Bacterial diseases: Introduction

Bacterial diseases include any type of illness or disease caused by bacteria, a type of microbe. Microbes are tiny organisms that cannot be seen without a microscope and include viruses, fungi, and some parasites as well as bacteria. The vast majority of bacteria do not cause disease, and many bacteria are actually helpful and even necessary to good health. Millions of bacteria normally live on the skin and in the intestines and can also be found on the genitalia. Bacterial diseases result when the harmful bacteria get into an area of the body that is normally sterile, such as the bladder, or when they crowd out the helpful bacteria in places such as the intestines. Harmful bacteria are called pathogenic and include Neisseria meningitidis, which can cause meningitis, Streptococcus pneumoniae, which can cause pneumonia, and Staphylococcus aureus, which can cause a variety of infections. Other common pathogenic bacteria include Helicobacter pylori, which can cause gastric ulcers, and Escherichia coli and Salmonella, which can both cause food poisoning. Pathogenic bacteria can enter the body through a variety of means, including inhalation into the nose and lungs, ingestion in food or through sexual contact. Once bacteria enter the body, a healthy immune system will recognize the bacteria as foreign invaders and try to kill or stop the bacteria from reproducing. However, even in a healthy person with a healthy immune system, the body is not always able to stop the bacteria from multiplying and spreading. As the harmful bacteria reproduce, many emit toxins which damage the cells of the body, resulting in symptoms of a bacterial disease. Symptoms of bacterial diseases often include fever and chills. For more information on symptoms, refer to symptoms of bacterial diseases. Bacterial infections can lead to serious, even life-threatening complications, such as sepsis, kidney failure, toxic shock syndrome, and death. People at risk for bacterial diseases and its complications include those who have had a significant

exposure to a pathogenic bacteria, such as Neisseria meningitidis, or Streptococcus pneumoniae. Other risk factors include having a compromised immune system due to such diseases as HIV/AIDS or combined immunodeficiencies. People who take certain medications, such as corticosteroids, which suppress the body's natural immune response, are also at risk for contracting bacterial diseases. Other risk factors include malnutrition, high stress levels, having a genetic predisposition to bacterial infection, and being very young or very old. Making a diagnosis of bacterial diseases begins with taking a thorough personal and family medical history, including symptoms, and completing a physical examination. The types of diagnostic testing performed for a suspected bacterial disease varies depending on the symptoms. A complete blood count (CBC) is a blood test is generally done on anyone who might have a bacterial disease. A complete blood count measures the numbers of different types of blood cells, including white blood cells (WBCs). Different types of WBCs increase in number in characteristic ways during an infectious process, such as bacterial diseases. A culture and sensitivity test (C and S) may be performed. This test requires taking a small sample from the body area that is suspected to be infected with bacteria and grows the sample in a lab. This test determines the type of bacteria causing a bacterial disease as well as which antibiotics would be most effective in treating that specific bacteria. Common samples tested with a culture and sensitivity include those from the throat, blood, and sputum from the lungs. Samples from lesions and abscesses are also tested with a culture and sensitivity. Diagnostic tests may also include a lumbar puncture, also called a spinal tap, which involves withdrawing a small sample of cerebrospinal fluid (CSF) from the spine with a needle. The sample of CSF is tested for white blood cells and other indications of bacterial diseases that may be in the spine or brain.

X-rays may be performed to assist in the diagnosis of some bacterial diseases. This may include taking a chest X-ray for suspected cases of pneumonia. Other imaging tests may include CT scan. Additional tests may be performed in order to rule out or confirm other diseases that may accompany bacterial diseases or cause similar symptoms, such as diarrhea or neck stiffness. It is possible that a diagnosis of bacterial diseases can be missed or delayed because some symptoms, such as fever, headache, and nausea and vomiting, are similar to symptoms of other diseases. For more information on misdiagnosis, refer to misdiagnosis of bacterial diseases. Bacterial diseases are treated with antibiotics. For more information on treatment, refer to treatment of bacterial diseases. ...more Bacterial diseases: Bacteria are single-celled creatures with tiny flagella. Bacteria are alive. They are very small organisms, often only a single cell. Bacteria need to get energy, and may emit toxins or waste products. By comparison, viruses are much smaller, and are not exactly "alive" in the normal sense. ...more Bacterial diseases: Symptoms Symptoms of bacterial diseases vary depending on the type of bacterial infection and the area of the body that is infected. The symptoms of bacterial diseases can also resemble symptoms of other diseases, such as colitis, influenza and other viral infections. The classic symptom of a bacterial infection is fever, although not all people with a bacterial infection will have a fever. ...more symptoms Bacterial diseases: Treatments The first step in treating bacterial diseases is preventing its occurrence and spread. Vaccines are available to prevent some bacterial diseases, such as meningitis, pneumonia, tetanus, and rabies. Prevention of the spread of harmful bacteria that cause bacterial diseases also includes frequent hand washing and

covering the mouth and nose with a tissue during sneezing or ...more treatments Bacterial diseases: Misdiagnosis A diagnosis of bacterial diseases may be delayed because some symptoms are vague, nonspecific, or may initially be mild. These include body aches, weight loss, fatigue, or irritability. Other symptoms, such as chest pain, headache, cough, or diarrhea, may initially be assumed to be related to another condition, such as influenza, "stomach flu", migraine ...more misdiagnosis Symptoms of Bacterial diseases Click to Check Tachypnoea Fever Tachycardia Hypoxemia Diaphoresis more symptoms... See full list of 6 symptoms of Bacterial diseases Home Diagnostic Testing Home medical testing related to Bacterial diseases: Cold & Flu: Home Testing: Home Fever Tests Home Ear Infection Test Kits Home Flu Tests CHOLERA: Cholera is an infection of the small intestine caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission is primarily through consuming contaminated drinking water or food. The severity of the diarrhea and vomiting can lead to rapid dehydration and electrolyte imbalance. Primary treatment is with oral rehydration solution and if these are not tolerated, intravenous fluids. Antibiotics are beneficial in those with severe disease. Worldwide it affects 3-5 million people and

causes 100,000-130,000 deaths a year as of 2010. Cholera was one of the earliest infections to be studied by epidemiological methods.

Signs and symptoms

A person with severe dehydration due to cholera. Note the sunken eyes and decreased skin turgor which produces wrinkled hands The primary symptoms of cholera are profuse painless diarrhea and vomiting of clear fluid.[1] These symptoms usually start suddenly, one to five days after ingestion of the bacteria.[1] The diarrhea is frequently described as "rice water" in nature and may have a fishy odor.[1] An untreated person with cholera may produce 10-20 liters of diarrhea a day.[1] For every symptomatic person there are 3 to 100 people who get the infection but remain asymptomatic.[2] If the severe diarrhea and vomiting are not aggressively treated it can, within hours, result in dehydration and electrolyte imbalances.[1] The typical symptoms of dehydration include low blood pressure, poor skin turgor (wrinkled hands), sunken eyes, and a rapid pulse.[1]

Cause
Main article: Vibrio cholerae

TEM image of Vibrio cholerae

Cholera is caused by the bacterium Vibrio cholerae, mainly of the serogroup O1, but also possible of serogroup O139.[3] Transmission is primarily due to the fecal contamination of food and water due to poor sanitation.[3] This bacterium can, however, live naturally in aquatic environments.[4]

TYPHOID:

Typhoid fever, also known as typhoid,[1] is a common worldwide illness, transmitted by the ingestion of food or water contaminated with the feces of an infected person, which contain the bacterium Salmonella enterica enterica, serovar Typhi.[2][3] The bacteria then perforate through the intestinal wall and are phagocytosed by macrophages. The organism is a Gram-negative short bacillus that is motile due to its peritrichous flagella. The bacterium grows best at 37 C/99 F human body temperature. This fever received various names, such as gastric fever, abdominal typhus, infantile remittant fever, slow fever, nervous fever, pythogenic fever, etc. The name of " typhoid " was given by Louis in 1829, as a derivative from typhus. The impact of this disease falls sharply with the application of modern sanitation techniques.

Signs and symptoms

Typhoid fever is characterized by a slowly progressive fever as high as 40 C (104 F), profuse sweating, gastroenteritis, and nonbloody diarrhea. Less commonly, a rash of flat, rosecolored spots may appear.[4] Classically, the course of untreated typhoid fever is divided into four individual stages, each lasting approximately one week. In the first week, there is a slowly rising temperature with relative bradycardia, malaise, headache and cough. A bloody nose (epistaxis) is seen in a quarter of cases and abdominal pain is also possible. There is leukopenia, a decrease in the number of circulating white blood cells, with

eosinopenia and relative lymphocytosis, a positive diazo reaction and blood cultures are positive for Salmonella typhi or paratyphi. The classic Widal test is negative in the first week. In the second week of the infection, the patient lies prostrate with high fever in plateau around 40 C (104 F) and bradycardia (sphygmothermic dissociation), classically with a dicrotic pulse wave. Delirium is frequent, frequently calm, but sometimes agitated. This delirium gives to typhoid the nickname of "nervous fever". Rose spots appear on the lower chest and abdomen in around a third of patients. There are rhonchi in lung bases. The abdomen is distended and painful in the right lower quadrant where borborygmi can be heard. Diarrhea can occur in this stage: six to eight stools in a day, green with a characteristic smell, comparable to pea soup. However, constipation is also frequent. The spleen and liver are enlarged (hepatosplenomegaly) and tender, and there is elevation of liver transaminases. The Widal reaction is strongly positive with antiO and antiH antibodies. Blood cultures are sometimes still positive at this stage. (The major symptom of this fever is the fever usually rises in the afternoon up to the first and second week.)

Cause
Transmission Flying insects feeding on feces may occasionally transfer the bacteria through poor hygiene habits and public sanitation conditions. Public education campaigns encouraging people to wash their hands after defecating and before handling food are an important component in controlling spread of the disease. According to statistics from the United States Centers for Disease Control and Prevention (CDC), the chlorination of drinking water has led to dramatic decreases in the transmission of typhoid fever in the U.S.

A person may become an asymptomatic carrier of typhoid fever, suffering no symptoms, but capable of infecting others. According to the CDC approximately 5% of people who contract typhoid continue to carry the disease after they recover. The most famous asymptomatic carrier was Mary Mallon (commonly known as "Typhoid Mary"), a young cook who was responsible for infecting at least 53 people with typhoid, three of whom died from the disease.[5] Mallon was the first apparently perfectly healthy person known to be responsible for an "epidemic". Many carriers of typhoid were locked into an isolation ward never to be released in order to prevent further typhoid cases. These people often deteriorated mentally, driven mad by the conditions they lived in.
[6]

Treatment
The rediscovery of oral rehydration therapy in the 1960s provided a simple way to prevent many of the deaths of diarrheal diseases in general. Where resistance is uncommon, the treatment of choice is a fluoroquinolone such as ciprofloxacin[11][13] otherwise, a thirdgeneration cephalosporin such as ceftriaxone or cefotaxime is the first choice.[14][15][16] Cefixime is a suitable oral alternative.
[17][18]

Typhoid fever in most cases is not fatal. Antibiotics, such as ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, Amoxicillin and ciprofloxacin, have been commonly used to treat typhoid fever in developed countries. Prompt treatment of the disease with antibiotics reduces the case-fatality rate to approximately 1%. When untreated, typhoid fever persists for three weeks to a month. Death occurs in between 10% and 30% of untreated

cases[citation needed]. In some communities, however, case-fatality rates may reach as high as 47%.

Tuberculosis: Tuberculosis or TB (short for tubercles

bacillus) is a common and often deadly infectious disease caused by various strains of mycobacteria, usually Mycobacterium tuberculosis in humans.[1] Tuberculosis usually attacks the lungs but can also affect other parts of the body. It is spread through the air when people who have the disease cough, sneeze, or spit.[2] Most infections in humans result in an asymptomatic, latent infection, and about one in ten latent infections eventually progresses to active disease, which, if left untreated, kills more than 50% of its victims. The classic symptoms are a chronic cough with blood-tinged sputum, fever, night sweats, and weight loss. Infection of other organs causes a wide range of symptoms. Diagnosis relies on radiology (commonly chest X-rays), a tuberculin skin test, blood tests, as well as microscopic examination and microbiological culture of bodily fluids. Treatment is difficult and requires long courses of multiple antibiotics. Contacts are also screened and treated if necessary. Antibiotic resistance is a growing problem in (extensively) multi-drug-resistant tuberculosis. Prevention relies on screening programs and vaccination, usually with Bacillus Calmette-Gurin vaccine. One third of the world's population is thought to be infected with M. tuberculosis,[3][4] and new infections occur at a rate of about one per second.[5] The proportion of people who become sick with tuberculosis each year is stable or falling worldwide but, because of population growth, the absolute number of new cases is still increasing.[5] In 2007 there were an estimated 13.7 million chronic active cases, 9.3 million new cases, and 1.8 million deaths, mostly in developing countries.[6] In addition, more people in the developed world are contracting tuberculosis because their immune systems are compromised by immunosuppressive drugs, substance abuse, or AIDS. The

distribution of tuberculosis is not uniform across the globe; about 80% of the population in many Asian and African countries test positive in tuberculin tests, while only 5-10% of the US population test positive.

Signs and symptoms

Main symptoms of variants and stages of tuberculosis,[7][8] with many symptoms overlapping with other variants, while others are more (but not entirely) specific for certain variants. Multiple variants may be present simultaneously.

Scanning electron micrograph of Mycobacterium tuberculosis

Phylogenetic tree of the genus Mycobacterium. When the disease becomes active, 75% of the cases are pulmonary TB, that is, TB in the lungs. Symptoms include chest pain, coughing up blood, and a productive, prolonged cough for more than three weeks. Systemic symptoms include fever, chills, night sweats, appetite loss, weight loss, pallor, and often a tendency to fatigue very easily.[5] In the other 25% of active cases, the infection moves from the lungs, causing other kinds of TB, collectively denoted extrapulmonary tuberculosis.[9] This occurs more commonly in immunosuppressed persons and young children. Extrapulmonary infection sites include the pleura in tuberculosis pleurisy, the central nervous system in meningitis, the lymphatic system in scrofula of the neck, the genitourinary system in urogenital tuberculosis, and bones and joints in Pott's disease of the spine. An especially serious form is disseminated TB, more commonly known as miliary tuberculosis. Extrapulmonary TB may co-exist with pulmonary TB as well.[10]

Causes
Main article: Mycobacterium tuberculosis The primary cause of TB, Mycobacterium tuberculosis, is a small aerobic non-motile bacillus. High lipid content of this pathogen accounts for many of its unique clinical characteristics.[11] It divides every 16 to 20 hours, an extremely slow rate compared with other bacteria, which usually divide in less than an hour.[12] (For example, one of the

fastest-growing bacteria is a strain of E. coli that can divide roughly every 20 minutes.) Since MTB has a cell wall but lacks a phospholipid outer membrane, it is classified as a Gram-positive bacterium. However, if a Gram stain is performed, MTB either stains very weakly Gram-positive or does not retain dye due to the high lipid & mycolic acid content of its cell wall.[13] MTB can withstand weak disinfectants and survive in a dry state for weeks. In nature, the bacterium can grow only within the cells of a host organism, but M. tuberculosis can be cultured in vitro.[14] Using histological stains on expectorate samples from phlegm (also called sputum), scientists can identify MTB under a regular microscope. Since MTB retains certain stains after being treated with acidic solution, it is classified as an acidfast bacillus (AFB).[1][13] The most common acid-fast staining technique, the Ziehl-Neelsen stain, dyes AFBs a bright red that stands out clearly against a blue background. Other ways to visualize AFBs include an auramine-rhodamine stain and fluorescent microscopy. The M. tuberculosis complex includes four other TB-causing mycobacteria: M. bovis, M. africanum, M. canetti

Prevention
Map showing the 22 high-burden countries (HBC) that according to WHO account for 80% of all

new TB cases arising each year. The Global Plan is especially aimed at these countries. TB prevention and control takes two parallel approaches. In the first, people with TB and their contacts are identified and then treated. Identification of infections often involves testing high-risk groups for TB. In the second approach, children are vaccinated to protect them from TB. No vaccine is available that provides reliable protection for adults. However, in tropical areas where the levels of other species of mycobacteria are high, exposure to nontuberculous mycobacteria gives some protection against TB.[56] The World Health Organization (WHO) declared TB a global health emergency in 1993, and the Stop TB Partnership developed a Global Plan to Stop Tuberculosis that aims to save 14 million lives between 2006 and 2015.[57] Since humans are the only host of Mycobacterium tuberculosis, eradication would be possible. This goal would be helped greatly by an effective vaccine.[58]

Pneumonia
Bacterial pneumonia is a type of pneumonia associated with bacterial infection.[1] Pneumonia is an inflammatory condition of the lung.[1] It is often characterized as including inflammation of the parenchyma of the lung (that is, the alveoli) and abnormal alveolar filling with fluid (consolidation and exudation).[2]

The alveoli are microscopic air filled sacs in the lungs responsible for gas exchange. Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi, or parasites, and chemical or physical injury to the lungs. Its cause may also be officially described as unknown when infectious causes have been excluded. Typical symptoms associated with pneumonia include cough, chest pain, fever, and difficulty in breathing. Diagnostic tools include x-rays and examination of the sputum. Treatment depends on the cause of pneumonia; bacterial pneumonia is treated with antibiotics. Pneumonia is common, occurring in all age groups, and is a leading cause of death among the young, the old, and the chronically ill.[3] Vaccines to prevent certain types of pneumonia are available. The prognosis depends on the type of pneumonia, the treatment, any complications, and the person's underlying health.

Signs and symptoms

People with infectious pneumonia often have a cough producing greenish or yellow sputum, or phlegm and a high fever that may be accompanied by shaking chills. Shortness of breath is also common, as is pleuritic chest pain, a sharp or stabbing pain, either experienced during deep breaths or coughs or worsened by them. People with pneumonia may cough up blood, experience headaches, or develop sweaty and clammy skin. Other possible symptoms are loss of appetite, fatigue, blueness of the skin, nausea, vomiting, mood swings, and joint pains or muscle aches. Less common forms of pneumonia can cause other symptoms; for instance, pneumonia caused by Legionella may cause abdominal pain and diarrhea, while pneumonia caused by tuberculosis or Pneumocystis may cause only weight loss and night sweats. In

elderly people, manifestations of pneumonia are seldom typical. They may develop a new or worsening confusion (delirium) or may experience unsteadiness, leading to falls. Infants with pneumonia may have many of the symptoms above, but in many cases they are simply sleepy or have a decreased appetite.[9]

Cause
Pneumonia can be caused by microorganisms, irritants and unknown causes. When pneumonias are grouped this way, infectious causes are the most common type. The symptoms of infectious pneumonia are caused by the invasion of the lungs by microorganisms and by the immune system's response to the infection. Although more than one hundred strains of microorganism can cause pneumonia, only a few are responsible for most cases. The most common causes of pneumonia are viruses and bacteria. Less common causes of infectious pneumonia are fungi and parasites. Viruses Main article: Viral pneumonia Viruses have been found to account for between 1828% of pneumonia in a few limited studies.[12] Viruses invade cells in order to reproduce. Typically, a virus reaches the lungs when airborne droplets are inhaled through the mouth and nose. Once in the lungs, the virus invades the cells lining the airways and alveoli. This invasion often leads to cell death, either when the virus directly kills the cells, or through a type of cell controlled self-destruction called apoptosis. When the immune system responds to the viral infection, even more lung damage occurs. White blood cells, mainly lymphocytes, activate certain chemical cytokines which allow fluid to leak into the alveoli. This combination of cell destruction and

fluid-filled alveoli interrupts the normal transportation of oxygen into the bloodstream. As well as damaging the lungs, many viruses affect other organs and thus disrupt many body functions. Viruses can also make the body more susceptible to bacterial infections; for which reason bacterial pneumonia may complicate viral pneumonia.[12] Viral pneumonia is commonly caused by viruses such as influenza virus, respiratory syncytial virus (RSV), adenovirus, and parainfluenza.[12] Herpes simplex virus is a rare cause of pneumonia except in newborns. People with weakened immune systems are also at risk of pneumonia caused by cytomegalovirus (CMV). Bacteria Main article: Bacterial pneumonia The bacterium Streptococcus pneumoniae, a common cause of pneumonia, photographed through an electron microscope. Bacteria are the most common cause of community acquired pneumonia with Streptococcus pneumoniae the most commonly isolated bacteria.[13] Another important Grampositive cause of pneumonia is Staphylococcus aureus, with Streptococcus agalactiae being an important cause of pneumonia in newborn babies. Gram-negative bacteria cause pneumonia less frequently than gram-positive bacteria. Some of the gram-negative bacteria that cause pneumonia include Haemophilus influenzae, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Moraxella catarrhalis. These bacteria often live in the stomach or intestines and may enter the lungs if vomit is inhaled. "Atypical" bacteria which

cause pneumonia include Chlamydophila pneumoniae, Mycoplasma pneumoniae, and Legionella pneumophila. Bacteria typically enter the lung when airborne droplets are inhaled, but can also reach the lung through the bloodstream when there is an infection in another part of the body. Many bacteria live in parts of the upper respiratory tract, such as the nose, mouth and sinuses, and can easily be inhaled into the alveoli. Once inside, bacteria may invade the spaces between cells and between alveoli through connecting pores. This invasion triggers the immune system to send neutrophils, a type of defensive white blood cell, to the lungs. The neutrophils engulf and kill the offending organisms, and also release cytokines, causing a general activation of the immune system. This leads to the fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation.

Fungi
Main article: Fungal pneumonia Fungal pneumonia is uncommon, but it may occur in individuals with immune system problems due to AIDS, immunosuppresive drugs, or other medical problems. The pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia. Fungal pneumonia is most often caused by Histoplasma capsulatum, blastomyces, Cryptococcus neoformans, Pneumocystis jiroveci, and Coccidioides immitis. Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis in the southwestern United States. Parasites Main article: Parasitic pneumonia

A variety of parasites can affect the lungs. These parasites typically enter the body through the skin or by being swallowed. Once inside, they travel to the lungs, usually through the blood. There, as in other cases of pneumonia, a combination of cellular destruction and immune response causes disruption of oxygen transportation. One type of white blood cell, the eosinophil, responds vigorously to parasite infection. Eosinophils in the lungs can lead to eosinophilic pneumonia, thus complicating the underlying parasitic pneumonia. The most common parasites causing pneumonia are Toxoplasma gondii, Strongyloides stercoralis, and Ascariasis.

Idiopathic
Main article: Idiopathic interstitial pneumonia Idiopathic interstitial pneumonias (IIP) are a class of diffuse lung diseases. In some types of IIP, e.g. some types of usual interstitial pneumonia, the cause, indeed, is unknown or idiopathic. In some types of IIP the cause of the pneumonia is known, e.g. desquamative interstitial pneumonia is caused by smoking, and the name is a misnomer.

Diagnosis
If pneumonia is suspected on the basis of a patient's symptoms and findings from physical examination, further investigations are needed to confirm the diagnosis. Information from a chest X-ray and blood tests are helpful, and sputum cultures in some cases. The chest X-ray is typically used for diagnosis in hospitals and some clinics with X-ray facilities. However, in a community setting (general practice), pneumonia is usually diagnosed based on symptoms and physical examination alone.[citation needed] Diagnosing pneumonia can be difficult in some people, especially those who have other illnesses.

Occasionally a chest CT scan or other tests may be needed to distinguish pneumonia from other illnesses.

Investigations
An important test for pneumonia in unclear situations is a chest x-ray. Chest x-rays can reveal areas of opacity (seen as white) which represent consolidation. Pneumonia is not always seen on x-rays, either because the disease is only in its initial stages, or because it involves a part of the lung not easily seen by x-ray. In some cases, chest CT (computed tomography) can reveal pneumonia that is not seen on chest xray. X-rays can be misleading, because other problems, like lung scarring and congestive heart failure, can mimic pneumonia on x-ray.[14] Chest x-rays are also used to evaluate for complications of pneumonia (see below.) If antibiotics fail to improve the patient's health, or if the health care provider has concerns about the diagnosis, a culture of the person's sputum may be requested. Sputum cultures generally take at least two to three days, so they are mainly used to confirm that the infection is sensitive to an antibiotic that has already been started. A blood sample may similarly be cultured to look for bacteria in the blood. Any bacteria identified are then tested to see which antibiotics will be most effective.

Prevention
There are several ways to prevent infectious pneumonia. Appropriately treating underlying illnesses (such as AIDS) can decrease a person's risk of pneumonia. Smoking cessation is important not only because it helps to limit lung damage, but also because cigarette smoke interferes with many of the body's natural defenses against pneumonia.

Research shows that there are several ways to prevent pneumonia in newborn infants. Testing pregnant women for Group B Streptococcus and Chlamydia trachomatis, and then giving antibiotic treatment if needed, reduces pneumonia in infants. Suctioning the mouth and throat of infants with meconium-stained amniotic fluid decreases the rate of aspiration pneumonia. Vaccination is important for preventing pneumonia in both children and adults. Vaccinations against Haemophilus influenzae and Streptococcus pneumoniae in the first year of life have greatly reduced the role these bacteria play in causing pneumonia in children. Vaccinating children against Streptococcus pneumoniae has also led to a decreased incidence of these infections in adults because many adults acquire infections from children. Hib vaccine is now widely used around the globe. The childhood pneumococcal vaccine is still as of 2009 predominantly used in high-income countries, though this is changing. In 2009, Rwanda became the first low-income country to introduce pneumococcal conjugate vaccine into their national immunization program. A vaccine against Streptococcus pneumoniae is also available for adults. In the U.S., it is currently recommended for all healthy individuals older than 65 and any adults with emphysema, congestive heart failure, diabetes mellitus, cirrhosis of the liver, alcoholism, cerebrospinal fluid leaks, or those who do not have a spleen. A repeat vaccination may also be required after five or ten years.[19] Influenza vaccines should be given yearly to the same individuals who receive vaccination against Streptococcus pneumoniae. In addition, health care workers, nursing home residents, and pregnant women should receive the vaccine.[20] When an influenza outbreak is occurring, medications such as amantadine, rimantadine, zanamivir, and oseltamivir can help prevent influenza.[21][22]
[18]

Treatment
In the United States more than 80% of cases of community acquired pneumonia are treated without hospitalization.[13] Typically, oral antibiotics, rest, fluids, and home care are sufficient for complete resolution. However, people who are having trouble breathing, with other medical problems, and the elderly may need greater care. If the symptoms get worse, the pneumonia does not improve with home treatment, or complications occur, then hospitalization may be recommended. Over the counter cough medicine has not been found to be helpful in pneumonia.[23] Bacterial Antibiotics improve outcomes in those with bacterial pneumonia.[24] Initially antibiotic choice depends on the characteristics of the person affected such as age, underlying health, and location the infection was acquired. In the UK empiric treatment is usually with amoxicillin, erythromycin, or azithromycin for community-acquired pneumonia.[25] In North America, where the "atypical" forms of community-acquired pneumonia are becoming more common, macrolides (such as azithromycin), and doxycycline have displaced amoxicillin as first-line outpatient treatment for community-acquired pneumonia.[13][26] The use of fluoroquinolones in uncomplicated cases is discouraged due to concerns of side effects and resistance.[13] The duration of treatment has traditionally been seven to ten days, but there is increasing evidence that short courses (three to five days) are equivalent.[27] Antibiotics recommended for hospital-acquired pneumonia include thirdand fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, and vancomycin.[28] These antibiotics are often given intravenously and may be used in combination.

Viral No specific treatments exist for most types of viral pneumonia including SARS coronavirus, adenovirus, hantavirus, and parainfluenza virus with the exception of influenza A and influenza B. Influenza A may be treated with rimantadine or amantadine while influenza A or B may be treated with oseltamivir or zanamivir. These are beneficial only if they are started within 48 hours of the onset of symptoms. Many strains of H5N1 influenza A, also known as avian influenza or "bird flu," have shown resistance to rimantadine and amantadine.