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9 February 2018 | Feature Article

Pneumonia, Know About Pneumonia

Pneumonia, Know About Pneumonia

Pneumonia is microbial (bacteria, viruses, fungi) infection of the lung(s).

The infection may result in lung air-sacs (alveoli) getting filled with fluids and pus, instead of air.

Pneumonia, may be life-threatening, and has been a leading cause of death, in children under 5 years, and, in those 65 years and older. Worldwide, pneumonia kills 3 million children annualy.

Who Is at Risk for Pneumonia?
Age: Pneumonia occurs at all ages, but much common in those younger than 5, and those at or older than 65 years.

Sex: Men are at a higher risk, than women.
Medical problems: Diabetes, COPD, Emphysema, Heart failure, sickle cell, stroke

Lifestyle: Smoking and alcohol intoxication.

ETIOLOGY
Pneumococcus (Streptococcal pneumonia), is the commonest cause of pneumonia.

Others bacteria include: Mycoplasma pneumoniae(walking pneumonia), Chlamydia pneumoniae, and Haemophilus influenzae.

Respiratory viruses, especially in children. They include: Flu viruses, the Respiratory syncytial virus.

Most respiratory viruses. especially the influenza viruses, injure the lung, making it possible for bacteria like Pneumococcus, Staphylococcus aureus to supra-infect the lung, a week or two, later.

TRANSMISSION:
The pathogens are transmitted airborne, from respiratory droplets from the throat, mouth and nose of an infected person.

SIGNS AND SYMPTOMS OF PNEUMONIA.
Fever
Cough
Phlegm production
Difficulty breathing
Chest pain on breathing
Fast Breathing
Fast heart beat
Abnormal breath sounds, on listening to the lungs
Confusion/Alteration in mentation, especially in the elderly.

DIAGNOSIS OF PNEUMONIA
A Chest X ray may show:
. Lung infiltration
. Pus/fluid in the lung
. Cavities in the lung
. Normal lung, (in those with severe dehydration).
In addition to a Chest X ray, Physicians may order
Blood test including:
. Total Blood Count and
. Serum Chemistry and Serology
Assessment of the body's oxygen saturation with a Pulse Oximeter must be done.

SEVERE PNEUMONIA. (This requires management in the intensive care setting).

In severe pneumonia, the elderly person may have:
. A Low body temperature, instead of fever.
. Become Confused and disoriented
. Respirations are usually, faster than 30/minute
. Chest X Ray, shows infiltration in more than 1 lobe.

TREATMENT OF PNEUMONIA.
Antibiotics are used to treat pneumonia. The antibiotic chosen will depend on the person's pre-existing conditions.

a.) An Adult in Normal Health: Usually, either Doxycycline or a macrolide (Azithromycin, Clarithromycin) is given for 5 days.

b.) Those at Risk for Pneumonia:, a combination of antibiotics is given

Either a Beta lactam (Amoxicillin, oxacillin) or a Fluoroquinolone (levofloxacin, moxifloxacin) Plus, either a Macrolide (azithromycin, clarithromycin), or Doxycycline, for 5 days.

COMPLICATIONS OF PNEUMONIA.
Fever, cough and breathing difficulties should improve with antibiotics within 2-3 days.

A pneumonia complication must be suspected, if the pneumonia symptoms do not improve within 3 days of starting antibiotics. Pneumonia complications include:

. Pleural effusion (fluid collection between the lungs and the chest).

. Empyema (collection of pus between the lungs and the chest)

. Lung Abscess
. The bacteria may spread into the general circulation, which may lead to sepsis and death

. Respiratory Failure.
All the pneumonia complications are life-threatening conditions which require intensive care management.

PREVENTION OF PNEUMONIA.
Most pneumonias could be prevented with vaccines. Pneumococcus, is the commonest cause of pneumonia. Two vaccines have been developed to prevent pneumonia.

Pneumococcal vaccines are: Prevnar13 (a pneumococcal conjugate vaccine)and Pneumovax 23 (polysaccharide vaccine).

PREVNAR 13 prevents pneumococcal pneumonia in both children and adults. Children who have completed their childhood vaccines, do not need this again

All adults aged 65 years and over require this vaccine, and so do

Younger adults with impaired immunity (sickle cell, HIV, cancer), and

All those adults, at risk for pneumonia, including those with cochlear implants.

PNEUMOVAX 23
This vaccine also protects against pneumococcal infections, in adults. It is not a conjugate vaccine, so protection is not long-term.

Both vaccines could be given to same person, but only after 1year interval. This is because Pneumovax 23 reduces the effectiveness of Prevnar, when both are given within the same year.

The recommendation is All elderly persons must receive Prevnar 13, followed by Pneumovax 23, at least 1 year later.

INFLUENZA Vaccines also help to reduce the incidence of pneumonia.

Author: Alex Sarkodie MD
Stories: 26 Publication(s)
Column: AlexSarkodie
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