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Bilateral (Double) Pneumonia

Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju
Sandeep Dhanyamraju MD
Medically reviewed by Sandeep Dhanyamraju

Lung inflammation or pneumonia is a viral disease that affects lung tissue and interferes with normal oxygen exchange between air and blood. Inflammatory secretions that enter the alveoli prevent the body from getting enough oxygen. And if the disease affects most of the lungs, acute respiratory failure develops.

Lungs are paired organs located in the right and left half of the chest cavity. With bacterial, viral, and other pneumonia, the inflammatory process can develop in the right, left, and sometimes in both lungs at once – in such cases, it is bilateral pneumonia. 

People with weak immune systems, children, and the elderly are susceptible to pneumonia. Millions of people suffer from the disease every year, and 30% of them are young children and people over 70 years of age.

Double pneumonia is caused by various infectious agents. These are bacteria in about 90% of cases, and 10% are viruses, fungi, protozoa, and helminths (roundworm, toxoplasma, schistosomes).

The most common pathogens include pneumococcus, Haemophilus influenzae, Mycoplasma pneumoniae, Staphylococcus aureus, influenza viruses, and respiratory syncytial infections. Most often, double pneumonia caused by these pathogens develops after hypothermia or as a complication of ARVI.

When does this disease arise, and how does it proceed? What treatment is prescribed in such cases? You can find the answers to all these questions below.


Causes of Bilateral Pneumonia in Adults

Depending on the epidemiological conditions, the occurrence of pneumonia is subdivided into:

  1. Community-acquired (outpatient) – occur outside the hospital or within 48 hours from the moment of admission to the hospital. Have a favorable prognosis.
  2. Nosocomial (hospital) – occurs in a hospital, 48-72 hours after admission. The prognosis largely depends on the resistance of the pathogen to antibiotics.
  3. Pneumonia in adults with immunodeficiency states – the prognosis is poor and requires active treatment in a hospital setting.
  4. Aspiration pneumonia – pneumonia resulting from the ingestion of the contents of the gastrointestinal tract into the respiratory tract.

Depending on the extent of the lesion and the mechanism of occurrence, pneumonia is divided into focal and lobar.

  1. Focal pneumonia is pneumonia with the localization of the inflammatory process in a limited area of ​​the lung tissue, within the small structural units of the lung – lobules. Focal pneumonia usually develops as a complication of ARVI or acute tracheobronchitis. The clinical picture, in this case, can be “erased” and resemble a protracted course of bronchitis.
  2. Lobar pneumonia is an inflammation of the lung of an infectious nature, which is characterized by the involvement in the process of one or more lobes of the lung, with the pleura covering them. The clinical picture is manifested by severe intoxication, intense cough, shortness of breath with tachypnea, and tachycardia. Lobar pneumonia most often develops due to prolonged hypothermia.


Causes of Double Pneumonia 

 To avoid double pneumonia, you need to know about the causes of its occurrence:

  1. With pneumonia in small sacs, alveoli, which are normally filled with air, an inflammatory process develops, which occurs due to infection caused by various pathogens. Most often, these are bacteria that penetrate the lower respiratory tract when inhaling air containing pathogens, primarily pneumococci, less often staphylococci, legionella, mycoplasma, and others. With a bacterial infection, both lungs can be affected. In the latter case, unilateral pneumonia develops – right- or left-sided.
  2. Viral infection. The causative agents can be various viruses: influenza A and B viruses, parainfluenza, adenoviruses, respiratory syncytial viruses. All of them are respiratory viruses that cause influenza and SARS.
  3. Less commonly, viral pneumonia is caused by cytomegaloviruses, enteroviruses, Epstein-Barr viruses, herpes, and measles. It used to be thought that viral pneumonia in adults with normal immune responses was rare. The disease developed in debilitated patients suffering from concomitant heart pathologies, diabetes mellitus, etc.


But with the onset of the novel coronavirus pandemic, the number of viral pneumonia cases has skyrocketed.

Double Pneumonia in COVID-19

Double Pneumonia in COVID-19

Viral pneumonia is considered the main manifestation of COVID-19: according to some experts, it is detected in more than 91% of patients with coronavirus infection. In this case, the disease is bilateral – the alveoli in both lungs are affected.


Symptoms are typical of COVID-19 in general. Among the classic signs:

  • increased body temperature (in more than 90% of cases);
  • cough, unlike bacterial pneumonia, dry or with little sputum;
  • shortness of breath – the appearance of difficulty breathing, a feeling of lack of air, which occurs due to a violation of the gas transport function;
  • a feeling of congestion, and chest pain;
  • fatigue and weakness, which are the result of general intoxication of the body.


Manifestations common to other respiratory infections may also occur:

  • sore throat;
  • runny nose;
  • signs of damage to the conjunctiva of the eye (lacrimation and redness of the eyes);
  • muscle pain;
  • headache;
  • diarrhea.

A decrease or complete loss of smell and taste is very characteristic of coronavirus infection – this is a fairly common but not mandatory sign of the disease.


The Course of Pneumonia with Coronavirus Infection

Double pneumonia develops with moderate to severe COVID-19.


A moderate course is accompanied by:

  • an increase in body temperature of more than 38 ° C;
  • an increase in the frequency of respiratory movements more than 22 per minute (at a rate of 16-22 movements);
  • shortness of breath on exertion;
  • saturation (oxygen level in the blood) from 93 to 95% – at a rate of more than 95%.


On computed tomograms in such cases, changes characteristic of “covid pneumonia” are already reflected in the form of areas of “frosted glass”. The volume of lesions is minimal or moderate: the degree of lesion corresponds to 1 or 2 points (the severity of changes is less than 25% or from 25 to 50% of the lungs). This may indicate a mild to moderate form of double pneumonia.


With a severe course of the disease, the situation is much more serious:

  • respiratory rate exceeds 30 per minute;
  • the saturation level is 93% or less;
  • the condition worsens, there is excitement or, conversely, depression of consciousness;
  • blood pressure decreases – systolic pressure drops less than 90 mm Hg. Art. or diastolic – less than 60 mm Hg. Art .;
  • urination is disturbed – the volume of urine excreted within an hour is less than 20 ml (50 ml per hour normally);
  • changes are much more pronounced than with a moderate course; the volume of the lesion is more than 50%, according to CT – 3-4 points.


Extremely severe pneumonia in adults can be accompanied by a persistent increase in temperature and acute respiratory failure. Sometimes patients need invasive ventilation of the lungs and a complex of severe disorders.

Double Pneumonia in a Child

Signs of Pneumonia in a Child and Types of Its Spreading

Signs of Pneumonia in a Child

Often pneumonia in children appears as a complication of any viral infection (ARVI, flu, etc.):

  • a cough that gets worse over time;
  • if the baby’s well-being has improved, and then it became bad again, this may indicate the presence of complications;
  • every deep breath leads to a violent attack of coughing;
  • there is a strong pallor of the skin against the background of the development of the listed symptoms;
  • shortness of breath.


How Does Double Pneumonia Spread?

The disease can be transmitted in different ways:

  1. Airborne method. During illness, droplets form on the mucous membrane of the mouth and nose, which spread through the air during sneezing and coughing. You can get infected by airborne droplets in any public place: a hospital, a store, and public transport. The pathogenic pathogen spreads through the air along with particles of mucus, sputum, and saliva.
  2. Contact. Also, the infection is transmitted through contact – handshaking, hugging, and kissing. People become infected by touching contaminated objects or touching their mouth, eyes, and nose with dirty hands.
  3. Domestic. The infection can be transmitted through shared towels, dishes, and bedding. Therefore, the patient needs to be provided with personal hygiene items, and they should be changed and washed more often. However, personal hygiene items must be handled very carefully. It has been proven that a viral microorganism can survive up to 4 hours on any surface. Pathogenic bacteria are not afraid of frost; even with the bleach, it can be destroyed only five minutes after direct processing.
  4. Fecal. The virus survives up to two days in fecal matter with normal bowel movements. The disease can be easily adopted by improper toilet cleaning or personal hygiene. To prevent contamination, especially from small children, it is important to constantly wash your hands after cleaning the baby pot, change diapers frequently and thoroughly wash the place of bowel movement.


Diagnostics, Treatment, and Vaccination in Double Pneumonia

Diagnostics of Pneumonia

Suspicion of pneumonia should arise if the patient has a fever, productive cough, discharge of mucopurulent sputum, shortness of breath, and/or chest pain. Also, patients with double pneumonia may complain of increased sweating at night, general weakness, rapid fatigue, and increased blood pressure.

At the slightest suspicion of this disease, you should undergo additional examination. The diagnostic minimum should include:

  • a clinical blood test;
  • a general urinalysis;
  • a chest x-ray in two projections;
  • a specialist consultation, during which a general examination, palpation of the chest, percussion, and auscultation of the lungs are performed.

To determine the pathogen and differential diagnosis with other diseases, the doctor may prescribe additional studies: 

  • general sputum analysis;
  • sputum culture for sterility;
  • serological tests;
  • IgG and IgM determination for individual pathogen;
  • PCR diagnostics;
  • chest MSCT with contrast;
  • tuberculin tests;
  • echocardiography;
  • ECG.

Treatment of Double Pneumonia


 Therapy depends on which pathogen is causing the infection.

  1. For bacterial forms, antibiotics are the first-line drugs. They are prescribed by the attending physician, based on the test data, as well as the characteristics of the course of the disease and other factors. It is important to understand that antibiotics should only be taken on the advice of a doctor.
  2. With double pneumonia of viral origin, including coronavirus, antibiotics are most often not indicated. The exception is cases when a bacterial, secondary infection joins the viral one. In such situations, the doctor, based on the data of blood tests and other indicators, decides on the appointment of antibacterial agents in addition to the main treatment regimen.


In addition, with pneumonia, regardless of the origin (both viral and bacterial), antipyretic drugs, pain relievers, expectorants can be prescribed. When bronchospasm occurs, bronchodilators may be indicated, including inhalation, using nebulizers. Some expectorants can also be inhaled.


Warm drinks, a gentle regimen, and restriction of physical activity are also advised.


Vaccination against double pneumonia as prevention

It is worth getting vaccinated against pneumococcal infection in cases where:

  • there are frequent outbreaks of disease;
  • someone visits public areas;
  • someone works in a bacteriological laboratory;
  • someone frequently suffers from pneumonia, SARS, and flu.

Several drugs are given intravenously to protect against disease. All of them differ in their composition, cost, and breadth of the spectrum of action.

In adulthood, the vaccine is given once, a persistent immune response to the pathogen is developed in 2-3 weeks. But at the same time, experts recommend vaccinating once every 5 years.


Bottom Line

Bilateral pneumonia is a dangerous disease that should be treated under medical supervision. With quality therapy in Lone Star Neurology, the lung tissue is completely restored in most cases. In 20% of cases, pneumosclerosis is formed in the affected area of ​​the lung. With it, the lung tissue is replaced by connective tissue. When replacing a significant area of ​​lung tissue, patients experience signs of respiratory failure: shortness of breath, cough, and chest pain. If a small area has undergone pneumosclerosis, there are no pronounced symptoms.

It is important to remember that self-treatment of pneumonia is unacceptable. When symptoms of the disease appear, you should consult a doctor as soon as possible, who will diagnose and prescribe therapy. Lone Star Neurology has many highly experienced specialists who can identify your symptoms and define quality treatment. We provide our services in different cities of Texas, including Dallas, Allen, Denton and others. 



  • When will the lungs recover from bacterial pneumonia?

In most patients, the lungs recover completely after a few months – a maximum of six months after the illness. The same recommendations as after any ARVI: frequent airing, proper nutrition, a gradual return to the usual physical activity.

  • What is viral bacterial pneumonia?

In some cases, viral pneumonia is complicated by the addition of a secondary bacterial infection. This happens, for example, with the respiratory syncytial virus and coronavirus. Treatment of viral-bacterial pneumonia is carried out using a course of antibiotics, which are selected only after the exact definition of the type of bacterial infection.

  • How is bacterial pneumonia diagnosed?

It can be diagnosed with x-rays, blood tests, and sputum culture. They are treated with antibiotics. The risk group includes children under the age of five and the elderly over 60. This type of pneumonia is characterized by the rapid development of complications, the most common of which is respiratory failure and a high probability of mortality.

  • How does pneumonia manifest in Covid-19?

All known coronaviruses are characterized by rapid (up to 14 days) development of acute respiratory failure. The virus quickly and aggressively affects the lungs, causing not only an extensive inflammatory process but also concomitant complications: edema of the respiratory organ, fibrosis (scarring of the lungs), acute heart failure, myocarditis.

  • What are the symptoms of bacterial pneumonia?

Bacterial pneumonia symptoms can develop suddenly or gradually, resembling a severe cold or flu. Bacterial pneumonia is usually treated with antibacterial drugs. Most patients get better after about two weeks. Sometimes pneumonia can lead to serious complications, including blood poisoning (sepsis), pulmonary failure, and meningitis.

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Edward Medina
Edward Medina
15:34 30 Jun 22
Just such an amazing staff that makes you feel like part of their family. I’ve been going there for over 5 years now... and each visit I get the very best care and treatments that I have ever received in the 20+ years that I’ve been dealing with severe debilitating migraines. Since i started seeing them the number of my migraines has dropped from 15-20 a month to 2-3 every 3 month. I highly recommend them …they will change your life!read more
Daneisha Johnson
Daneisha Johnson
22:20 19 May 22
Dr. Askari was very kind and explained everything so I could understand. The other staff were nice as well. I would... have gave 5 stars but I was a little taken aback when I checked in and had to pay 600.00 upfront. I think that should have been discussed in a appointment confirmation call or email just so I could have been more
Jean Cooper
Jean Cooper
16:54 29 Apr 22
I love the office staff they are friendly and very helpful. Dr. JODIE is very caring and understanding to your needs... and wants to help you. I will go back. would recommend Dr. Dr. Jodie to other Patients in a heart beat. The team works well more
Linda M
Linda M
19:40 02 Apr 22
I was obviously stressed, needing to see a neurologist. The staff was so patient and Dr. Ansari was so kind. At one... point he told me to relax, we have time, when I was relaying my history of my condition. That helped ease my stress. I have seen 3 other neurologists and he was the only one who performed any assessment tests on my cognitive and physical skills. At one point I couldn't complete two assessments and got upset and cried. I was told, it's OK. That's why you're here. I was truly impressed, and super pleased with the whole experience!read more
Leslie Durham
Leslie Durham
15:05 01 Apr 22
I've been coming here for about 5 years. The staff are ALWAYS friendly and knowledgeable. The Doctors are the absolute... best!! Jodie Moore is always in such a great mood which is a plus when you are already stressed. Highly recommendedread more
Monica Del Bosque
Monica Del Bosque
14:13 25 Mar 22
Since my first post my thoughts have changed here. It's unfortunate. My doctor and PA were great, but the office staff... is horrible. They never call you back when they say they will, they misinform you, they cause you too much stress wondering what's going on, they don't keep you posted. They never answer the phone. At this point I've left four messages in the last week, and I have sent three messages. Twice from their portal and one direct email. No response. My appointment is on Monday morning at 8:30am, no confirmation on my insurance and what's going on. What the heck is going on, this is ridiculous!I've given up... the stress her office staff has put me through is just not worth it. You can do so much better, please clean house, either change out your office staff, or find a way for them to be more efficient please. You have to do something. This is not how you want to run your practice. It leaves a very bad impression on your more
Ron Buckholz
Ron Buckholz
23:32 23 Mar 22
I was actually pleasantly surprised with this visit! It took me a long time to get the appointment scheduled because no... one answers your phones EVER! After a month, I finally got in, and your staff was warm, friendly, and I was totally impressed! I feel like you will take care of my needs!read more
Steve Nabavi
Steve Nabavi
16:28 16 Mar 22
It was a nice visit. Happy staff doing all they can do to comfort the patients in a very calming environment. You ask... me they are earned a big gold star on the fridge. My only complaint they didn't give me any more
Katie Lewis
Katie Lewis
16:10 10 Feb 22
Had very positive appointments with Jodie and Dr. Sheth for my migraine care. Jodie was so fast with the injections and... has so much valuable info. I started to feel light headed during checkout and the staff was SO helpful—giving me a chair, water, and taking me into a private room until I felt better. Highly recommend this practice for migraine patients, they know what they’re doing!!read more
Joshua Martinez
Joshua Martinez
16:02 10 Dec 21
I was scheduled to be checked and just want to say that the staff was fantastic. They were kind and helpful. I was... asked many questions related to what was going on and not once did I feel as though I was being brushed off. The front desk staff was especially great in assisting me. I'm scheduled to go back for a mri and am glad that I'll be going more
Isabel Ivy
Isabel Ivy
21:42 03 Nov 21
I had such a good experience with Lone Star Neurology, Brent my MRI Tech was so awesome and made sure I was very... comfortable during the appointment. He gave me ear plugs, a pillow, leg support and blanket, easiest MRI ever lol 🤣 My 72 hour EEG nurse Amanda was also so awesome. She made sure I was take care of over the 3 days and took her time with the electrodes to make sure it was comfortable for me! Paige was also a huge help in answering all my questions when it came to my test results, and letting me know her honest opinions about how I should go forth with my more
Leslie Luce
Leslie Luce
17:37 20 Oct 21
The professionalism and want to help attitude of this office was present from the moment I contacted them. The follow... up and follow through as well as their willingness to find a way to schedule my dad was above and beyond. We visited two offices in the same day with the same experience. I am appreciative of this—we spend a lot of time with doctors and this was top notch start to more
robert Parker
robert Parker
16:38 16 Apr 21
I love going to this office. The staff is friendly and helpful. The doctor is great. I am getting the best... neurological tests and treatment I have ever had. The only reason I did not give them a 5 star rating is because it is impossible to reach a live person at the office to reschedule appointments. Every time I have tried to get through to the office it says all people are busy and I am sent to a voicemail. If they could get their phone answering fixed, I would give them a strong 5 more
MaryAnn Hornbaker
MaryAnn Hornbaker
00:26 25 Feb 21
Dr. Harney is an excellent Dr. I found him friendly , personable and thorough. I evidently am an unusual case. ... Therefore he spent a Hugh amount of time educating me. He even gave me literature to further explain my condition and how to follow up. This is something you rarely get from your doctors. So I am more than please with my doctor and his more
Roger Arguello
Roger Arguello
03:05 29 Jan 21
Always courteous, professional. The staff is very friendly and always work with you to find the best appointment time.... The care team has been great. Always taking the time to listen to your concerns and to find the best more
Margaret Rowland
Margaret Rowland
01:12 27 Jan 21
I have been a patient at Lone Star Neurology for several years. Now both my adult daughters also are patients there. I... love Jodie. She is always so prompt whether it is a teleamed call are a visit in the office. She takes the time to explain everything to me and answers all my questions. I am so blessed to have Jodie as my more
Susan Miller
Susan Miller
03:01 13 Jan 21
My husband had an accident 5 years ago and Lone Star Neurology has been such a blessing to us with my husbands care.... Jodie Moore is his provider and she is amazing! Jodie is very knowledgeable, caring, and thorough. She takes her time with you, making sure your needs are met and she is happy to answer any questions you may have. Lone Star Neurology’s patients are very lucky to have Jodie providing their care. Thank you Lone Star Neurology and especially Jodie for everything you have done for us. Jodie, you are the best!read more
Windalyn C
Windalyn C
01:32 09 Jan 21
Jodie is wonderful. She is very caring and knowledgeable. I have been to over a dozen neurologists, and none were able... to help me as much as they have here. Thanks!read more
Katie Kordel
Katie Kordel
00:40 09 Jan 21
Jodi Moore, nurse practitioner, is amazing. I have suffered from frequent, debilitating headaches for almost 20 years.... She has provided the best proactive and responsive care I have ever received. My quality of life has been greatly improved by her caring approach and tenacity in finding more
Ellie Natsis
Ellie Natsis
15:41 07 Jan 21
I have had the best experience at this neurologist's office! For over a year I have been receiving iv treatments here... each month and my nurse, Bobbie is beyond wonderful!! She's so attentive, knowledgeable, caring, and detail oriented. She makes an otherwise uncomfortable experience much more pleasant and definitely puts me at ease! She also helps me with my insurance,ordering this specialty medication and dealing with the ordering process which is no easy feat.Needless to say, she goes above a beyond in every way and I'm so grateful to this office and to Bobbie for all they do for me!read more
Matt Morris
Matt Morris
15:39 07 Jan 21
Let me start by saying that I have been coming here for years. Due to my autoimmune disease, I am in this office... once every three weeks for multiple hours at a time. The office is very clean and the staff very friendly. My only complaint would be there communication via phone. They aren't the best at responding if you leave a voicemail and expect a call back. I understand that this is prob just due to the sheer number of alls they receive daily. What I can say I like the best about the office are the people. Bobby who handles my infusions is great. I never have any issues with her setting up my infusions. She is very quick to reply to messages sent via text and if she were to leave then my whole opinion of the office may change. I also enjoy people like Matt, Lauren, and Jodi. I appreciate all that they do for me and without this team I'm not sure I would be as happy as I am to visit the office as frequently as I have to. Please ensure that these folks are recognized as they are what makes my visit to this office so tolerable :).read more
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