Pneumonia: Clinical Causes, Signs, and Treatment

Pneumonia is an inflammatory lung infection that primarily affects the alveoli (microscopic air sacs in the lungs) inflaming them with fluid and consequently making breathing difficult. One can contract pneumonia in daily life at work or at school or even when in hospital. It often starts by inhalation of germs into the lungs often likely to occur after a cold or the flu that leaves the lungs volatile to infections.

Causes of pneumonia

Pneumonia is mainly caused by pneumococcal infection caused by the bacteria Streptococcus pneumoniae that has the ability to occur on its own after having a cold or flu, the type of pneumonia caused by this bacteria usually affect one part of the lobe, a condition known as lobar pneumonia. Other bacteria-like organisms such as Mycoplasma pneumoniae can also cause pneumonia but with mild symptoms. Viruses causing flu and cold can also cause pneumonia mainly in children under five years, it can also be caused by inhalation of large amounts of fungi found in soil or bird droppings.

The signs and symptoms of pneumonia

The signs and symptoms of pneumonia vary from mild to severe depending on the type of germ causing the illness, age and health of an individual. The following are the signs and symptoms.

Signs and symptoms of severe pneumonia

• Difficulty in breathing
• High fever
• Shaking chills
• Coughs that produce phlegm (bloody sputum)
• Chest pains when coughing or breathing
• Nausea and vomiting
• Rapid heart rates
• Bluish tints on lips and nails
• Fatigue or tiredness
• Loss of appetite

Rare symptoms of walking pneumonia (mild pneumonia)

• Sore throat
• Diarrhoea
• Rash

New-borns are most likely not to show any signs of infections, they may only appear restless, fatigue and fever while people above 65 with weak immune systems may have a body temperature lower than normal. However, when one develops the signs and symptoms above, it is advisable to seek medical attention from a doctor.

Types of pneumonia

The following are the main types of pneumonia: Bacterial pneumonia, fungal pneumonia, Aspiration pneumonia, Mycoplasma pneumonia, Hospital-Acquired pneumonia, Eosinophilic pneumonia and viral pneumonia.

Bacterial pneumonia

It is caused by Streptococcus bacteria which mainly presents itself in people with existing lung infections, people who have nutrition problems, have weakened immune system and older adults. Once infected with this type of pneumonia, the lungs remain vulnerable to other bacteria since it weakens the immunity of the lungs. Anyone can be infected with this type of pneumonia but those with weak immune systems, drink excessively or are post medical operations are the most vulnerable groups. This condition is often accompanied by serious chest pains, fever, chills, rapid heart rate, blue lips, chattering teeth, mental confusion and delirium in some cases.

Treatment and control of bacterial pneumonia

Bacterial pneumonia can be contained by the following methods.

• Pneumovax and Pnu-Immune vaccines
• Anti-fever medication such as ibuprofen
• Fluid hydration (taking of plenty non-alcoholic drinks)
• Use of antibiotics
• Avoidance of smoking
• Hospitalization if need arises
• Viral pneumonia

It is caused by respiratory viruses. Mainly occurs in elderly adults and young children. The main virus that causes this infection is the respiratory syncytial virus (RSV) or at times the flu influenza type A or B virus. It has the same symptoms as bacterial pneumonia including coughs which may come with mucus, muscle pains, headache, wheezing and chills. If left untreated, it can be very fatal mainly to individuals with heart and lung infections and pregnant women. In some cases, it can lead to bacterial pneumonia.

reatment and control of viral pneumonia

• Hydration
• Use of anti-flu drugs like Amantadine, Rimantadine, Zanamivir (Relenza) and Oseltamivir
• Treatment with acyclovir or a similar antibiotic
• Follow ups when treatment is done at home
• Prevention vaccines for chickenpox
• Use of steroids. Meant to open air passages to easen breathing.
• Plenty of rest when recovery process begins
• Cleaning of surfaces often touched like doorknobs and countertops.

Mycoplasma pneumonia

Is caused by mycoplasma characterized both as a virus and bacteria though it is neither .It generally occurs outside the lungs and is most often during cold seasons. It is communicable and can affect people at all age brackets. It is mainly symbolized by severe and persistent coughs.

Treatment and control of mycoplasma pneumonia

• Antibiotic treatment
• Covering of mouth and nose when sneezing
• Placing used tissues in waste baskets
• Frequent washing of hand and nose with soap for at least 20 seconds
• Use of alcohol based hand rubs in case water and soap is unavailable

Fungal pneumonia

Is an infection to the lungs caused by fungi that invade the lungs through inhalation of their spores or by the reactivation of latent infection. The fungi causing this infection can either be endemic or opportunistic or even a combination of both. It is often characterized by chills, fatigue and fever just like in bacterial pneumonia.

Treatment and control of fungal pneumonia

• Use of antifungal drugs
• Surgical debridement
• Use of azoles e.g. variconazole
• Cardiothoracic surgery
• Avoiding activities that increase exposure to fungal spores for patients likely to have prolonged neutropenia

Eosinophilic pneumonia

Is caused by accumulation of eosinophil (a type o red blood cell) in the lungs leading to disruption of the alveoli. The main cause of this accumulation of eosinophil in the lungs is not known but others like cigarette smoking, use of certain drugs like aminosalicylic acid, exposure to chemical fumes and parasites are known. Its most common symptoms of include: difficulty in breathing, cough, fever, general feeling of illness and night sweats.

Treatment and prevention of Eosinophilic pneumonia

• For mild cases, the patients often get well without treatment
• Administration of prednisone for chronic Eosinophilic pneumonia
• Use of anti-inflammatory drugs
• Use of drugs to widen the airways

Aspiration pneumonia

Is caused by aspiration of foreign objects into the lungs like food and drinks leading to formation of pus and inflammation of the lungs. The organisms behind this inflammation as studies have revealed are: Streptococcus pneumoniae, Haemophilus influenza and Staphylococcus aureus. It often result in breathing difficulties, swallowing and a decrease in gag reflex. Most affected by aspiration pneumonia are those of older age, people who use alcohol and drugs, people under sedation medication and patients put under anaesthesia. However, in some cases, inhalation of foreign materials may not result in aspiration pneumonia but will worsen the condition by increasing the acidity of the material.

Prevention and treatment of aspiration pneumonia.

• Avoidance of use of alcohol and drugs

Hospital-Acquired pneumonia (nosocomial pneumonia)

This type of pneumonia is contracted during hospital stays and is of the deadliest and severe form owing to the organisms associated with its contraction and the weakened immune systems at the time of contraction. Though it can occur to people of all ages, it is often common in alcoholics, elderly and those with weakened immune systems. It is characterized by loss of appetite, nausea and vomiting, decreased blood pressure, fast heart beat rate, fever, chills, general discomfort, uneasiness, malaise, coughs with bloody sputum and shortness of breath.

Prevention and treatment

• Use of ventilator (breathing machine to support breathing)
• Injection of antibiotics through veins to treat the lung infection. The antibiotic fights the germs in the patient’s sputum culture.
• Washing of hands by relatives visiting patients in hospitals.
• Keeping immunizations up to date
• Use of kinetic beds in hospitals
• Use of red cell transfusions
• Ensuring cleanliness of the environment
• Use of prophylactic antifungal agents during building work
• Legionella control
• Use of anaesthetic machines and breathing equipment

Complications caused by pneumonia

Pneumonia complications are predominantly common in young children, the elderly and people with existing health conditions. The following are the complications associated with it.

• Pleurisy. Is the inflammation of the pleura (the linings between the lungs and the ribcage). Fluids build up in the space between the lungs and the chest putting more pressure on the lungs.
• Lung abscess. It is a puss cavity that develops inside the tissue of the lungs resulting in coughing and production of unpleasant smelling phlegm. Is rare but predominant in people with history of existing illness and alcohol abuse.
• Blood poisoning (septicaemia). Is rare but very serious when it occurs in pneumonia patients. Often characterized by loss of consciousness, change in mental behaviour, reduced urine flow and high temperature fever above 380C. Consequently, other organs of the body like brain (outer layers of the meningitis), joints (septic arthritis) and abdomen lining (peritonitis).
• Death. Though most people fully recover from pneumonia, to some in special cases, it is fatal.
• Cardiovascular events e.g. heart attacks that occurring during the recovery period and persists for several years even after complete recovery.
• Rash and diarrhoea. Often arise as a side effect of medication

Reasons why pneumonia patients need care

Pneumonia results in fatigue and unconsciousness of the affected patients. Most of these patients are often weakened by the disease and are in need of much rest and therapies most of the time, as such every patient needs a personal team that will see him/her through the recovery process.

Members of a healthcare team

Apart from the primary health care service providers in hospital, pneumonia patients will need the following additional members, dietician who will evaluate the best food for the patient considering nutrition needs and swallowing concerns, volunteers to offer companionship to the patient, therapists, a nurse, physician who will be monitoring the patient’s progress as well as prescription of drugs, a nursing assistant who will be responsible for providing personal care to the patient and family members who will offer mental support to the patient as well as informing the medical team of changes in the patient’s symptoms.

Care for pneumonia patients

• Oxygen therapy. Mainly applicable when the doctor in charge of the patient feels that the patient’s body cells are not getting enough oxygen.
• Fluids intake through veins when patients cannot drink due to shortness of breath.
• Respiratory therapy encompassing breathing exercises and postural drainage to remove mucus from the lungs.
• Chest physiotherapy involving striking of the chest with a vibrating device to help loosen mucus in the lungs.
• Adult smoking cessation advice to patients who have a long-time prognosis after stopping smoking to help them reduce the risk of contracting pneumonia again.
• Antibiotics administration within six hours of arrival to patients who have bacterial pneumonia.
• Daily personal care for pneumonia patients at home
• Take enough time to rest, have enough sleep in the night and take naps during the day.
• Drink plenty of water to avoid dehydration, no quantity is recommended but thirst is an indicator of more fluids needed. The water helps in loosening mucus on the walls of the lungs.
• Try not to stop your cough unless it complicates breathing
• Take acetaminophen such as aspirin to reduce fever
• Take the prescribed medicines as per the doctor’s guidelines. Do not cease from taking the prescribed medication for pneumonia without notifying the doctor. Even if you feel better, the entire the entire course of antibiotics must be depleted to prevent a possible comeback of the disease.
• Strict following of one’s healthy dietary plan
• Be careful with medicines, read and follow the label instructions keenly.
• Maintain communication and follow ups with your doctor for assessments to check on your improvements and determine whether more medication is needed and also to check the possibilities of complications arising
• When pregnant, planning to get pregnant or breastfeeding, do not take any medicines as they may harm your baby. Let your doctor know your situation and advice you on what to do.

Medicines used to treat pneumonia

The choice of drugs used in the treatment of pneumonia depends on the type which it is or rather the organism causing infection.

For bacterial pneumonia

• Levaquin oral
• Moxifloxacin in sodium acetate, sulfate in water intravenous
• BenoxylDoxy 30
• BenoxylDoxy 30
• Morgidox 1x100
• Avidoxy oral
• Doxy-100 intravenous
• Claforan intravenous
• PCE oral
• Maxipime injection
• Morgidox oral
• Timentin intravenous
• E.E.S. 400oral
• Piperacilin tazobactam.

These are just some of the drugs used in treating bacterial pneumonia, however, the list is very long.

For viral pneumonia

• Amantadine
• Rimantadine
• Zanamivir
• Zovirax
• Cidofovir
• Foscarnet
• Oseltamivir
• Ribavirin

For mycoplasma pneumonia

• Azithromycin Dose Pack
• Zithromax
• Doxycycline
• Erithrocin lactobionate
• E.E.S granules
• Doxy 100
• Biaxin XL
• EryPed
• Ery-Tab
• Vibra-Tabs

For fungal pneumonia

• Diflucan
• Variconazole
• For aspiration pneumonia
• Piperacili / tazobactam systemic
• Metronizadole systemic
• Lansoprazole systemic
• Cilaststin / imipenem systemic
• Ampicillin / sulbactam systemic
• Penicillin g potassium systemic
• Metronizadole systemic
• Cefoxitin systemic
• Clavulanate
• Cilastatin
• Dexamethasone systemic

For Eosinophilic pneumonia

• Nitrofurantoin
• Trimethoprim
• Naproxen
• Isoniazid
• Carbamazepine
• Clorpropamide
• Phenyntoin
• Prednisone (RAYOS)

For hospital acquired pneumonia (Nosocomial pneumonia)

• Meropenem intravenous
• Ciprofloxacin intravenous
• Tobramycin in 5% dextrose intravenous
• Cipro in D5W intravenous
• Piperacilin-tazobactam-dextrose (iso) intravenous
• Zosyn intravenous
• Amikacin injection
• Tobramycin in 0.9% sodium chloride intravenous
• Merrem intravenous
• Ciprofloxacin in 5% dextrose intravenous
• Tobramycin injection
• Piperacilin-tazobactum intravenous

Other drugs that can be used to treat pneumonia

• Antibiotics like fluoroquinolones, cephalosprins, macrolydes, penacilins and vancomycin. Depending on the type of pneumonia, doctors are able to choose on the best antibiotics to use. They are used because they have a high cure rate for pneumonia caused by bacteria, for instance, vancomycin works best against certain of bacteria that have become resistant to other antibiotics.
• Atovaquone. Is a drug in the class of medication called antiprotozoal agents. It has the capability of stopping the growth of certain protozoa that cause pneumonia, for this reason, it is used in both treatment and prevention of pneumonia. It is mainly prescribed for people affected with Human Immunodeficiency Virus (HIV) owing to their weak immune systems. It is used by both adults and teenagers. However, instructions on its usage should be followed keenly since it has serious side effects like hives when not used correctly.

Monitoring one’s pneumonia

Pneumonia Severity Index (PSI)

This is the first step that pneumonia patients should take in monitoring their pneumonia. The Pneumonia Severity Index score determines the severity of pneumonia and is the key determiner as to whether a patient should be hospitalized or not. The tools for Pneumonia Severity tests are available at the Agency for Healthcare Research and Quality (AHRQ), as such, one should make efforts to have the severity of his pneumonia tested and the best mode of treatment chosen.

Respiratory support

Patients should visit their medication centres for respiratory therapy encompassing breathing exercises and postural drainage to help remove mucus from their lungs. While at home, they should avoid heavy duties but have enough rest and sleep.

Record temperature changes

If the patient is a child, the parent should frequently take reading of the temperature every morning and alert the doctor if it goes above 38.90C. The parent should also check the lips and fingernails of the child to ensure they are rosy and pink, else, if they turn bluish, its an indicator that the lung are not getting enough oxygen and such, the doctor should be called immediately.

Frequent follow-ups appointments with the doctor

Every six weeks after treatment, the patient should make follow ups and maintain communication with the doctor for assessment on improvements, further prescriptions, additional medication and examinations on the possibities of complications arising.