All cases of pneumonia of the lungs are dangerous. Pneumonia is the 3rd cause of deaths in Singapore behind cancer and heart attacks. Pneumonia patients should always treated as an emergency and should be sent to hospital.
Pneumonia is a serious medical disease which causes inflammation and infection of the lung tissues of one or both lungs.
The alveoli of the lungs are filled with exudates and white blood cells sent by the body to contain the infection.
Because of the congestion of the lungs there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .
It is one of the top causes of death in the world.
Bacterial Infections:
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1.Gram positive bacteria such as Streptococcus pneumoniae and Staphphylococcus may be serious and fatal in some cases.
2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia
Mycobacterium tuberculosis pneumonia are more common in developing countries and in people whose immune systems are impaired(eg. AIDS) and are preceded by active tuberculosis infections elsewhere.
Viral infections:
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Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus
Fungal infections:
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Cryptococcus neoformans
Non-infectious:
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1.chemicals such as asbestos can damage the lungs and cause pneumonia
2.Othostatic pneumonia occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs
3.Aspiration pneumonia occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.
This occurs in comatose patients and people having seizures or stroke.
Symptoms:
1.cold or runny nose is usually the first symptom
2.Fever is usually high
3.cough with productive purulent sputum which can yellow, green or bloody
4.Breathlessness due to congestion of the lungs
5.chest pain especially the sides of the chest due to coughing and fever
6.Myalgia (bodyaches) and headache which may be related to the fever
7.abdominal discomfort
8.lethargy especially in small children
Signs:
1.crepitation sounds on auscultation with stethoscope due to large amount of phlegm in the alveoli of the lungs
2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs
3.Reduced breath sounds - air movement is reduced in the lungs
4.Hyporesonance on percussion of the lungs
5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.
This will considered as a medical emergency.
Children and babies with pneumonia may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
Elderly people also do not have much symptoms except for fever and breathlessness
Diagnosis is based on:
1.Symptoms and signs of fever, breathlessness and productive cough
2.blood tests (complete blood count, ESR and blood culture) including viral and legionaire's disease
3.Sputum culture to determine the type of micro-organism
4.Chest X-rays to establish site and character of the lung infection
5.Pleural tap may be necessary if there is pleural effusion. The pleural aspirate is then sent for culture and microscopic examination.
6.CT or MRI of the lungs may be done if required especially if there is suspicion of lung cancer.
Complications of pneumonia are
1.Pleural effusion
2.septic shock,
3.adult respiratory distress syndrome
4.seizures also more in children
5.Emphysema
6.Pericarditis
Treatment of pneumonia is always urgent:
1.Hospitalization should be immediate as pneumonia can be a life threatening condition.
2.Antibiotics or antivirals depending on the organism found:
a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus
b.cephalosporins, gentamycin for pseudomonas
c.Tetracycline or erythromycin for mycoplasma and chlamydia
d.Erythromycin and rifampicin for Legionaire's disease.
e.Antivirals such as Tamiflu for Influenza infection
Acyclovir may be given for herpes virus infection
f.High dosages of antifungals may be given for Fungal pneumonia for a prolonged period of time
3.corticosteroids is useful to reduce complications
4.High-flow oxygen
5.intravenous fluids
Prognosis depends on the severity and type of infection.
Most cases if treated early and correctly recovered completely.
The elderly, babies and bedridden has a higher mortality.
Prevention against pneumonia is by use of vaccinations:
Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of peumonia.
Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumonia.
The danger of pneumonia is particularly dangerous in:
Adults age 65 or older
Patient over two years of age
1. with diseased lungs, heart, liver, or kidneys
2. health problems like diabetes, alcoholism, AIDS
3. taking any medications or therapy that can affect the body's immune system eg chemotherapy
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