Pneumonia : An infection of the lungs
Pneumonia, an infection of the lungs, needlessly affects millions of people worldwide each year. Pneumonia infections can often be prevented and can usually be treated.
Globally, pneumonia kills nearly 2 million children younger than 5 years of age each year. This is greater than the number of deaths from any infectious disease, such as HIV infection, malaria or tuberculosis. In India approximately 4 to 5 lakh of children die of pneumonia. Thus we are holding 25% of global burden among children.
Pneumonia is one of the leading cause of death in adults. Pneumonia is a major health & public issue in both developing countries like India & developed part of the globe, like USA. For example, each year in the United States, about 1 million people are hospitalized with pneumonia, and about 50,000 people die from the disease. There’s no gross data available in India to say exact epidemiology in Adults.
Chest x-ray of an adult patient with pneumonia.
What Is Pneumonia?
Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages. The lungs are filled with thousands of tubes, called bronchi, which end in smaller sacs called alveoli. Each one has a fine mesh of capillaries. This is where oxygen is added to the blood and carbon dioxide removed. If a person has pneumonia, the alveoli in one or both lungs fill with pus and fluids (exudate), which hinders the gas exchange. Pneumonia can strike suddenly or gradually. With appropriate treatment, one can expect to get better in around one week to 10 days.
Who Is At Risk for Pneumonia?
Certain people are more likely to become ill with pneumonia:
- Adults 65 years of age or older
- Children younger than 5 years of age
- People who have underlying medical conditions (like asthma, diabetes, Heart disease HIV, Chronic Kidney Disease, COPD, Cancer, Alcohol habit & Smoking)
Causes and Types of Pneumonia:
Pneumonia can be caused by viruses, bacteria, and fungi. The common causes of viral pneumonia are influenza and respiratory syncytial virus (RSV), and a common cause of bacterial pneumonia is Streptococcus pneumoniae (pneumococcus).
When someone develops pneumonia in the community (not in a hospital), it’s called community-acquired pneumonia(CAP). Pneumonia developed during or following a stay in a healthcare facility (like hospitals, long-term care facilities, and dialysis centers) is called healthcare-associated pneumonia (HCAP), which includes hospital-acquired pneumonia(HAP) and ventilator-associated pneumonia(VAP).
The symptoms of pneumonia depend on the age of the person, the cause and severity of the infection, and any existing problems with immunity. Some of the symptoms may include:
- Breathing difficulties
- General malaise
- Loss of appetite
- Abdominal pain
- Chest pain
- Blue coloration of the skin around the mouth (cyanosis), caused by lack of oxygen.
A range of causes
Pneumonia can be triggered by a cold or bout of flu, which allows the germs to gain access to the alveoli. In approximately half of all cases, no cause is ever found. Bacteria, Viruses, Mycoplasma, Tuberculosis & Rarely Fungi
If you or your child or the person you are caring for seems to be recovering well from a cold or flu, but then gets worse, pneumonia may be the cause. See your doctor immediately, since pneumonia can be life threatening in high risk groups.
Pneumonia is diagnosed using a variety of tests, including:
- General examination
- Chest x-rays.
- Sputum tests
- Naso-pharyngeal swab (eg- H1N1 RT PCR to diagnose viral pneumonias like Swine flu)
- Blood tests (like cultures, CBP ESR, Blood Urea, S. Creatinine, ABG are first line of blood investigations)
- Bronchoscopy (rarely Pneumonias demand advanced investigations like Bronchoscopy, particularly to rule out underlying Lung cancer, Foreign body in airway, Tuberculosis & fungal organisms)
In the days before antibiotics as many as 1 in 5 people with pneumonia could die from pneumonia and recovery was sometimes very prolonged. Antibiotics are thus a mainstay of treatment. For the most cases antibiotics are treatment of choice. In mild cases, which can be treated @ home, can be treated with oral tablets:
- Hospital admission – for babies, young children or anyone who is very unwell. Those who are pretty sick (as decided by pulmonologist or a GP) have to be admitted into ICU. Once fever is completely controlled for more than 24hrs without a paracetmol, pulmonologist can start think of to initiate a discharge.
- Plenty of fluids – taken orally or intravenously
- Medications – to relieve pain and reduce fever
- Rest – sitting up is better than lying down.
Treatment of Complications:
- Empyema / Para-pneumonic effusion: Empyema is presence of pus in the covering layers of lung & requires some surgical intervention.
- Lung Abscess: Presence of pus filled cavity in lung tissue. Antibiotics are usual stay of management & might require surgical management.
- Hemoptysis: Hemoptysis is coughing out of blood. It’s a life threatening complication, usually suggests a severe underlying damage to the lung and usually necessitates an ICU admission.
- Pneumothorax: Collection of air in the pleural space. It’s a rare complication & usually requires surgical management.
- Septic Shock with MODS (Multi organ Dysfunction Syndrome) : Toxins released from bacteria at times lead to drop in blood pressure & compromise in function of various organs like Kidney (Renal Failure) & Liver (Liver dysfunction). This if not addressed at right moment with an aggressive approach in an ICU, there’s every chance that we might lose patients in close to 40% of times.
Since the introduction of streptococcal pneumonia vaccine in the year 2000, there is a considerable reduction in severity of disease in population. It has resulted in 35% reduction in admission rates & severe form of streptococcal infections like Bacteremia (blood stream infection) & Meningitis (infection to covering layers of brain).
One of the most common types of bacterial pneumonia is pneumococcal pneumonia, caused by infection with Streptococcus pneumoniae. There are vaccines against this strain that reduce the risk of infection.
Influenza is a common preceding viral infection. Being vaccinated against influenza can help prevent that infection and the pneumonia which may complicate it.
Other vaccines like, Haemophilus influenza, Measles, Pertussis, Zoster & Mumps also useful for prevention.
Protect Your Health with These Healthy Living Practices
Try to avoid close contact with sick people. Good hygiene practices includes washing hands regularly with soap & water, cleaning frequently touched surfaces, and coughing or sneezing into a tissue or into your elbow or sleeve. You can also reduce your risk of getting pneumonia by limiting exposure to cigarette smoke and treating and preventing conditions like diabetes.
Things to remember
- Pneumonia is an infection of the air sacs of the lungs, caused by bacteria or viruses.
- Anyone of any age can be affected, but children under the age of four years and the elderly are very susceptible.
- Certain people can be immunized against one of the most common types of bacterial pneumonia- People shall get timely vaccinated.
- Hit Hard & Hit fast rule works here (Immediate & Appropriate empirical antibiotic has to be started) without wasting time by waiting for culture reports.
- Central government has not taken measures to include vaccinations to prevent pneumonia as a part of National Immunization Schedule.
Dr VIJAY KUMAR CHENNAMCHETTY
INTERVENTIONAL PULMONOLOGIST & SLEEP DISORDER SPECIALIST
APOLLO HEALTH CITY, HYDERABAD