Multifocal (Bilateral) Pneumonia

However, for elderly and extremely young patients, or those with risk factors such as a compromised immune system, multifocal pneumonia can be more severe and may require hospitalization and a longer recovery period. In extreme cases, multifocal pneumonia can cause a loss of life.

Bilateral Interstitial Pneumonia

Bilateral interstitial pneumonia is a serious infection that can inflame and scar your lungs. It’s one of many types of interstitial lung diseases, which affect the tissue around the tiny air sacs in your lungs. You can get this type of pneumonia as a result of COVID-19.

Bilateral types of pneumonia affect both lungs. In bilateral interstitial pneumonia, the tissue around your air sacs (interstitial tissue) get irritated and may fill with pus and other fluids. As the pneumonia gets worse, your lungs can develop permanent scars.

When interstitial tissue gets scarred, it may stiffen and make it hard for you to breathe. Your condition can quickly get worse, leading to respiratory failure.

Links to COVID-19

Infection by bacteria or viruses is one cause of pneumonia. Infected people cough or sneeze particles into the air that you breathe or onto surfaces that you touch. You can get pneumonia as a result.

The new coronavirus is also spread by contact with droplets spread into the air or onto a surface when someone who is infected coughs or sneezes. Most people who get it have only mild symptoms similar to a cold or the flu. But others end up with severe pneumonia as a complication of COVID-19.

Symptoms

Bilateral interstitial pneumonia symptoms often include:

  • Fever
  • Dry cough
  • Shortness of breath
  • Hard time breathing
  • Fatigue

Warning signs of COVID-19 are similar.

Diagnosis

In people with serious COVID-19 symptoms, doctors may use CT scans to look for signs of pneumonia. These powerful X-rays show visual signs of damage to your lungs.

When people with bilateral interstitial pneumonia have CT scans, doctors can often see white patches they call “ground glass.” These are a sign of sores on the lungs.

If you have symptoms of interstitial lung disease but aren’t thought to have COVID-19, your doctor will start by giving you a physical exam. They may also give you some tests to rule out other problems. These include chest X-rays and CT scans as well as:

  • Pulmonary function test. These tests measure how well your lungs are working. The doctor may ask you to exhale into a tube for this type of test.
  • Bronchoscopy. In this test, your doctor inserts a long, flexible tube into your lungs to flush out your airways with saline solution. They’ll remove the fluid and examine it. They’re looking for high levels of white blood cells in your lungs. This is seen in about half of people with interstitial pneumonia.
  • Biopsy. It’s not always necessary, but your doctor may remove a small piece of lung tissue during your bronchoscopy to test for signs of inflammation or scarring.

Treatment

While most cases of COVID-19 are mild, your doctor may prescribe an antiviral medicine to keep your symptom from getting worse. The antiviral that doctors prefer to use is a pill called ritonavir-boosted nirmatrelvir (Paxlovid) which has been given emergency use authorization from the FDA. Remdesivir (Veklury), which is given by IV is the only antiviral drug that has full FDA approval. A EUA has also been given to the antiviral molnupiravir (Lageviro) but that should only be used when the other treatments are not available.

If you get pneumonia as a result of the virus, your doctor may help you breathe by giving you oxygen through a mask or tubes. If it’s very serious, you might need a breathing machine.

If you’re diagnosed with interstitial pneumonia, your doctor may prescribe oral corticosteroids like prednisone. But they don’t work for everyone. They can also have lots of side effects.

Drugs that suppress your immune system may help, too. These include:

  • Azathioprine (Imuran)
  • Cyclophosphamide (Cytoxan)
  • Mycophenolate mofetil (CellCept)
  • Mycophenolic acid (Myfortic)
  • Rituximab (Rituxan)

Some people take steroids along with one of these drugs.

Once your lungs are scarred, you can’t reverse the damage. But anti-fibrotic drugs like nintedanib (Ofev) and pirfenidone (Esbriet) help keep the scarring from getting worse.

Other treatments include oxygen therapy and pulmonary rehab, which includes breathing exercises to improve your lung strength. If nothing else works for you, you might need a lung transplant.

Prevention

To keep your lungs healthy, don’t smoke. To prevent any infection, including COVID-19:

  • Wash your hands often with soap and water for at least 20 seconds.
  • Avoid touching your hands, eyes, or mouth until you’ve washed your hands.
  • Use hand sanitizer gels that are at least 60% alcohol if you’re not in a place where you can wash your hands.
  • Stay away from others who are sick. Keep a safe distance when you go out.
  • Stay home if you’re sick except to go to the doctor.
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Show Sources

Case Reports in Medicine: “Acute Interstitial Pneumonia (Hamman-Rich Syndrome) as a Cause of Idiopathic Acute Respiratory Distress Syndrome.”

National Jewish Health: “Interstitial Lung Disease (ILD) Overview.”

Cleveland Clinic: “Nonspecific Interstitial Pneumonia,” “Pneumonia.”

Radiopaedia.org: “Coronavirus disease 2019 (COVID-19).”

American Journal of Roentgenology: “Relation Between Chest CT Findings and Clinical Conditions of Coronavirus Disease (COVID-19) Pneumonia: A Multicenter Study.”

Johns Hopkins Medicine: “Pulmonary Function Tests.”

CDC: “Coronavirus Disease 2019 (COVID-19): How to Protect Yourself,” “Information for Clinicians on Therapeutic Options for COVID-19 Patients.”

Radiology: “Artificial Intelligence Distinguishes COVID-19 from Community Acquired Pneumonia on Chest CT.”

Multifocal (Bilateral) Pneumonia

The answer is C: COVID-19 interstitial pneumonia, a novel acute respiratory illness caused by SARS-CoV-2 infection. Many patients with acute COVID-19 present with respiratory symptoms, including dry cough, shortness of breath, tachypnea, and hypoxemia. Pneumonia and acute respiratory failure can develop in the 5% to 10% of patients with severe disease. 1 Patients with COVID-19 typically follow a biphasic disease course, with a milder initial presentation that is followed by clinical deterioration about seven to 10 days after the onset of symptoms. 1 Imaging findings include bilateral ground-glass opacities, and subsegmental and lobar areas of consolidation. 2

The patient’s nasal swab test was positive for COVID-19 at the urgent care clinic three days before the patient presented to the emergency department. Polymerase chain reaction testing is most useful for the initial diagnosis of COVID-19. Treatment is generally supportive with oxygen, antiviral therapy, and intravenous fluids. Patients who require mechanical ventilation and dialysis have a much poorer prognosis. Bacterial pneumonia typically presents with a focal or lobar consolidation on chest radiography. Other viral causes of pneumonia can present with similar interstitial infiltrates, which makes polymerase chain reaction testing for common viruses, such as influenza A and B, important when diagnosing COVID-19.

Aspiration pneumonia is caused by the inhalation of foreign particles into the lungs. Certain populations are at greater risk of this disease, including older people and those with dysphagia or impaired neurologic status (e.g., due to stroke or alcohol or drug use). Radiographs show opacification of the posterior segment of the upper lobes and the superior segment of the lower lobes. Because of the more obtusely angled right bronchus, the right lower lobe is most often involved with aspiration, but the position of the patient during the aspiration event leads to bilateral involvement in 50% of cases. 3 The low specificity of diagnostic radiography in aspiration pneumonia can be improved with computed tomography. 3

Congestive heart failure is characterized by dyspnea and volume overload, including peripheral edema and pulmonary rales. 4 Characteristic radiograph findings include cardiomegaly, pulmonary venous congestion, septal lines, airspace opacification, and pleural effusions. 4

Mycoplasma pneumonia typically presents with mild symptoms, including fever, cough, wheezing, and dyspnea. Chest radiography may show airspace opacities, reticular opacities, and bronchial thickening. Computed tomography findings are similar to radiography, but in more detail, and can include interstitial thickening and centrilobular nodules. 5

Condition Signs and symptoms Characteristic radiograph findings
Aspiration pneumonia Pneumonia symptoms in at-risk patients, such as older people and those with dysphagia or impaired neurologic status (e.g., due to stroke or alcohol or drug use) Opacification of the posterior segment of the upper lobes and the superior segment of the lower lobes; because of the more obtusely angled right bronchus, the right lower lobe is most often involved
Congestive heart failure Dyspnea and volume overload, including peripheral edema and pulmonary rales Cardiomegaly, pulmonary venous congestion, septal lines, airspace opacification, and pleural effusions
COVID-19 interstitial pneumonia Dry cough, shortness of breath, tachypnea, and hypoxemia; biphasic disease course, with a milder initial presentation that is followed by clinical deterioration about seven to 10 days after onset of symptoms Bilateral ground-glass opacities, and subsegmental and lobar areas of consolidation
Mycoplasma pneumonia Typically mild symptoms; fever, cough, wheezing, dyspnea Airspace opacities, reticular opacities, and bronchial thickening

Understanding Multifocal Pneumonia: Symptoms And Causes

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What is multifocal pneumonia?

The lungs are a pair of air-filled, spongy organs that consist of many areas. To breathe, air must travel through the windpipe, also known as the trachea, which carries inhaled air into the lungs through hollow branches, called the bronchi.

These bronchi then divide into smaller and smaller branches which finally lead to the alveoli. These tiny air-filled sacs are vital for life, as they take oxygen from the air you inhale to the bloodstream.

Pneumonia is an umbrella term used to describe an infection of the lungs caused by inflammation. Pneumonia generally targets the lower parts of the lungs, such as the alveoli. The infection results in inflammation and/or fluid and pus buildup in the alveoli, leading to symptoms such as a cough, fever, breathlessness, or chills.

Pneumonia can be classified in many ways, depending on the environment (hospital or community) or even what caused pneumonia (bacterial, viral, and fungal).

Additionally, the infection rates and severity of these classes can differ depending on the type of pneumonia acquired. The different pneumonia types can result in a range of disease severities, determined by the amount of inflammation in the lungs. In general, the more inflammation within the lungs, the more severe the infection.

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One type of pneumonia is multifocal pneumonia, which can be defined as inflammation that affects more than one part of the lobes of the lungs and can either affect one (unilateral) or both (bilateral) of the lungs at one time.

Causes of multifocal pneumonia

Multifocal pneumonia can be caused by the same pathogens (bacteria, viruses, and fungi) that cause other types of pneumonia. What makes multifocal pneumonia different is how the illness presents in the lungs, with more than one site of infection and inflammation.

In many cases, multifocal pneumonia is caused by viruses, such as COVID-19, respiratory syncytial virus (RSV), or the common flu. This is because viruses, like RSV, can cause similar types of inflammation that generally present in multiple areas of the lung or even in both lungs, whereas bacterial infections are likely to stay as unilateral infections.

This does not mean that multifocal pneumonia cannot be caused by bacteria or fungi. Bacteria such as streptococcus pneumoniae or legionella pneumophila, and fungi such as pneumocystis pneumonia, coccidioidomycosis, or cryptococcus are all capable of causing multifocal pneumonia.

To properly test for the cause of multifocal pneumonia, your doctor will take a sample of sputum (thick mucus produced by the lung) and test for any microbes, which should help to identify the type of bacteria or fungus causing the infection.

Risk factors

Pneumonia has several risk factors, the main ones being the following:

  • Age above 65 years old
  • Infancy
  • Smoking
  • Alcoholism
  • Immunosuppressive conditions
  • Conditions such as COPD (chronic obstructive pulmonary disease)
  • Cardiovascular diseases
  • Cerebrovascular diseases
  • Renal diseases
  • Liver diseases
  • Dementia
  • Diabetes

Symptoms

Multifocal pneumonia shares the same symptoms as all other types of pneumonia and can be just as mild or severe. However, due to multifocal pneumonia in different areas of the lungs, the illness can sometimes be more powerful, resulting in hospitalization.

The main symptoms of pneumonia can be different depending on the age of the patient, as well as other factors. For example, symptoms in elderly patients are different from those for children.

However, the main set of symptoms are as follows:

  • Cough
  • Chest pain
  • Fever
  • Fatigue
  • Loss of appetite
  • Headache
  • Nausea
  • Abdominal pain
  • Shortness of breath
  • Sputum production (mucus produced by the lungs)
  • Chills.

In most cases, and if caught early, patients should be able to recover at home with sufficient rest, hydration, and antibiotics (only for bacterial pneumonia). However, some cases may result in hospitalization, with assisted ventilation sometimes needed.

Treatment for multifocal pneumonia

Depending on the severity of the multifocal pneumonia infection, as well as the cause of pneumonia, the treatment plan can differ greatly. Firstly, for treatment to occur, a proper diagnosis must be made to determine the severity and the cause of the infection.

Diagnosing pneumonia can be achieved through various techniques such as a chest X-ray, blood test, sputum culture, pulse oximetry, chest CT scan, bronchoscopy, or a pleural fluid culture.

Once a diagnosis and cause have been determined, a treatment plan will be formed, depending on the severity and type of pneumonia. For most people who show mild symptoms, treatment will revolve around home rest and hydration, with an appropriate medication prescribed only if needed.

If the pneumonia is bacterial, antibiotics will be prescribed. If the infection is viral, some antiviral medications may be prescribed, such as Tamiflu. As for fungal pneumonia, antifungal medications will be utilized to clear the infection.

In most cases, people who have few underlying medical conditions and demonstrate none of the typical risk factors will typically clear the infection quickly.

However, for elderly and extremely young patients, or those with risk factors such as a compromised immune system, multifocal pneumonia can be more severe and may require hospitalization and a longer recovery period. In extreme cases, multifocal pneumonia can cause a loss of life.

Complications

In rare cases, and if you have certain risk factors, complications can present after pneumonia. Some of these complications include:

  • Acute respiratory distress syndrome.
  • Lung abscesses present as pockets of pus or fluid that form inside or around the infected tissue of the lung.
  • Respiratory failure requiring ventilation and hospitalization.
  • Sepsis depends on the cause of pneumonia and is more common in bacterial pneumonia.

The lowdown

Multifocal pneumonia is a type of pneumonia that affects more than one area of the lungs and causes similar symptoms to other types of pneumonia. Multifocal pneumonia, if diagnosed early, can be treated with a relatively short recovery period. However, this type of pneumonia tends to result in a more severe infection that may require hospitalization.

FAQ

How long does it take to recover from pneumonia?

The recovery time for pneumonia generally depends on the severity of the disease affecting the person. For most people who experience mild pneumonia, recovery is around 1 to 2 weeks. However, it may take a bit longer to feel 100%. For others experiencing a more severe illness, it can take much longer to recover.

What does multifocal mean when it comes to pneumonia?

Multifocal pneumonia is a type of pneumonia that is caused by multiple presentations of inflammation and infection in different areas of the lungs. It can be present in only one lung or both at the same time.

What bacteria, fungi, and viruses cause multifocal pneumonia?

Multifocal pneumonia is not only caused by viruses such as influenza but can also be caused by bacteria such as streptococcus pneumoniaeor legionella pneumophila and fungi like pneumocystis pneumonia, coccidioidomycosis, or cryptococcus. Other viral causes include respiratory syncytial virus and common cold or flu viruses.

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Alex Koliada, PhD

Alex Koliada, PhD

Alex Koliada, PhD, is a well-known doctor. He is famous for his studies of ageing, genetics and other medical conditions. He works at the Institute of Food Biotechnology and Genomics NAS of Ukraine. His scientific researches are printed by the most reputable international magazines. Some of his works are: Differences in the gut Firmicutes to Bacteroidetes ratio across age groups in healthy Ukrainian population [BiomedCentral.com]; Mating status affects Drosophila lifespan, metabolism and antioxidant system [Science Direct]; Anise Hyssop Agastache foeniculum Increases Lifespan, Stress Resistance, and Metabolism by Affecting Free Radical Processes in Drosophila [Frontiersin].
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