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Top 15 Facts on Pneumonia

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Top 15 Facts on Pneumonia
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The importance of pneumonia as a major health concern may be gleaned by the following facts about this disease.

1. Pneumonia can be caused by several agents. It is important to know the cause, as treatment varies. The important causes include
  • Bacteria – usually caused by Streptococcus pneumoniae
  • Viruses
  • Fungus
  • Mycoplasma
  • Chemicals
Having viral pneumonia increases the risk of secondary bacterial pneumonia.

2. Recently, emerging infections such as avian flu epidemics and pandemics, severe acute respiratory syndrome (SARS), coronavirus, Middle Eastern Respiratory Syndrome (MERS) are also associated with pneumonia. Environmental reservoirs such as Legionella can cause localized outbreaks. Anthrax, considered a bio-weapon can also cause pneumonia.

3. It is the most important cause of mortality in children under 5 years of age worldwide, accounting for 15 percent of deaths in that age group. Of the estimated 120 million episodes annually, nearly 10 percent progress to severe pneumonia, and there were nearly a million pneumonia-related deaths in children under 5 years of age in 2013.

In the US, pneumonia is the leading cause of hospital admissions in children.

4. The elderly have a higher risk of developing pneumonia, due to their weakened immune systems, and presence of chronic underlying conditions such as heart disease and diabetes. They are also less likely to realize that they have pneumonia and seek medical attention, before it is too late and has spread to other parts of the body.

5. In the elderly, hospitalization for pneumonia is associated with more deaths than other reasons for admission.

6. Interestingly, viral pneumonia is the leading cause of hospitalization of infants. In fact, the WHO has allotted top priority for development of newer drugs and vaccines for these pneumonia, that by and large don’t have any drugs or vaccines that can be used.

7. Persons hospitalized for other illnesses are also at risk of developing pneumonia. This is due to the fact that they may be already immunocompromised, and the hospital environment is a breeding ground for various organisms. Such infections are termed nosocomial or hospital acquired infections.

Persons on the ventilator are especially susceptible to contract severe antibiotic-resistant pneumonia.

8. Depending on the extent of lung infection, pneumonia may be classified as
  • Lobar pneumonia – involving an entire lung lobe
  • Lobular – involving a segment of a lobe
  • Bronchopneumonia – involving bronchioles and adjacent alveoli
  • Interstitial pneumonia – involves the space between adjacent alveoli
9. The lungs, especially in bacterial pneumonia is said to be consolidated. The air spaces or alveoli become filled with fluid and bacterial debris, making the lungs heavy and congested. The fluid collection in the alveoli naturally impairs gas exchange and the patient becomes breathless due to inadequate oxygenation of tissues and excretion of carbon-di-oxide.

Uncomplicated cases start to resolve by the second week, with an absorption of the excess fluid by the lymphatics and also by coughing out of the sputum.

Viral and mycoplasma pneumonia, on the other hand, don’t cause consolidation. They typically involve the bronchioles, alveoli and the interstitial tissues of the lungs.

10. The signs and symptoms of pneumonia can vary from mild to severe, and include
  • Fever with shaking (chills)
  • Cough with greenish or yellowish sputum
  • Breathlessness
  • Confusion and headache, especially in the elderly
  • Tiredness and loss of appetite
  • Sharp stabbing pain in chest on deep inspiration
In bacterial pneumonia the fever can be high grade and touch 105oF. Initial symptoms of viral pneumonia are non-specific and resemble the flu with fever, headache, muscle pain and fatigue. Within a few hours, it is characterized by progressively increasing breathlessness and cough.

11. Pneumonia is typically diagnosed by chest auscultation, and listening for abnormal breath sounds and wheeze. Diagnosis is confirmed by a chest x-ray. Sputum may be sent to the bacteriology lab to determine the organism causing pneumonia and for antibiotic sensitivity tests.

12. Treatment of pneumonia involves the following
  • Getting plenty of rest
  • Staying hydrated with adequate fluids
  • Taking antibiotics as prescribed by the doctor
  • Medicines to reduce fever, breathlessness and cough
Aspirin should not be given to children for reducing fever.

Occasionally, if the symptoms are severe, hospital admission may be required. Intravenous fluids may be administered to maintain hydration, Antibiotics may be given parenterally and Oxygen may be given for breathlessness.

13. Complications from pneumonia are more likely to occur in the elderly, those with underlying illnesses, smokers, persons with chronic lung disease and the immunocompromised. Complications include
  • Sepsis and bacteria spreading into the bloodstream (bacteremia)
  • Pleural effusion (fluid collection between the 2 layers of the lungs)
  • Meningitis (spread of infection to brain)
  • Lung collapse
  • Cavity formation in lungs with pus collection (lung abscess)
  • Pericarditis (inflammation of the layers of the heart)
Long-term complications in the elderly including worsened exercise capacity, cognitive decline and a reduced quality of life.

14. The incidence or risk for developing pneumonia may be reduced by the following tips.
  • Getting the annual flu shot (influenza vaccine)
  • Pneumococcal vaccine – recommended for all children less than 5 years and those 65 years and older. All children and adults who are vulnerable should also receive the vaccine.
  • Avoidance of smoking
  • Good personal hygiene – such as regular handwashing, using sanitizers
  • Adequate sleep and exercise
  • Healthy and balanced diet
  • Staying away from sick individuals whenever possible

15. Last but not the least, the fast increasing emergence of antibiotic resistant strains is a major source of concern and challenge for effective treatment of lung infections. This has occurred largely due to misuse of antibiotics, both in the community as well as the hospital setting. There is an urgent need for the development of newer and more effective antibiotics to combat this situation.

References:
  1. Five Facts You Should Know About Pneumonia - (http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/pneumonia/five-facts-you-should-know.html)

  2. Diagnosing and Treating Pneumonia - (http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/pneumonia/diagnosing-and-treating.html)

  3. Top 20 Pneumonia Facts—2015 - (https://www.thoracic.org/patients/patient-resources/resources/top-pneumonia-facts.pdf)

  4. Symptoms and Complications - (http://www.cdc.gov/pneumococcal/about/symptoms-complications.html)

  5. Pneumonia - Complications - (http://familydoctor.org/familydoctor/en/diseases-conditions/pneumonia/complications.html)



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