How do we get Pneumonia?
What is pneumonia?
Pneumonia is an infection born out of inflammation in the air sacs of your lungs called alveoli. Alveoli are found at the end of the bronchioles or the joining air tubes of the lungs, where the circulating blood in our body exchanges oxygen and carbon dioxide every time we breathe in and out. When these are inflamed, in one or both of our lungs, these sacs start filling with pus or fluids. It leads to bouts of cough with phlegm or pus, often accompanied by fever or chills. Over time this blocks the air sacs causing breathing difficulty.
Who is at risk?
Pneumonia can vary between mild to life-threatening. However, it can be serious for :
- Children up to 5 years of age: Due to weakened immune systems.
- Seniors around the age of 65 years: Due to weakened immune systems, existing chronic diseases, hospitalisation, etc.
- Those hospitalised for long periods and have machine-assisted breathing. Also, those who are undergoing daycare or OPD treatments.
- Those with pre-existing problems like asthma, COPD and cardiac diseases.
- Chain smokers, since their respiratory and circulatory systems, are weak, making it ideal for infections to grow.
What causes pneumonia?
This is an infection that spreads over an inflamed surface. This is the perfect breeding ground for a variety of organisms, like bacteria, viruses and fungi, which can all cause pneumonia. Of all the germs, airborne bacteria and viruses are the most common causes.
Our immune system is capable of dealing with this infection, but sometimes these germs can also overpower it despite having good health. We can classify pneumonia based on the germ that causes the infection and the place where it is acquired from.
Bacteria or Bacteria organisms: One lobe-inflamed pneumonia caused by streptococcus pneumoniae bacteria is called lobar pneumonia. Those experiencing illness, poor nutrition, old age, or impaired immunity are more susceptible to this. When both lobes are affected by the mycoplasma pneumonia bacteria it is called bronchial pneumonia. This is mild and does not require bed rest, hence referred to as Walking Pneumonia.
Virus or virus-like organisms: Various viruses can cause this, but almost 1/3rd of all cases are traced back to the flu (influenza) virus. Bacterial pneumonia can also develop in an existing viral infection. With the recent onset of the COVID-19 virus, pneumonia was a closely followed occurrence in the majority of cases. Viral pneumonia is very common in children.
Fungi: Fungal infection is common for people having chronic health problems and weak immune systems. It is also found in people with proximity to higher concentration of fungal matter. For example Fungi rich soil or bird droppings.
Community-acquired pneumonia: This is a community-based spread of the infection and is concentrated in areas where more people are suffering from the infection. This was a phenomenon we observed during the COVID-19 outbreak. Containment zones depicted where the infection was spreading more.
Hospital/ Healthcare acquired pneumonia: This can happen in two ways: during prolonged hospital stays due to or during daycare or outpatient treatments.
In the first case, the infection is acquired during hospital stays for ongoing treatment. The infection develops a higher resistance to antibiotics, due to pre-existing comorbidities for which the patient is undergoing a prolonged hospital stay. Usually, these patients have to be put on ventilation devices from which the infection travels.
In the second case, it is acquired from daycare procedure devices. For example, Dialysis or OPD treatment, assisted living facilities. These usually transmit from commonly used equipment.
Other ways of acquiring pneumonia:
When you inhale any type of food or drink, bodily fluids like the vomit or saliva of an infected patient into your lungs can also get pneumonia.
What are the symptoms of pneumonia?
The symptoms are dependent on the germ causing the Pneumonia, your age and your level of immunity. While a newborn’s prominent symptom will be fever & vomiting, an older person might show increased weakness and lower body temperature. So every case will be different. The overall symptoms common to all forms of pneumonia are:
- Green/ yellow/ bloody mucous heavy cough.
- Difficulty in breathing, gasping, shallow or rapid breathing.
- Fever or cold sweats with chills
- Sharp or deep chest pain that increases with deep breaths or bouts of cough
- Low energy and fatigue due to coughing fits
- Nausea and vomiting primarily in children
- Sudden disorientation post a coughing fit primarily in older people
Bacterial pneumonia is more serious than others. Here symptoms surface with very high fever, excessive sweating, rapid change in pulse rate and pale or bluish lips and nail beds due to lack of oxygen. Lack of oxygen also makes these patients delirious.
Viral pneumonia develops over several days. Initial symptoms are like flu, which gets worse, with increased coughing, breathlessness and muscle pain. Fever will follow if the symptoms are not attended to.
How is pneumonia diagnosed?
Your recent health and travel history might be enough to diagnose pneumonia. In addition to this, an ENT or Pulmonologist will perform a physical examination. After assessing these the following tests will be performed:
- Thoracic cavity X-ray: To get proper imaging of the internal tissues, bones, and lungs.
- Blood tests: This will reveal if the infection has spread to your bloodstream and the level of oxygen in it.
- Sputum culture: Your saliva or sputum is collected in a swab and tested to check the extent of infection.
- Pulse-oximetry: A small device clipped to your finger that checks the level of oxygen in your body. During the COVID outbreak, this has been an indispensable test.
- Chest CT Scan: A more detailed imaging than x-rays, often suggested when there is a pre-existing chronic disease.
- Bronchoscopy: This is prescribed in severe cases, where one tries to evaluate the extent of respiratory blockages and take out samples of tissue or fluid to assess whether the pneumonia is just an indication of a bigger fatality like cancer.
How is pneumonia treated?
Treatment is mostly given with home care and over-the-counter medicines. Bacterial pneumonia is treated with antibiotics, but viral pneumonia doesn’t have any specific treatment. Your doctor will prescribe medicines, rest, proper diet and fluid intake to bring your immunity back.
In severe cases, however, the doctor will ask you to get hospitalised for increased observation and targeted treatment. But prevention of pneumonia can help us avoid the disease at its source. Vaccines and flu shots are the best way to prevent pneumonia. A pneumococcal vaccine will protect you from bacterial pneumonia. These are a must for high-risk age groups.
What are the complications of pneumonia?
Pneumonia affects each person differently. Some respond well to treatment, but others might be suffering from a much more fatal infection. In severe cases, the body develops complications which mixed with weak immunity, high blood sugar or cirrhosis can create further complications.
- Pneumonia complications might lead to acute respiratory distress syndrome (ARDS), a severe form of respiratory failure.
- Pleural effusion or fluid accumulation in the lungs between the tissue lining and chest cavity. This needs to be drained else it leads to organ failure.
- Lung abscesses might be found all over the lungs. These tiny pockets of pus can be the starting point of COPD or lung cancer.
- Total respiratory failure due to heightened breathlessness and gasping can occur in severe cases. The patient needs life support through a ventilator.
- Sepsis is the most fatal complication, as this implies that the infection has spread to the patient’s blood completely leading to multiple organ failures.
Q1. What are the 4 stages of pneumonia?
- Congestion: First 24 hours of acquiring the infection. Here the patient experiences coughing & deep breathing.
- Red Hepatization: The next two to three days after congestion. Here the air sacs of the lungs will be completely congested. The lungs look red and packed, resembling a healthy liver.
- Grey Hepatization: The next two to three days after red hepatization the lungs will appear to be a greyish brown or yellow colour and look pale and dried.
- Resolution: Complete recovery.
Q2. Do all patients with COVID-19 get pneumonia?
It has been observed that most patients who underwent a serious COVID diagnosis also developed pneumonia-like symptoms and further in fatal cases it led to severe complications similar to pneumonia which resulted in increased fatalities.
Q3. How long does it take for the lungs to heal after pneumonia?
It all depends on your level of immunity, the severity of pneumonia, your age and the time taken for recovery. In severe cases, it is very taxing upon the body to get back to its former glory since severe respiratory infections leave the person very weak.
In normal cases of pneumonia, which can be treated with home care and over-the-counter medication, the lungs recover back to health within two weeks.
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