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Pneumonia (Lung Infection)


Pneumonia is an infection that causes inflammation of the air sacs in one or both lungs. The air sacs may be filled with fluid or pus (purulent material) which causes cough with phlegm or pus, fever, chills, and difficulty in breathing. There are a variety of organisms that can cause pneumonia which includes bacteria, viruses and fungi.

Pneumonia can be mild or even life-threatening. It can cause most serious damage to infants and young children, people older than age 65, and people with health problems or weakened immune systems.

Symptoms

The signs and symptoms of pneumonia may vary for different individuals. It depends on factors such as the type of bacteria causing the infection, the patient’s overall health. Besides, the signs and symptoms can range from mild to severe. Mild signs and symptoms usually are almost identical to those of a common cold or flu; however, they will last longer.

Most of the pneumonia patients will experience chest pain when breathing or coughing, having confusion, productive cough (with phlegm), fatigue, fever, sweating, chills, nausea, vomiting, diarrhea and shortness of breath. For patients age 65 and above, they also experience signs and symptoms such as changes in mental awareness and lower body temperature. There may be no signs or symptoms at all in newborns and infants. However, some newborns and infants may vomit, fever, cough, lethargy and have difficulty in breathing and eating if they are infected.

Causes

The common causes of pneumonia include viruses, bacteria and fungi. For example, the common causes of viral pneumonia are influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19). On the other hand, the common cause of bacterial pneumonia is Streptococcus pneumoniae (pneumococcus). However, it is hard for the physicians to detect which bacteria causes the pneumonia in patients.

We also say it is community-acquired pneumonia when someone got the pneumonia in the community (not in a hospital). While if someone develops pneumonia in a healthcare setting (hospital, long-term care facilities, dialysis centre), that would be considered as healthcare-associated pneumonia. Ventilator-associated pneumonia is when someone develop pneumonia after using ventilator (a machine that supports breathing).

Risk Factors

Pneumonia can affect anyone regardless of the age; however, children under 2 years old and adult above 65 years old are at the highest risk to get pneumonia. Even the signs and symptoms are more severe in this age group.

There are few risk factors that may contribute to developing of pneumonia, such as being in hospital as the patient’s immune system is already weakened especially if the patient is using a ventilator, the risk is even greater. Having a chronic disease such as COPD, asthma, heart disease, diabetes will pose a greater risk to the patient. People with suppressed immune system either due to disease or taking immunosuppressants will also have a greater risk of contracting pneumonia. 

There are some lifestyles that will increase the risk of getting pneumonia. For example, smoking will compromise the immune system’s ability to defend itself. Drug or excessive alcohol use will also increase the risk of developing pneumonia as one may aspirate food, drink or vomit into the lungs. Being malnutrition also contributes to a higher risk of contracting pneumonia and a higher death risk.

Treatment

A mild pneumonia can be usually treated at home with rest and antibiotics (if the cause is bacteria). Drinking plenty of fluid is also necessary in recovery from pneumonia. Antibiotics should be taken as prescribed by doctors following the course even if the patient already feels better. This is because if stopped half way without finishing the antibiotic course, it will create an antibiotic resistant in the bacteria which help the bacteria to evolve and become stronger. There is a general guideline for the recovery of pneumonia.

  • 1 week: high temperature should have reduced
  • 4 weeks: chest pain and mucus production should have slowly decreased
  • 6 weeks: cough and breathlessness should have substantially reduced
  • 3 months: most symptoms should have reduced, just the patient may still feel fatigue
  • 6 months: many people will feel back to normal

However, if there is no improvement after three days of starting antibiotics, the patient should go to doctor. This may due to the bacteria causing the infection is actually resistant to the antibiotic prescribed by the doctors or the pneumonia is not caused by bacteria rather it is caused by virus.

Painkillers such as paracetamol and ibuprofen usually will be given also to cope with the pain and fever. Cough medicine can also help to relive the cough and phlegm so that the patient can have a good rest.

There will usually be a follow up with doctor after 6 weeks of starting an antibiotics course. A chest X-Ray may be needed for patient whose symptoms have no improvement at all or the symptoms come back after they have gone away.

Hospitalization may be needed for patient who is older than 65 years old, having signs of confusion, declined kidney function, low blood pressure, rapid breathing, need breathing assistance, low body temperature or a rapid heart rate.

Prevention

Pneumonia can be prevented by getting vaccination. Taking a flu shot every year can help to prevent seasonal flu. It is important as flu is a common cause of pneumonia. Certain group of people should also take vaccination against pneumococcal pneumonia as it is a common form of bacterial pneumonia. This group of people includes children younger than 2, children aged 2 to 5 but with chronic disease, adults aged 19 to 64 with chronic disease such as asthma, COPD, diabetes and also includes all adults older than 65 years old.

Regularly hand washing especially after coughing or blowing your nose can also reduce the risk of getting pneumonia. Avoid smoking as tobacco damages the lungs’ ability to fight infection, which will expose the smoker to higher risk of getting pneumonia.

Good habits such as eating healthy diet, having sufficient rest and exercise regularly can keep one from illness. They also help to boost the recovery from respiratory illness such as cold and flu. Patient with existing respiratory health conditions such as asthma, COPD, diabetes and heart disease should also manage their condition well to lower the risk of getting pneumonia.

Reference

– Pneumonia. https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204#:~:text=Pneumonia%20is%20an%20infection%20that,and%20fungi%2C%20can%20cause%20pneumonia. Mayo Clinic. June 13, 2020.
– Causes of Pneumonia. https://www.cdc.gov/pneumonia/causes.html#:~:text=Common%20Causes%20of%20Pneumonia,is%20Streptococcus%20pneumoniae%20(pneumococcus). Centers for Disease Control and Prevention. October 22, 2020.
– Causes and Risk Factors of Pneumonia. https://www.verywellhealth.com/pneumonia-causes-risk-factors-770691. Verywell Health. Accessed April 8, 2022.
– The impact of childhood malnutrition on mortality from pneumonia: a systematic review and network meta-analysis – World. https://reliefweb.int/report/world/impact-childhood-malnutrition-mortality-pneumonia-systematic-review-and-networkmeta#:~:text=We%20estimated%20a%20median%2018.3,dramatically%20increases%20with%20malnutrition%20severity. ReliefWeb. Accessed April 8, 2022.
-https://www.nhs.uk/conditions/pneumonia/treatment/#:~:text=Mild%20pneumonia%20can%20 usually%20be,cases%20may%20need%20hospital%20treatment. NHS Choices. Accessed April 8, 2022.
– Preventing Pneumonia. https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/preventing-pneumonia#:~:text=Get%20a%20flu%20shot%20every,Children%20younger%20than%202. American Lung Association. Accessed April 9, 2022.