What is pneumonia and how is it treated?

Pneumonia is a disease characterized by an inflammation of the lung tissue. In most cases, it is caused by infection.

The term pneumonia combines a big group of diseases each having its own causes, disease progression, and clinical manifestations, changes observed in x-ray visualizations, laboratory tests data, and therapeutic peculiarities.

Short information about pneumonia

Non-infectious inflammatory processes in the lungs are called pneumonitis. They can usually progress to pneumonia with the attachment of a bacterial, viral, or fungal infection.

The main methods of pneumonia diagnosis are x-ray and mucus laboratory tests. The main treatment is the use of antibiotics. Late diagnosis and start of the therapy worsen the prognosis of the disease and can even lead to the death of a patient.

Pneumonia is estimated to be causing death in children below 5 years in 15% of cases. Statistically, pneumonia results in the death of one in 64 patients. Frequency of pneumonia occurrence In a year, the diagnosis of pneumonia is established for 450 million people worldwide which makes around 7% of the total world population. It is estimated that men develop pneumonia by 30% more frequently than women. The special risk groups are children under 5 years of age and the elderly aged 65 and more. Pneumonia has quite high mortality rate compared to other diseases: 8% in men and 9% in women.

The incidence of pneumonia depends on many factors: quality of living, social and marital status, working conditions, exposure to animals, traveling, bad habits, exposure to sick people, individual characteristics of a person, and the geographical prevalence of one or another pathogen.

What causes pneumonia?

The most common cause of pneumonia is a viral or bacterial infection. The pathogens penetrate into the lungs from:

- Inhaled air;
- Expansion of the infection from the upper respiratory system (nose, pharynx);
- During medical procedures (bronchoscopy, tracheal intubation, mechanical ventilation, inhalation of drugs from contaminated inhalers, etc.

In most cases people develop pneumonia as a complication of a common cold or flu. Which is why it is crucial to check lung function if the high body temperature, coughing and troubled breathing persist on a 4-5 day of common cold or flu.

The infection also may spread to the lungs with blood and lymph (for instance, from a mother to an unborn child, in unsterile injections, etc.) but these ways of acquiring pneumonia are very rare.

How pneumonia progresses?

When the bacteria or virus gets to the lower respiratory system, it attaches to the bronchial epithelium and actively replicates. This causes acute bronchitis which in the spread of the pathogen outside bronchi causes inflammation of the lung tissue.

The violation of the bronchial patency, develop the foci of atelectasis, i.e. the partial collapse of the lung. The body tries to restore bronchial patency through coughing and sneezing but it only spreads the infection to the healthy tissue and creates new foci of pneumonia. It causes oxygen deficiency, respiratory failure, and in severe cases, heart failure. Often, regional lymph nodes are also involved in the process.

Various types of pneumonia and their peculiarities

By the spread of the process, pneumonia can be:

- Focal - when it is manifested in small foci;
- Segmental - when it is spread on one or more segments of the lung;
- Lobar - when it captures the lobe of the lung (it is frequent in croup);
- Merging - when the separate foci merge into bigger ones;
- Total - if the inflammation spreads to the whole lung. In addition, pneumonia can be unilateral if only one lung is affected, and bilateral if both lungs are inflamed.

Depending on the cause there are:

- Primary pneumonia that develops as an independent disease;
- Secondary pneumonia that occurs on the basis of another condition (for instance, chronic bronchitis);
- Radiation form - develops on the basis of radiotherapy for cancer;
- Post-traumatic - develops as a result of chest injuries;

By causative agents, pneumonia is divided into:

- Bacterial - is caused by bacteria;
- Viral - the herpetic form is most common in cases of Epstein-Barr virus or cytomegalovirus infection;
- Fungal - caused by different types of fungi;
- Mixed - caused by several types of pathogens at once.

By the severity, pneumonia can be mild, moderate, and severe.

What are the symptoms of pneumonia?

There are different types of pneumonia so the symptoms also differ:

- “Typical” pneumonia is usually manifested in the sharp elevation in the body temperature, cough with intense expectoration of purulent sputum, and, sometimes, also pain in the lungs. It is also accompanied by severe weakness. X-ray of the lungs shows pronounced dark spots.
- “Atypical” pneumonia is manifested in the gradual start, dry, unproductive cough, with the predomination of other, secondary symptoms such as headache, muscle ache, soreness of the throat, weakness, and malaise with insignificant changes in the x-ray.
- “Secondary” pneumonia develops on the basis of immunodeficiency, after an injury, and so on.
- Aspiration pneumonia occurs after inhalation of foreign matter into the lungs (for instance, vomit, blood, amniotic fluid during childbirth). The pathogens enter the lungs with this foreign mass. On x-ray, this type of pneumonia looks like focal pneumonia.

Risk factors for the development of pneumonia

Young children:

- Intrauterine hypoxia and asphyxia;
- Birth injury;
- Pneumopathy of the newborn;
- Congenital heart defects;
- Malformations of the lung;
- Cystic fibrosis;
- Hereditary immunodeficiency;
- Malnutrition;
- Vitamin deficiency

School-age children:

- Chronic foci of infection in the nasopharynx;
- Recurrent bronchitis;
- Cystic fibrosis;
- Acquired heart defects;
- Immunodeficiency conditions;
- Smoking.

Adults:

- Smoking and chronic bronchitis;
- Chronic lung disease;
- Endocrine diseases;
- Heart failure;
- Immunodeficiency conditions;
- Surgery on the chest and abdomen;
- Long stay in a horizontal position;
- Alcohol abuse.

In the studies conducted in 2013-2016, the relationship between the incidence of bacterial pneumonia and dental health was revealed. 441 people out of more than 26,000 examined had bacterial pneumonia at least once. People who have never attended a dental check-up had an 86% higher risk of pneumonia than those who underwent oral sanitation regularly 2 times a year.

Pneumonia diagnosis

The diagnosis is based on the main and additional diagnostic methods.

Main:

- Chest x-ray;
- Laboratory sputum test;
- Blood gas test;
- General and biochemical blood test.

Additional:

- Computed tomography of the chest;
- Biopsy;
- Test for antibodies;
- Blood culture test;
- Urine test, and others.

Treatment of pneumonia

The main role in the treatment of pneumonia is given to antibiotics. The antibiotic is chosen based on the pathogen that caused infection. One of the most commonly used antibiotics is Azithromycin (brand name Zithromax).

If the causative agent isn’t identified, the combination of penicillins and cephalosporins, macrolides, carbapenems, respiratory fluoroquinolones, i.e. antibiotics with the broad spectrum of activity are used.

If the therapy is considered ineffective, one antibiotic is replaced with another. The criteria for the identification of antibiotic efficacy are the normalization of the body temperature on the third day of therapy, as well as based on the repeated x-ray of the chest.

Along with antibiotics, other medications can be used:

- Bronchodilating medications;
- Medications for sputum thinning;
- Corticosteroids;
- Intravenous saline infusions;
- Oxygen.

Commonly physiotherapy is used such as ultraviolet irradiation, vibration massage, physiotherapy exercises, paraffin, and others.

What complications can pneumonia cause?

Pneumonia can cause severe complications if it is not treated timely, they include:

- Lung abscess and gangrene,
- Pleurisy,
- Pleural empyema,
- Lung obstruction,
- Acute respiratory failure,
- Endocarditis,
- Pericarditis,
- Meningitis,
- Pulmonary edema,
- Sepsis.

Besides, after pneumonia, almost any patient develops lung scars.

Prognosis for pneumonia patients

Treatment with antibiotics is effective in most cases so in timely treatment the prognosis is favorable. Only in case of untimely, incorrect and unadjusted treatment or in immunodeficiency pneumonia can cause death.