Pneumonia is an infection of the small air sacs in the lungs (alveoli) and the surrounding tissue. In the United States, about two million people get pneumonia each year, and between 40,000 and 70,000 die from it.
Pneumonia is often a fatal disease in patients with other serious chronic illnesses. In general, this is the sixth leading cause of death and the most common fatal infection in the hospital.
In developing countries, pneumonia is either the leading cause of death or the second (being overcome only by dehydration caused by severe diarrhea).
What are the causes of pneumonia
Pneumonia is not a single disease, but rather a conglomeration of diseases, each disease being caused by a certain microscopic organism – be it a bacterium, a virus or a fungus.
Pneumonia usually occurs after microorganisms are inhaled into the lungs, but sometimes the infection reaches the lungs through the bloodstream or migrates to the lungs directly from a nearby infectious site.
Pneumonia can occur after surgery, especially in the abdominal cavity, as such trauma leads to shallow breathing, impaired coughing and mucus retention.
Pneumonia sometimes occurs when particles in the oral cavity are inhaled and then not removed from the airways or when an obstruction (such as a tumor) traps bacteria in the distal parts of the lungs.
Risk factors for pneumonia
The location of pneumonia is one of the most important features that doctors consider. Pneumonia can occur in people living in the community, in hospitalized patients, or in people in other institutions (nursing homes).
The site of pneumonia often helps to identify the infectious microorganism responsible for the disease. For example, community-acquired pneumonia is more likely to be caused by an infection with the gram-positive bacterium Streptococcus pneumoniae.
Hospital-acquired pneumonia is usually caused by Staphylococcus aureus or a gram-negative bacterium, such as Klebsiella pneumoniae or Pseudomonas aeruginosa.
Depending on the infectious agent, there are differences between the severity of the pneumonia and how it is treated (for example, by taking oral medications at home or by intravenous administration).
Another critical feature is whether pneumonia occurs in a healthy person or in a person with a weakened immune system.
Certain medications (corticosteroids) affect the functioning of the immune system, as well as certain diseases, such as AIDS. Sometimes the immune system may be overwhelmed by a serious acute or chronic illness, as is often the case with the elderly.
A person whose immune system is affected is more likely to develop pneumonia and may not respond as well to treatment as a person whose immune system is functioning normally.
Other conditions that make some people prone to pneumonia include alcoholism, smoking, diabetes, heart failure, and chronic obstructive pulmonary disease (COPD).
People who are very young or very old have an above average risk of developing this disease. Weakened persons, those bedridden, paralyzed persons or unconscious persons are also at high risk.
How pneumonia manifests itself (symptoms)
Types of pneumonia
- Pneumococcal pneumonia, caused by Streptococcus pneumoniae; Although it can be cured most of the time, it can be fatal, especially to very young, very old people, or people with other serious illnesses.
- Pneumonia caused by Haemophilus influenzae; It can be prevented by vaccination and can be treated with very effective antibiotics.
- “Legionnaires’ disease”; is caused by bacteria Legionella pneumophilla and other Legionella species – this bacterium is responsible for 8% of pneumonia cases and 4% of fatal hospital-acquired pneumonia. About 20% of people with the disease die, and mortality is higher in those who contract the disease in the hospital or have immune system diseases.
- Pneumonia cu Mycoplasma pneumoniae; causes most cases of pneumonia in people aged 15 to 35 years. This type of pneumonia is usually mild and most people recover without treatment, but there may be serious cases that require specific antibiotics and individualized therapy.
- Pneumonia caused by Chlamydia pneumonia: it usually occurs in those aged between 5 and 35 years and is transmitted through small drops of fluid eliminated at the time of cough; the condition can be treated with antibiotics (erythromycin, doxycycline, clarithromycin, etc.), but if treatment is stopped too soon, the symptoms may return (fatigue, sore throat, dry cough, anemia, joint pain).
- Viral pneumonia: It is treated with antiviral drugs and can be prevented in most cases by flu vaccination annual.
- Psittacosis (poultry fever) is a rare type of pneumonia caused by Chlamydia psitacci, a bacterium usually present in birds. It is treated with oral tetracycline for at least 10 days, but mortality can reach 30% in severe untreated cases.
- Staphylococcal pneumonia: caused by Staphylococcus aureus. Although uncommon, this type of pneumonia is severe – mortality is between 15-40%
- Pneumonia with gram-negative bacteria (Klebsiella, Pseudomonas, Enterobacter, Proteus, Serratia and Acinetobacter): it is a severe disease and worsens rapidly, which is why treatment is intensive and the patient often requires mechanical ventilation. Despite effective treatment options, between 25-50% of patients die.
- Pneumonia fungică (Histoplasma capsulatum, Coccidiodides immitis, Blastomices dermatitidis) – Most infected patients have only minor symptoms, which can be treated with antifungal medication, but in some cases the disease can have a severe course.
- Pneumocystis carinii pneumonia – even with treatment, the general mortality in this type of pneumonia is 15-20%.
- Aspiration Pneumonia –
How to diagnose pneumonia
Your doctor or nurse will try to detect pneumonia by auscultation of the lungs with a stethoscope. Pneumonia is usually associated with the appearance of specific noises. These abnormal noises are caused by narrowing of the airways or the presence in the lung segments normally filled with air of inflammatory cells and fluid, the process being called condensation.
In the majority of cases, the diagnosis of pneumonia is confirmed by performing a chest x-ray. In most bacterial pneumonias, the affected lung tissue appears on the x-ray as a dense white region (because X-rays do not cross the area as easily as adjacent areas), compared to which nearby lung tissue appears black.
In the case of viral pneumonia, it is found the presence of diffuse white streaks or spots, the color intensity being lower than that found in bacterial pneumonia.
Some pneumonias can progress to formation of a lung abscess, which appears on the x-ray as a space filled with fluid (pus).
Therefore, radiography helps the doctor (but not always) to determine which microorganism causes the disease.
Doctors realize crops of sputum and blood cultures in an attempt to identify the microorganism that causes pneumonia.
However, despite these tests, in up to half of cases of pneumonia the causal agent cannot be identified.
When it is necessary to identify it, as is the case when the patient is very ill and does not respond well to treatment, doctors may try to obtain better samples by inserting the bronchoscope into the airway, a procedure called bronchoscopy.
How to prevent pneumonia
Several types of pneumonia can be prevented by use of vaccines. There are vaccines that create protection against pneumococcal pneumonia, a pneumonia caused by the bacterium Haemophilus influenzae and pneumonia caused by the flu virus, which also leads to bacterial pneumonia.
How to treat pneumonia
- Deep breathing exercises and specific treatment for the elimination of airway secretions helps to prevent pneumonia in high-risk patients, such as those who have undergone thoracic or abdominal surgery and those whose immunity is low.
- If patients with pneumonia are dyspneic or if blood oxygen levels are low, then additional oxygen is administered.
- Administration of antibiotics It usually begins when bacterial pneumonia (including obstructive pneumonia) is suspected, just before the causative agent is identified. Prompt use of antibiotics reduces the severity of pneumonia and the risk of complications, some of which can even lead to death.
When choosing to use a particular antibiotic, doctors consider what type of bacteria could cause pneumonia. The doctor may change the antibiotic later, when the bacterium has been identified and its sensitivity to antibiotics is known.
Oral antibiotics are often given to patients with pneumonia who are not very ill and remain at home.
The elderly and those with dyspnoea or pre-existing lung or heart disease are usually hospitalized and given intravenous antibiotics from the outset. After a few days, the antibiotics are administered orally.
These patients may also need extra oxygen and intravenous fluids as well mechanical fan support.
Antibiotics are not helpful for viral pneumonia, but they can be used for viral pneumonia that is more likely to be complicated by bacterial pneumonia, such as those caused by viral pneumonia. respiratory syncytial virus in children and sometimes those caused by the flu virus, at least in some people who are very susceptible to pneumonia.
Source: “Merck Medical Agenda – Home Doctor”, All Publishing House
–
