Pneumonia Causes

Aka: Pneumonia Causes, Pneumonia Causes in Children

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II. Epidemiology: Adults:

  1. Israeli adult patients (346) admitted for Pneumonia
    1. Pneumococcal Pneumonia (43%)
    2. Mycoplasma pneumonia (29%)
    3. Chlamydia pneumoniae (18%)
    4. Legionella pneumonia (16%)
  2. References
    1. Lieberman (1996) Chest 109:1243-9 [PubMed]

III. Epidemiology: Hospitalized Children

  1. Viral Pneumonia (66%)
    1. Respiratory Syncytial Virus (esp. under age 4 years)
    2. Human Rhinovirus
    3. Adenovirus (esp. age <2 years)
    4. Human Metapneumovirus (esp. age <10 years)
    5. Coronaviruses
    6. Influenza Virus
    7. Parainfluenza Virus
  2. Bacterial Pneumonia (8%)
    1. Mycoplasma pneumonia (esp. age >4 years old)
    2. Streptococcus Pneumoniae
    3. Staphylococcus aureus
    4. Streptococcus Pyogenes

IV. Causes: Viral Pneumonia

  1. Common viral causes
    1. Influenza A
    2. Influenza B
    3. Parainfluenza Virus
    4. Respiratory Syncytial Virus
    5. Adenovirus
  2. Other viral causes
    1. Rubeola
    2. Herpes Simplex Virus
    3. Varicella Zoster Virus
    4. Cytomegalovirus

V. Causes: Bacterial Pneumonia

  1. Typical Bacterial Pneumonia causees
    1. Pneumococcal Pneumonia
    2. Haemophilus Influenzae Pneumonia
    3. Moraxella pneumonia
    4. Staphylococcal Pneumonia
  2. Atypical Bacterial Pneumonia Causes
    1. Mycoplasma pneumonia
    2. Legionella pneumonia
    3. Chlamydia Pneumonia
    4. Q Fever
    5. Psittacosis

VI. Causes: Fungal Pneumonia

  1. Blastomycosis
  2. Coccidioidomycosis
  3. Histoplasmosis

VII. Causes: Newborn (birth to 3 weeks)

  1. General
    1. Vertical transmission from mother at birth
  2. Virus (See Viral Pneumonia)
    1. Cytomegalovirus (CMV)
    2. Rubella
    3. Herpes Simplex Virus (HSV)
  3. Bacteria (See Bacterial Pneumonia)
    1. Group B Streptococcus (common)
    2. Listeria monocytogenes (common)
    3. Escherichia coli (common)
    4. Group D Streptococcus
    5. HaemophilusInfluenzae
    6. Streptococcus Pneumoniae
    7. Ureaplasma Urealyticum

VIII. Causes: Age 3 weeks to 3 months

  1. Virus (See Viral Pneumonia)
    1. Respiratory Syncytial Virus (common)
    2. Parainfluenza Virus 1-3 (common)
    3. Influenza Virus (common)
    4. Adenovirus (common)
    5. Cytomegalovirus
  2. Bacteria (See Bacterial Pneumonia)
    1. Streptococcus Pneumoniae (most common Bacteria)
    2. Chlamydia trachomatis (common)
    3. Bordetella pertussis
    4. HaemophilusInfluenzae type B
    5. Moraxella catarrhalis
    6. Staphylococcus aureus
    7. Ureaplasma Urealyticum

IX. Causes: Age 4 months to 5 years

  1. Mixed viral and Bacterial Community Acquired Pneumonia may account for 30-50% of cases in children
  2. Virus (See Viral Pneumonia)
    1. Respiratory Syncytial Virus (common)
    2. Parainfluenza Virus Types 1-3 (common)
    3. Adenovirus
      1. Most common cause of Conjunctivitis
    4. Human Metapneumovirus (common)
      1. Similar presentation to RSV
    5. Influenza Virus Type A (common) and Type B
    6. Rhinovirus
    7. Varicella Zoster Virus
  3. Bacteria (See Bacterial Pneumonia)
    1. Streptococcus Pneumoniae (common)
    2. Chlamydia pneumoniae (common)
    3. Mycoplasma pneumoniae (common)
    4. HaemophilusInfluenzae Type B
    5. Moraxella catarrhalis
    6. Staphylococcus aureus
    7. Mycobacterium tuberculosis
    8. Neisseria Meningitis

X. Causes: Ages 5 to 18 years

  1. Virus
    1. Adenovirus
    2. Epstein-Barr Virus
    3. Parainfluenza Virus
    4. Adenovirus
      1. Most common cause of Conjunctivitis
    5. Influenza Virus
    6. Rhinovirus
    7. Respiratory Syncytial Virus
    8. Varicella Zoster Virus
  2. Bacteria (See Bacterial Pneumonia)
    1. Streptococcus Pneumoniae (common)
      1. Invasive disease is less common with Prevnar (but still increased risk in day care attendance)
      2. Penicillin Resistant Pneumococcus is more common with Antibiotics in the prior 60 days
    2. Staphylococcus aureus
      1. MRSA Pneumonia is increasing in Incidence with higher morbidity and mortality
    3. Atypical Pneumonia
      1. Mycoplasma pneumonia (common)
      2. Chlamydia pneumoniae (common)

XI. Causes: Age 18 to 65 years (no comorbidity)

  1. Virus (See Viral Pneumonia)
    1. Parainfluenza Virus
    2. Adenovirus (Most common cause of Conjunctivitis)
    3. Influenza Virus
  2. Bacteria (See Bacterial Pneumonia)
    1. Streptococcus Pneumoniae
      1. Middle aged patients
      2. Super-infection of post-viral Bronchitis
    2. Atypical Pneumonia
      1. Mycoplasma pneumonia (young patients)
      2. Chlamydia pneumoniae

XII. Causes: Age over 65 years (no comorbidity)

  1. Virus: See Viral Pneumonia
  2. Bacteria: Most common (See Bacterial Pneumonia)
    1. Streptococcus Pneumoniae
    2. Respiratory viruses
    3. HaemophilusInfluenzae
    4. Gram Negative Bacilli
    5. Staphylococcus aureus
  3. Bacteria: Less common (See Bacterial Pneumonia)
    1. Moraxella catarrhalis
    2. Legionella pneumonia (Atypical Pneumonia)

XIII. Causes: Patients with chemical addiction

  1. Tobacco Abuse
    1. Streptococcus Pneumoniae
    2. Haemophilus Influenzae
    3. Moraxella catarrhalis
    4. Legionella pneumonia (Atypical Pneumonia)
  2. Alcohol Abuse (See also Aspiration Pneumonia)
    1. Streptococcus Pneumoniae
    2. Anaerobic Bacteria
    3. Coliform Bacteria (e.g. KlebsiellaPneumonia)
    4. Mycobacterium tuberculosis
  3. Intravenous Drug Abuse
    1. Staphylococcus aureus
    2. Streptococcus Pneumoniae
    3. Mycobacterium tuberculosis
    4. Anaerobic Bacteria

XIV. Causes: Patients with chronic disease

  1. Chronic Obstructive Pulmonary Disease
    1. Streptococcus Pneumoniae
    2. Haemophilus Influenzae
    3. Moraxella catarrhalis
    4. Legionella pneumonia
    5. Chlamydophila pneumoniae
    6. Pseudomonas aeruginosa
    7. Gram-negative rods
  2. Cystic Fibrosis
    1. Early disease: Staphylococcus aureus
    2. Later disease: Pseudomonas aeruginosa
  3. HIV
    1. See Pulmonary Manifestations of HIV
    2. Early HIV
      1. Mycobacterium tuberculosis
      2. Haemophilus Influenzae Pneumonia
      3. Pneumococcal Pneumonia
    3. Late HIV or AIDS
      1. Aspergillus
      2. Cryptococcal Pneumonia
      3. Histoplasma capsulatum
      4. Haemophilus Influenzae Pneumonia
      5. Nocardia
      6. Nontuberculous Mycobacteria
      7. Pneumocystis jiroveci

XV. Causes: Animal Exposure

  1. Bat exposure: Histoplasma capsulatum
  2. Bird Exposure: Psittacosis, Histoplasma capsulatum
  3. Rabbit Exposure: Tularemia
  4. Livestock or cats: Coxiella Burnetii (Q Fever)

XVI. Causes: Bioterrorism

  1. Bacillus anthracis (Anthrax)
  2. Francisella tularensis (Tularemia)
  3. Yersinia pestis (Plague)

XVII. Causes: Chronic or refractory Pneumonia

  1. Mycobacterium tuberculosis
  2. Coccidioidomycosis
  3. Histoplasmosis

XVIII. Causes: Travel

  1. Hotel or cruise ship
    1. Legionella
  2. Middle East:
    1. Middle East Respiratory Syndrome
  3. Southeast or East Asia
    1. Avian Influenza
    2. Severe Acute Respiratory Syndrome
  4. Southeast or southcentral U.S.
    1. Blastomyces dermatidis
  5. Southwestern U.S.
    1. Coccidioidomycosis
    2. Hantavirus

XIX. References

  1. Gilbert (2001) Sanford Antimicrobial, p. 28
  2. Bartlett (2000) Clin Infect Dis 31:347-82 [PubMed]
  3. Kaysin (2016) Am Fam Physician 94(9); 698-706 [PubMed]
  4. Mandell (2007) Clin Infect Dis 44(suppl 2): S27-72 [PubMed]
  5. Niederman (1993) Am Rev Respir Dis 148:1418-26 [PubMed]

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