Pneumonia

Symptoms: Chest pain, confusion, loss of mental awareness, fatigue, tiredness, coughing with phlegm, fever, sweating, chills, below average body temperature in some instances, difficulty breathing, vomiting, nausea, diarrhoea, restlessness, headaches, loss of appetite, fast breathing or wheezing in infants, lips and nailbeds turning blue

Causes: Bacteria, Fungi, Viruses

Risk Factors: Compromised immune systems, pre-existing illnesses or chronic conditions, indoor air pollution, smoking or passive smoking, living in crowded spaces, using drugs or alcohol

Severity: Mild to severe (depending on the stage of infection)

Which doctor to consult: If an individual starts noticing symptoms, he/she can visit primary care providers or general physicians. They may direct the individual to a lung specialist, a respiratory therapist, or an infectious diseases specialist depending upon the severity of the cases.

Overview

Pneumonia is a disease that leads to inflammation in the alveoli (air sacs) in the lungs. The air sacs fill up with fluid or pus, resulting in coughing up phlegm. This disease can be caused by viruses, bacteria, fungi and other microorganisms. Some other symptoms of pneumonia include chills, difficulty breathing and fever.

Pneumonia can either be very mild or life-threatening. Especially, it is dangerous for newborns, children, people over 65, and those with complicated health issues.

Pneumonia, both viral and bacterial, is infectious. This implies that it can be passed from person to person by inhaling airborne particles or droplets from a cough or a sneeze. A patient can also contract this disease by coming into contact with objects or surfaces contaminated with bacteria or viruses that cause pneumonia. Fungal pneumonia, contracted from the environment, does not pass from person to person.

Furthermore, pneumonia can be classified into several stages based on the area of the lungs that the pathogen infects. Bronchopneumonia affects the entirety of the lung or lungs and is localised close to the bronchi or around them. On the other hand, lobar pneumonia is more nuanced and affects one or more lobes of the lungs.

Lobar pneumonia’s level of progression happens in four stages.

• Congestion: The lung tissues become heavy with infectious organisms and cause congestion.
• Red hepatisation: The lungs appear solid and red-coloured due to the accumulation of red blood cells and immune cells in the blood.
• Grey hepatisation: The red blood cells start to break down and change colour from red to grey, with only the immune cells remaining.
• Resolution: The infection starts to clear out from the lungs, and the remaining fluid gets ejected through cough.
• Pneumonia is curable. Typically a visit to the doctor is enough for it to reach its natural resolution. However, when left to fester for too long, it can result in severe infections that may require hospitalisation.

When to Consult a Doctor?

• On observing symptoms: Like every disease, it is best to see a doctor at the earliest signs of the illness. However, it can be somewhat confusing to figure out whether it is pneumonia or something less severe. Hence, it is best to look out for some of the more apparent signs of pneumonia. These symptoms include difficulty breathing, an abnormally high or low body temperature, coughing fits, chills, or all of them at once.
• Precautionary doctor’s visit: Nevertheless, even if these symptoms don't show up at once, it's best to receive a consultation from a regular physician. The doctor can then direct the patient to the right medical care provider. This can be a respiratory therapist, lung specialist or infectious diseases specialist.

Diagnosis

• Physical examination: During a physical examination, doctors generally glance through the patient’s entire medical history to determine the possibility of pneumonia. They then ask questions regarding the early occurrences of the symptoms. Post that, they may monitor the patient’s breathing pattern and record the pulse rate. To determine the infection's severity, lab tests can also be prescribed.

• Lab Tests

Blood culture: A blood test or blood culture is extremely effective in indicating whether an infection is present in the bloodstream or not. The arterial blood gas test checks the amount of oxygen in the bloodstream.

Sputum culture: Sputum tests are done on the saliva and mucus coughed up by the patient. This is also a good indicator of the presence of infection.

Pleural fluid culture: This uses the fluid present in the pleural space in the chest. The fluid is extracted by inserting a needle between the ribs. After that, the fluid is used to determine the presence of infection and identify its cause.

• Imaging Tests

CT scan: If the pneumonia is taking more time to heal, a doctor may order a chest CT scan to take a better look at the lungs.

Pulse oximetry: Pulse oximetry determines the amount of oxygen in the blood. A sensor attached to the finger of an individual indicates the oxygen saturation level in the bloodstream.

Chest x-ray: This is a vital test when diagnosing pneumonia and helps specify the infection's severity and location. However, it does not offer any insight into the cause of the infection.

• Advanced Tests

Bronchoscopy: A bronchoscopy helps to view the inside of the airway in the lungs using a camera fitted on the end of a flexible tube. The tube moves slowly down the throat and into the lungs. If the patient's early symptoms are severe, or if the patient is hospitalised and not responding to antibiotics, doctors may perform this test.

Treatment

• Home Care: Community-acquired pneumonia can be cured through home remedies. Most symptoms reduce in a few weeks. However, tiredness and fatigue can often persist for months. In addition, a regular physician can suggest certain antibiotics and cough medicine to help ease the symptoms. Nevertheless, it is not difficult to get rid of.

• Medication: Medications for pneumonia treatment can include antibiotics, cough medicine, fever reducers and pain relievers. Antibiotics are mainly used to treat bacterial pneumonia. Cough medicines, on the other hand, are used to reduce or suppress coughing fits. Moreover, doctors may prescribe pain relievers and fever reducers to ease the discomfort and bring the body temperature to normal levels. Some doctors may also prescribe immunity boosters to help fight the infection quickly.

• Hospitalisation: While pneumonia is highly treatable, in rare cases, it may require hospitalisation. This usually happens when the patient is either over 65 years or below two years old. Moreover, a patient must be hospitalised immediately if pneumonia affect the kidney or brain function. Abnormally low temperature or breathing difficulty may also signal severity. In this case, too, one may require hospitalisation.

Risks & Complications if Left Untreated

• Bacteraemia or sepsis: Bacteraemia occurs when infection enters the bloodstream and ends up in other organs, eventually causing an organ failure.
• Worsened chronic conditions: While pneumonia alone is curable, it can cause complexities in patients with immunosuppressive diseases such as HIV and diabetes. Pneumonia can have an aggravated impact and cause significant damage to the body.
• Lung abscesses: Lung abscesses are pockets of fluid or pus that form around the lungs and need to be drained through surgery.
• Impaired breathing: Pneumonia can lead to lifelong respiratory issues since it impacts the lungs directly.
• Pleural effusion: Pneumonia can cause fluid to accumulate in the narrow gaps between the tissue layers that border the lungs and chest cavity, known as pleura. If the fluid gets contaminated, it may need to be drained by a chest tube or surgically removed.

• Acute Respiratory Distress Syndrome (ARDS): This is a severe respiratory failure requiring immediate medical attention. It is categorised as a medical emergency.

Additional Information

Types of Pneumonia

• Community-acquired pneumonia: The most prevalent kind of pneumonia is community-acquired pneumonia. It happens outside of health facilities or other medical institutions. Bacteria, bacteria-like organisms, fungi, and viruses can all cause community-acquired pneumonia. Nevertheless, they are far easier to cure and less severe.
• Hospital-acquired pneumonia: Some individuals develop pneumonia while in the hospital for another ailment. Hospital-acquired pneumonia can be hazardous since the bacterium that causes it may be resistant to medication, and the patients who develop it are already severely ill. People who use ventilators are most susceptible to this kind of pneumonia.
• Healthcare-acquired pneumonia: Bacterial pneumonia that develops in individuals who reside in long-term care homes or receive care through outpatient clinics is known as healthcare-acquired pneumonia. Healthcare-acquired pneumonia, including hospital-acquired pneumonia, can be caused by antibiotic-resistant bacteria.
• Aspiration-acquired pneumonia: Aspiration pneumonia occurs when something disturbs the natural gag reflex in the human body. A brain injury, swallowing issues, or overuse of drugs and alcohol can result in aspiration-acquired pneumonia.