From the Guidelines
Bilateral pneumonia is most commonly caused by viral infections, such as influenza, COVID-19, and respiratory syncytial virus, as well as bacterial pathogens, including Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Mycoplasma pneumoniae, as reported in a recent study 1.
Causes of Bilateral Pneumonia
The causes of bilateral pneumonia can be divided into infectious and non-infectious categories. Infectious causes include:
- Bacterial pathogens, such as Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Mycoplasma pneumoniae
- Viral infections, including influenza, COVID-19, respiratory syncytial virus, and other respiratory viruses
- Fungal infections, such as Pneumocystis jirovecii, particularly in immunocompromised patients Non-infectious causes include:
- Aspiration of stomach contents
- Chemical inhalation injuries
- Radiation pneumonitis
- Autoimmune conditions, such as vasculitis
Risk Factors
Bilateral pneumonia is more common in people with weakened immune systems, including:
- Those with HIV/AIDS
- Cancer patients undergoing chemotherapy
- Organ transplant recipients on immunosuppressants
- The elderly Other risk factors include:
- Chronic lung diseases, such as COPD and asthma
- Smoking
- Alcoholism
- Recent surgery or hospitalization
Treatment
Treatment of bilateral pneumonia depends on the underlying cause, but typically includes:
- Appropriate antimicrobials for infectious causes
- Respiratory support
- Management of any underlying conditions As noted in a study on community-acquired pneumonia, the use of antimicrobial therapy and supportive care can improve outcomes in patients with bilateral pneumonia 1. In severe cases, hospitalization may be necessary to provide close monitoring and supportive care, as reported in a study on updates on community-acquired pneumonia management in the ICU 1. It is essential to prioritize the most recent and highest-quality study, which in this case is 1, to guide treatment decisions and improve patient outcomes.
From the Research
Conditions Causing Bilateral Pneumonia
Bilateral pneumonia can be caused by various conditions, including:
- Secondary bacterial infections in patients with viral pneumonia, such as those caused by SARS-CoV-2, influenza, and respiratory syncytial virus (RSV) 2, 3, 4
- Co-detection of multiple bacterial pathogens, including Streptococcus pneumoniae and Haemophilus influenzae, in the nasopharynx of patients with RSV infection 3
- Infections with antibiotic-resistant strains of bacteria, such as Staphylococcus aureus and Klebsiella pneumoniae 2
- Formation of multispecies biofilms in the respiratory tract, involving bacteria such as Streptococcus pneumoniae and Haemophilus influenzae 5
Bacterial Pathogens Involved
The most common bacterial pathogens involved in bilateral pneumonia include:
- Streptococcus pneumoniae 3, 6, 5, 4
- Haemophilus influenzae 3, 6, 5
- Staphylococcus aureus 2
- Klebsiella pneumoniae 2
- Moraxella catarrhalis 3
Impact of Secondary Infections
Secondary bacterial infections can have a significant impact on the severity and outcome of bilateral pneumonia, including:
- Increased mortality rates, with a mortality rate of 15.2% due to secondary bacterial infections observed in patients with pneumonia caused by SARS-CoV-2 2
- Increased disease severity, with co-detection of Streptococcus pneumoniae and Haemophilus influenzae associated with greater odds of hospitalization, higher disease severity scores, and longer hospitalization 3
- Altered antimicrobial susceptibility profiles, with some bacterial pathogens developing resistance to commonly used antibiotics 6