Dr. Gaurav Ghatawat
Chest Physician
According to a 2018 report released by Our World in Data, an online publication focusing on problems affecting the globe, pneumonia is a leading cause of death among children under five years of age globally. It also reveals that in 2017 alone, more than 809,000 children under five years lost their lives to this lung condition. [1]
Pneumonia is an inflammatory lung infection that primarily affects the alveoli (tiny air sacs in the lungs). The air sacs or alveoli may even get filled with fluid or pus, and the symptoms range from mild to severe. These prominent symptoms include cough with phlegm or pus, high fever, chills and breathing difficulties. Pneumonia, which can affect one or both the lungs, can be caused by viral or bacterial infections. Senior citizens (above 65 years of age), infants below two years, people with chronic lung conditions and severe infections are more vulnerable to pneumonia. This is because their immune systems are compromised. Also, lifestyle habits like smoking and alcoholism escalate your risk of catching this lung infection.[2]
Based on the causative organism and the location of infection, pneumonia can be divided into the following types.
Community-Acquired Pneumonia (CAP)
This occurs when the individual has not visited a hospital or a health care facility recently and is further subdivided as follows.
Consolidation, red hepatisation, grey hepatisation and resolution are the four stages of pneumonia. Their brief explanation is given below:
Consolidation
This stage occurs within the first 24 hours. Due to bacteria and fluid, the lungs become red, heavy and congested. A person experiences coughing and deep breathing during this stage.
Red Hepatization
This stage occurs around three days after the first stage. The lungs resemble the liver due to its red, firm and airless appearance. This stage is characterised by alveoli filled with erythrocytes, neutrophils, desquamated epithelial cells, and fibrin.
Grey Hepatisation
This is an avascular (no involvement of blood vessels) stage that occurs two to three days after the red hepatisation. In this stage, red blood cells collapse, which gives the lungs a greyish appearance. Lungs appear pale and dry. Fibrin and exudate (fluids consisting of cells and proteins which leak out from blood vessels into surrounding tissues) dominate this stage.
Resolution
This stage is achieved when the pulmonary structure returns to normal. Enzymatic digestion of exudate occurs, which gets reabsorbed, coughed out or ingested by macrophages. The consolidate tissue gets re- aerated. Fluid infiltration may cause excess sputum.[3]
Pneumonia mainly affects the lungs. The primary responsibility of the lungs is to oxygenate your blood and remove the excess carbon dioxide. For optimal functioning of the lungs, your airways (the bronchi) need to be open and clear. Any obstruction due to mucus will obstruct your airways, and this will lead to the symptoms of pneumonia.
Pneumonia is characterized by symptoms that include breathing issues, cough and high- grade fever. However, the signs and symptoms may differ based on age and the type of pneumonia you have as well as your overall health condition. Here, we guide you through some common manifestations.
Causes
Viruses, bacteria and fungi are the main culprits behind pneumonia. You are likely to catch this infection via droplets (loaded with these pathogens) which are emitted by an infected person as he coughs and sneezes. Contaminated fomites may also give you pneumonia. You can acquire this infection during a hospital stay while undergoing procedures related to ventilators, or from the people around you. The bacteria that are commonly responsible for this ailment are commonly known as Streptococcus pneumoniae and Mycoplasma pneumoniae. Respiratory viruses that could also be the culprits for pneumonia include influenza (flu), respiratory syncytial virus (RSV) and rhinoviruses (common cold). Additionally, fungi from the soil and bird droppings may also lead to pneumonia. Examples of these pathogens are Pneumocystis jirovecii, Cryptococcus species, Histoplasmosis species, etc.[5]
Risk factors
High-risk groups for pneumonia are as follows:
The best way to prevent pneumonia is through vaccination. Pneumococcal vaccine, PCV13 and Haemophilus Influenzae Type b (Hib) can protect you against bacterial pneumonia. A regular flu shot is recommended as well to safeguard you against pneumonia which often accompanies flu. Apart from vaccines, other infection control measures can be taken.
A review of medical history and physical examination are of priority to detect pneumonia. Lungs will make crackling, bubbling or rumbling sounds in case of pneumonia. On suspicion of pneumonia further tests may be advised.
The line of treatment depends on the type of pneumonia you are suffering from. For bacterial pneumonia, your doctor will prescribe antibiotics. For viral form, he will suggest antiviral medications. Fungal pneumonia requires antifungal medications. Your physician may also prescribe cough medications to help you eliminate it. The infection will take long to recover.
Alongside your medicines, you will need to rest a lot and keep yourself sufficiently hydrated. In case of severe pneumonia, hospitalisation may be required. Hospital treatment may include intravenous antibiotics, respiratory therapies that involve administering drugs and breathing exercises, etc. You may also need oxygen therapy to increase its levels in your bloodstream. This therapy is carried out through a nasal tube, face mask, or ventilator. The severity of your condition will determine the device to be used.[2]
Quit smoking because it can have a detrimental effect on your lungs.
Ensure adequate intake of vitamins including vitamin C rich foods like strawberries, papaya, broccoli and peas have proven beneficial in preventing and treating pneumonia.
Your diet should have sufficient minerals like zinc as these are useful in building immunity and preventing pneumonia.[6]
Prognosis
The prognosis of an individual with pneumonia depends on three factors, viz age, existence of comorbidities and severity of disease, if any. For patients treated on an outpatient basis, mortality is less than 1%. For patients admitted in a ward, the mortality ranges from 5% to15% and from 20% to 50% for patients admitted in an ICU (Intensive care unit).[7]
Complications
This lung infection may come with a host of other health complications. Here is a low-down on them.
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Flu and pneumonia can increase the risk of having a heart attack and stroke by six times, states a study.
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