Overview of Pneumonia

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Pneumonia. It's not something you expect to hear the doctor say. It's probably more common than you think. Depending on the type, it can be prevented and treated - likely more easily than you might think.

What is Pneumonia?

Pneumonia is inflammation of the lungs, usually caused by an infection. It involves infection deep in the lungs. It affects the alveoli, the tiny sacs where oxygen is transferred from the air into our blood.

In pneumonia, these sacs can fill will fluid and pus making it harder to breathe.

Bronchitis affects the large airways, the bronchi, but can lead to further infection, leading to pneumonia.

What causes pneumonia?

Usually pneumonia is caused by breathing in infectious material – bacteria, viruses, fungi. 

What are the symptoms?

Pneumonia often causes a cough and fever. Many have a cough that produces sputum – which may be white, or yellow or green, or even pink or blood stained. Some may feel out of breath, pain or tightness in the chest; some may breathe fast. Many have chills or sweats, feel unwell, and lose an appetite. 

Infection can spread from the lung to the rest of the body. This can cause fever, chills, and low blood pressure. This can lead to sepsis.

Rarely does infection spread from elsewhere in the body to cause pneumonia, but it is possible.

How is pneumonia diagnosed?

Pneumonia can be diagnosed by a doctor taking a history and exam.

The diagnosis can be confirmed with a Chest X-Ray (or even a Cat scan). The diagnosis can also specifically be made using microbiology tests – a sample of sputum may show bacteria under the microscope or the bacteria may grow from a culture of the sputum. This can show exactly which bug caused the infection and can pinpoint which treatment is best.

There are also blood tests that can help identify certain specific types of pneumonia.

How is pneumonia treated?

Pneumonia that is caused by bacteria is often treated with antibiotics. Those caused by fungus are treated with antifungals. Many viral infections do not have a specific treatment, though there are medications that are given for influenza-associated pneumonias. Keeping hydrated and eating well help. 

Some will have trouble breathing. They may require supplemental oxygen – temporarily – that is supplied by a tube at the nose or through a facemask. Some become tired and may require machines that assist with breathing like BiPAP machines – or even intubation with a ventilator breathing for the patient. 

Serious pneumonia infections require admission to intensive care – or else hospitalization. There are many pneumonias, however, which are simply treated at home.

How can pneumonia be prevented?

Many types of pneumonia can be prevented by vaccination. The influenza vaccination and “pneumonia” vaccine (which helps prevent Strep pneumo - Streptococcus pneumonia) prevent many cases of pneumonia.

Other vaccines also reduce the number of cases pneumonia, such as the Hib (Haemophilus Influenza b), MMR and Varicella (chickenpox) vaccinations

Managing other underlying medical problems will also help. Keeping diabetes well controlled will lower risk. For those who are HIV positive, Keeping steadily on HIV medications will prevent many infections. 

Stopping smoking will also help. Air pollution, even just from fires at home, can lead to increased risk of pneumonia.

Medications like steroids (prednisone) that lower the immune systems ability to control infection can increase the chance of having pneumonia.

What types of pneumonia are there?

There are many bacterial causes, notably Streptococcus pneumonia, which can be prevented by vaccination, as well as Haemophilus influenzae type b (Hib), which also has a vaccine. There are also other bacterial causes of pneumonia, like Mycoplasma pneumonia, that cause milder disease and are treated by different type of antibiotics than most other causes.There are also bacteria like Legionella that can cause a serious disease called Legionnaire's Disease.

Viruses that cause pneumonia include RSV, especially in children, and influenza.

There are rare fungal infections – like Coccidioidomycosis, Histoplasmosis, and Aspergillus which affect those in particular locales, especially those with weaker immune systems.

Those with HIV are particularly prone to PCP (Pneumocystis pneumonia), but also to Streptococcus pneumonia.

Whom does it affect?

Pneumonia takes more lives of children than any other infectious cause, causing 15% of all deaths under 5. It is thought 935,000 children under 5 die from pneumonia each year.

Pneumonia also affects the elderly and those with weakened immune systems, such as those with HIV. It often strikes those already suffering from other disorders.

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