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Viral pneumonia

Definition

Viral pneumonia is inflammation (irritation and swelling) of the lungs due to infection with a virus.

See also:

• Atypical pneumonia
• Influenza
• Respiratory syncytial virus

Alternative Names

Pneumonia - viral; "Walking pneumonia" - viral

Causes, incidence, and risk factors

Viralpneumonia is more likely to occur in young children and older adults, because their bodies have a harder time fighting off the virus.

Viral pneumonia is most often caused by one of several viruses:

• Adenovirus
• Influenza
• Parainfluenza
• Respiratory syncytial virus

People who are at risk for more serious viral pneumonia often have a weakened immune system, including:

• Adult HIV/AIDS patients
• Babies who are born too early
• Children with heart and lung problems
• People receiving chemotherapy for cancer, or other medications that weaken the immune system.
• Organ transplant recipients

Symptoms

Symptoms of viral pneumonia often begin slowly and may not be severe at first.

The most common symptoms of pneumonia are:

• Cough (with some pneumonias you may cough up mucus, or even bloody mucus)
• Fever, which may be mild or high
• Shaking chills
• Shortness of breath (may only occur when you climb stairs)

Other symptoms include:

• Confusion, especially in older people
• Excessive sweating and clammy skin
• Headache
• Loss of appetite, low energy, and fatigue
• Sharp or stabbing chest pain that gets worse when you breathe deeply or cough
• Fatigue

Signs and tests

Persons with suspected pneumonia should have a complete medical evaluation, including a thorough physical exam and a chest x-ray -- especially since the physical exam may not always distinguish pneumonia from acute bronchitis or other respiratory infections.

Depending on the severity of illness, other tests may be done, including:

• Complete blood count (CBC)
• CT scan of the chest
• Blood cultures
• Blood tests to diagnose specific viruses
• Bronchoscopy (rarely needed)
• Open lung biopsy (only done in very serious illnesses when the diagnosis cannot be made from other sources)
• Sputum culture

Treatment

Antibiotics do not treat viral pneumonia. Medication only works against influenza pneumonia. These medications are called antivirals.

Treatment may also involve:

• Increased fluids
• Oxygen
• Use of humidified air

A hospital stay may be necessary to prevent dehydration and to help with breathing if the infection is serious.

You are more likely to be admitted to the hospital if you:

• Are older than 65 years or a young child
• Are unable to care for yourself at home, or are unable to eat or drink
• Have another serious medical problem, such as a heart or kidney problem
• Have been taking antibiotics at home and are not getting better
• Have severe symptoms

However, many people can be treated at home.

You can take these steps at home:

• Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs, such as ibuprofen or naproxen), or acetaminophen. DO NOT give aspirin to children.
• Do not take cough medicines without first talking to your doctor. Cough medicines may make it harder for your body to cough up the extra sputum.
• Drink plenty of fluids to help loosen secretions and bring up phlegm.
• Get a lot of rest. Have someone else do household chores.

Support Groups

Expectations (prognosis)

Most cases of viral pneumonia are mild and get better without treatment within 1 - 3 weeks, but some cases are more serious and require hospitalization.

Complications

More serious infections can result in respiratory failure, liver failure, and heart failure. Sometimes, bacterial infections occur during or just after viral pneumonia, which may lead to more serious forms of pneumonia.

Calling your health care provider

Call your health care provider if symptoms of viral pneumonia develop.

Prevention

Wash your hands often, especially after blowing your nose, going to the bathroom, diapering a baby, and before eating or preparing foods.

Don't smoke. Tobacco damages your lungs' ability to ward off infection.

Vaccines may help prevent pneumonia in children, the elderly, and people with diabetes, asthma, emphysema, HIV, cancer, or other chronic conditions.

• A drug called palivizumab (Synagis) is given to some children under 24 months old to prevent pneumonia caused by respiratory syncytial virus.
• Flu vaccine prevents pneumonia and other problems caused by the influenza virus. It must be given each year to protect against new virus strains.

If your immune system is weak, stay away from crowds. Ask visitors who have a cold to wear a mask.

References

Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27-S72.

Donowitz GR. Acute pneumonia. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 64.