Why do i get pneumonia every year

Certain people are more likely to become ill with pneumonia: adults 65 years or older; children younger than 5 years old; people who have ongoing medical conditions like asthma, diabetes or heart disease ; and people who smoke cigarettes. Encourage friends and loved ones to make sure they are up to date with their vaccines.

Viruses, bacteria, and fungi can all cause pneumonia. In the United States, common causes of viral pneumonia are influenza and respiratory syncytial virus RSV. A common cause of bacterial pneumonia is Streptococcus pneumoniae pneumococcus. However, clinicians are not always able to find out which germ caused someone to get sick with pneumonia. Community-acquired pneumonia is when someone develops pneumonia in the community not in a hospital.

Healthcare-associated pneumonia is when someone develops pneumonia during or following a stay in a healthcare facility.

Healthcare facilities include hospitals, long-term care facilities, and dialysis centers. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Disease or Condition of the Week. Onset of common variable immune deficiency CVID is typically before age 30, and usually in young childhood.

Chronic granulomatous disease can also be diagnosed in adulthood, but this is quite rare. Lastly, recurrent pneumonia in the basal segments of the lower lobes in patients who have been upright or semi-recumbent or in the posterior upper lobes and apical lower lobes for patients who have been recumbent in susceptible patients should suggest aspiration pneumonia.

The clinical presentation of aspiration pneumonia is often more indolent than that of community-acquired pneumonia, with slowly progressive symptoms developing over days to weeks.

Chills are often absent. The overall prevalence of recurrent pneumonia is not clear; estimates of the percentage of patients who have had one episode of pneumonia and then present with a second episode vary from 7. Young patients without known comorbidities should not develop recurrent pneumonia and repeated episodes of pneumonia should trigger a search for an underlying cause.

Younger patients presenting with recurrent bacterial pneumonia are more likely to have immune deficiencies or cystic fibrosis see Bronchiectasis. Older patients with recurrent pneumonia are more likely to have aspiration pneumonia related to alcohol use or dementia , COPD, or a secondary immune deficiency such as HIV, multiple myeloma or chronic lymphocytic leukemia. In patients with recurrent fever and pulmonary infiltrate in whom an immune defect, comorbidity such as COPD or anatomic abnormality has not been found, non-infectious conditions such as malignancy or immune-mediated conditions should be considered.

Eosinophilia could indicate immune-mediated lung disease such as vasculitis, drug reaction, chronic eosinophilic pneumonia or allergic bronchopulmonary aspergillosis. Hypersensitivity pneumonitis presents acutely with fever, non-productive cough and pulmonary infiltrates 4 to 6 hours after exposure to an inhaled antigen or drug; there may be transient leukocytosis.

Repeated episodes may follow re-exposure to the antigen. There is also an indolent, progressive form of this condition caused by persistent exposure to the antigen see Hypersensitivity Pneumonitis. The characteristic radiographic pattern is peripheral alveolar infiltrates, often in upper lobes and with central sparing.

Bronchiolitis obliterans-organizing pneumonia or cryptogenic organizing pneumonia is characterized by a subacute presentation of cough, fever, dyspnea, weight loss, malaise and focal alveolar infiltrates. It is often preceded by upper or lower respiratory tract infection or influenza-like illness. ESR is often elevated and there may be peripheral leukocytosis. Chest radiographs may show multifocal segmental or lobar alveolar infiltrates with air bronchograms. Some drugs, such as methotrexate and amiodarone, can rarely cause pulmonary toxicity that could present similarly to recurrent or nonresolving pneumonia with cough, dyspnea, fever and pulmonary infiltrates.

Alveolar hemorrhage syndromes caused by connective tissue disease or other disorders could occasionally be mistaken for recurrent pneumonia, especially if hemoptysis is minimal or absent. Pulmonary alveolar proteinosis is a rare disorder presenting with diffuse alveolar infiltrates, cough, hypoxemia, progressive dyspnea and occasionally fever.

Pulmonary neoplasms such as bronchoalveolar carcinoma and pulmonary lymphangitic carcinomatosis can sometimes mimic nonresolving pneumonia in radiographic appearance. Recurrent or persistent infiltrate on chest radiograph without these clinical findings may suggest an alternate diagnosis. Clubbed digits suggest chronic underlying respiratory disease.

A patient presenting acutely with a suspected recurrence of pneumonia should have a chest radiograph, blood and sputum cultures, and a CBC with differential. Perform an arterial blood gas in hypoxic patients. If present, parapneumonic effusions should be tapped as usual in order to provide diagnostic information about the pathogen.

A comprehensive swallow evaluation should be performed in patients with suspected recurrent aspiration pneumonia; aspiration is often silent and simple observation of swallowing is not sensitive for the detection of aspiration. A CBC with differential, blood and sputum cultures should be obtained with each episode of pneumonia. Leukocytosis is common in patients with pneumonia; leukopenia can also be present. The diagnostic value of expectorated sputum gram stain and culture is debated; S.

However, if a specimen is produced correctly, it can sometimes be helpful in guiding antibiotic therapy. A sputum culture with sensitivities may be helpful in determining if recurrent or nonresolving pneumonia was caused by antibiotic failure. It should be obtained before starting antibiotic therapy, more than one hour after eating, and after the patient rinses his or her mouth.

The sample should be promptly transported to the laboratory see Typical Bacterial Pneumonia. In a younger patient with recurrent bacterial pneumonia, IgA, IgG and IgM levels should be ordered to screen for common variable immunodeficiency or an IgG subclass deficiency. A chest CT scan is recommended if a patient has a recurrence in the same anatomic location, because it suggests localized intrathoracic disease. Pulmonary consultation and bronchoscopy should also be considered in patients with recurrent pneumonia in the same anatomic location or with multiple recurrences of pneumonia without obvious risk factors.

The initial management of a patient presenting with a recurrence of pneumonia is similar to the initial management of any patient with pneumonia see Typical Bacterial Pneumonia. Immediate management, as in any patient presenting with pneumonia, includes oxygen therapy and intravenous fluids if necessary.

Timely initiation of antibiotics, as in any case of pneumonia, is very important. As in community acquired pneumonia, S. Smokers and those with COPD and other chronic respiratory conditions are predisposed to infection with Legionella. Patients with alcohol dependence are susceptible to infections by S. Patients with recurrent pneumonia related to bronchiectasis such as patients with cystic fibrosis are susceptible to infections with Pseudomonas, H.

One study showed a relatively high prevalence of infection by H. Mycoplasma pneumoniae may also be an important cause of recurrent pneumonia. Antibiotic therapy for suspected recurrent aspiration pneumonia should generally cover gram-negatives as well as S. Gram negatives including pseudomonas are more common in patients with recurrent aspiration pneumonia in a health care setting. Anaerobic therapy may not always be necessary. While earlier studies suggested that anaerobic organisms are very common pathogens in aspiration pneumonia, more recent studies suggest that anaerobic organisms are fairly rare pathogens in this syndrome.

Good initial antibiotic regimens for patients with suspected recurrent aspiration pneumonia include clindamycin, amoxicillin-clavulanate or amoxicillin combined with metronidazole. Quinolones and ceftriaxone are also thought to be effective.

Metronidazole is not sufficient monotherapy. One study of elderly patients with mild to moderate aspiration pneumonia compared ampicillin-sulbactam to IV clindamycin and a carbapenem and concluded that all three regimens were effective but that patients treated with IV clindamycin had a lower rate of post-treatment staph aureus colonization of their sputum; clindamycin is also less expensive. Most of them have a known predisposing factor. The most common cause was oropharyngeal incoordination.

Recurrent pneumonia has been defined as at least 2 pneumonia episodes in 1 year or more than 3 at any time, with radiographic clearing between episodes. These previous series may not be generalizable to most recurrent pneumonia patients cared for in our setting because they have consisted of immunocompromised populations, 12 - 14 were limited to cases of bacterial pneumonia, 15 - 17 or were not performed in an industrialized country.

From these data, a series of investigations for the child with recurrent pneumonia is proposed. A medical record review was performed on all children with recurrent pneumonia.

All children admitted to The Hospital for Sick Children, Toronto, Ontario, from January through December with a hospital discharge diagnosis of pneumonia were identified. The hospital is a tertiary care referral center but also serves as the pediatric hospital for children in downtown Toronto.

Children younger than 18 years are admitted to the hospital. The records of all children with diagnostic codes corresponding to a diagnosis of pneumonia were identified according to the International Classification of Diseases, Ninth Revision, Clinical Modification 19 codes , Patients were included in this analysis if they had 2 or more episodes of pneumonia per year or 3 or more episodes in a lifetime and if there was radiographic confirmation of pneumonia during hospital admission.

Only patients with pneumonia who were hospitalized or whose diagnosis was recorded on admission to our hospital would be identified. Patients were classified according to underlying illnesses that have previously been associated with childhood pneumonia. The duration of time between the underlying illness diagnosis and the initial pneumonia recurrence was calculated. Confirmation of cardiac anomalies was based on findings from an echocardiogram.

Most cases of aspiration syndrome were diagnosed clinically. In some patients, however, fluoroscopic feeding studies were performed by occupational therapists to confirm oropharyngeal incoordination resulting in aspiration. Gastroesophageal reflux was documented either with a barium swallow or esophageal pH manometry. The T and B lymphocytes were assayed using lymphoproliferation studies to assay cell function, and flow cytometry was used to assess the number of lymphocytes.

Microbiological studies, such as sputum samples and nasopharyngeal swabs, were obtained in only a subgroup of patients. Of these, The mean age when recurrent pneumonia was diagnosed was 3. An underlying illness was identified in One hundred fourteen patients Twenty-four patients All patients with aspiration disorders had involvement on radiography of more than one lung lobe.

Of these, cerebral palsy accounted for nearly half the causes. The mean age at diagnosis of recurrent pneumonia in children with aspiration disorders was 6. Of the 24 patients who had immune disorders, 13 had malignant neoplasms; 5, dysgammaglobulinemia 3, hypogammaglobulinemia; 1, hyperimmunoglobulin E syndrome; 1, agammaglobulinemia ; 5, HIV infection; and 1, autoimmune pancytopenia. The mean age at diagnosis of recurrent pneumonia in children with immune disorders was 3.

The patients with congenital heart disease included 16 Six other patients had more complex cardiac disorders. The mean age at diagnosis of recurrent pneumonia in children with congenital heart disease was 1. The mean age at diagnosis of recurrent pneumonia in the 19 children with asthma was 4. Airway and pulmonary anomalies were diagnosed early in life and were found in 18 patients. The mean age of diagnosis was 4 months age range, 0 days to 6 months. Children with tracheoesophageal fistulas formed the largest group in this category with 7 patients.

Two patients each had congenital cystic adenomatoid malformation, vocal cord paralysis, subglottic stenosis, and tracheomalacia. The 3 remaining patients had an esophageal bronchus, a tracheoesophageal cleft, and tracheal stenosis, respectively. The mean age at diagnosis of recurrent pneumonia in children with airway and pulmonary anomalies was 3. Associated gastroesophageal reflux was found in 13 patients with recurrent pneumonia.

In all patients there was a notable association between feeding and subsequent respiratory symptoms. All of these children were neurologically normal on physical examination.

The mean age at diagnosis of recurrent pneumonia in children with gastroesophageal reflux was 1. Children for whom no underlying etiologic diagnosis was identified had growth, development, and physical examination findings within reference limits.

The mean age at diagnosis of recurrent pneumonia in these children was 4. All were asymptomatic prior to and after the illness leading to hospitalizations. Findings from all hospital investigations were within reference limits. One hundred seventy-eight patients Twenty-five patients Aspiration disorders, immune disorders, and congenital heart disease were underlying illnesses that tended to be known prior to the first pneumonia.

Of the 17 underlying illness diagnoses discovered after pneumonia recurrence, asthma was the most common, occurring in 7 patients, followed by oropharyngeal incoordination leading to aspiration in 4. The remaining causes included gastroesophageal reflux disease in 3 patients, underlying airway anomalies in 2, and immune disorders in 1.

Prior to their asthma diagnosis, children with asthma presented with episodes of pneumonia but were otherwise healthy. They underwent extensive laboratory evaluation, including sweat chloride and quantitative serum immunoglobulin measurements. Growth, development, and physical examination findings were all within reference limits. These children were clinically diagnosed as having asthma multiple episodes of partially reversible airway obstruction or diagnosed by pulmonary function tests.

Recurrent pneumonia prior to a diagnosis of an underlying aspiration disorder was seen in 4 cases.