Principi N, Scala A, Daleno C, Esposito S. Influenza Other Respir Viruses. In: Goldman-Cecil Medicine. Five Facts You Should Know About Pneumonia, Five Top Pneumonia Questions For Your Doctor. Healthcare settings include hospitals, long-term care facilities, and dialysis centers. The flu virus weakens a person's immune system, making them more likely to pick up other infections. Sepsis Due to Haemophilus influenzae and Masked Influenza A Infection. Can you have Covid pneumonia without a fever? Children younger than age 5 and adults ages 65 and older should get this shot. Breathing may be labored. Thank you for taking the time to confirm your preferences. 2022 American Lung Association. Ventilator associated pneumonia. Your chance of getting pneumonia is higher if you live or spend a lot of time in a crowded place such as military barracks, prison, homeless shelters, or nursing homes. You will be subject to the destination website's privacy policy when you follow the link. Review/update the Coronavirus 2019 (COVID-19) may cause pneumonia, which can become severe. Pratheepamornkull T, Ratanakorn W, Samransamruajkit R, Poovorawan Y. Southeast Asian J Trop Med Public Health. Our service is free and we are here to help you. This type of pneumonia can have some different symptoms and physical signs such as white phlegm, nausea and vomiting. Healthcare-associated pneumoniais when someone develops pneumonia during or following a stay in a healthcare setting. A .gov website belongs to an official government organization in the United States. Share sensitive information only on official, secure websites. Pneumonia is a type of infection that affects your lungs. Receive automatic alerts about NHLBI related news and highlights from across the Institute. Lee: Regardless of what causes it, regaining strength after pneumonia can take quite a long time from several weeks to many months. The most common are the influenza virus, human adenovirus and the respiratory syncytial virus. The signs and symptoms of pneumonia vary from mild to severe, depending on factors such as the type of germ causing the infection, and your age and overall health. Ahmed AK, Sayad R, Mahmoud IA, El-Monem AMA, Badry SH, Ibrahim IH, Hafez MH, El-Mokhtar MA, Sayed IM. Some bacteria cause pneumonia with different symptoms or other characteristics than the usual pneumonia. . We take your privacy seriously. Federal government websites often end in .gov or .mil. Official websites use .gov These cookies may also be used for advertising purposes by these third parties. Common causes of bacterial pneumonia areStreptococcus pneumoniae (pneumococcus) and, especially in kids, Mycoplasma pneumoniae. Bacteria are one of the most common causes of pneumonia in adults. 2016;29(3):695747. 2015 Jul;46(4):650-6. Pneumonia in adults is usually the result of a pneumococcal infection, caused by bacteria called Streptococcus pneumoniae. 2022 May 24;11(11):2968. doi: 10.3390/jcm11112968. As influenza infection develops the virus causes cell damage and death within the host's airways and up-regulates the production of toxins, causing further destruction. Bacterial pneumonia can develop on its own or after you have a cold or the flu. 2022 Apr;28(2):189-200. doi: 10.1007/s13365-022-01060-9. http://www.uptodate.com/home. It can cause a dangerous fever (as high as 105 degrees), rapid pulse rate, bluish lips or nail beds, and confusion. Depending on which kind of pneumonia you contract, then you'll need ether antibiotics or antivirals. Alimi Y, Lim WS, Lansbury L, Leonardi-Bee J, Nguyen-Van-Tam JS. Other. Pneumonia can affect anyone. (the most common cause of bacterial pneumonia), and by having the annual flu (influenza) virus immunisation. Aspiration is more likely if something disturbs your normal gag reflex, such as a brain injury or swallowing problem, or excessive use of alcohol or drugs. Viruses, bacteria, and fungi can all cause pneumonia. Number of studies according to most commonly identified viral pathogen. 25th ed. You will now receive email updates from the American Lung Association. 2005;3(8):591600. Pneumonia is an infection of the lungs caused by bacteria, fungi, or viruses (including COVID-19). But in some cases it can become very serious. Flu is a respiratory illness caused by viruses that infect the nose, throat, and sometimes the lungs. -, Jain S., Self W.H., Wunderink R.G. Adults: Protect yourself with pneumococcal vaccines. Your tax-deductible donation funds lung disease and lung cancer research, new treatments, lung health education, and more. Most cases of pneumonia are caused by common viruses that cause cold, flu and other respiratory infections such as adenovirus, rhinovirus, influenza (flu), respiratory syncytial virus (RSV) and parainfluenza virus. Inflammation can cause your air sacs to fill up with fluid and pus and cause pneumonia. Seasonal influenza, or flu, is a highly contagious respiratory disease caused by any of several human influenza viruses that circulate globally and cause annual outbreaks of varying severity. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2013. Viruses are the most common cause of pneumonia in children younger than 5 years. Viral pneumonia can happen as a direct result of viruses that infect your airways and lungs, like the flu (which is caused by the influenza virus) or the common cold (caused by. INTRODUCTION. Southeast Asian J Trop Med Public Health. 2013;62:9. 2011;124:689. Teng F, Liu X, Guo SB, Li Z, Ji WQ, Zhang F, Zhu XM. The air sacs fill with pus and other liquid, blocking oxygen from reaching the bloodstream. Influenza is a common cause of pneumonia, especially among younger children, the elderly, pregnant women, or those with certain chronic health conditions or who live in a nursing home. Many other viruses can cause pneumonia, including SARS-CoV-2, the virus that causes COVID-19. J Neurovirol. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. 580 Rentals has a huge selection of Houses, Apartments, Mobile Homes, and Storage Units for rent or lease in Ada, Oklahoma 74820. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Pneumonia is a lung infection that prevents your lungs from getting enough oxygen into the blood, creating a strain on the heart. Babies, children, and older adults who do not get the recommended vaccines topreventpneumonia have an even higher risk. The shingles vaccine, however, is considered to be safe and poses a small risk of side effects.The Zostavax shingles vaccine may cause: Redness, soreness, swelling, or itching at the site of the injection, or. What Is The Connection Between Influenza and Pneumonia? Influenza cytotoxins for example causes necrosis of host cells ( Conenello and Palese, 2007; Iverson et al., 2011 ). Flu symptoms include: Body aches and pains Dry cough Extreme fatigue Fever above 100.4 degrees Headache Pneumonia symptoms include: Bluish fingernails and lips Chills Confusion (most common in older adults) Coughing All mammals use fever to deal with infections and heat has been used throughout human history in the form of hot springs, saunas, hammams, steam-rooms , sweat-lodges, steam inhalations, hot mud and poultices to prevent and treat respiratory infections and enhance health and wellbeing. AskMayoExpert. "The elderly do still make . Seasonal influenza is characterized by a sudden onset of fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and a runny nose. Some bacteria cause pneumonia with different symptoms or other characteristics than the usual pneumonia. information is beneficial, we may combine your email and website usage information with If you think your flu is turning into pneumonia, doctors can do a few tests to determine the best treatment. Pneumonia is classified according to the types of germs that cause it and where you got the infection. Mayo Clinic; 2020. Let's join together to end the youth vaping epidemic by supporting parents, schools and students. This video shows how the immune system works to get rid of germs and how pneumonia develops. Bacteria such as Streptococcus pneumoniae can cause pneumonia, too. eCollection 2022 Feb. Gentile F, Bocci T, Coppola S, Pozzi T, Modafferi L, Priori A, Chiumello D. Biomedicines. Epub 2012 Dec 12. Another common cause of pneumonia is infection by mycoplasma, a kind of bacterium. If you are a Mayo Clinic patient, this could Respiratory syncytial virus (RSV), which is more common in infants and children than in adults. They need to stay in the hospital. But sometimes, influenza and its complications can be deadly. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Proportion of pneumonia and associated outcomes in patients admitted to the hospital with influenza infection. Hospital-acquired pneumonia Accessed April 15, 2016. A classic sign of bacterial pneumonia is a cough that produces thick, blood-tinged or yellowish-greenish sputum with pus. Infectious Diarrhea, Indigestion and Other Minor Causes The most common cause of this is the presence of parasitic microbes in the digestive tract. Join the 700,000+ people getting our email updates! Aspiration pneumonia occurs when you inhale food, drink, vomit or saliva into your lungs. You can review and change the way we collect information below. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. The most common are bacteria and viruses in the air we breathe. Our key findings add to the evidence that a changing climate is making it harder to protect human health. Epidemiology of influenza in Canada. Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Extracorporeal membrane oxygenation (ECMO). The .gov means its official. family fuck slut literoticia. Medical Animation Copyright 2022 Nucleus Medical Media Inc. All rights reserved. health information, we will treat all of that information as protected health Influenza was the cause of pneumonia in twice as many patients 80 and older than any other type of virus except HRV, the study revealed. Pneumonia is a serious infection or inflammation of the lungs. Sometimes germs, such as bacteria, viruses, or fungi, get into your lungs and cause infections. Many other viruses can cause pneumonia, including SARS-CoV-2, the virus that causes COVID-19. Dockrell DH, et al. Disclaimer, National Library of Medicine The flu may also lead to lung infection (pneumonia) or . AskMayoExpert. Saving Lives, Protecting People, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services, SARS-CoV-2 (the virus that causes COVID-19). Bacteria are a common cause of pneumonia in adults. Historical perspectiveemergence of influenza A (H1N1) viruses. Bacterial pneumonia may also lead to severe complications. Select your location to view local American Lung Association events and news near you. Most cases of flu never lead to pneumonia, but those that do tend to be more severe and deadly. 2022 Mar 21;10(3):729. doi: 10.3390/biomedicines10030729. Pneumonia in the immunocompetent patient. Cureus. Talk to our experts at the American Lung Association Lung HelpLine and Tobacco QuitLine. 2012;142:482. Accessed April 18, 2016. Treatment of community-acquired pneumonia in adults in the outpatient setting. Chest radiograph (. Bacterial pneumonia may be accompanied by shaking chills, high fever, sweating, chest pain (pleurisy), and a productive cough with yellow/green mucus. Flu (influenza) is a seasonal upper airway and lung infection that causes fever and a cough or sore throat. Influenza viruses infect the nose, throat, and lungs and produce symptoms that include sudden fever, extreme fatigue, coughing, chills, and . N Engl J Med. They noted that between 2020 and 2022, 73.7% of deaths due to flu and pneumonia occurred among those 80 years and over, compared to 58.3% of deaths due to COVID-19. Health care-acquired pneumonia is a bacterial infection that occurs in people who live in long-term care facilities or who receive care in outpatient clinics, including kidney dialysis centers. A wide range of viruses can cause viral pneumonia, including: influenza A, B, and C viruses coronaviruses, including those that cause COVID-19, Middle East respiratory syndrome (MERS), and. Olson EJ (expert opinion). Community-acquired pneumonia in children: A look at the IDSA guidelines. Similarly, the radiological findings of viral infection are nonspecific. The bacteria and viruses that most commonly cause pneumonia in the community are different from those in healthcare settings. Signs and symptoms of pneumonia may include: Newborns and infants may not show any sign of the infection. But viral pneumonia caused by the influenza virus can be fatal, especially in people with . About 36,000 people in the United States die each year of problems from the flu. Flu (influenza) is an infection of the nose, throat and lungs, which are part of the respiratory system. PMC Epub 2018 Nov 15. RSV, respiratory syncytial virus. Viruses that infect your lungs and airways can cause pneumonia. Viral pneumonia: caused by various viruses, including influenza. Journal of Family Practice. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Thank you! A single copy of these materials may be reprinted for noncommercial personal use only. Fungi such asPneumocystis jiroveciimay cause pneumonia, especially for people who have weakened immune systems. Community-acquired pneumoniais when someone develops pneumonia in the community (not in a hospital). 2017;391(10127):12851300. Clin Microbiol Rev. Coronaviruses, including SARS-CoV-2, the new virus that causes COVID-19. Community-acquired bacterial co-infection predicts severity and mortality in influenza-associated pneumonia admitted patients. 2017 Oct;95:26-35. doi: 10.1016/j.jcv.2017.07.019. Many germs can cause pneumonia. sesame street episodes . Medical Animation Copyright 2022 Nucleus Medical Media Inc. All rights reserved, Bacteria are a common cause of pneumonia in adults. This content does not have an Arabic version. Pneumococcal pneumonia in adults. This website uses cookies to improve content delivery. Ourvideo about how SARS-CoV-2 affects the lungstalks about this. It causes the air sacs in the lungs, called alveoli, to fill with pus or other liquid. The two most common causes of pneumonia are from viral pathogens or bacterial pathogens. Nat Rev Microbiol. Viral pneumonia causes muscle pain,. Respiratory syncytial virus (RSV) is the most common cause of viral pneumonia in young children. Most pneumonia occurs when a breakdown in your body's natural defenses allows germs to invade and multiply within your lungs. If there is too little oxygen in the blood, the body's cells cannot work properly, which can lead to death. sharing sensitive information, make sure youre on a federal N Engl J Med. Mycoplasma pneumonia: caused by the bacterium Mycoplasma pneumoniae. Accessed April 15, 2016. It is most common during the fall and winter months. government site. 8600 Rockville Pike The majority of deaths during the influenza pandemic of 1918-1919 were not caused by the influenza virus acting alone, report researchers from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Viral pneumonia is caused by a virus. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Community-acquired pneumonia requiring hospitalization among U.S. adults. Enveloped viruses such as SAR-CoV-2 are sensitive to heat and are destroyed by temperatures tolerable to humans. You are most likely to encounter these germs if you work in a chicken or turkey processing center, pet shop, or veterinary clinic. The flu (influenza virus) and the common cold (rhinovirus) are the most common causes of viral pneumonia in adults. As flu strains change each year, it is necessary to get a flu vaccination each season to make sure you are protected against the most current strains. Most cases of flu never lead to pneumonia, but those that do tend to be more severe and deadly. Pneumonia caused by viruses is usually milder and shorter in duration compared to bacterial pneumonia. 2014;20:215. It can cause bacterial infections ranging from mild (such as bronchitis) to severe (such as septic arthritis). "It's more stress on your heart. The flu (influenza virus) and the common cold (rhinovirus) are the most common causes of viral pneumonia in adults. J Clin Virol. 1998-2022 Mayo Foundation for Medical Education and Research (MFMER). It can also increase risks for stroke patients. Flu virus can cause pneumonia. The second most common trigger of pneumonia is a virus. RSV, respiratory syncytial, Proportion of pneumonia and associated outcomes in patients admitted to the hospital with, Probability of influenza according to presence of combined cough and fever in patients, Chest radiograph and computed tomography, Chest radiograph and computed tomography of the chest of a 42-year-old male patient, Computed tomography of the chest revealing diffuse ground-glass opacities and small bilateral pleural, Treatment approach in patients presenting. Human parainfluenza viruses: These viruses cause respiratory infections, including pneumonia, in people of all ages, especially in young children, the elderly, and people with suppressed immune systems. The flu is caused by an influenza virus. People who have Influenza often feel some or all of these symptoms: fever, chills, cough, sore throat, runny or stuffy nose, body aches, headaches, and fatigue. Barson WJ. Learn More about preventing the flu and pneumonia or find a flu vaccine near you. To destroy the attacking organisms, white blood cells rapidly accumulate. Many other types of bacteria, including Haemophilus influenzae and Staphylococcus aureus, can also cause pneumonia. National Heart, Lung, and Blood Institute. Influenza (flu) is a very contagious viral infection of the respiratory system. Pneumonia is the leading cause of death among children under age 5, with the majority of those deaths occurring in the developing world. You may have an increased risk of pneumonia if you have any of the following medical conditions. This site needs JavaScript to work properly. Careers. The exact type of germs that. Bacterial pneumonia can develop on its own or after you have a cold or the flu. File TM. and transmitted securely. official website and that any information you provide is encrypted . Haemophilus influenzae type b (Hib) is a type of bacteria that can cause pneumonia and meningitis. There is a problem with Influenza is caused by a virus, but the most common cause of death is secondary bacterial pneumonia rather than the influenza virus per se. In some people, small pouches called diverticula can form in the wall of the large intestine where the. Mycoplasma pneumoniae infection. Accessed April 20, 2016. CDC twenty four seven. . Immune cells attack the germs and may cause, of your air sacs, or alveoli. Most people recover from fever and other symptoms within a week without requiring medical attention. Join over 700,000 people who receive the latest news about lung health, including COVID-19, research, air quality, inspiring stories and resources. It occurs outside of hospitals or other health care facilities. These viruses are airborne and therefore spread in the air by coughing or sneezing;. Fever is the most common symptom . Marrie TJ, et al. Haemophilus influenzae type b (Hib) - the second most common cause of bacterial pneumonia; respiratory syncytial virus is the most common viral cause of pneumonia; in infants infected with HIV, Pneumocystis jiroveci is one of the most common causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants. Influenza is commonly called the flu, but it's not the same as stomach "flu" viruses that cause diarrhea and vomiting. Human Parainfluenza Virus (HPIV) Infection, Respiratory Syncytial Virus (RSV) Infection, Centers for Disease Control and Prevention. Accessed April 15, 2016. Live Chat with us, Monday through Friday, 8:30 a.m to 5:00 p.m. EST. Early symptoms may include: sore throat sneezing runny nose Symptoms often worsen as the virus progresses. Before In many cases, bacterium enters the weakened body and attacks the lungs directly. information submitted for this request. Many influenza experts, policy makers, and knowledgeable observers believe that a novel influenza A (H1N1) strain directly caused most deaths during the 1918-19 pandemic, often from a hemorrhagic pneumonitis that rapidly progressed to acute respiratory distress syndrome and death (1-3).Not surprisingly, plans and resources to respond to the next influenza pandemic focus almost exclusively . What is the role of respiratory viruses in community-acquired pneumonia? Haemophilus influenzae, or H. influenzae, is a kind of bacteria. Symptoms: Fever - Rare; Headache - Rare; Muscle aches and pains - Slight . other information we have about you. http://www.cdc.gov/pneumonia/atypical/mycoplasma/. When these germs get into your lungs, your immune system, which is your body's natural defense against germs, goes into action. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Knowing the difference between the common cold and Influenza and Pneumonia is important for the effectiveness of treatment. All information these cookies collect is aggregated and therefore anonymous. Computed tomography of the chest revealing diffuse ground-glass opacities and small bilateral pleural effusion in a 62-year-old female patient with respiratory syncytial virus infection who developed pneumonia and acute respiratory distress syndrome. badminton court cad block. Viruses, bacteria, and fungi can all cause pneumonia. Most children are ill with the flu for less than a week. 2022 Feb 21;14(2):e22424. Please enable it to take advantage of the complete set of features! It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems. Along with bacteria and fungi, they fill the air sacs within your lungs (alveoli). Secure .gov websites use HTTPS Fungus in the soil in certain parts of the United States can become airborne and cause pneumonia. Pneumonia is often caused by viruses, such as the influenza virus (flu) and adenovirus. Community-acquired pneumonia is the most common type of pneumonia. Viruses, bacteria, and fungi can all cause pneumonia. It's especially important that people in these high-risk groups see a doctor: For some older adults and people with heart failure or chronic lung problems, pneumonia can quickly become a life-threatening condition. Putative Role of the Lung-Brain Axis in the Pathogenesis of COVID-19-Associated Respiratory Failure: A Systematic Review. CMV, cytomegalovirus; HSV, herpes simplex virus; IV, intravenous; RSV, respiratory syncytial virus; VZV, varicella zoster virus. Cookies used to make website functionality more relevant to you. This video shows how the immune system works to get rid of germs and how pneumonia develops. The viruses that cause colds and flu (influenza) can cause pneumonia. Haemophilus Influenzae. 2022 Jun;111(6):1159-1173. doi: 10.1002/JLB.1MR1221-345R. See this image and copyright information in PMC. Confusion or changes in mental awareness (in adults age 65 and older), Lower than normal body temperature (in adults older than age 65 and people with weak immune systems), Children younger than age 2 with signs and symptoms, People with an underlying health condition or weakened immune system, People receiving chemotherapy or taking medication that suppresses the immune system. You May Also Like A lock ( A locked padlock) or https:// means youve safely connected to the .gov website. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Pneumonia vaccinations are usually only necessary once, although a booster vaccination may be recommended for some individuals. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Pneumonia can range in seriousness from mild to life-threatening. This bacteria can also be transferred to you by touching a surface an infected person has come into contact with. Influenza (flu) is a highly contagious viral infection that is one of the most severe illnesses of the winter season. Epub 2017 Aug 5. Centers for Disease Control and Prevention. 2013 Nov;7(6):999-1003. doi: 10.1111/irv.12062. Zhang Y, Wang Q, Mackay CR, Ng LG, Kwok I. J Leukoc Biol. Every year, about 2,000 New Yorkers die of seasonal flu and pneumonia, which can develop as a complication of the flu. But the two age groups at highest risk are: Even with treatment, some people with pneumonia, especially those in high-risk groups, may experience complications, including: Mayo Clinic does not endorse companies or products. Antiviral; Epidemiology; Influenza; Pneumonia; Polymerase chain reaction; Symptoms; Virus. Fungi (molds): Pneumonia caused by fungi is the least common as pneumonia. Pneumococcal pneumonia: Mechanisms of infection and resolution. One example is valley fever. Epub 2022 Jan 18. Because of that, getting a flu shot every year can help prevent both the flu and pneumonia. It will protect you from a common form of bacterial pneumonia. Treatment includes antibiotics but you may also require hospitalization depending on the severity of your condition. Reynolds RH, et al. For example, your young child or toddler could have a fever every month. Reviewed and approved by the American Lung Association Scientific and Medical Editorial Review Panel. The bacteria that cause pneumonia can be breathed in via sneezes or coughs. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014. It can cause mild to severe illness, and at times can lead to death. Most people with the flu get better on their own. Sarmin M, Mahfuz M, Shahrin L, Shaly NJ, Shaima SN, Shikha SS, Jeorge DH, Islam SB, Chisti MJ, Ahmed T. J Clin Med. Influenza C virusassociated community-acquired pneumonia in children. Adenovirus: This type of virus can cause anything from a cold to a sore throat, bronchitis to pneumonia. Respiratory viruses that have the potential to cause pneumonia include: Respiratory syncytial virus (RSV), the most common cause of bronchiolitis and pneumonia in children younger than 1 Influenza viruses Adenovirus, which causes cold-like symptoms It is possible for viral pneumonia to turn into bacterial pneumonia. Goldman L, et al., eds. Some less common causes of pneumonia include. information and will only use or disclose that information as set forth in our notice of Immune cells attack the germs and may causeinflammationof your air sacs, or alveoli. Most people get better within a week or two, but thousands of people with the flu develop pneumonia or a brain infection. The site is secure. Viral pneumonia is usually mild. Comparative Clinical Characteristics, Laboratory Findings, and Outcomes of Hypoxemic and Non-Hypoxemic Patients Treated at a Makeshift COVID-19 Unit in Bangladesh: A Retrospective Chart Analysis. Pneumonia is an infection that inflames the air sacs in one or both lungs. 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