Pneumonia is one of the most prevalent diseases on the planet. So much so that it’s hard to estimate the number of people that have it in the world. There are as many people that have it sub clinically as there are people that have it in the clinically detectable form and are under treatment. So what is pneumonia, what are the organisms and substances that cause it, what are some of the risk factors and what are the types of pneumonia? How do the signs and symptoms manifest, what are its dangerous signs and how do doctors manage it?
Pneumonia is an acute respiratory illness consisting of inflammation of the lungs with productive cough, fever and physical and radiological changes that are compatible with consolidation of the lungs. The organisms that cause pneumonia vary from person to person and are different with different age groups and personal habits. From Hemophilus influenza, which is prevalent in smokers to Pneumocystis jiroveci which is prevalent in patients with HIV, to Staph and Strep infections that many people have heard about, there is always going to be a multitude of organisms and substances that cause Pneumonia.
There are also a range of things that can put one at the risk of having pneumonia. Many of these can be avoided such as cigarette smoking, excessive alcohol consumption and intravenous drug abuse. Other risk factors however are not so easy to avoid, such as lung cancer but not if it’s due to smoking and immune-suppression due to extensive steroid therapy or HIV infections.
Pneumonia can affect two places in the lungs. It can affect the lung lobes and it can affect the bronchial airways or both. Doctors furthermore classify it according to acquisition, whether its community acquired, hospital acquired, aspiration pneumonia (here pneumonia occurs when food is regurgitated and it accidentally goes into the trachea) and pneumonia in the immunocompromised.
The clinical features of pneumonia include cough, fever, chest pain, shortness of breath, loss of appetite and confusion. The doctor examining such a patient will note an increase in heart rate but a decrease in blood pressure and bluish discoloration of lips and finger tips. There will be an array of changes during the examination of the chest corresponding to congestion. Most cases will undergo spontaneous resolution, however many cases will require medications and medical intervention. Some cases that have undergone the severe form of the disease will be in respiratory distress, circulatory shock and reductions in consciousness levels. The problems of pneumonia will be compounded if there is a coexisting disease.
The investigation of choice for a patient with a provisional diagnosis of pneumonia is the Chest X-ray. It is followed by taking a sample of sputum from expectorated cough or in children a throat swab for culture. Blood oxygenation levels are monitored in severe cases and, blood related investigations are also done. In the most confounding cases a biopsy (the pleural biopsy which consists of taking a sample tissue from the lung and observation of it under a microscope) is performed.
Managing pneumonia consists of administering oxygen and IV fluids. Treatment of chest pain is with opiates. Antibiotics are given empirically at first but are switched if needed after culture and sensitivity. Sometimes with or without treatment complications can occur ranging from lung collapses to infections of the adjacent organs. Complications beyond the scope of pneumonia can also occur in which other far off organs and systems are involved, another major one being rheumatic heart disease which affects children exposed to a certain type of streptococcal infection.
As mentioned above many cases of pneumonia resolved on their own. In the times when antimicrobial agents weren’t discovered or developed people suffered from pneumonia but eventually would get better on their own with therapies done at home. Hot soups, steam inhalation, plenty of fluids and bed rest were the key and these techniques hold firm ground in getting better from the common cold to very debilitating diseases and will continue to be so just as long as mankind exists. However historically there were a number of people that succumbed to the disease and died as well. Even today the sick, frail and elderly die due to pneumonia and its complications. But in today medications have been developed to combat the various forms and causative agents of pneumonia. Hospital stays have shortened and the time of infection to the time of resolution has also decreased. Complications are better controlled and prevented with today’s medical techniques. Vaccines have been developed to provide immunity against some particularly troublesome bacteria and viruses. So will pneumonia always be a threat to life? I would say no for the average person adult or child and even for many people living with different co-morbid conditions.