Pneumonia risk factors
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.D. [2]Philip Marcus, M.D., M.P.H.[3]
Overview
The risk factors for pneumonia include: smoking, age, immuno-suppression, exposure to chemicals, underlying lung disease, and exposure to chemicals.
Risk Factors
Airway Obstruction
- When part of the airway (bronchi) leading to the alveoli is obstructed, the lung is not able to clear fluid when it accumulates. This can lead to infection of the fluid resulting in community-acquired pneumonia (CAP).
- One cause of obstruction, especially in young children, is inhalation of a foreign object such as a marble or toy. The object is lodged in the small airways and pneumonia can form in the trapped areas of lung.
- Another cause of obstruction is lung cancer, which can grow into the airways blocking the flow of air.
Lung Disease
- Smoking, and diseases such as emphysema, result in more frequent and severe bouts of CAP.
- In children, recurrent episodes of CAP may be the first clue to diseases such as cystic fibrosis or pulmonary sequestration.
Immune Compromise
- People who have immune system problems are more likely to get CAP.
- Risk factors for increased mortality from community acquired pneumonia are: active malignancy, immuno-suppression, neurological disease, congestive heart failure, coronary artery disease, and diabetes mellitus
- People who have AIDS are much more likely to develop CAP. Pneumonia could be the first manifestation of an underlying undiagnosed HIV. It is thus recommended by the Center for Disease Control (CDC) that all patients aged 13 to 64 in a medical setting regardless of known risk factors be screened for HIV. The American College of Physicians and HIV Medicine Association recommends expanding screening for HIV from age 13 to 75 [1], [2].
- Other immune problems range from severe immune deficiencies of childhood such as Wiskott-Aldrich syndrome to less severe deficiencies such as common variable immunodeficiency.[4]
- Elderly people are affected with increased incidence and severity of community acquired pneumonia. It is the fifth most common cause of death among individuals who are > 65 years of age, and fourth in individuals who are 85 years or older. The clinical picture in elderly could be subtle and could present only as delirium without any fever, cough or sputum. Therefore, a high index of suspicion should be kept in these groups of people.
Risk Factors Related to Specific Causative Pathogens in Community-acquired Pneumonia
Exposure to Animals
| Animals | Most Common Pathogens |
|---|---|
| Bat or bird droppings | Histoplasma capsulatum |
| Birds | Chlamydophila psittaci |
| Rabbits | Francisella tularensis |
| Farm animals or parturient cats | Coxiella burnetti (Q fever) |
| Table adapted from IDSA/ATS Guidelines for CAP in Adults [3] | |
Travel
| Condition | Most Common Pathogens |
|---|---|
| Hotel or cruise ship stay | Legionella spp |
| Travel to southwestern US | Coccidioides spp, Hantavirus |
| Travel to southeast or east Asia | Burkholderia pseudomallei, avian influenza, SARS |
| Table adapted from IDSA/ATS Guidelines for CAP in Adults [3] | |
References
- ↑ "Summaries for patients. Screening for HIV infection in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association". Annals of Internal Medicine. 150 (2): I–44. 2009. PMID 19047021. Retrieved 2012-09-04. Unknown parameter
|month=ignored (help) - ↑ Qaseem A, Snow V, Shekelle P, Hopkins R, Owens DK (2009). "Screening for HIV in health care settings: a guidance statement from the American College of Physicians and HIV Medicine Association". Annals of Internal Medicine. 150 (2): 125–31. PMID 19047022. Retrieved 2012-09-04. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 3.2 Mandell, L. A.; Wunderink, R. G.; Anzueto, A.; Bartlett, J. G.; Campbell, G. D.; Dean, N. C.; Dowell, S. F.; File, T. M.; Musher, D. M.; Niederman, M. S.; Torres, A.; Whitney, C. G. (2007). "Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults". Clinical Infectious Diseases. 44 (Supplement 2): S27–S72. doi:10.1086/511159. ISSN 1058-4838.