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Stop pneumonia before it strikes

By Sola Ogundipe

Pneumonia is an infection in one or both   lungs. Many germs, such as bacteria, viruses, and fungi, can cause pneumonia. It is not a single disease and can have more than 30 different causes. The most common bacterial type that causes pneumonia is Streptococcus pneumoniae.

Common causes 

Streptococcus pneumoniae, a type of bacteria, is the most common cause of pneumonia. Legionella pneumophila is the bacterial type that causes the pneumonia known as Legionnaires’ disease. Other bacteria types that can cause pneumonia include the bacteria that cause so-called “atypical” pneumonia, Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumonia.

How it starts/spreads

You can get pneumonia in your daily life, such as at school or work. You can also get it when you are in a hospital or nursing home.   Pneumonia usually starts when you breathe the germs into your lungs. You may be more likely to get the disease after having a cold or the flu. These illnesses make it hard for your lungs to fight infection, so it is easier to get pneumonia. Having a long-term, or chronic, disease like asthma, heart disease, cancer, or diabetes also makes you more likely to get pneumonia.

When you have pneumonia, oxygen may have trouble reaching your blood. If there is too little oxygen in your blood, your body cells can’t work properly. Because of this and the risk of the infection spreading through the body, pneumonia can cause death.

Pneumonia affects your lungs in two ways. It may be in only one part, or lobe, of your lung, which is called lobar pneumonia. Or, it may be widespread with patches throughout both lungs, which is called bronchial pneumonia (or bronchopneumonia).

Signs and symptoms

These include fever, chills, cough, shortness of breath, and fatigue. Community-acquired pneumonia (CAP) is acquired outside of the health-care setting and is typically less severe than hospital-acquired pneumonia (HAP). About 20 percent of those with CAP require treatment in a hospital.

Symptoms of pneumonia caused by bacteria usually come on quickly. They may include coughing up mucus (sputum) from your lungs. Mucus may be rusty or green or tinged with blood.

Fever – Fast breathing and feeling short of breath. Shaking and “teeth-chattering” chills. Chest pain that often feels worse when you cough or breathe in, fast heartbeat, feeling very tired or very weak, nausea and vomiting and diarrhoea.

When you have mild symptoms, your doctor may call this “walking pneumonia.” Older adults may have different, fewer, or milder symptoms. They may not have a fever. Or they may have a cough but not bring up mucus. The main sign of pneumonia in older adults may be a change in how well they think. Confusion or delirium is common. Or, if they already have a lung disease, that disease may get worse.

Symptoms caused by viruses are the same as those caused by bacteria. But they may come on slowly and often are not as obvious or as bad. After you’ve been infection with a pneumonia-causing organism, symptoms appear in 1 to 3 days or as long as 7 to 10 day. How severe pneumonia is and how long it lasts depend on the following:

Age and health-Older, sicker people usually have more severe cases. And their cases of pneumonia are more likely to cause complications, such as bacteria in the bloodstream (bacteremia) or throughout the body (septicemia). Whether bacteria or a virus caused the pneumonia. Viral pneumonia usually is less severe than bacterial pneumonia.

How quickly it is treated: The sooner you treat pneumonia, the sooner symptoms go away.

Immune system: People who have impaired immune systems are more likely to have more severe pneumonia than people who have healthy immune systems.

In healthy people, pneumonia can be a mild illness that is hardly noticed and clears up in 2 to 3 weeks. In older adults and in people with other health problems, recovery may take 6 to 8 weeks or longer.

Going to the hospital

If you have severe pneumonia, you may have to go to the hospital: In most cases of pneumonia you get in your daily life, such as at school or work (community-based pneumonia), it is not necessary to go to the hospital. About one-third of people with community-based pneumonia are age 65 or older. Older adults are treated in the hospital more often and stay longer for the condition than younger people. Pneumonia is more serious in this group, because they often have and may develop other medical problems.

Spreading pneumonia to others

If pneumonia is caused by a virus or bacteria, you may spread the infection to other people while you are contagious. How long you are contagious depends on what is causing the pneumonia and whether you get treatment. You may be contagious for several days to a week. If you get antibiotics, you usually cannot spread the infection to others after a day of treatment

Examinations and tests 

Diagnosis begins with medical history, physical examination, and chest X-ray, which is almost always done to check for changes in the lungs that may mean pneumonia and to look for other causes of your symptoms. But an X-ray does not always show whether you have pneumonia, especially if it is done when you first get sick. In some cases, the X-ray results may suggest the type of organism (bacterial, viral, or fungal) causing pneumonia.

It may also show complications of pneumonia, such as infection of the heart muscle or the sac surrounding the heart; conditions that may occur with pneumonia, such as fluid in the chest cavity or a collapsed lung, and reveal another condition, such as heart failure, lung cancer, or acute bronchitis.

Lab tests 

The need for more tests often depends on how severe symptoms are, age, and   overall health. In general, the sicker you are, the more tests you may need. This is especially true for older adults and infants. One example of a test you may have is the arterial blood gas test.

Mucus test-If you are very ill, have severe shortness of breath, or have a condition that increases your risk (such as asthma or COPD), your doctor may test your mucus. Tests include a Gram stain and a sputum culture.

Rapid urine test-This test can identify some bacteria that cause pneumonia. This can help guide treatment for pneumonia.

HIV test-In people who have impaired immune systems, pneumonia may be caused by other organisms, including some forms of fungi. Other lung tests-If you have severe pneumonia, you may need other tests, including tests to check for complications and to find out how well immune system is working.

Treatment

Antibiotics treat pneumonia by controlling the bacterial or fungal infection. The initial choice of antibiotic depends on the organism presumed to be causing the infection as well as local patterns of antibiotic resistance. Antibiotic medications are the treatment of choice for pneumonia caused by bacterial and fungal infections. The exact choice of medications depends on many factors. Antibiotics are not effective against viral pneumonia. Depending upon the type of virus that causes pneumonia, antiviral medications can provide benefit when started early in the course of the disease. Pneumonia can be fatal in up to 30 per cent of severe cases that are managed in the intensive-care setting. Complications of pneumonia include sepsis, pleural effusion, and empyema.

Risk factors

There are a number of factors that increase the risk of developing pneumonia. These include a weakened immune system, either due to disease such as HIV/AIDS or cancer, or to medications that suppress immune function; infants and children 2 years of age or younger; age 65 and older.

Others are having a chronic disease such as cystic fibrosis, COPD, sickle cell anemia, asthma, heart disease, or diabetes; swallowing or coughing problems, as may occur following stroke or other brain injury; being a patient in an intensive-care unit of a hospital, particularly if on ventilator support; malnutrition; and cigarette smoking.

Complications

There are a number of potential complications of pneumonia. The infection that causes pneumonia can spread to the bloodstream, causing sepsis. Sepsis is a serious condition that can result in lowering of blood pressure and failure of oxygen to reach the tissues of the body. Another complication is the accumulation of fluid in the space between the lung tissue and the chest wall lining, known as a pleural effusion. The organisms responsible for the pneumonia may infect the fluid in a pleural effusion, known as an empyema. Pneumonia can also result in the formation of an abscess (collection of pus) within the lungs or airways.

Prevention

Most people with pneumonia improve after three to five days of antibiotic treatment, but a mild cough and fatigue can last longer, up to a month. Patients who required treatment in a hospital may take longer to see improvement. Pneumonia can also be fatal. The mortality (death) rate is up to 30 per cent for patients with severe pneumonia who require treatment in an intensive-care unit. Overall, around 5-10 per cent of patients who are treated in a hospital setting die from the disease. Pneumonia is more likely to be fatal in the elderly or those with chronic medical conditions or a weakened immune system. It is not possible to prevent all types of pneumonia, but one can take steps to reduce the chance of contracting the condition by quitting smoking, practicing good hand-washing, and avoiding contact with people who have colds, the flu, or other infections.

Immunisation

A vaccine is available against the most common bacterial cause of pneumonia, Streptococcus pneumoniae (Pneumococcus). There are two types of vaccine: PPSV23 (Pneumovax), a pneumococcal polysaccharide vaccine against 23 types of the bacteria, and PCV13 (Prevnar 13), a pneumococcal conjugate vaccine that protects against 13 types of the bacteria. These vaccines may not always prevent pneumococcal pneumonia, but they may prevent serious complications of pneumonia if it does occur.

Key Facts

Pneumonia is an infection in your lungs. It may be a complication of infection. Most healthy people recover from pneumonia in 1 to 3 weeks, but it can be life-threatening. One form of bacterial pneumonia can be prevented by getting vaccinated and practicing good health habits. A chest X-ray is typically done to diagnose pneumonia. Vaccinations are available against several common organisms that are known to cause pneumonia. Understanding the cause is important because   treatment depends on its cause. Pneumonia is a lung infection that can make you very sick. You may cough, run a fever, and have a hard time breathing. For most people, pneumonia can be treated at home. It often clears up within three weeks. But older adults, babies, and people with other diseases can become very ill. They may need to be in the hospital.

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