Antibiotic Side Effects and How to Manage Them

Walking Pneumonia: What You Should Know

Not all medical conditions have names that spell out their meaning, but "walking pneumonia" seems to be an exception.

Walking pneumonia is a nonmedical term for a mild form of pneumonia. While a more typical case of pneumonia might send you to bed—or even the hospital—with walking pneumonia, you can usually go about your everyday activities, even though you likely have symptoms, including cough, fatigue, and, sometimes, fever.

"It's more of a colloquial term than an exact medical diagnosis," explains Matthew Ellman, MD, a Yale Medicine primary care physician.

Thomas Murray, MD, Ph.D., a Yale Medicine pediatric infectious diseases specialist, describes a typical patient with walking pneumonia as having a cough and some mild breathing difficulties that last longer than the standard three to five days of an acute respiratory infection, such as the common cold. "It isn't severe enough that it incapacitates you, but it lingers and can make you feel uncomfortable," he adds.

Even though walking pneumonia isn't usually serious, you should contact your doctor if you are experiencing worrisome symptoms or if a cold lasts more than five days, the doctors advise.

Below, Drs. Ellman and Murray talk more about walking pneumonia, including how it is diagnosed and treated.

What causes walking pneumonia?

Pneumonia is caused by various microorganisms, usually bacteria and viruses. The infection usually starts after one of these microorganisms is inhaled from the upper airways into one or both lungs. There, the infection causes the air sacs, or alveoli, to fill with pus or fluid.

Broadly speaking, pneumonia falls into two categories: community-acquired and hospital-acquired, the latter of which is considered more dangerous, as this type is more likely to be resistant to antibiotics.

Walking pneumonia is a common subtype of community-acquired pneumonia, and is typically caused by a difficult-to-detect bacterium called Mycoplasma pneumoniae. Infections caused by this bacteria are generally mild but can sometimes be severe.

There are a few different ways one can get a bacterial infection, Dr. Murray explains. "In many cases, it can happen with bacteria you are colonized with. In other words, it's already part of your upper respiratory tract. It lives in your nose or the back of your throat. When you get sick with a virus, it allows the bacteria to get into your lower lung and cause disease," he says. "Say, for example, you've had the flu—that increases your risk for pneumonia afterward."

And because winter is virus season, many respiratory viruses—including respiratory syncytial virus (RSV)—can travel from the upper respiratory tract to the lungs and cause pneumonia, Dr. Murray notes.

Pneumonia can also spread when an infected individual coughs or sneezes, and someone else breathes in those respiratory droplets. It occurs most often in crowded settings, including schools, college dormitories, and military training sites.

However, those who spend a short amount of time with someone who has a mycoplasma infection do not usually get sick, the CDC says.

"In general, any type of pneumonia, particularly if it's bacterial, is less contagious than the viruses that cause colds, flu, or COVID," Dr. Ellman says.

How is walking pneumonia diagnosed?

Walking pneumonia is sometimes called an "atypical" pneumonia—a term used to describe pneumonia caused by bacteria that is difficult to detect through standard bacterial cultures.

"There are blood tests that don't work very well. There are also swabs, just like you do for COVID, to check for mycoplasma, the bacteria often associated with walking pneumonia. But not every lab does those, so they're not easy to get," Dr. Murray says. "And if it's negative, it doesn't mean you don't have it, because you can still have symptoms after it goes away from your upper respiratory tract."

Therefore, walking pneumonia is often diagnosed by a physical exam and possibly an X-ray, Dr. Murray says. It can sometimes be hard to tell the difference between a more typical case of pneumonia and walking pneumonia, he adds.

"One of the ways you can differentiate it is with a chest X-ray. A more typical pneumonia would be called 'lobar pneumonia," meaning you can see that one part of the lung is infected on the X-ray," he says. "Walking pneumonia will look patchy on the X-ray. There isn't just one part of the lung involved; it's more spread throughout."

How is walking pneumonia treated?

While many community-acquired cases of pneumonia caused by bacteria are treated with antibiotics, the most prescribed ones, such as amoxicillin, don't always work for mycoplasma pneumonia, Dr. Murray says. But certain antibiotics, such as azithromycin, work well, so it's important to get the proper diagnosis, he says.

"The good news is that this type of pneumonia does not tend to be serious in healthy people, and most do very well with treatment," he says.

If the pneumonia is believed to be caused by a virus, antibiotics won't help. In fact, for children under 2 years of age, the majority of cold and lung infections are viral. Instead, those patients should rest, drink plenty of fluids, and, if needed, use over-the-counter medications, such as acetaminophen or ibuprofen, for discomfort.

There are potential treatments for influenza, such as Tamiflu, and COVID-19, such as Paxlovid, depending on your age and underlying risk factors for complications, adds Dr. Murray.

Are there vaccines for walking pneumonia?

Certain types of pneumonia have vaccines to protect against them and are recommended for children and older adults, "but there isn't a shot that covers walking pneumonia," Dr. Murray says.

"Still, it's good to stay up to date on all recommended vaccines—including those for RSV, flu, COVID, and pneumonia caused by a common bacteria called streptococcus," Dr. Ellman says. "All of these can help reduce the risk of getting pneumonia."

When should you contact your doctor?

While most cases of walking pneumonia aren't dangerous, it's important to pay attention to your symptoms, particularly if you develop new problems after seemingly recovering from another illness, such as the flu.

"Say you have the flu and you start to feel better, but then you begin to feel sick again—it's more difficult to breathe, and the fever comes back. Although it's not that common, it could be a community-acquired pneumonia setting in that requires an antibiotic," Dr. Murray says. "That would be a great reason to reach out to your primary care doctor."

Another reason to pay attention to symptoms that aren't resolving is that walking pneumonia can turn into a more serious form of pneumonia if left untreated. Each year, 4 to 5 million people in the United States get pneumonia (not including pneumonia caused by COVID-19), and about 55,000 people die from it.

"Pneumonia is a common cause of hospitalization, and it can be life-threatening. It can cause organ damage and be complicated by cardiac and kidney problems, as well as cause permanent damage to the lungs," Dr. Ellman says. "Because walking pneumonia can become a more serious case of pneumonia, it's important to be in touch with your doctor."

Citation: Walking pneumonia: What you should know (2024, February 26) retrieved 24 March 2024 from https://medicalxpress.Com/news/2024-02-pneumonia.Html

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Enlarged Prostate Follows After A Bout Of Bacterial Pneumonia

Posted March 6

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Dr. Keith Roach

DEAR DR. ROACH: I recently contracted a rather severe case of bacterial pneumonia, requiring 10 days of amoxicillin. It has left me with a problem — I have an enlarged prostate. Prior to getting pneumonia, I had to go to the bathroom three times a night, which I could handle. Now I have to urinate every hour on average, which is keeping me from getting a good night's sleep. Why the change, and can anything be done about it? — E.W.ANSWER: A sudden change in urinary frequency leads me to suspect that something has happened other than just an enlarged prostate. The first thing I would consider would be medication. Amoxicillin doesn't worsen the prostate, so you should ask your doctor or pharmacist if you were given another medicine at the time you had pneumonia. Antihistamines are common causes.I would also be concerned that you might have a urine infection. Some bacterial pneumonias can be complicated by bacteria in the blood, which can then go into the urinary system. Amoxicillin, however, is a pretty good antibiotic for the urinary system, so unless the bacteria is highly resistant, this doesn't seem likely. Still, a urine test would be appropriate.If you had a urinary catheter (Foley) placed, this can exacerbate prostate problems after it is removed due to trauma and inflammation. A stone can also cause these symptoms.If none of these are the issue, then it is time to visit a urologist, who can do some flow studies and look at how much urine is in your bladder after you finish urinating. If it's just the enlarged prostate, medicines like tamsulosin help immediately, while finasteride and similar medications shrink the prostate slowly over a span of months.Finally, an overactive bladder and prostate enlargement sometimes go together, causing worse symptoms and requiring two different types of treatment.DEAR DR. ROACH: Every morning, after drinking 1-2 cups of coffee, I spend a few hours having to clear my throat. It's like having a chest cold. I've tried avoiding milk, using powdered creamer and drinking it black. Nothing helps. Any ideas? — L.M.ANSWER: You might be getting gastroesophageal reflux, which is when stomach contents go backward from the stomach up into the esophagus. There is a muscular valve, the lower esophageal sphincter, that is supposed to prevent this, but caffeine in coffee weakens the muscle and can allow acid to go backward where it doesn't belong. Most people notice heartburn (a burning sensation), while others have a cough. But throat-clearing is not an uncommon symptom for gastroesophageal reflux disease (GERD). The timing of the symptoms (after the coffee) is very suspicious.Although there are medicines to promote movement of food and acid the correct way, we seldom use them due to their long-term side effects. Avoiding the offending foods (or beverages, in your case) is effective.At least one study showed that switching to decaffeinated coffee improved symptoms; however, there seem to be substances even in decaf coffee that also promote reflux.Medicines to reduce acid production by the stomach, like famotidine, are effective at improving symptoms. It would be a useful diagnostic test to see if the medicine can stop the throat-clearing after you have your coffee.* * *Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.Cornell.Edu or send mail to 628 Virginia Dr., Orlando, FL 32803.(c) 2024 North America Syndicate Inc.All Rights Reserved

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Rapid PCR Tests For Pneumonia In The ED Speed Up Targeted Treatment

For people with suspected community-acquired pneumonia (CAP) in the emergency department (ED), routine polymerase chain reaction (PCR) testing on lower respiratory tract samples led to faster and more targeted treatment, according to a randomized, single-center trial.

People who got rapid PCR tests were more likely to receive pathogen-directed treatment in the first 48 hours post-randomization compared with those receiving standard of care (35.3% vs 13.4%; OR 3.53, 95% CI 2.13-6.02). And in those receiving a pathogen-directed agent in that timeframe, the intervention group received treatment significantly sooner (median 34.5 vs 43.8 hours, P<0.001), reported Harleen Grewal, MD, PhD, of the University of Bergen in Norway, and coauthors.

Among patients with confirmed CAP, rapid PCR was associated with both greater pathogen-directed treatment (47.4% vs 15.5%, P<0.001) and faster time to such treatment (median 29.9 vs 42.3 hours, P<0.001) within 48 hours, the superiority trial published in JAMA Network Open found.

"Routinely deployed rapid syndromic testing could complement or replace targeted components of the standard laboratory-based diagnostic repertoire for patients who are admitted to the hospital with an acute respiratory illness," the authors concluded from their 374-person study, which had been stopped early for efficacy.

Current culture-based methods are labor intensive and in most cases fail to detect a pathogen for targeted treatment, Grewal's group explained.

Despite the limited evidence so far, a PCR panel for CAP is believed by some to improve pathogen detection, reduce unnecessary antibiotic use, shorten hospital length of stay, and potentially facilitate pathogen-directed treatment.

Yet Susan Butler-Wu, PhD, D(ABMM), of the Keck School of Medicine at the University of Southern California in Los Angeles, warned that "despite assertions to the contrary, this is not a replacement for culture. Culture is essential to assess the quality of the specimen, and critically, for performing antimicrobial susceptibility testing."

She expressed concerns about the present study's generalizability, noting that participating labs called ordering providers to inform them that a PCR result was available -- "a practice that isn't operationally feasible for many clinical labs."

"To get the most benefit from tests such as the one studied in this paper, it has to be combined with rapidly directing results to individuals who will rapidly take action. Otherwise, it won't necessarily get acted upon in an ultra-rapid fashion when the result solely just goes into the medical chart alone," she told MedPage Today via email.

The study was conducted within the ED of Haukeland University Hospital in Bergen, Norway, with recruitment spanning 2020 to 2022.

In order to be included in the trial, patients needed to experience two or more symptoms: new or worsening cough, expectoration, or dyspnoea; hemoptysis; pleuritic chest pain; radiological evidence of pneumonia; abnormalities on chest auscultation and/or percussion; or a fever of 38 °C (100.4 °F) or higher.

Patients were excluded from the trial if they were diagnosed with cystic fibrosis, were experiencing severe bronchiectasis, were hospitalized within the past 14 days before admission, were under a palliative approach, or were not willing to provide a lower respiratory tract sample for analysis.

Ultimately, there were 374 patients randomized 1:1 to have lower respiratory tract samples undergo either the BioFire FilmArray Pneumonia plus panel or standard of care (blood cultures, a pneumococcal urine test, and an in-house PCR test for oropharyngeal and/or nasopharyngeal swabs targeting respiratory viruses and atypical bacteria). Both the trial participants and the ED clinicians were blinded to patient randomization.

The cohort averaged 72 years old and 59% were men. Just under 20% of patients in both treatment groups were current smokers. Over half of the patients had received their annual influenza vaccine, while just under 40% had received a pneumococcal vaccine within the previous 5 years.

As for the trial's secondary endpoints, patient turnaround time was nearly 54 hours shorter in the intervention group than in the standard of care group (P<0.001).

Use of pathogen-directed treatment within the first 48 hours led to more broad-spectrum antimicrobial treatment in 14.4% of intervention patients and 3.9% of standard care patients (P=0.009). Empirical antibiotic treatment was de-escalated to a more narrow-spectrum treatment in 10.3% and 4.9%, respectively (P=0.14). Empirical treatment was maintained in 16.5% and 6.8%, respectively (P=0.03).

Length of stay, readmittance, and death rates did not significantly differ between the two groups, and no serious adverse events were observed.

Researchers cited the single-center design and early termination as major limitations of the trial.

"Future studies should examine the effect of comprehensive rapid syndromic testing on clinical outcomes, the cost-effectiveness of this diagnostic tool, and the development of implementation strategies that facilitate the integration of rapid syndromic testing into routine clinical practice," Grewal's group urged.

Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow

Disclosures

This trial was supported by the Research Council of Norway, the Trond Mohn Foundation, the University of Bergen, and Haukeland University Hospital.

Markussen reported no disclosures. Coauthors reported various relationships with industry, government, and non-governmental organizations.

Butler-Wu has served as a consultant to BioFire.

Primary Source

JAMA Network Open

Source Reference: Markussen DL, et al "Diagnostic stewardship in community-acquired pneumonia with syndromic molecular testing: a randomized clinical trial" JAMA Netw Open 2024; DOI: 10.1001/jamanetworkopen.2024.0830.

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