CONDITIONS
Pneumonia
What is Pneumonia?
Pneumonia is an infection that causes inflammation in one or both lungs. There are many different types of pneumonia, most of them are caused by bacteria, viruses, or fungus. Although most people with pneumonia will recover in a few weeks, elderly people, younger children, and those with heart or lung conditions are at risk of seriously getting ill and may need treatment in hospital.
Who gets Pneumonia?
Pneumonia is more prevalent among:
- Elderly individuals and young children.
- Those with preexisting lung or heart conditions such as asthma, chronic obstructive pulmonary disease (COPD), or emphysema.
- Individuals with specific neurological conditions like stroke, Parkinson’s disease, or dementia.
- People with weak immune systems. E.g. individuals with HIV/AIDS, those who have undergone organ transplants, and individuals undergoing chemotherapy or long-term steroid treatment.
- Smokers and those exposed to tobacco smoke.
What causes Pneumonia?
Pneumonia typically results from exposure to viruses or bacteria in the environment or transmitted from another individual. Infection can spread through direct contact, often via hands or through inhaling droplets in the air from coughing or sneezing.
Bacterial pneumonia can occur due to infection or arise following a viral cold or flu. It commonly affects only one part, or lobe, of a lung, a condition known as lobar pneumonia. Individuals at highest risk for bacterial pneumonia include those recovering from surgery, individuals with
respiratory disease or viral infections, and those with weakened immune systems. The most common type of pneumonia is called pneumococcal pneumonia, caused by Streptococcus pneumoniae germs.
Viruses that infect the upper respiratory tract can also lead to pneumonia. SARS-CoV-2, responsible for COVID-19, and the influenza virus are the primary causes of viral pneumonia in adults. In young children, respiratory syncytial virus (RSV) is the most frequent cause of viral pneumonia. Viral pneumonia can be complicated by a secondary bacterial invasion, presenting with the typical symptoms of bacterial pneumonia.
Fungal pneumonia primarily affects individuals with chronic health issues or compromised immune systems and those exposed to significant amounts of certain fungi from contaminated soil or bird droppings. Pneumocystis pneumonia is a severe fungal infection caused by Pneumocystis jirovecii. It typically occurs in individuals with weakened immune systems due to HIV/AIDS or prolonged use of immunosuppressive medications, such as those for cancer treatment or organ transplant management.
What are the different types of Pneumonia?
Pneumonia is classified based on the pathogens (virus, bacteria, or fungi) responsible for it and its mode of acquiring it, whether community-acquired, hospital-acquired, or ventilator-associated.
Community-acquired pneumonia (CAP): Refers to pneumonia acquired outside of healthcare settings. It can be caused by various pathogens, including bacteria, viruses, and fungi, and it typically affects otherwise healthy individuals.
Hospital-acquired pneumonia (HAP): Develops after 48 hours of hospitalization and is associated with higher mortality rates compared to CAP. HAP is often caused by antibiotic-resistant bacteria, and it commonly affects individuals who are critically ill or have underlying health conditions. Ventilator-associated pneumonia refers to HAP occurring in patients with lung infections requiring a ventilator. A ventilator is a machine that is used to help a patient breathe by giving
oxygen through a tube placed in a patient’s mouth or nose, or through a hole in the front of the neck. An infection may occur if germs enter the tube and enter the patient’s lungs.
Aspiration pneumonia: Occurs when foreign materials, such as food, liquids, or vomit, are inhaled into the lungs, leading to inflammation and infection. Aspiration pneumonia is more common in individuals with impaired swallowing reflexes, neurological disorders, or conditions that affect consciousness.
Is Pneumonia Contagious?
Pneumonia itself is not contagious, but the bacteria and viruses responsible for it can be. For example, the flu is contagious and can result in pneumonia, although most individuals who get the flu will not develop pneumonia.
The bacteria primarily responsible for pneumonia, such as Streptococcus pneumoniae, can spread from person to person through contact with contaminated surfaces or via coughing and sneezing.
Fungal pneumonia is not contagious. Fungal infections, like viruses and bacteria, do not spread from person to person.
What are the symptoms of Pneumonia?
Pneumonia symptoms can range from mild, where they are barely noticeable, to severe, necessitating hospitalization. How the body responds to pneumonia depends on the type of germ causing the infection, age, and overall health of an individual.
The common signs and symptoms may include:
- Cough, which may produce greenish, yellow, or even bloody mucus
- Fever, sweating and chills
- Shortness of breath
- Rapid, shallow breathing
- Sharp or stabbing chest pain that gets worse with deep breathing or cough
- Poor of appetite, low energy, and fatigue
- Nausea and vomiting, especially in small children
- Confusion, especially in older people
Bacterial pneumonia, the most common form, often requires medical attention due to its seriousness. Symptoms can develop gradually or suddenly, including high fever, profuse sweating, rapid breathing, and pulse rate, and bluish lips and nailbeds from oxygen deprivation. Mental confusion or delirium may also occur.
Viral pneumonia symptoms typically emerge over several days, resembling influenza symptoms initially, such as fever, dry cough, headache, muscle pain, and weakness. Symptoms worsen within a day or two, with increased coughing, shortness of breath, muscle pain, and possibly a high fever. Bluish lips may also appear.
Symptoms may vary among different populations. Newborns and infants may exhibit vomiting, fever, coughing, restlessness, or appear lethargic. Older adults and individuals with serious illnesses or weakened immune systems may experience milder symptoms, including a lower-than-normal temperature or sudden changes in mental awareness. Those with chronic lung diseases may experience exacerbated symptoms.
How is Pneumonia diagnosed?
The doctor will take the history and do a physical examination. On physical examination, there can be reduced or abnormal sounds on lung auscultation.
Blood tests: Blood tests may be done to look at white blood count and other tests that may be abnormal due to infection.
Chest x-ray or CT scan may reveal pneumonia-affected areas.
Sputum test and cultures: Sputum test and cultures may be done of sputum (also called phlegm or mucus) from the lungs that is coughed out to see if a bacteria or virus can be found. If a person has a severe infection or is at high risk of an unusual infection, mucus samples may be obtained from the lungs through the airways using a procedure known as flexible bronchoscopy.
How is pneumonia treated?
Treatment for pneumonia varies depending on the cause (bacterial, viral, or fungal) and severity of the case. When the cause cannot be determined, treatment focuses on symptom management and preventing worsening of the condition.
Common treatments include:
Antibiotics: Prescribed to treat bacterial pneumonia; they are ineffective against viruses but may be given if a bacterial infection coincides with a viral one.
Antifungal medications: Used to treat pneumonia caused by fungal infections.
Antiviral medications: Generally not used for viral pneumonia, as the condition often resolves on its own; however, medications like oseltamivir (Tamiflu®), zanamivir (Relenza®), or peramivir (Rapivab®) may be prescribed to shorten the duration and severity of symptoms.
Oxygen therapy: Administered through a nasal tube or face mask if oxygen levels are low.
IV fluids: Delivered directly into the vein to treat or prevent dehydration.
Fluid drainage: If there is excessive fluid accumulation between the lungs and chest wall (pleural effusion), drainage may be performed using a catheter or surgery.
How is Pneumonia prevented?
To prevent pneumonia, vaccination against common bacteria and viruses is recommended:
- Pneumococcal vaccines: Pneumovax23® and Prevnar13® target pneumonia-causing bacteria and are recommended based on age group or increased risk.
- Vaccination against viruses: Immunization against COVID-19 and influenza reduces pneumonia risk.
- Childhood vaccinations: Inquire with a doctor about recommended childhood vaccines, which prevent infections leading to pneumonia.
Other measures to lower pneumonia risk include:
- Quitting smoking and avoiding secondhand smoke.
- Handwashing with soap and water before eating, handling food, and after restroom use; use alcohol-based hand sanitizers when soap is not available.
- Avoiding close contact and sharing items if either person has an infectious disease
- Maintaining a balanced diet, regular exercise, and getting enough rest.
- Treating existing infections or health issues promptly
- Limiting alcohol consumption
In summary, pneumonia is a lung infection caused by bacteria, viruses, and fungi. Diagnosis involves physical examinations and tests such as blood tests and sputum analysis. The severity of pneumonia varies from mild to fatal. Common symptoms include fever, chills, shortness of breath, and chest pain. Treatment for pneumonia varies depending on the cause (bacterial, viral, or fungal) and severity of the case.
References
- American Thoracic Society. What is pneumonia? Available from: https://www.thoracic.org/patients/patient-resources/resources/what-is-pneumonia.pdf Accessed on 24th April 2024
- UpToDate. Patient education: Pneumonia in adults (The Basics). Available from: https://www.infectiousdiseasedoctors.org/wp-content/uploads/2018/02/Patient-education_-Pneumonia-in-adults-The-Basics-1-30-18.pdf Accessed on 24th April 2024
- Cleveland Clinic. Pneumonia. Available from: https://my.clevelandclinic.org/health/diseases/4471-pneumonia Accessed on 24th April 2024
- American Lung Association. What causes pneumonia? Available from: https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/what-causes-pneumonia Accessed on 24th April 2024
- American Lung Association. What Are the Symptoms of pneumonia? Available from: https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/symptoms-and-diagnosis Accessed on 24th April 2024
