by Dr. B Nagaraj, MBBS,MD,FCCP(USA), Consultant Interventional Pulmonologist & Sleep Specialist, Aster Prime Hospital
Pneumonia is the leading cause of death worldwide especially among children under 5 and of old age above 75 years. As per WHO statistics pneumonia affects 450 million people globally and is the reason for death among 4 million. Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed 808 694 children under the age of 5 in 2017, accounting for 15% of all deaths of children under five years old. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa.
According to Government of India estimates Pneumonia contributes to 1.4 lakh deaths amongst under-five children in India annually. The situation got aggravated during the COVID pandemic. Most of the COVID deaths are occurring due to severe Pneumonia that is developing among them. The vaccination is the only solution to the problem, advice medical experts.
Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake. Pneumonia is a lung infection that causes inflammation in the tiny air sacs inside your lungs. You may have severe shortness of breath, a cough, a fever, chest pain, chills, or fatigue.
Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. They are further classified into community acquired, hospital acquired, Aspiration Pneumonia. The most common are:
Through Bacteria (50% of the Cases) –
- Streptococcus pneumoniae – the most common cause of bacterial pneumonia in children;
- Haemophilus influenzae type b (Hib) – the second most common cause of bacterial pneumonia;
- Pseudomonas pneumonia, pulmonary infection with the gram-negative pathogen Pseudomonas aeruginosa, is mostly a hospital-acquired pneumonia.
- Mycoplasma pneumoniae also can cause pneumonia. It typically produces milder symptoms than do other types of pneumonia.
- Klebsiella pneumoniae (K. pneumoniae) are bacteria that normally live in your intestines and feces. These bacteria are harmless when they’re in your intestines. But if they spread to another part of your body, they can cause severe infections.
Through Viruses – Pneumonia is also acquired due to Rhinovirus, Influenza, Corona Virus and Respiratory Syncytial Virus.
Through Fungi – It is a rare possibility but Pneumonia can also occur due Histoplasma Capsulatum, Cryptococcus Neoformans, pneumocystis jiroveci and is most common in HIV/AIDS patients.
Through Parasites – It is also said to be very rare possibility but Pneumonia can also occur due to parasites such as Toxoplasma Gondii, Ascaris Lumbricoides, Plasmodium Malariae(Malaria Causing Paratise) etc,
Through Non Infectious ways – idiopathic intestinal Pneumonia, Lipoid Pneumonia etc.,
Pneumonia risk factors
Anyone can get pneumonia, but certain groups do have a higher risk. These groups include: infants from birth to 2 years old and people ages 65 years and older. The common risk factors include –
- people with weakened immune systems because of disease or use of medications, such as steroids or certain cancer drugs
- people with certain chronic medical conditions, such as asthma, cystic fibrosis, diabetes, or heart failure
- people who’ve recently had a respiratory infection, such as a cold or the flu
- people who’ve been recently or are currently hospitalized, particularly if they were or are on a ventilator
- people who’ve had a stroke, have problems swallowing, or have a condition that causes immobility
- people who smoke, use certain types of drugs, or drink excessive amounts of alcohol
- people who’ve been exposed to lung irritants, such as pollution, fumes, and certain chemicals
Symptoms of pneumonia
Pneumonia symptoms can be mild to life-threatening. They can include:
- coughing that may produce phlegm (mucus)
- sweating or chills
- shortness of breath that happens while doing normal activities or even while resting
- chest pain that’s worse when you breathe or cough
- feelings of tiredness or fatigue
- loss of appetite
- nausea or vomiting
Other symptoms can vary according to your age and general health:
- Children under 5 years old may have fast breathing or wheezing.
- Infants may appear to have no symptoms, but sometimes they may vomit, lack energy, or have trouble drinking or eating.
- Older people may have milder symptoms. They can also exhibit confusion or a lower than normal body temperature.
Is pneumonia contagious?
The germs that cause pneumonia are contagious. This means they can spread from person to person. Both viral and bacterial pneumonia can spread to others through inhalation of airborne droplets from a sneeze or cough. You can also get these types of pneumonia by coming into contact with surfaces or objects that are contaminated with pneumonia-causing bacteria or viruses. You can contract fungal pneumonia from the environment. However, it doesn’t spread from person to person.
Your doctor will start by asking about your medical history and doing a physical exam, including listening to your lungs with a stethoscope to check for abnormal bubbling or crackling sounds that suggest pneumonia.
If pneumonia is suspected, your doctor may recommend the following tests:
- Blood tests. Blood tests are used to confirm an infection and to try to identify the type of organism causing the infection. However, precise identification isn’t always possible.
- Chest X-ray. This helps your doctor diagnose pneumonia and determine the extent and location of the infection. However, it can’t tell your doctor what kind of germ is causing the pneumonia.
- Pulse Oximetry. This measures the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream.
- Sputum test. A sample of fluid from your lungs (sputum) is taken after a deep cough and analyzed to help pinpoint the cause of the infection.
Your doctor might order additional tests if you’re older than age 65, are in the hospital, or have serious symptoms or health conditions. These may include:
- CT scan. If your pneumonia isn’t clearing as quickly as expected, your doctor may recommend a chest CT scan to obtain a more detailed image of your lungs.
- Pleural fluid culture. A fluid sample is taken by putting a needle between your ribs from the pleural area and analyzed to help determine the type of infection.
Treatment for pneumonia involves curing the infection and preventing complications. People who have community-acquired pneumonia usually can be treated at home with medication. Although most symptoms ease in a few days or weeks, the feeling of tiredness can persist for a month or more.
Specific treatments depend on the type and severity of your pneumonia, your age and your overall health. The options include:
- Antibiotics. These medicines are used to treat bacterial pneumonia. It may take time to identify the type of bacteria causing your pneumonia and to choose the best antibiotic to treat it. If your symptoms don’t improve, your doctor may recommend a different antibiotic.
- Antivirals – These medicines are used to treat virus acquired pneumonia.
- Cough medicine. This medicine may be used to calm your cough so that you can rest. Because coughing helps loosen and move fluid from your lungs, it’s a good idea not to eliminate your cough completely.
- Fever reducers/pain relievers. You may take these as needed for fever and discomfort.
- Oxygen/NIV/Ventilatory Support and Corticosteroids along with monitoring other Co-morbid Conditions.
Sometimes among elderly it may lead to complications such as empyema (through formation of puss between lungs and inner surface of chest walls), ARDS (Acute respiratory distress syndrome is a type of respiratory failure), Lung abscess, Septic Shock and Multi Organ Failures.
Prevention is better than Cure
Simple and cost effective way to prevent Pneumonia is getting vaccinated. It is advised to take Influenza Vaccine once in a year for kids below 6 months and for older people. Pneumococcal Conjugate Vaccine has to be given at 6 and 14 weeks of birth and PCV booster at 9 months. The non conjugate vaccine can also be administered every 5 years for kids below 2 years and for older people. Hib Vaccine also recommended for certain category of people
Apart from Vaccination, There are things you can do instead of or in addition to the pneumonia vaccine. Healthy habits, which help to keep your immune system strong, may reduce your risk of getting pneumonia. Good hygiene also may help. Things you can do include:
- Avoid smoking.
- Wash your hands often in warm, soapy water.
- Use an alcohol-based hand sanitizer when you can’t wash your hands.
- Avoid exposure to people who are ill whenever possible.
- Eat a healthy diet that includes lots of fruits, vegetables, fiber, and lean protein.
- Make sure to get enough rest while recovering from a cold or other illness.
- Drink lots of fluid to help eliminate congestion.
- Use a humidifier.
- Take supplements, such as vitamin C and zinc, to help bolster your immune system.
Keeping children and babies away from people who have colds or the flu may help reduce their risk. Also, make sure to keep little noses clean and dry, and teach your child to sneeze and cough into their elbow instead of their hand. This can help reduce the spread of germs to others.
At the outset, it is early detection of Pneumonia is more important to prevent life threatening complications and death. Immediately consult your doctor if symptomatic.