care.
How to Tell If a Cough Might Be Pneumonia
A cough can indicate any infection from a common cold, bronchitis, to pneumonia. The below table summarises the key differences in these 3 infections and helps you to understand if your cough might be pneumonia14,16,17.
Common Cold
Bronchitis
Pneumonia
Duration of Cough
Short duration
Short duration
Persistent Cough
Type of Cough
Productive / nonproductive cough
Productive cough (Clear or yellow-green mucous)
Productive cough (greenish, yellowish or blood stained mucous)
Symptoms
Sore throat, runny nose, sneezing, coughing and headache
Chest discomfort, productive cough, tiredness, low-grade fever, shortness of breath
Rest, fluids, and over-the-counter pain or cold or cough medicines
Rest, fluids, and over-the-counter pain or cold or cough medicines
Antibiotic treatment
Diagnosis
After a careful assessment of your symptoms, your doctor will be able to diagnose your condition with the help of18,19:
Chest X-ray: If you present with clinical symptoms, your chest X-ray may show infiltrates, consolidation, or opacities in your lungs which maybe a sign of pneumonia.
Blood Tests: Your doctor may recommend laboratory tests such as:
Complete blood count: To check for any infections, such as leucocytosis with neutrophilia (bacterial) or lymphocytosis (viral).
Arterial blood gases: Used only in severe cases. It can be used to help assess the oxygenation and acid-base balance in cases of hypoxia or when any other respiratory compromise is expected.
Pulse Oximetry: To measure your oxygen level in your blood. Pneumonia fills air spaces in lungs with fluids, impairing gas exchange, which leads to hypoxemia. If you are suffering from pneumonia, it can prevent your lungs from getting enough oxygen into your blood.
Sputum Test: To identify the organism causing your illness.
Blood Culture Test: To identify the causative agent and to check for bacterial infection in your blood which has prognostic implications in severe CAP or suspected sepsis.
Polymerase Chain Reaction (PCR) Test: To identify the DNA of the causative agent
Bronchoscopy: A tube is inserted into your airway and your doctor may collect samples of the tissue and fluid from your lungs to identify the cause of your pneumonia. This method is only done in complicated cases, cases of unresolved pneumonia or immunocompromised patients.
Chest Computed Tomography (CT) Scan: This tool can help to identify the extent to which your lungs are affected by pneumonia and can also identify abscesses and other lung disorders.
Based on these tests, your doctor will be able to accurately diagnose your condition and will suggest the appropriate treatment for your condition18.
Treatment for Pneumonia
Depending on the type of pneumonia you have, your doctor may suggest the following treatments20,21:
Bacterial pneumonia: Antibiotics may be prescribed. You should start to notice a reduction in your symptoms in 48-72 hours. However, complete recovery can take a much longer time in elderly patients (several weeks). Take your medications as prescribed by your doctor and do not discontinue your medication.
Viral pneumonia: While in most cases, viral pneumonias clear up by itself, Influenza, RSV and SARS-CoV-2 can cause severe disease, especially in children, elderly individuals and individuals who are immunocompromised. Oseltamivir may be prescribed for managing influenza, ribavirin may be prescribed for RSV, parainfluenza virus, adenovirus, and measles virus22.
Fungal pneumonia: Treatment prescribed is dependent on the causative organism. For example, if your infection is caused by Pneumocystis jirovecii, your doctor may prescribe a combination of trimethoprim-sulfamethoxazole, or if your infection is caused by Histoplasma, your doctor may prescribe itraconazole or amphotericin B for the management of your condition22.
Apart from these medications, it is important to get plenty of rest, drink plenty of fluids, and you may take over-the-counter medications for pain, cough, cold and fever.
In cases of severe pneumonia, you may have to be a hospitalised to receive medications (antibiotics and fluids) through an intravenous (IV) line. Your doctor may also recommend oxygen therapy to increase the amount of oxygen in your blood. If you are suffering from a serious infection, you may need ventilator support20,21.
Prevention Tips
Taking a few proactive steps and getting vaccinated, can reduce your chances of developing pneumonia. This includes23:
Apart from getting vaccinated, certain simple tips that you can follow to protect yourself against pneumonia include23,25:
Avoid close contact with infected and sick individuals.
If you are sick, stay at home to prevent the spread of infection.
When in a public place, cover your nose and mouth with a tissue while sneezing and coughing or cough or sneeze into your elbow followed by good hand hygiene.
Quit smoking and avoid alcohol consumption.
Make sure you wash your hands regularly with warm water and soap for at least 20 seconds.
It is important to clean and disinfect frequently contacted surfaces to reduce the risk of infection.
Consult your doctor for any medical issues such as heart disease, diabetes and take medications as directed. These conditions can lead to secondary pneumonia and managing them is essential for pneumonia prevention.
You should consult a doctor if you experience symptoms of pneumonia. If you face difficulty in breathing, high fever, difficulty breathing, chest pain, and a productive cough, seek immediate medical care26.
Moreover, it is important to get immediate medical care in high-risk individuals (adults over the age of 65, children below the age of 2 and adults with any underlying health condition such as diabetes, heart disease) or weakened immune system (immunocompromised individuals) as the disease can progress quickly in these individuals. Moreover, if you notice symptoms such as bluish lips or nails (cyanosis), confusion, and rapid breathing, it is best to seek prompt medical care26,27.
Conclusion
Talking about the main question – is pneumonia contagious in adults? Well, it may or may not be, depending on its underlying cause. It is important to recognise the type of pneumonia you have and how it may be transmitted. Taking appropriate precautions such as getting timely vaccinations and promoting good hygiene can help prevent its spread. Early diagnosis and treatment are essential for a quick recovery.
Frequently Asked Questions (FAQs)
What are the complications of pneumonia, if left untreated?
The complications of untreated or incompletely treated pneumonia include respiratory failure, accumulation of pus in between the lung and the lining of the chest wall (empyema), lung abscess, sepsis and may also lead to multi organ failure5.
Is pneumonia more dangerous during pregnancy?
Yes, pregnant individuals are at higher risk of complications of pneumonia such as low weight at birth and increased risk of preterm birth due to weakened immunity28.
Can pets transmit pneumonia to humans?
Yes, this can occur, though rarely. Certain infections such as Q fever (caused by Coxiella burnetii) and Psittacosis (caused by Chlamydophila psittaci) may occur in individuals working closely with animals or livestock29,30.
What is the difference between bronchitis and pneumonia?
Bronchitis affects your bronchial tubes (airways), while pneumonia affects the air sacs (alveoli) in the lungs. The symptoms of pneumonia tend to be more severe and may involve high-grade fever, chest pain, and shortness of breath14,17.
Troeger C, Blacker B, Khalil IA, Rao PC, Cao J, Zimsen SRM, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Infectious Diseases [Internet]. 2018 Nov;18(11):1191–210. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6202443/
Smith DJ, Williams SL, Benedict KM, Jackson BR, Toda M, Adame G, et al. Surveillance for Coccidioidomycosis, Histoplasmosis, and Blastomycosis — United States, 2019. MMWR Surveillance Summaries [Internet]. 2022 Aug 19;71(7):1–14. Available from: https://www.cdc.gov/mmwr/volumes/71/ss/ss7107a1.htm
José RJ, Periselneris JN, Brown JS. Opportunistic bacterial, viral and fungal infections of the lung. Medicine [Internet]. 2020 Jun 1;48(6):366–72. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7206443/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
Bacterial Pneumonia: What Is It, Causes, Symptoms & Treatment
Introduction
Pneumonia is one of the leading causes of mortality in the world, making it a global health concern1. It is a serious infection that affects your lungs by causing inflammation and fluid or pus accumulation in the alveoli (air sacs) of your lungs2. Bacterial pneumonia, especially from Streptococcus pneumoniae or Haemophilus influenzae type b, is a common cause of pneumonia-related deaths. However, viral pneumonia, caused by viruses like respiratory syncytial virus (RSV) and influenza, also contributes significantly to pneumonia cases and fatalities1,3.
What Is Bacterial Pneumonia?
Bacterial pneumonia, as the name suggests, is caused by various bacteria that invade your lungs. Your body’s natural defence system tries to fight these bacteria as a part of the immune response, leading to inflammation of the air sacs of your lungs and the accumulation of fluid and pus in them4. Inflammation occurs as part of the immune response, but sometimes pathogenic bacterial factors also directly damage tissue, e.g., inflammation caused by the toxin pneumolysin from S. pneumoniae5. Bacterial pneumonia can be of different types, including3:
Community-acquired Pneumonia: Occurs in individuals who acquire the infection outside of hospital settings or within 48 hours of admission.
Hospital-acquired Pneumonia: This type of pneumonia occurs in individuals who develop the infection 48 hours after admission to any hospital.
Atypical Pneumonia: This type of pneumonia is generally caused by bacteria that are less commonly associated with pneumonia, e.g., Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella spp. These organisms are not generally identified by the traditional staining methods (Gram stain), but the pneumonia often presents with symptoms that occur outside the lungs. Though atypical bacterial pneumonia is mostly bacterial in origin, it may not be categorised as typical bacterial pneumonia6.
Ventilator-associated Pneumonia: This type of pneumonia occurs 48 hours or more after a person has been placed on a ventilator to help them breathe.
Community-acquired Pneumonia: The main organisms that cause this infection include S. pneumoniae, H. influenzae, M. pneumoniae, Legionella spp., Moraxella catarrhalis, and Staphylococcus aureus (especially methicillin-resistant S. aureus), which is commonly associated with severe cases or following a viral infection like influenza.
Hospital-acquired Pneumonia: The main organisms that cause this infection include S. aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii.
Atypical Pneumonia: The main organisms that cause this infection include M. pneumoniae, C. pneumoniae, or Legionella pneumophila.
Ventilator-associated Pneumonia: The main organisms that cause this infection include S. aureus, P. aeruginosa, enterobacter species (such as Klebsiella, E. coli) and gram-negative bacilli8.
In 50% of pneumonia cases, the etiological factor remains unknown. Identifying the causative organism is essential for appropriate treatment7.
How Does Bacterial Pneumonia Spread?
Bacterial pneumonia is contagious and can spread from person to person. This infection is transmitted through contact with infected surfaces. It can also spread when the droplets released when an infected person coughs or sneezes are inhaled by another person3,7.
It is always recommended to avoid close contact with infected individuals, wear a mask and practice proper hand hygiene to reduce your risk of infection9.
Who Is More Likely to Get Bacterial Pneumonia?
While bacterial pneumonia can affect anyone, certain groups of people, including the following, are more likely to develop bacterial pneumonia3,7,10:
Children (under 5 years of age) or older adults (over 65 years of age).
Chronic conditions (such as diabetes, chronic lung disease, and heart disease).
Weakened immune system.
Smoking and alcohol consumption.
Poor oral hygiene
Use of certain medications (e.g., proton pump inhibitors like omeprazole and pantoprazole).
Symptoms of Bacterial Pneumonia
The signs and symptoms of bacterial pneumonia include3,7:
Productive cough with mucus that can be clear, yellow/green, or contain blood. Dry cough is more common with viral and atypical pneumonia6,11.
Systemic symptoms of bacterial pneumonia may include3,7:
Headache
Sweaty and clammy skin or chills
Altered mental status or confusion
Hypotension
Cyanosis due to low oxygen levels
Increased heart rate (tachycardia). Decreased heart rate (bradycardia) is uncommon and may be associated with pneumonia caused by Chlamydia sp, Legionnaire’s disease, and typhoid12.
In children under 5 years of age, the signs and symptoms of bacterial pneumonia may include rapid breathing, chest pain, abdominal pain, and pale colour of the face3,7.
Diagnosis of Bacterial Pneumonia
After a careful assessment of your symptoms, your doctor will be able to diagnose your condition with the help of3,7:
Chest X-ray: If you present with symptoms of pneumonia, your chest X-ray serves as a first-line imaging tool for the diagnosis of bacterial pneumonia. Your chest X-ray may show pulmonary infiltrates and may suggest the type of pneumonia present (for example, lobar or interstitial pneumonia). However, it cannot accurately distinguish between bacterial and non-bacterial pneumonia (such as viral pneumonia).
Computed Tomography: Helpful in unclear cases or when other conditions may be present.
Blood Tests: Your doctor may recommend laboratory tests such as:
Complete blood count: Creatinine levels and complete white blood cell count (for the diagnosis and detection of severity of infection)
Liver function tests: Abnormalities on the liver function tests may be observed in cases of severe or complicated pneumonia or Legionella infections13.
Inflammatory biomarkers (e.g., erythrocyte sedimentation rate and C-reactive protein): Supportive markers for inflammation and severity. Elevated levels of C-reactive protein are suggestive of bacterial pneumonia. However, this result is not definitive, and these tests cannot distinguish between bacterial and viral pneumonia.
Arterial blood gases: Used in severe cases where hypoxia (low oxygen supply to tissues) and respiratory acidosis (acidic blood due to the presence of carbon dioxide) are present.
Sputum Culture: May be advised in severe cases or hospitalised cases to identify the bacteria causing your illness.
Gram Staining: To identify the bacteria and guide your treatment. For example, Gram-positive cocci, such as S. pneumoniae, and Gram-negative bacilli like H. influenzae.
Respiratory Viral Panel (including influenza): Done by collecting a sample from your respiratory tract (nasopharyngeal swab) to check for viral pathogens such as influenza, RSV or SARS-CoV-2. The results may indicate a secondary bacterial infection, which is common after a viral infection.
Based on these tests, your doctor will be able to diagnose your condition accurately and will suggest the appropriate treatment for your condition. A definitive diagnosis, especially in hospitalised cases or complicated cases will always require identification of the organism.
Bacterial vs. Viral Pneumonia
While bacterial and viral pneumonia are two common types of lung infections that share similar symptoms, the table below highlights the key differences between the two types of pneumonia3,7,11.
Bacterial Pneumonia
Viral Pneumonia
Aetiology
Bacterial (e.g., Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus)
Viral (for example, Respiratory syncytial virus or RSV, influenza virus, adenovirus and coronaviruses like SARS-CoV-2)
Onset
Sudden onset and more severe symptoms
Gradual onset and symptoms may not be severe initially
Nasal or throat swab (PCR), Chest X-ray, and patient’s history
Treatment
Antibiotics
Supportive care (rest, fluids, fever control); antivirals in some cases (e.g., influenza)
Complications
Abscess, empyema, and sepsis
Respiratory failure, liver failure, heart failure, and secondary bacterial infection
If you are suffering from any lung infection and are unsure whether it is a bacterial or viral infection, it is best to consult your doctor and get appropriate medical treatment.
Bacterial Pneumonia Treatment
The main treatment of bacterial pneumonia involves the use of antibiotics. If you are healthy and do not have any other chronic medical conditions, the treatment may include antibiotics like3,7:
If you have any chronic medical conditions such as diabetes or heart disease, the treatment may include combination treatments like3,7:
Amoxicillin/clavulanate or cephalosporins (such as cefpodoxime or cefuroxime) along with a macrolide (such as azithromycin or clarithromycin) or doxycycline.
Alternatively, your doctor may recommend a single stronger antibiotic like levofloxacin or moxifloxacin.
If you are admitted to the hospital but your pneumonia is not too severe, your doctors may recommend3,7:
A beta-lactam antibiotic (such as ceftriaxone) along with a macrolide (such as azithromycin or doxycycline).
Alternatively, a single respiratory fluoroquinolone (such as levofloxacin) may be used. However, it is important to note that overuse of these respiratory fluoroquinolones may lead to resistance to the antibiotic and an increased risk of Clostridium difficile infection14.
If you are admitted to the hospital and your pneumonia is severe, your treatment will be more aggressive and usually includes3,7:
A beta-lactam antibiotic plus a macrolide
Alternatively, your doctor may recommend a beta-lactam antibiotic along with a respiratory fluoroquinolone.
Prevention of Bacterial Pneumonia
Certain tips that you can follow to reduce your risk of pneumonia include3,7,9:
Ensure good hand hygiene by washing your hands regularly with warm water and soap.
Avoid smoking and alcohol consumption.
Maintain good oral hygiene, as poor oral hygiene is a risk factor for bacterial pneumonia.
Ensure prompt medical care if you have chronic conditions such as asthma.
Consult your doctor regarding the following vaccinations for infants and children to prevent pneumonia:
H. influenzae type b vaccination (Hib Vaccination): Recommended for infants and children under 5 years of age. The vaccination schedule can be a 3-dose series with doses taken at 2, 4, and 6 months plus a booster dose at 12-15 months or a 2-dose series with doses taken at 2 and 4 months plus a booster dose)15,16
Pertussis vaccination (DTaP / Tdap Vaccination): The DTaP vaccine is administered during childhood, while the Tdap booster is advised for adolescents and adults, especially for pregnant women. However, this vaccination does not directly prevent bacterial pneumonia17.
Pneumococcal vaccination (PCV 15/PCV20 and PPSV23): Helps protect against S. pneumoniae. This vaccination is recommended for all children under 5 years of age and for children and adults with chronic conditions like diabetes and chronic lung disease18.
By following these steps, you can reduce your risk of developing bacterial pneumonia and improve your overall health3,7.
If left untreated, bacterial pneumonia can lead to complications like7:
Fluid buildup around the lungs (pleural effusion)
Pus collection in the lung area (empyema)
Infection in the lung (lung abscess)
Breathing difficulty due to lung damage
Residual lung scarring after severe pneumonia or acute respiratory distress syndrome (ARDS)19
Widespread infection in the body (sepsis)
Bacteria in the bloodstream (bacteraemia)
Low oxygen levels in the blood (hypoxemia)
Early diagnosis and proper treatment of bacterial pneumonia can help prevent serious and potentially life-threatening complications7.
When to See a Doctor
You should consult a doctor for bacterial pneumonia if you experience symptoms like a persistent cough, chest pain, difficulty breathing, or a high fever3,7.
You should seek immediate medical attention if you are at an increased risk of developing bacterial pneumonia (if you are an adult over 65 years of age, a child under 5 years of age, or if you are facing any other chronic medical conditions)3,7.
Bacterial pneumonia is a serious infection that continues to pose a major global health challenge. Understanding its causes, risk factors, symptoms, and the importance of timely diagnosis and appropriate antibiotic treatment is key to improving outcomes. Preventive measures such as good hygiene, vaccination, and lifestyle modifications play a crucial role in reducing the risk of bacterial pneumonia. Most importantly, early medical attention, especially for high-risk individuals, can significantly lower the chances of complications and ensure better recovery.
Frequently Asked Questions (FAQs)
Can bacterial pneumonia recur after treatment?
Yes, bacterial pneumonia can recur after treatment. The chances of recurrence are increased in individuals with underlying health conditions, weakened immunity, or poor lung function. Recurrence may also happen if the initial infection wasn’t completely treated3,7.
When will my symptoms start to improve?
Most patients show improvement in 48 to 72 hours. If there is no improvement, an alternative cause should be suspected3.
Can bacterial pneumonia develop as a complication of viral pneumonia?
Yes, bacterial pneumonia can often develop as a secondary infection following viral illnesses like COVID-19 or influenza, often worsening the clinical outcome11.
What benefits does walking have for individuals with bacterial pneumonia?
Mild physical activity like walking can aid recovery; however, strenuous exercise should be avoided until your doctor confirms full recovery and lung function is stable. Consult your doctor to understand if exercises are suitable for your condition20.
References
Troeger C, Blacker B, Khalil IA, Rao PC, Cao J, Zimsen SRM, et al. Estimates of the global, regional, and national morbidity, mortality, and aetiologies of lower respiratory infections in 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Infectious Diseases [Internet]. 2018 Nov;18(11):1191–210. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6202443/
Miyashita N. Atypical pneumonia: Pathophysiology, diagnosis, and treatment. Respiratory Investigation [Internet]. 2021 Nov;60(1). Available from: https://pubmed.ncbi.nlm.nih.gov/34750083/
Pahal P, Rajasurya V, Sharma S. Typical Bacterial Pneumonia [Internet]. National Library of Medicine. StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534295/
Kohbodi GA, Rajasurya V, Noor A. Ventilator-associated Pneumonia [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507711/
Ostergaard L, Huniche B, Andersen PL. Relative bradycardia in infectious diseases. The Journal of Infection [Internet]. 1996 Nov 1;33(3):185–91. Available from: https://pubmed.ncbi.nlm.nih.gov/8945708/
Patterson CM, Loebinger MR. Community acquired pneumonia: assessment and treatment. Clinical Medicine [Internet]. 2012 Jun;12(3):283–6. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4953496/
Shea KM, Hobbs ALV, Jaso TC, Bissett JD, Cruz CM, Douglass ET, et al. Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection. Antimicrobial Agents and Chemotherapy [Internet]. 2017 Jun;61(6). Available from: https://journals.asm.org/doi/10.1128/aac.00125-17
Gilsdorf JR. Hib Vaccines: Their Impact on Haemophilus influenzae Type b Disease. The Journal of Infectious Diseases [Internet]. 2021 Sep 30;224(Supplement_4):S321–30. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC8482018/
Matthay MA, Zemans RL, Zimmerman GA, Arabi YM, Beitler JR, Mercat A, et al. Acute Respiratory Distress Syndrome. Nature Reviews Disease Primers [Internet]. 2019 Mar 14;5(1). Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6709677/
Ikeda T, Inoue S, Konta T, Murakami M, Fujimoto S, Iseki K, et al. Can Daily Walking Alone Reduce Pneumonia-Related Mortality among Older People? Scientific Reports [Internet]. 2020 May 22;10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244731/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
Walking Pneumonia: What Is It, Causes, Symptoms, Diagnosis & Treatment
Introduction
Are you wondering what is walking pneumonia? Walking pneumonia or atypical pneumonia is an infection of the lower respiratory tract1. This condition is generally a milder form of pneumonia where the patient may be well enough to walk around, that’s why it’s called “walking pneumonia2”.
This type of pneumonia is usually acquired outside of hospital or healthcare settings and caused by pathogens that are not commonly associated with pneumonia and not easily detectable by common staining and culture methods1. The most common organisms associated with walking pneumonia include the bacteria Mycoplasma pneumoniae, Chlamydia pneumoniae, or Legionella pneumoniae3.
Bacterial atypical pneumonia comprises around 15% of the total pneumonia cases acquired outside of hospital and healthcare settings4.Although, usually these infections are not very severe, the mortality of walking pneumonia among the elderly is 8.0%, while in younger, healthy individuals, the mortality is 0.5-2.0%5.
What Is Walking Pneumonia?
Walking Pneumonia, scientifically referred to as atypical pneumonia, is a milder form of lung infection, often caused by Mycoplasma pneumoniae, that generally does not require hospitalisation.
As this pneumonia usually has a mild course , most affected individuals can still continue their routine without any interruption to your daily activities and hence, this condition is commonly referred to as walking pneumonia2. However, it is important to note that the severity of pneumonia can range from mild to life-threatening depending on factors such as age, the type of organism causing the infection, and when the walking pneumonia treatment is started1.
Causes of Walking Pneumonia
You may be wondering what causes walking pneumonia. Actually, walking or atypical pneumonia is caused by an invasion of bacteria (most commonly), and viruses or fungi (less commonly), that leads to inflammation of your air sacs or alveoli in your lungs1.
Bacteria: Bacteria such as Mycoplasma pneumoniae, Chlamydia pneumoniae and Legionella pneumoniae are the most common causative organisms of atypical pneumonia3.
Viruses: Viruses such as the severe acute respiratory syndrome coronavirus 2 may cause atypical pneumonia3.
Fungi: Rarely, pneumonia may be caused by fungi, especially in individuals with a weak immune system6.
Walking pneumonia is typically acquired from the community (outside a hospital setting), most often by inhalation of respiratory secretions that contain the causative organism.
Types of Atypical Pneumonia
Based on what causes walking pneumonia, the different types of atypical pneumonia include:
Mycoplasma pneumonia: This condition generally affects children, adolescents and young individuals (typically 5-15 years), but it can occur at any age7,8. In individuals, it can cause a range of symptoms, from mild respiratory tract infections to severe atypical pneumonia9.
Chlamydia pneumonia: This condition can cause upper and lower respiratory tract infections causing symptoms such as headaches, tiredness, hoarseness of voice, fever, sore throat and cough that becomes worse over time10.
Legionnaire’s disease: This condition generally affects middle age and older individuals. It is more often noticed in individuals with a weak immune system or chronic illness and in smokers7. This infection mainly spreads by inhalation or aspiration of contaminated water (For example: showers, hot tubs, etc) The symptoms noticed include fever, muscle pain, headaches, shortness of breath, diarrhoea and cough11.
Q Fever: This condition is caused by the bacteria Coxiella burnetii which may present with symptoms such as fever, tiredness, muscle aches and chills. Q fever is often zoonotic (infection transmitted from animals to humans) and it is commonly noticed in individuals who work closely with animals or livestock. Individuals may get infected by inhaling dust contaminated with animal products and excreta such as faeces, urine and milk3,12.
Psittacosis: Less commonly noticed, this condition generally affects individuals in close contact with pet birds and poultry and is caused by the bacteria, Chlamydophila psittaci (formerly Chlamydia psittaci) which is a zoonotic atypical pneumonia. Common symptoms of psittacosis include headaches, fever, chills, dry cough and muscle pain3,13.
Signs and Symptoms
Though walking pneumonia is a mild infection, it does not always mean that you may be asymptomatic or fully functional. The walking pneumonia symptoms are generally mild and mainly include1,7:
Fever and chills
Shortness of breath
Dry cough that worsens at night
Sore throat
Headaches
Loss of appetite
Tiredness and low energy
Chest pain
Sweaty skin
Muscle pain and joint stiffness
Less common signs of walking pneumonia that may be noticed in the different types of walking pneumonia include7:
Mycoplasma pneumonia: Otitis media (Ear pain), cervical lymphadenopathy (lump in the neck), erythema multiforme (rashes), and conjunctivitis (eye pain and soreness)
Legionella pneumonia: Diarrhoea, vomiting, blood in mucous
Chronic medical conditions such as diabetes, heart or lung disease, chronic liver disease, etc.
Living in crowded settings
Smoking
Excessive alcohol consumption
You may pose an increased risk of developing specific types of atypical pneumonia if you are:
A child, teenager or an adult under 40 years of age (Risk factor for Mycoplasma pneumonia). Although it can occur in older adults, it is less common7.
Increased age, smoking, weak immune system, chronic lung disease and exposure to contaminated water (Risk factor for Legionella pneumonia)7 ,11.
In close contact with infected birds and poultry or exposure to bird droppings and secretions increase your risk of Psittacosis infection. (Risk factor for Psittacosis)13.
Is walking pneumonia contagious?
Yes, it is contagious and walking pneumonia symptoms can spread from person to person. However, infections caused by Legionella pneumonia and Coxiella burnetii (Q fever) are not spread from person-to-person1.
The most common type of walking pneumonia caused by Mycoplasma pneumonia is highly contagious and spreads through infected droplets of affected individuals especially when they cough and sneeze. The disease spreads when you inhale these infected droplets15.
Hence, close proximity with an infected individual over an extended period of time causes the spread of infection. The symptoms are generally noticed two to three weeks post exposure to the causative agent (Mycoplasma pneumonia). However, it is important to note that you may be contagious before any symptoms appear and generally, once infected, the contagious period is around 10 days and may be longer, if not treated15.
How is walking pneumonia diagnosed?
Your doctor will be able to diagnose walking pneumonia with certain examinations and laboratory tests such as7:
Chest X-ray: Your Chest X-ray may show patchy infiltrates which is a feature of atypical pneumonia. However, it cannot accurately distinguish between walking pneumonia and other pneumonias or respiratory conditions like bronchitis4.
Blood Tests: Based on the severity of your condition, your doctor may recommend laboratory tests such as:
Measurement of arterial blood gases: To check oxygen and carbon dioxide levels in blood (Used in cases where ventilatory failure or hypoxia is suspected)16.
Other blood tests: To identify the specific bacteria causing your illness.
Bronchoscopy (Tube with a camera is passed to your lungs): Only used when diagnosis is unclear, atypical presentations, or failure to respond to treatment.
Swab of nose or throat: To identify any bacteria and viruses
Sputum Culture: To identify specific bacteria causing your illness.
Urine Test: To help in the diagnosis of Legionella pneumonia.
Based on these tests, your doctor will be able to accurately diagnose your condition and will suggest the appropriate walking pneumonia treatment.
Treatment
After a careful assessment of your condition, your doctor will be able to suggest the best walking pneumonia treatment suitable for you.
Macrolide antibiotics: This is generally the first line of treatment to manage walking pneumonia. Macrolide antibiotics prescribed may include azithromycin and clarithromycin1.
The macrolide antibiotics may be combined with broad-spectrum medications including ceftriaxone, cefotaxime depending on the severity of your condition (particularly when both typical and atypical pathogens are suspected)1. If your condition is severe, your doctor may recommend antibiotics intravenously7.
Over-the-counter medications: Non-Steroidal Anti-Inflammatory Drugs or NSAIDs (such as aspirin, ibuprofen, naproxen) and cough medication may be effective in managing symptoms such as fever and cough7. However, in children, aspirin is not recommended.
Drink lots of fluid. This will help to loosen your secretions and bring up the phlegm7.
Delayed treatment in individuals suffering from Legionella or weakened immune systems can worsen treatment outcomes. While delayed treatment may not always lead to severe disease in cases of Mycoplasma infections, early treatment is key for good recovery and prognosis1,11.
Prevention
To reduce your risk of infection, you can follow these steps2,7:
Wash your hands regularly with warm water and soap.
Avoid close contact with individuals who are sick and wear a mask to reduce your risk of infection.
Exercise regularly and eat timely meals with a well-balanced diet.
Ensure that you get a flu vaccination every year to reduce your chance of infection.
If you have a weak immunity, it is recommended to avoid crowds.
Consult your doctor about pneumonia vaccination. Your doctor may suggest that you get vaccinated for pneumococcal pneumonia as it can help protect against Streptococcus pneumoniae, which causes a type of pneumonia not associated with healthcare settings.
To ensure good respiratory health, consult your doctor about DTaP/ Tdap Vaccination (Diptheria, tetanus and pertussis vaccine) as it helpful for your respiratory health.
By following these simple methods, you can avoid catching pneumonia especially if you are at high risk and protect your overall health2.
While individuals with walking pneumonia may be able to carry on with routine activities, certain self-care and hygiene measures can aid in a faster recovery. These include2,7,17:
Get adequate rest and sleep well.
Pay attention to your diet; choose food that is healthy for your heart and stay hydrated.
Quit smoking and avoid alcohol.
Do light exercise. (You doctor can suggest the appropriate regimen)
Practise deep breathing.
Take medications as advised by your doctor.
Keep a watch of your symptoms. If there is no improvement or there is worsening of symptoms even after taking antibiotics, contact your doctor immediately.
Remember, if you are walking around with pneumonia, it’s your responsibility to prevent its spread to others. Avoid any unnecessary contact with other individuals. Avoid going to public places and always cover your mouth while sneezing and coughing or wear a protective mask. Wash your hands with soap and water regularly. Following these simple measures can have a huge public health impact.
You should consult your doctor if you develop signs of walking pneumonia such as fever, shortness of breath, or cough. Your doctor will thoroughly assess your condition and will advise you on the best method to manage your condition.
You should also consult your doctor if you have been diagnosed with pneumonia and if your walking pneumonia symptoms get worse after an initial improvement7.
Walking pneumonia, or atypical pneumonia, is generally a mild respiratory infection commonly caused by atypical bacteria such as Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumoniae. While walking pneumonia symptoms are not very severe, it still requires proper medical care. With timely diagnosis, appropriate walking pneumonia treatment, and good hygiene, you can recover smoothly and avoid complications. Tips like handwashing, vaccinations, and avoiding smoking play a key role in reducing your risk and promoting your overall health.
Frequently Asked Questions (FAQs)
Can walking pneumonia recur after treatment?
Although not very common, walking pneumonia can recur after treatment. The chances of recurrence are increased if the infection is not completely removed with antibiotics or if you face any antibiotic resistance1.
What are the complications of walking pneumonia?
If not diagnosed and treated properly, complications may arise and may include brain and nervous system infections (such as meningitis, encephalitis), severe lung damage, haemolytic anaemia (a condition in which the body destroys its own red blood cells) and respiratory failure7.
Can walking pneumonia be detected on a regular physical exam?
Walking pneumonia may not be detected on a routine physical exam alone and your doctor may require a chest X-ray or other laboratory tests to confirm the diagnosis7.
Can I exercise if I have pneumonia?
Exercise may be beneficial in pneumonia. A study18 has shown lower mortality rate in elderly individuals having pneumonia who walk daily compared to individuals who did not walk or exercise in any other form. However, you doctor will guide you best if exercising or walking is suitable for you if you have pneumonia.
References
Stamm DR, Stankewicz HA. Atypical Bacterial Pneumonia [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2020. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532239/
Miyashita N. Atypical pneumonia: Pathophysiology, diagnosis, and treatment. Respiratory Investigation [Internet]. 2021 Nov;60(1). Available from: https://pubmed.ncbi.nlm.nih.gov/34750083/
Dueck NP, Epstein S, Franquet T, Moore CC, Bueno J. Atypical Pneumonia: Definition, Causes, and Imaging Features. RadioGraphics [Internet]. 2021 Apr 9;41(3):200131. Available from: https://pubs.rsna.org/doi/full/10.1148/rg.2021200131
Bajantri B, Toolsie O, Venkatram S, Diaz-Fuentes G. Mycoplasma Pneumoniae Pneumonia: Walking Pneumonia Can Cripple the Susceptible. Journal of Clinical Medicine Research [Internet]. 2018 Dec 1;10(12):891–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6225856/
Meyer Sauteur PM, Unger WWJ, Nadal D, Berger C, Vink C, van Rossum AMC. Infection with and Carriage of Mycoplasma pneumoniae in Children. Frontiers in Microbiology [Internet]. 2016 Mar 23;7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803743/
Levin KP, Hanusa BH, Rotondi A, Singer DE, Coley CM, Marrie TJ, et al. Arterial blood gas and pulse oximetry in initial management of patients with community-acquired pneumonia. Journal of General Internal Medicine. 2001 Sep;16(9):590–8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC1495269/
Ikeda T, Inoue S, Konta T, Murakami M, Fujimoto S, Iseki K, et al. Can Daily Walking Alone Reduce Pneumonia-Related Mortality among Older People? Scientific Reports [Internet]. 2020 May 22;10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7244731/
Disclaimer: The information provided here is for educational/awareness purposes only and is not intended to be a substitute for medical treatment by a healthcare professional and should not be relied upon to diagnose or treat any medical condition. The reader should consult a registered medical practitioner to determine the appropriateness of the information and before consuming any medication. PharmEasy does not provide any guarantee or warranty (express or implied) regarding the accuracy, adequacy, completeness, legality, reliability or usefulness of the information; and disclaims any liability arising thereof.
