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There Are Actually 4 Types Of Pneumonia. These Are The Differences.

In recent weeks, the news of American gymnast Mary Lou Retton's hospitalization for a rare type of pneumonia raises the question of what the major risks are for developing the condition.

Pneumonia is the world's leading cause of death for children under the age of five, and the leading cause of hospitalization for adults in the United States, with over one million admissions per year; about 40,000 Americans die from the disease annually. Pneumonia, which can range from mild to life-threatening, is caused by inflammation within the tiny air sacs in the lungs. It can lead to deadly consequences—including a lack of oxygen and blood infections—if left untreated.

National Geographic spoke with several experts to gain a better understanding of the various types of pneumonia, and the risks of contracting different forms of the disease.

How is it diagnosed? 

Pneumonia is an infection of the lower airways, specifically the tiny air sacs, called alveoli, which serves as the exchange point for delivering oxygen to the blood, and removing carbon dioxide. This infection can be triggered by various factors that initiate in the upper airway and then travel into the deeper parts of the lungs.

Some of the common symptoms for pneumonia include cough, shortness of breath, chest pain, and general fatigue. To diagnose pneumonia, a doctor will use a stethoscope to check a patient's breathing, listening for a characteristic crackling sound, similar to the sound of crumpling paper, says Tianshi David Wu, a pulmonologist at Baylor College of Medicine. "That's all that's needed to diagnose pneumonia," Wu says, adding that if a doctor is still unsure, they can also order an X-ray of the lungs, which will confirm the diagnosis.

Four types of pneumonia? 

The four main types of pneumonia that are characterized based on the cause: bacterial, viral, fungal, and hospital-acquired.

For the most part, "there's no way to tell if a pneumonia is being caused by a bacterium, a virus, or a fungi just by examination," Wu says. "Most pneumonias don't ultimately get a diagnosis" of what is causing it. Instead, doctors will treat pneumonia based on a patient's symptoms and their medical history, using this information to determine the best course of treatment.

Bacterial pneumonia, which is the most common type, is caused by bacteria, which means that it is easily treated with an antibiotic. For many patients, treating pneumonia with an antibiotic will help resolve their symptoms, and help them start to feel better within days of starting treatment. "The earlier the treatment, the better," Wu says. There is also a vaccine that protects against the most prominent bacterial strain that causes pneumonia, and is approved for certain groups, including patients over the age of 65 and those with certain pre-existing conditions.

Viral pneumonia, which is less common, is caused by a virus, such as influenza, SARS-CoV-2—‑the virus that causes COVID-19—or RSV, a respiratory virus that usually causes mild, cold-like symptoms. Many of these viral infections begin in the upper airways, then travel down into the lungs.

A viral infection can also lead to bacterial pneumonia by weakening a patient's immune system, leaving them vulnerable to a secondary infection. Although no virus can be treated with an antibiotic, there are vaccines that can help prevent infection: the yearly flu shot, COVID vaccine, and for those who are eligible, the new RSV vaccine.

Fungal pneumonias are rare, and usually found in patients with pre-existing conditions, such as a compromised immune system. Fungal pneumonias tend to affect people with autoimmune disorders, patients who are undergoing chemotherapy, or other chronic conditions that can affect a person's immune system, says Lucas Kimmig, a pulmonologist at University of Chicago Medicine. Fungal pneumonias require a different treatment strategy and can often be more serious, due to both the complications of pneumonia, as well as the patient's other underlying conditions.

Hospital-acquired pneumonias are considered a separate category because a hospital environment often exposes patients to a different set of bacteria, including strains that are more likely to be resistant to antibiotics. A case of pneumonia that was acquired in a hospital setting can affect how doctors treat the condition. "They're at risk for some different bugs that we don't usually see in the outpatient setting," Kimmig says. "That affects the antibiotic choice."

Why is pneumonia so serious? 

The risk of pneumonia is that, if left untreated, it can cause serious complications, and can spread to other parts of the body.

"If there is a bacteria or a virus that infects the lungs, there's really no way to get it out," says Jason Turowski, a pulmonologist at the Cleveland Clinic. "That infection can rage and rage."

The primary risk of pneumonia is that it can damage the lungs, affecting a person's ability to get the oxygen they need. This damage usually happens because inflammation can cause a buildup of inflammatory cells in the tiny sacs of the lung that prevents oxygen from getting delivered, and carbon dioxide from getting released. "It's causing an injury that doesn't enable you to get the vital oxygen you need and to release the carbon dioxide your body's making," Turowski says.

The secondary risk is that the infection can spread to other parts of the body, such as the space between the lung and the chest wall, or into the bloodstream. When this infection starts to spread to other parts of the body, this can turn into a condition called sepsis, which is an out-of-control, systemic response to an infection. Sepsis can quickly grow into a life-threatening condition that often results in death.

Who is most at risk for developing pneumonia? 

The people who are at the highest risk for developing serious complications from pneumonia include children under the age of five, adults over the age of 65, and people with pre-existing conditions, such as heart and lung disease, or a weakened immune system due to chemotherapy or organ transplantation.

Other risk factors include having uncontrolled diabetes or smoking or drinking heavily.

"Most forms of pneumonia end up being mild and self-limiting," Wu says. "If it is severe enough to be hospitalized, there are probably other things going on."

Warning signs pneumonia is worsening 

For patients who have been diagnosed with pneumonia, and are recovering at home, some of the major warning signs that they may need to seek out additional medical care include a worsening in their condition, even after treatment, whether it's a fever that won't go away, chest pain or shortness of breath that won't resolve, or rapid breathing, which can indicate a failure to get enough oxygen.

"It's important to always contact your doctor when something feels different," Turowski says. "When we're involved early, we can guide you, and if we get a follow up call, that I'm getting worse, then we can help get things ready for you in the hospital."

Could A Fungal Disease Cause The Most Common Type Of Banana To Go Extinct? Here's What Experts Say

The future of the most popular type of banana could be in question, thanks to a fungal disease that experts say could send them into extinction. The disease, called Panama Disease, infects the banana tree's roots and kills it by disabling its ability to absorb water, according to the U.S. Department of Agriculture.The disease "can also establish in the soil where it can survive for decades without its host, and spread long distance through movement of infested soil, contaminated equipment, and infected plant parts," the USDA says. According to the USDA, a similar strain of the disease was responsible for the near extinction of the world's most popular bananas in the 1930s. James Dale, a professor and leader of the banana biotechnology program at Queensland University of Technology, told Business Insider that the impact likely won't happen overnight."The disease moves slowly, so we have at least a decade before the impact is drastic," he said. In the meantime, Dale and his colleagues have developed a genetically modified banana that is highly resistant to the disease. Other researchers are attempting grafting and natural selection in banana plants to strengthen resistance to the fungal disease.Dale said he predicts with certainty that there will be a solution before banana crops are severely impacted and consumers see shortages.Other experts say the best long-term solution would be mass production and selling more than one banana variety to reduce dependence on one type. "It's true that there is some resistance, but I'd say right now, nobody is even close to solving the problem," journalist Dan Koeppel, author of the book "Banana: The Fate of the Fruit That Changed the World," told Business Insider. "The answer is going to be the end of monoculture. The answer is variety."

The future of the most popular type of banana could be in question, thanks to a fungal disease that experts say could send them into extinction.

The disease, called Panama Disease, infects the banana tree's roots and kills it by disabling its ability to absorb water, according to the U.S. Department of Agriculture.

The disease "can also establish in the soil where it can survive for decades without its host, and spread long distance through movement of infested soil, contaminated equipment, and infected plant parts," the USDA says.

According to the USDA, a similar strain of the disease was responsible for the near extinction of the world's most popular bananas in the 1930s.

James Dale, a professor and leader of the banana biotechnology program at Queensland University of Technology, told Business Insider that the impact likely won't happen overnight.

"The disease moves slowly, so we have at least a decade before the impact is drastic," he said.

In the meantime, Dale and his colleagues have developed a genetically modified banana that is highly resistant to the disease. Other researchers are attempting grafting and natural selection in banana plants to strengthen resistance to the fungal disease.

Dale said he predicts with certainty that there will be a solution before banana crops are severely impacted and consumers see shortages.

Other experts say the best long-term solution would be mass production and selling more than one banana variety to reduce dependence on one type.

"It's true that there is some resistance, but I'd say right now, nobody is even close to solving the problem," journalist Dan Koeppel, author of the book "Banana: The Fate of the Fruit That Changed the World," told Business Insider. "The answer is going to be the end of monoculture. The answer is variety."

Surgical Site Infections: Causes, Symptoms & Treatments

Ann Schreiber

A surgical site infection (SSI) is an infection that happens where you had surgery.

SSIs happen in 2% to 4% of people who have surgery while in the hospital, says the Agency for Healthcare Research and Quality. Even though most infections can be treated with antibiotics, SSIs can still lead to serious problems and sometimes even death after surgery.

In this article, experts explore what SSIs are, what causes them, their types, symptoms and how they can be treated.

What is a surgical site infection?

An SSI is an infection that happens after surgery in the area where the surgery was performed, according to the U.S. Centers for Disease Control and Prevention. Some SSIs are minor, affecting only the skin, while others can be severe, involving tissues beneath the skin, organs or implanted materials, according to the CDC. These infections occur in the body part where the surgery took place.

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Causes of surgical site infections

Infections after surgery result from harmful germs, with Staphylococcus, Streptococcus, and Pseudomonas bacteria being the most common culprits. "SSIs, and specifically DSWIs [deep sternal wound infections], are dreaded complications of cardiac surgery," Dr. Edward Soltesz, Cleveland Clinic's director of cardiac surgery affiliate and alliance programs, said in a recent Cleveland Clinic article.

According to Johns Hopkins Medicine, these germs can infiltrate surgical wounds through different means, like contact with contaminated caregivers or instruments, airborne germs or traveling from your body into the wound.

The risk of a surgical site infection depends on the type of surgical wound:

Clean wounds: These are uncontaminated, non-inflamed wounds that don't involve internal organs

Clean-contaminated wounds: These wounds don't indicate any sign of infection before surgery but involve internal organ operations

Contaminated wounds: These occur when surgery involves an internal organ with contents spilling into the wound

Dirty wounds: These wounds have a known infection during surgery

Surgical site infections can occur during your hospital stay, even after you've left the operating room. Factors such as the hospital's cleanliness, adherence to infection control measures and the type of surgical procedure you had can influence the risk of developing an infection.

Types of surgical site infections

SSIs are a significant health care challenge. These infections result in considerable illness and mortality, with over 2 million cases reported among hospitalized patients in the United States.

Superficial incisional infections: These involve only the skin and subcutaneous tissues. They constitute more than half of all surgical infections

Deep incisional infections: These affect deeper tissues, including muscles

Organ/space infections: These involve organs other than the incision site, linked to the surgical procedure

Surgical site infection symptoms

Any SSI may display redness, fever, pain, tenderness, delayed healing, warmth or swelling.

Additional symptoms are linked to specific SSI types:

A superficial incisional SSI may result in pus discharge from the wound, which can be cultured to identify the infecting germs

Deep incisional SSIs may also produce pus, and the wound may reopen spontaneously or be reopened by a surgeon to reveal pus

Organ or space SSIs may exhibit pus draining from a skin-placed drain or form an abscess, seen when the wound is reopened or through special X-rays

Surgical site infection treatment

Mount Sinai outlines the following standard courses of surgical site infection treatment:

In most cases, antibiotics are prescribed to combat wound infections. The duration of treatment typically spans at least one week, often starting with intravenous antibiotics and transitioning to oral pills. Completing the entire antibiotic course is essential, even if you start feeling better. In instances of wound drainage, testing may determine the most effective antibiotic. Methicillin-resistant Staphylococcus aureus (MRSA) infections require specific antibiotics.

Sometimes, surgical intervention is necessary to address the infection. Procedures can occur in the operating room, hospital room or clinic. Steps include wound opening, pus or tissue analysis, dead tissue removal, wound rinsing, pus drainage (if needed), and wound packing and bandaging.

Regular wound cleaning and dressing changes are often needed. Patients can learn to do this themselves or have nurses perform it. In some cases, a vacuum-assisted closure (VAC) dressing enhances healing by increasing blood flow. Healing times can vary, with some wounds taking days, weeks or even months to fully heal. If a wound doesn't close naturally, a skin graft or muscle flap surgery may be required for post-infection clearance.

Living with a surgical site infection

Surgical site infections are temporary and, although healing time can vary from days to months, they will eventually clear up.

For less severe infections with small openings, self-care at home is possible. Deeper infections or larger openings might require a hospital stay. After that, you'll continue to care for yourself at home with nurse visits or go to a nursing facility.

Remember to contact your health care provider if your surgical wound exhibits any signs of infection, including pus, foul odor, fever, warmth, redness or pain.

Agency for Healthcare Research and Quality: Surgical Site Infections

Johns Hopkins Medicine: Surgical Site Infections

U.S. National Library of Medicine (MedlinePlus): Surgical Wound Infection – Treatment

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