Pneumonia : Symptoms and Treatment

Lungs are responsible for the oxygenation of blood. Air enters the lungs via the nose, trachea and the bronchioles, which end into blind end pouches called alveoli. The alveoli are surrounded by tiny blood vessels, which pick up oxygen from the air in the alveoli and throw out carbon dioxide from the blood into the alveoli. Pneumoniais an inflammatory disease affecting the air sacs, known as alveoli, is either or both of the lungs. Annually 544,000 individuals visit the ER because of pneumonia.

Causes of Pneumonia 

Pneumonia is generally caused by the bacteria, virus or rarely fungi present in the inhaled air. These germs may get lodged in the alveoli and result in an infection leading pneumonia; most of the times your body is well equipped to fight against the invading germs, but sometimes the immune system gets overwhelmed and results in a disease. Pneumonia can be classified into three main types depending upon where you acquired the infection from:

• Community acquired pneumonia: the commonest type of pneumonia, it is acquired from your everyday surrounding. It can be caused by
• Bacterial: the commonest type of bacterial pneumonia is caused by Streptococcus pneumonia. The bacteria may affect either a part of the lung (lobar pneumonia) or the whole lung. Bacterial pneumonia can be sequel to a cold or a flu, or it may occur independently.
• Virus: many viruses that cause cold and flu can cause pneumonia. Viral pneumonia is common in children under the age of five and is generally a mild disease.
• Fungi: fungal pneumonia is most common amongst individuals having a weakened immune system. Fungi causing pneumonia are found in bird droppings, soil etc.
• Bacteria like organism: mycoplasma pneumonia is an organism smaller than most bacteria and causes a mild form of pneumonia.
• Hospital acquired pneumonia: when the germs causing pneumonia are acquired from a hospital, the disease is termed as hospital acquired pneumonia. Individuals on ventilator are at a greater risk of acquiring it. Hospital acquired pneumonia is more difficult to treat than community acquired pneumonia because the organism causing it are generally resistant to antibiotics and because the individual is already unwell.
• Healthcare acquired pneumonia: pneumonia acquired from long term care facilities. Like hospital acquired pneumonia the organisms causing it are resistant to antibiotics, making the diseases difficult to treat.

Symptoms of Pneumonia

Individuals affected by pneumonia may experience:

• Fever which may be accompanied by sweating and chills
• Difficulty in breathing
• Cough with or without sputum
• Nausea, vomiting
• Confusion, alteration of mental state
• Chest pain on breathing or coughing

Older individuals (more than 65 years) may experience lower than normal body temperature. New borns and infants may not show any signs of infection in some cases. Smoking increases the risk of pneumonia.

Diagnosis of Pneumonia

Your doctor will first like to record a history or your symptoms followed by a physical examination. The doctor will listen to your breath sounds with the help of a stethoscope placed on your chest, to loos for abnormal crackles or crepitation. After this a few tests will be requested to confirm the diagnosis of pneumonia.  The tests are:

• Blood test: a sample of your blood will be analysed to confirm the infection and type of organism causing it
• Sputum test: if you are experiencing productive cough, a sample of your sputum will be analysed for the presence of infecting organisms
• Chest X Ray: this helps your doctor determine the extent of the disease and hence decide the course of treatment accordingly.
• Sometimes your doctor may order a CT scan of the chest for better visualising the extent and spread of the disease.

Complications of Pneumonia 

Untreated pneumonia may progress to result in:

• Bacteremia and Sepsis: the disease causing bacteria may enter the blood and infect other organs resulting in an organ failure
• Lung abscess: infection causing organisms may destroy a part of the lung resulting in a pus filled cavity. The abscess is treated with the help of antibiotics and surgery for drainage if necessary.
• Pleural effusion: the infection may cause a build up of fluid between the lungs and the chest wall. This fluid may get infected and will have to be drained out by a chest tube or a surgery.

Treatment of Pneumonia

Your doctor will review and discuss the results of your test with you before finalising the treatment plan. Pneumonia is generally treated with the help of:

• Antibiotics: your doctor will prescribe a course of antibiotics to help your body fight against the invading germs. It is imperative that you complete taking the antibiotics and not stop the medications midway. If your symptoms do not improve, you are advised to inform your doctor.
• Anti fever medications: Acetaminophen or ibuprofen may be prescribed to help relieve the fever.

Uncomplicated pneumonia is cured by taking prescribed medications and adequate rest. Complications like pleural effusion or lung abscess may require admission to the hospital.

Resources:

• National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables, table 27
• Diagnostic testing for community-acquired pneumonia, Clin (ISSN: 0272-5231),Skerrett SJ