Pneumonia

Symptoms: Chest pain, confusion, loss of mental awareness, fatigue, tiredness, coughing with phlegm, fever, sweating, chills, below average body temperature in some instances, difficulty breathing, vomiting, nausea, diarrhoea, restlessness, headaches, loss of appetite, fast breathing or wheezing in infants, lips and nailbeds turning blue

Causes: Bacteria, Fungi, Viruses

Risk Factors: Compromised immune systems, pre-existing illnesses or chronic conditions, indoor air pollution, smoking or passive smoking, living in crowded spaces, using drugs or alcohol

Prevalence: The estimated global prevalence of community-acquired pneumonia ranges from 1.5 to 14 cases per 1000 person-years and is influenced by geography, season, and population characteristics.

Severity: Mild to severe (depending on the stage of infection)

Which doctor to consult: If an individual starts noticing symptoms, he/she can visit primary care providers or general physicians. Depending upon the severity of the cases, they may direct the individual to a lung specialist, a respiratory therapist, or an infectious diseases specialist.

Overview

Pneumonia is a disease that causes inflammation in the alveoli (air sacs) in the lungs. The air sacs fill up with fluid or pus, resulting in coughing up phlegm. Viruses, bacteria, fungi, and other microorganisms can cause this disease. Some other symptoms of pneumonia include chills, difficulty breathing, and fever.

Pneumonia can either be very mild or life-threatening. Especially, it is dangerous for newborns, children, people over 65, and those with complicated health issues.

Pneumonia, both viral and bacterial, is infectious. This implies that it can be passed from person to person by inhaling airborne particles or droplets from a cough or a sneeze. A patient can also contract this disease by coming into contact with objects or surfaces contaminated with bacteria or viruses that cause pneumonia. Fungal pneumonia, contracted from the environment, does not pass from person to person.

Furthermore, pneumonia can be classified into several stages based on the area of the lungs that the pathogen infects. Bronchopneumonia affects the entirety of the lung or lungs and is localised close to the bronchi or around them. On the other hand, lobar pneumonia is more nuanced and affects one or more lobes of the lungs.

Lobar pneumonia’s level of progression happens in four stages.

• Congestion: The lung tissues become heavy with infectious organisms and cause congestion.

• Red hepatisation: The lungs appear solid and red-coloured due to the blood accumulation of red blood cells and immune cells.

• Grey hepatisation: The red blood cells start to break down and change colour from red to grey, with only the immune cells remaining.

• Resolution: The infection starts to clear out of the lungs, and the remaining fluid is ejected through coughing.

• Pneumonia is curable. Typically, a visit to the doctor is enough for it to reach its natural resolution. However, when left to fester for too long, it can result in severe infections that may require hospitalisation.

Types of Pneumonia

• Community-acquired pneumonia: The most prevalent kind of pneumonia is community-acquired pneumonia. It happens outside of health facilities or other medical institutions. Bacteria, bacteria-like organisms, fungi, and viruses can all cause community-acquired pneumonia. Nevertheless, they are far easier to cure and less severe.

• Hospital-acquired pneumonia: Some individuals develop pneumonia while in the hospital for another ailment. Hospital-acquired pneumonia can be hazardous since the bacterium that causes it may be resistant to medication, and the patients who develop it are already severely ill. People who use ventilators are most susceptible to this kind of pneumonia.

• Healthcare-acquired pneumonia: Bacterial pneumonia that develops in individuals who reside in long-term care homes or receive care through outpatient clinics is known as healthcare-acquired pneumonia. Healthcare-acquired pneumonia, including hospital-acquired pneumonia, can be caused by antibiotic-resistant bacteria.

• Aspiration-acquired pneumonia: Aspiration pneumonia occurs when something disturbs the natural gag reflex in the human body. A brain injury, swallowing issues, or overuse of drugs and alcohol can result in aspiration-acquired pneumonia. 

Symptoms of Pneumonia:

Symptoms can vary in severity and may include:

• Cough, which may produce phlegm or pus

• Fever, often high-grade, accompanied by chills

• Shortness of breath or difficulty breathing

• Chest pain that worsens when you cough or breathe deeply

• Fast heartbeat

• Fatigue and weakness

• Nausea, vomiting, and diarrhoea

• Loss of appetite

• Body pain

In severe cases, patients may cough up blood or exhibit cyanosis, which is a bluish colour around the mouth due to lack of oxygen.

If you or someone you know is exhibiting symptoms of pneumonia, it’s important to seek medical attention immediately, as it can lead to serious complications if left untreated.

Causes:

Various organisms, including bacteria, viruses, and fungi can cause pneumonia. Common causes include:

Bacterial pneumonia: Often caused by Streptococcus pneumonia and less commonly by Mycoplasma pneumoniae and Legionella pneumophila.
Viral pneumonia: Common viruses include those that cause the flu (influenza), common cold, COVID-19, and respiratory syncytial virus (RSV).
Fungal pneumonia: Although rare, it can occur in individuals with weakened immune systems and is caused by fungi such as Cryptococcus or Pneumocystis jirovecii.
It’s important to note that lifestyle habits like smoking cigarettes and excessive alcohol consumption can also raise the risk of developing pneumonia. You can refer to health resources like the Mayo Clinic or the CDC for more detailed information.

Risk factors:

The risk factors for pneumonia are varied and can include:

• Age: Infants below 2 years and adults above 65 years are more vulnerable.

• Hospitalization: Especially those in intensive care units or on ventilators for extended periods.

• Chronic lung diseases: Conditions like asthma or COPD increase the risk.

• Smoking: This habit can damage lung tissue and increase susceptibility.

• Weakened immune system: People with conditions like HIV/AIDS, cancer, or those who have undergone organ transplants are at higher risk.

Maintaining a healthy lifestyle and following preventive measures are important to lower the risk of pneumonia. Vaccinations, good hygiene practices, and avoiding smoking can help protect against pneumonia. It’s best to consult with a healthcare provider if you have concerns about your risk factors.

Possible Complications:

• Bacteraemia or sepsis: Bacteraemia occurs when infection enters the bloodstream and reaches other organs, eventually causing organ failure.

• Worsened chronic conditions: While pneumonia alone is curable, it can cause complexities in patients with immunosuppressive diseases such as HIV and diabetes. Pneumonia can have an aggravated impact and cause significant damage to the body.

• Lung abscesses: Lung abscesses are pockets of fluid or pus that form around the lungs and must be drained through surgery.

• Impaired breathing: Pneumonia can lead to lifelong respiratory issues since it impacts the lungs directly.

• Pleural effusion: Pneumonia can cause fluid to accumulate in the narrow gaps between the tissue layers that border the lungs and chest cavity, known as pleura. If the fluid gets contaminated, it may need to be drained by a chest tube or surgically removed.

• Acute Respiratory Distress Syndrome (ARDS): This is a severe respiratory failure requiring immediate medical attention. It is categorised as a medical emergency.

Prevention:

Preventing pneumonia involves several key steps that can significantly reduce the risk of contracting this lung infection:

Vaccination: Getting vaccinated is one of the most effective ways to prevent pneumonia. There are vaccines for pneumococcal bacteria and the flu virus, which are common causes of pneumonia.
Hand Hygiene: Regular hand washing with soap and water or using alcohol-based hand sanitisers can kill germs that may cause pneumonia.
Healthy Habits: Adopting a healthy lifestyle, including a balanced diet and regular physical activity, helps to keep your immune system strong.
Avoid Smoking: Smoking damages the lungs and increases the risk of pneumonia, so quitting smoking is highly recommended.
Avoid Exposure to Illness: Stay away from people who are sick, as pneumonia can be spread through respiratory droplets.
For those with swallowing difficulties, eating smaller meals of thickened food and sleeping with the head of the bed raised can help prevent aspiration pneumonia.

Remember, while these measures can greatly reduce the risk, they do not completely eliminate the possibility of getting pneumonia. It’s always best to consult with a doctor for personalized advice. If you or someone you know is exhibiting symptoms of pneumonia, seek medical attention immediately.

When to Consult a Doctor?

• On observing symptoms: Like every disease, it is best to see a doctor at the earliest signs of the illness. However, figuring out whether it is pneumonia or something less severe can be somewhat confusing. Hence, it is best to look out for some of the more apparent signs of pneumonia. These symptoms include difficulty breathing, an abnormally high or low body temperature, coughing fits, chills, or all of them at once.

• Precautionary doctor’s visit: Nevertheless, even if these symptoms don't show up immediately, it's best to receive a consultation from a regular physician. The doctor can then direct the patient to the right medical care provider. This can be a respiratory therapist, lung specialist or infectious diseases specialist.

Diagnosis

• Physical examination: During a physical examination, doctors generally glance through the patient’s entire medical history to determine the possibility of pneumonia. They then ask questions regarding the early occurrences of the symptoms. They may then monitor the patient’s breathing pattern and record the pulse rate. Lab tests can also be prescribed to determine the infection's severity.

• Lab Tests

Blood culture: A blood test or culture effectively indicates whether an infection is present in the bloodstream. The arterial blood gas test checks the amount of oxygen in the bloodstream.

Sputum culture: Sputum tests are done on the patient's saliva and mucus. This is also a good indicator of the presence of infection.

Pleural fluid culture: This uses the fluid present in the pleural space in the chest. The fluid is extracted by inserting a needle between the ribs. The fluid is then used to determine the presence of infection and identify its cause.

• Imaging Tests

CT scan: If the pneumonia is taking longer to heal, a doctor may order a chest CT scan to examine the lungs more closely.

Pulse oximetry: Pulse oximetry determines the amount of oxygen in the blood. A sensor attached to an individual's finger indicates the oxygen saturation level in the bloodstream.

Chest x-ray: This is a vital test when diagnosing pneumonia and helps specify the infection's severity and location. However, it does not offer any insight into the cause of the infection.

• Advanced Tests

Bronchoscopy: A bronchoscopy uses a camera fitted on the end of a flexible tube to view the inside of the airway in the lungs. The tube moves slowly down the throat and into the lungs. If the patient's early symptoms are severe or if the patient is hospitalised and not responding to antibiotics, doctors may perform this test.

Treatment

• Home Care: Community-acquired pneumonia can be cured through home remedies. Most symptoms reduce in a few weeks. However, tiredness and fatigue can often persist for months. In addition, a regular physician can suggest certain antibiotics and cough medicines to help ease the symptoms. Nevertheless, it is not difficult to get rid of.

• Medication: Here are some examples of medications used to treat pneumonia:

• Antibiotics: These are used for bacterial pneumonia. Examples include:
  Levofloxacin
  Azithromycin
  Amoxicillin
  Clarithromycin
  Doxycycline

• Antivirals: These may be prescribed for viral pneumonia. Examples are:
  Oseltamivir
  Zanamivir

• Antifungals: These are used if pneumonia is caused by fungi. Examples include:
  Fluconazole
  Itraconazole
  Additionally, supportive treatments such as analgesics (e.g., acetaminophen, ibuprofen) for pain and fever and cough suppressants (e.g., dextromethorphan, codeine) may be used to relieve symptoms.

• Hospitalisation: While pneumonia is highly treatable, it may require hospitalisation in rare cases. This usually happens when the patient is either over 65 years or below two years old. Moreover, a patient must be hospitalised immediately if pneumonia affects the kidney or brain function. Abnormally low temperature or breathing difficulty may also signal severity. In this case, too, one may require hospitalisation.

Additional information:

How long does it take to recover from pneumonia?

Recovery from pneumonia can take weeks or months, depending on your age, the severity of the condition, and your underlying health status. Most otherwise healthy people recover from pneumonia in 1 to 3 weeks, but some may feel tired for up to a month.

Here's a breakdown of what to expect from a slightly more severe case of pneumonia.

A high fever usually subsides after one week.
One month: Chest symptoms such as pain, mucus production, and shortness of breath should subside.
Six weeks: Coughing and breathing usually improve.
Three months later, the majority of pneumonia symptoms have resolved. Fatigue is still a possibility.
Six months later, all symptoms have disappeared.

Can a cold or bronchitis turn into pneumonia? 

Yes, a cold or bronchitis can lead to pneumonia.
Bronchitis develops when a cold spreads to the airways that transport air into your lungs (bronchial tubes). A chest cold is often referred to as acute bronchitis, which is an inflammation and swelling of the bronchial tubes. A viral infection typically causes acute bronchitis and lasts less than three weeks. On the other hand, chronic bronchitis is characterized by a cough that lasts two to three months each year for years.
If the infection spreads from the airways to the air sacs in your lungs, it can progress to pneumonia, which is an infection in the lungs' air sacs (alveoli). Pneumonia causes the air sacs to fill with fluid, resulting in coughing, fever, chills, and difficulty breathing.

Symptoms that suggest a cold has morphed into bronchitis may include:

Runny nose
Low-grade fever
Chest congestion
Wheezing
Yellow or green mucus
Feeling run-down

Bronchitis usually resolves independently after resting and taking cough suppressants and/or pain relievers.

Signs that bronchitis is progressing to pneumonia may include:

Cough
Green, yellow or bloody mucus
Fever
Chills
Shortness of breath
Rapid breathing
Chest pain
Loss of appetite
Low energy
Fatigue
Nausea and vomiting in children
Confusion in older people

Blood tests and imaging exams may be required to diagnose pneumonia, as well as other tests that can identify the bug that is causing pneumonia and help guide treatment. If bacteria cause the infection, antibiotics may be necessary.