All about Pneumonia

World Pneumonia Day is annually held on November 12 to raise awareness of pneumonia, promote prevention and treatment, and generate action to fight the illness. 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 two million children younger than five years of age each year. This is greater than the number of deaths from any infectious disease, such as HIV infection, malaria or tuberculosis. Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages. Common signs of pneumonia can include cough, fever and breathing difficulty.

Lungs are filled with 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. This is sometimes known as ‘consolidation of the lung’ Pneumonia can strike suddenly or gradually. With appropriate treatment, one can expect to get better in around one week to ten days.

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 or heart disease)

• People who smoke cigarettes

• People with immune-compromised states like Cancer

• Patients who got hospitalised for any other reason–Hospital Acquired Pneumonia (HAP)

• Patients who got admitted in Intensive Care Unit (ICU) and on ventilator for a different reason–Ventilator Associated Pneumonia (VAP)

• People who consume alcohol and drug addicts (risk of Aspiration Pneumonia)

Causes and types of Pneumonia

Pneumonia can be caused by viruses, bacteria and fungi. When someone develops pneumonia in the community (not in a hospital), it's called community-acquired pneumonia. 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 and ventilator-associated pneumonia.

Symptoms

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 rapid breathing, fever, general malaise, loss of appetite, abdominal pain, headache, chest pain, cough and blue colouration of skin around mouth. It is diagnosed using a variety of tests, including chest x-rays, sputum tests, naso-pharyngeal swabs, bronchoscopy and CT guided biopsy or (rarely) Radial EBUS guided biopsy.

Treatment of complications

1. Empyema/Para-pneumonic effusion: Empyema is presence of pus in the covering layers of lung. Pulmonologist suspects based on Clinical, CXR findings, Ultrasound thorax and rarely a CT thorax might be needed to diagnose extent and severity of problem. In presence of such a severe problem, pulmonologist can advise removal of fluid by placing a needle or a tube into the pus or fluid. If pus or fluid is present in multiple pockets, Interventional pulmonologist opinion has to be sought and shall be removed using a procedure called Thoracoscopy.

2. Lung Abscess: This is presence of pus filled cavity in lung tissue. Antibiotics are usual stay of management. It usually requires longer hospital stay and duration of antibiotics.

3. Hemoptysis: Hemoptysis is coughing out blood. It’s a life threatening complication that usually suggests a severe underlying damage to the lung.

4. Pneumothorax: Collection of air in the pleural space. It’s a rare complication and usually requires surgical management.

5. Septic Shock with MODS (Multi organ Dysfunction Syndrome): Toxins released from bacteria at times lead to drop in blood pressure and compromise in function of organs like kidney (Renal Failure) and liver (Liver dysfunction).

Immunisation

Since the introduction of streptococcal pneumonia vaccine in 2000, there is a considerable reduction in severity of the disease in population. It has resulted in 35 per cent reduction in admission rates and severe form of streptococcal infections like Bacteremia (blood stream infection) and Meningitis (infection to covering layers of brain). Influenza is a common preceding viral infection. Being vaccinated against influenza can help prevent that infection and the pneumonia, which may complicate it. Protect yourself with these healthy living practices

Try to avoid close contact with sick people. While sick, limit contact with others as much as possible to keep from infecting them. Following good hygiene practices can also help prevent respiratory infections. This includes washing hands regularly, cleaning frequently touched surfaces and coughing or sneezing into a tissue or into your elbow or sleeve. (The author is Interventional Pulmonologist and Sleep Disorder Specialist at Apollo Health City in Jubilee Hills, Hyderabad.)

BY Dr Vijay Kumar Chennamchetty