A GLANCE TO A COMMON DISEASE

CALLED “PNEUMONIA”
• Pneumonia is a lung infection that can be caused by different types of
microorganisms, including bacteria, viruses, and fungi.
• Symptoms of pneumonia include cough with sputum production, fever,
and sharp chest pain on inspiration (breathing in).
• Pneumonia is suspected when a doctor hears abnormal sounds in the
chest, and the diagnosis is confirmed by a chest X-ray.
• Bacteria causing pneumonia can be identified by sputum culture.
• A pleural effusion is a fluid collection around the inflamed lung.
• Bacterial and fungal (but not viral) pneumonia can be treated with
antibiotics.

Pneumonia is an inflammatory condition of the lung. It is often

characterized as including inflammation of the parenchyma of the lung (that
is, the alveoli) and abnormal alveolar filling with fluid (consolidation and
exudation).

The alveoli are microscopic air filled sacs in the lungs responsible for gas
exchange. Pneumonia can result from a variety of causes, including infection
with bacteria, viruses, fungi, or parasites, and chemical or physical injury to
the lungs. Its cause may also be officially described as unknown when
infectious causes have been excluded.

Typical symptoms associated with pneumonia include cough, chest pain,

fever, and difficulty in breathing. Diagnostic tools include x-rays and
examination of the sputum. Treatment depends on the cause of pneumonia;
bacterial pneumonia is treated with antibiotics.

Pneumonia is common, occurring in all age groups, and is a leading cause of

death among the young, the old, and the chronically ill Vaccines to prevent
certain types of pneumonia are available. The prognosis depends on the type
of pneumonia, the treatment, any complications, and the person's underlying
health.

How do people catch pneumonia?

Some cases of pneumonia are contracted by breathing in small droplets that

contain the organisms that can cause pneumonia. These droplets get into
the air when a person infected with these germs coughs or sneezes. In other
cases, pneumonia is caused when bacteria or viruses that are normally
present in the mouth, throat, or nose inadvertently enter the lung. During
sleep, it is quite common for people to aspirate secretions from the mouth,
throat, or nose. Normally, the body's reflex response (coughing back up the
secretions) and their immune system will prevent the aspirated organisms
from causing pneumonia. However, if a person is in a weakened condition
from another illness, a severe pneumonia can develop. People with recent
viral infections, lung disease, heart disease, and swallowing problems, as
well as alcoholics, drug users, and those who have suffered a stroke or
seizure are at higher risk for developing pneumonia than the general
population. As we age, our swallowing mechanism can become impaired as
does our immune system. These factors, along with some of the negative
side effects of medications, increase the risk for pneumonia in the elderly.

Once organisms enter the lungs, they usually settle in the air sacs and
passages of the lung where they rapidly grow in number. This area of the
lung then becomes filled with fluid and pus (the body's inflammatory cells) as
the body attempts to fight off the infection.

Developing pneumonia: (Signs and symptoms)

Most people who develop pneumonia initially have symptoms of a cold

(upper respiratory infection, for example, sneezing, sore throat, cough),
which are then followed by a high fever (sometimes as high as 104 F),
shaking chills, and a cough with sputum production. The sputum is usually
discolored and sometimes bloody. Depending on the location of the infection,
certain symptoms are more likely to develop. When the infection settles in
the air passages, cough and sputum tend to predominate the symptoms. In
some, the spongy tissue of the lungs that contain the air sacs is more
involved. In this case, oxygenation can be impaired, along with stiffening of
the lung, which results in shortness of breath. At times, the individual's skin
color may change and become dusky or purplish (a condition known as
"cyanosis") due to their blood being poorly oxygenated.

The only pain fibers in the lung are on the surface of the lung, in the area
known as the pleura. Chest pain may develop if the outer aspects of the lung
close to the pleura are involved. This pain is usually sharp and worsens when
taking a deep breath and is known as pleuritic pain or pleurisy. In other
cases of pneumonia, depending on the causative organism, there can be a
slow onset of symptoms. A worsening cough, headaches, and muscle aches
may be the only symptoms.

Children and babies who develop pneumonia often do not have any specific
signs of a chest infection but develop a fever, appear quite ill, and can
become lethargic. Elderly people may also have few symptoms with
pneumonia.

What are some of the organisms that cause pneumonia?

The most common cause of a bacterial pneumonia is Streptococcus

pneumoniae. In this form of pneumonia, there is usually an abrupt onset of
the illness with shaking chills, fever, and production of a rust-colored
sputum.

Klebsiella pneumoniae and Hemophilus influenzae are bacteria that often

cause pneumonia in people suffering from chronic obstructive pulmonary
disease (COPD) or alcoholism. Useful antibiotics in this case are the second-
and third-generation cephalosporins, amoxicillin and clavulanic acid,
fluoroquinolones (levofloxacin [Levaquin], moxifloxacin-oral [Avelox], and
sulfamethoxazole/trimethoprim [Bactrim, Septra]).

Mycoplasma pneumoniae is a type of bacteria that often causes a slowly

developing infection. Symptoms include fever, chills, muscle aches, diarrhea,
and rash. This bacterium is the principal cause of many pneumonias in the
summer and fall months, and the condition often referred to as "atypical
pneumonia." Macrolides (erythromycin, clarithromycin, azithromycin, and
fluoroquinolones) are antibiotics commonly prescribed to treat Mycoplasma
pneumonia.

Legionnaire's disease is caused by the bacterium Legionella pneumoniae

that is most often found in contaminated water supplies and air conditioners.
It is a potentially fatal infection if not accurately diagnosed. Pneumonia is
part of the overall infection, and symptoms include high fever, a relatively
slow heart rate, diarrhea, nausea, vomiting, and chest pain. Older men,
smokers, and people whose immune systems are suppressed are at higher
risk of developing Legionnaire's disease. Fluoroquinolones are the treatment
of choice in this infection. This infection is often diagnosed by a special urine
test looking for specific antibodies to the specific organism.

Mycoplasma, Legionnaire's, and another infection, Chlamydia pneumoniae,

all cause a syndrome known as "atypical pneumonia." In this syndrome, the
chest X-ray shows diffuse abnormalities, yet the patient does not appear
severely ill. These infections are very difficult to distinguish clinically and
often require laboratory evidence for confirmation.

The more virulent organisms often come from the health-care environment,
either the hospital or nursing homes. These organisms have been exposed to
a variety of the strongest antibiotics that we have available. They tend to
develop resistance to some of these antibiotics. These organisms are
referred to as nosocomial bacteria and can cause what is known as
nosocomial pneumonia when the lungs become infected.

How to treat pneumonia?

Two vaccines are available to prevent pneumococcal disease: the

pneumococcal conjugate vaccine (PCV7; Prevnar) and the pneumococcal
polysaccharide vaccine (PPV23; Pneumovax). The pneumococcal conjugate
vaccine is part of the routine infant immunization schedule in the U.S. and is
recommended for all children < 2 years of age and children 2-4 years of age
who have certain medical conditions. The pneumococcal polysaccharide
vaccine is recommended for adults at increased risk for developing
pneumococcal pneumonia including the elderly, people who have diabetes,
chronic heart, lung, or kidney disease, those with alcoholism, cigarette
smokers, and in those people who have had their spleen removed. This
vaccination should be repeated every five to seven years, whereas the flu
vaccine is given annually.

Antibiotics often used in the treatment of this type of pneumonia include

penicillin, amoxicillin and clavulanic acid (Augmentin, Augmentin XR), and
macrolide antibiotics including erythromycin, azithromycin (Zithromax,
Zmax), and clarithromycin (Biaxin). Penicillin was formerly the antibiotic of
choice in treating this infection. With the advent and widespread use of
broader-spectrum antibiotics, significant drug resistance has developed.
Penicillin may still be effective in treatment of pneumococcal pneumonia, but
it should only be used after cultures of the bacteria confirm their sensitivity
to this antibiotic.

Conclusion and some teachings:

Pneumonia can be a serious and life-threatening infection. This is true
especially in the elderly, children, and those who have other serious medical
problems, such as COPD, heart disease, diabetes, and certain cancers.
Fortunately, with the discovery of many potent antibiotics, most cases of
pneumonia can be successfully treated. In fact, pneumonia can usually be
treated with oral antibiotics without the need for hospitalization. Then for
home treatment of child, If your doctor has prescribed antibiotics for
bacterial pneumonia, give the medicine on schedule for as long as directed.
This will help your child recover faster and will decrease the chance that
infection will spread to other household members. Don't force a child who's
not feeling well to eat, but encourage drinking of fluids, especially if fever is
present. Ask the doctor before you use a medicine to treat your child's cough
because cough suppressants stop the lungs from clearing mucus, which may
not be helpful in some types of pneumonia. If your child has chest pain, try a
heating pad or warm compress on the chest area. Take your child's
temperature at least once each morning and each evening, and call the
doctor if it goes above 102° Fahrenheit (38.9° Celsius) in an older infant or
child, or above 100.4° Fahrenheit (38° Celsius) in an infant under 6 months
of age. Check your child's lips and fingernails to make sure that they are rosy
and pink, not bluish or gray, which is a sign that the lungs are not getting
enough oxygen.