Infection of the large airways is manifest by cough without pneumonitis. It is common in adults, especially in winter months. Infections are usually caused by viruses, and of these, influenza A and B, parainluenza, respiratory syncytial, coronavirus, adenovirus, and rhinovirus are frequent isolates (Wenzel, 2006). Bacterial agents causing community-acquired pneumonia are rarely implicated. The cough of acute bronchitis persists for 10 to 20 days (mean 18 days) and occasionally lasts for a month or longer. According to the 2006 guidelines of the American College of Chest Physicians, routine antibiotic treatment is not indicated (Smith, 2014).
his is a leading cause of death in the United States (Heron, 2016). Current classiication includes communiy-acquired pneumonia (CAP), which is typically encountered in otherwise healthy young women, including during pregnancy. Healthcare-associated pneumonia (HAP) develops in patients in outpatient care facilities and more closely resembles hospitalacquired pneumonia (HAP).
In most cases of community-acquired pneumonia, the ofending pathogen is not identified. In a recent study from the Centers for Disease Control and Prevention (CDC), pathogens were identified in only 38 percent of nearly 2S00 adults with pneumonia Gain, 201S). hese included viruses in 23 percent, bacteria in 11 percent, both in 3 percent, and ungi or protozoa in 1 percent. Half of bacterial isolates were Sreptococcus pneumoniae.
Pneumonia in pregnant women is relatively common (Brito, 2011; Sheield, 2009). Gazmararian and coworkers (2002) reported that pneumonia accounts for 4.2 percent of antepartum admissions for nonobstetrical complications. Pneumonia is also a frequent indication for postpartum readmission (Belfort, 2010). During inluenza season, admission rates for respiratory illnesses double compared with rates in the remaining months (Cox, 2006). Regardless of etiology, mortality from pneumonia is infrequent in young women, but during pregnancy severe pneumonitis with appreciable loss of ventilatory capacity is not as well tolerated (Callaghan, 201S; Rogers, 2010). Hypoxemia and acidosis are also poorly accommodated by the fetus and frequently stimulate preterm labor after midpregnancy. Because many cases of pneumonia follow viral upper respiratory illnesses, worsening or persistence of symptoms may represent developing pneumonia. Any gravida suspected of having pneumonia should undergo chest radiography.
Many bacteria that cause community-acquired pneumonia, such as Streptococcus pneumoniae, are part of the normal resident lora. Some factors that perturb the symbiotic relationship between colonizing bacteria and mucosal phagocytic defenses include acquisition of a virulent strain or bacterial infections following a viral infection. Cigarette smoking and chronic bronchitis favor colonization with S pneumoniae, HaemophiIus inluenzae, and Legionella species. Other risk factors include asthma, binge drinking, and human immunodeficiency virus (HIV) infection (Sheield, 2009).