Understanding pneumonia - causes, symptoms,vaccine, prevention, treatment

We talked to Dr Mehul Thakkar about pneumonia and its symptoms, diagnosis, treatment, vaccination and complications.

These days it is not uncommon to hear about people suffering from pneumonia, children and senior citizens especially so. We talked to Dr Mehul Thakkar, experienced pulmonologist working with Jupiter Hospital, Thane about pneumonia and its symptoms, diagnosis, treatment, vaccination and complications.

How can one recognise pneumonia? What are the classic symptoms?

Pneumonia is a disease in which lungs get filled up with pus like fluid mostly due to an infection. Commonly patients would complain of cough with green or yellow sputum; occasionally the sputum is rust colored or with frank blood, fever usually high grade (more than 100 F), chest pain while breathing -pricking or dull aching type with or without shortness of breath. Chills (called rigors) and a change in mental status (confusion, unclear thinking) can occur. In children, there may additionally be lethargy, restlessness, inability to eat due or loss of appetite, or abdominal pain.

How does a common cold progress to pneumonia?

Pneumonia can follow a common cold. The agents causing pneumonia are most often transmitted by droplet spread resulting from close contact with a source case. Contact with contaminated fomites also may be important in the acquisition of viral agents. An upper respiratory tract illness permits invasion of the lower respiratory tract by bacteria, viruses, or other pathogens that trigger the immune response and produce inflammation. The lower respiratory tract air spaces fill with white blood cells (WBC), fluid, and cellular debris.And the pathogens along with the cells, fluid and debris cause all the symptoms of pneumonia. (Read: Why you shouldn't neglect cough)

What predisposes people to this condition?

High risk groups include:

• People above 65 years of age
• Smokers
• Malnourished patients
• People with existing lung problems like bronchiectasis, asthma or chronic obstructive pulmonary disease (emphysema)
• People with medical problems like diabetes or chronic kidney or heart disease
• People with a weak immune system due to HIV infection, organ transplant, cancer chemotherapy, or steroid use for a long time
• People with difficulty coughing due to stroke, sedating drugs or alcohol, or limited mobility
• People who have had a recent viral upper respiratory tract infection including influenza

What should the patient's caretakers do in order to avoid the onset of the disease?

Infection control measures can help to prevent the spread of any type of infection, including pneumonia. Frequent hand washing with soap and water or alcohol-based hand rubs can be effective.Because pneumonia is spread by contact with infected respiratory secretions, people with pneumonia should limit face-to-face contact with uninfected family and friends. The mouth and nose should be covered while coughing or sneezing, and tissues should be disposed of immediately. Sneezing/coughing into the sleeve of one's clothing (at the inner elbow) is another means of containing sprays of saliva and secretions and has the advantage of not contaminating the hands.

The best way to prevent infection with pneumococcus bacteria is pneumococcal vaccine. The influenza vaccine can also help to prevent pneumonia, which can develop as a complication of the flu.

Who are the ideal candidates for the pneumonia vaccine?

Everyone aged 65 years or older should be vaccinated, if they have not previously been vaccinated.

In the case of younger people whose immunity isn't very good and are at risk of pneumococcal disease (people with diabetes mellitus, heart and lung disease, alcoholism, liver disease, cerebrospinal fluid leaks, cochlear implants, those with a weakened immune system, those who have no spleen, adults who smoke cigarettes, and people living in special environments like the nursing home residents) should also be immunized.

Those aged 2 to 64 years who are at risk for pneumonia (usually family members and/or caretakers of those affected) should be given the vaccine when the need for immunization is recognized.

Lastly, women who are pregnant or who intend to become pregnant should receive the vaccine if they have an indication.

How is pneumonia diagnosed and treated?

Medical history and physical examination usually gives some clues in the diagnosis of pneumonia. Chest x-ray and sometimes CT scanmay also be used. The patient's sputum (collected from a deep cough) may be tested for identification of the bacteria that caused the pneumonia.

Patients who require hospitalization may undergo blood testing, including a complete blood cell count (CBC) and sometimes a blood culture. A CBC measures the number of many types of blood cells, including white blood cells (WBC); these cells multiply when there is a bacterial infection.

A sample of blood from a vein may be taken for culture and tested for bacteria. Normally, there should be no bacteria in the bloodstream. Blood cultures are used to identify the bacteria that caused the pneumonia and to guide the choice of antibiotic.Urine tests can be helpful for diagnosing pneumonia caused by certain bacteria.

Pneumonia can decrease the amount of oxygen available in the blood. Measuring blood oxygen levelcan also help with the diagnosis. It is measured by attaching a small clip to the finger or ear that uses infrared light or by taking a blood sample from an artery.

Endoscopy of the lungs i.e. bronchoscopy may be required in patients who present initially with severe pneumonia or who fail to improve or worsen during their hospitalization despite treatment with antibiotics. In this procedure, a physician uses a thin, flexible tube with a camera to view the trachea and bronchi (the tube between the trachea and lungs). This allows them to look directly at the lungs, collect fluid samples or a biopsy (a small tissue sample), and determine whether there is an underlying cause of infection, such as a mass or inhaled foreign body.

Most patients are treated with oral antibiotics at home. Some severe cases might require hospitalization, if very severe. The number of days spent in the hospital is variable, and depends upon how a person responds to treatment and if there are underlying medical problems.

Some patients, including people with previous lung damage or disease, a weakened immune system, or infection in more than one lobe of the lungs, may be slow to recover and require a longer hospitalization. Improvement occurs after three to five days of antibiotic treatment. Cough and fever decrease but fatigue and a persistent but milder cough can last for up to one month, although most people are able to resume their usual activities within seven days. Patients treated in the hospital may require three weeks or more to resume normal activities

Why is pneumonia dangerous? What are the possible complications of leaving this condition untreated?

Pneumonia can usually be treated successfully without leading to complications. However, complications like the ones listed below can develop in some patients, especially those in high-risk groups.

Fluid or pus could get accumulated (also called effusion) between the covering of the lungs (pleura) and the inner lining of the chest wall; this is called a pleural effusion (or empyema in case of pus). A chest tube (or less commonly, surgery) may be needed to drain the fluid/pus.

Pus might collect in the lung area infected with pneumonia (also known as an abscess). Rarely this may require surgery.

Bacteria can spread to the bloodstream and other organs. This is a serious complication since the infection can cause the blood pressure to be dangerously low.

Although most people recover from pneumonia, it can be fatal in some cases. Approximately 5 to 10 percent of patients admitted to a general medical ward, and almost 30 percent patients with severe infection admitted to an intensive care unit can die. (Read: Diarrhoea and Pneumonia: The biggest killer diseases of kids!)

Read more about causes, symptoms, diagnosis and treatment of lung disease.

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