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Early detection of pneumonia can save lives during Covid pandemic

 by Dr. B Nagaraj, MBBS,MD,FCCP(USA), Consultant Interventional Pulmonologist & Sleep Specialist, Aster Prime Hospital, Ameerpet, Hyderabad

Pneumonia is the leading cause of death in children under 5 years of age and those over 75 years of age. The World Health Organization estimates that 450 million people die of pneumonia each year, of which 4 million die. Pneumonia is the most common infectious disease, especially in children. According to 2017 statistics 808694 children under the age of 5 died. It accounts for 15 percent of all under-5 infant deaths. Although the disease is observed in children around the world, it is more common in South Asian and sub-Saharan Africa.

In India, 1.4 lakh children under the age of 5 die of pneumonia every year. The situation is said to have worsened due to covid. It is slowly becoming clear that the vast majority of deaths due to covid are due to acute pneumonia. The solution is to vaccinate against this deadly disease.

Pneumonia –

Pneumonia is an infection of the lungs. Our lungs have small chambers called alveoli. These rooms are filled with air when we breathe air. However, in a person with pneumonia, the air-filled fluid in these rooms instead of the air will make it harder for us to breathe air and reduce the amount of oxygen we take in. In addition the disease causes inflammation in the air chambers. This can lead to shortness of breath, cough, fever, lung pain, chills and fatigue.

Causes of pneumonia

Causes

 

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)
  • fever
  • 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
  • headaches

 

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.

Diagnosis

 

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

 

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 pulmonologist if symptomatic.

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