Pneumonia

Pneumonia refers to an infection that exacerbates the air sacs in one or both lungs of a person. The air sacs may be filled with either pus (purulent material) or fluid that causes cough with phlegm or fever, pus, chills, and difficulty breathing.

Pneumonia is caused by various organisms that include viruses, bacteria, and fungi. Depending on the cause of the disease, its seriousness ranges from mild to life-threatening.

Bacteria

The most common kind of bacterial pneumonia is pneumococcal pneumonia caused by Streptococcus pneumoniae germ that often lives in the upper respiratory tract. It may occur on its own or when a patient has had viral flu or cold. 

Other types of bacterial pneumonia include Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. The first two can be transmitted from one person to another, but Legionella occurs due to exposure to contaminated water from whirlpool spas, cooling towers, and outdoor fountains. 

Viruses

The virus that causes viral pneumonia in adults is the influenza virus which attacks the upper respiratory tract. It invades the lungs and multiplies and is often serious in individuals with pre-existing lung or heart disease and pregnant women.

The virus that causes pneumonia in children is the Respiratory Syncytial Virus (RSV). The majority of the viral cases of pneumonia are never serious and only last for a short while compared to bacterial pneumonia.

Fungi

Fungal pneumonia is common in people with weakened immune systems or chronic health conditions. People exposed to large doses of fungi from contaminated bird droppings or soil are also at high risk. The main types of fungal pneumonia are Pneumocystis pneumoniais caused by Pneumocystis jirovecii; histoplasmosis, coccidioidomycosis, and Cryptococcus.

According to a report by the World Health Organization, pneumonia is the largest infectious cause of death in children globally. In 2015, pneumonia killed 920, 136 children aged 5 and below which signified 16% of all deaths of children in the world.

On average, pneumonia kills approximately 1.4 million children in the world, accounting for 18% of all deaths in children aged 5 and below. Unlike other conditions such as typhoid that are prevalent in developing countries, pneumonia kills children everywhere although it is highly prevalent in South Asia than in other regions.

Global Burden of Diseases reported in 2016 that 11, 203 children aged 5 and below died of pneumonia in Kenya. The deaths occurred in counties of Kakamega (818), Nakuru (593), Meru (674), Homabay (534), and Mandera (566 deaths).

Symptoms

The symptoms of pneumonia range from mild to severe depending on the type of germ causing it, overall patient health, and patient’s age. Mild symptoms of pneumonia are similar to those of flu and cold, but they persist for long.

Symptoms of pneumonia include:

  • Changes or confusion of mental awareness (age 65 and older)
  • Chest pain when the patient breathes or coughs
  • Fatigue
  • Cough that may produce phlegm
  • Fever, shaking chills and sweating
  • Shortness of breath
  • Nausea, diarrhea, or vomiting
  • Low body temperature in aging people and people with weak immune systems

Diagnosis

Sometimes the diagnosis of pneumonia may be tricky given that its symptoms are highly variable and are mostly similar to those of influenza and cold. To diagnose pneumonia, the doctor asks questions concerning the patient’s medical history, conduct a physical exam, and run some tests.

With regard to medical history, the doctor will ask questions related to patient’s occupation, any recent travel, contact with animals, exposure to other sick individuals at work, home or school, and whether the patient has recently had another illness or not.

Physical exam involves listening to the lungs using a stethoscope when the patient inhales and exhales.

With regard to diagnostic tests, if the doctor suspects a patient has pneumonia, he or she will recommend certain tests to confirm the diagnosis and know more about the infection. The tests include blood tests, chest X-ray, pulse oximetry, and sputum test.

If the patient is considered a high-risk patient because of overall health and age, the doctor may want to do further tests that include CT scan, arterial blood gas test, bronchoscopy, and pleural fluid culture.

Risk Factors

  • Children with weak immune systems are at higher risk of pneumonia. The immune system of a child may be weakened by undernourishment or malnutrition particularly infants who are not breastfed.
  • Pre-existing health conditions such as measles and HIV also increase risk of contracting pneumonia
  • Parental smoking
  • Living in crowded homes
  • Indoor air pollution caused by heating and cooking with wood or dung
  • Being hospitalized in intensive care unit particularly if breathing through a ventilator

Treatment

Pneumonia is normally treated with antibiotics. The most common antibiotic used is amoxicillin dispersible tablets. As of May 2019, Amoxicillin Dispersible Tablets (Amoxyl DT) 50ml syrup retailed for KSH. 400.00 – Medication for children. Similarly, Amoxicillin Dispersible Tablets (Amyxyl DT) 500mg tablets for adults costs KSH.705.00.

Doctors recommend the use of oral antibiotics normally prescribed at a health centers. Hospitalization is recommended only for extreme cases of pneumonia.

Prevention

  • Immunization for Children: Immunization is done against pneumococcus, Hib, whooping cough, and measles.
  • Provide adequate nutrition to the children to improve their natural defences. The first one is exclusive breastfeeding for six months of life.
  • Address environmental factors such as encouraging good hygiene and work on indoor air pollution (through providing clean indoor stoves etc.).
  • Give children infected with HIV antibiotic cotrimoxazole daily to reduce risk of contracting pneumonia.
  • Get Vaccinated: Vaccination is available for both children and adults at high risk of pneumonia. Make sure you talk with the doctor about getting vaccinated. Note that vaccine for children is different from that of adults and thus, you must always consult the doctor before getting vaccinated.
  • Stop smoking: Smoke damages lungs and natural defenses against respiratory infections
  • Keep personal immune system strong: Exercise regularly, get enough sleep and eat a balanced diet.

Sources

https://www.lung.org/lung-health-and-diseases/lung-disease-lookup/pneumonia/what-causes-pneumonia.html

https://www.who.int/maternal_child_adolescent/news_events/news/2011/pneumonia/en/

https://www.mayoclinic.org/diseases-conditions/pneumonia/symptoms-causes/syc-20354204

https://www.nation.co.ke/health/pneumonia-still–leading-killer/3476990-4848966-ntbtbp/index.html

https://www.kibs.co.ke/dawa/branddetails.php?brnd=Amoxicillin

https://www.businessdailyafrica.com/economy/Hope-for-children-with-pneumonia-as-new-drug/3946234-4188020-q1ylcq/index.html