Tuesday, January 15, 2008

All About Pneumonia

By Sudipa Sarkar
Is pneumonia contagious?

Pneumonia is contagious. There are certain viruses that can cause pneumonia contagious. In our normal daily activities, such as having food, coughing, sneezing, even kissing and hugging, for example, we usually pass out with several numbers of viruses, but they, as such are not able to harm our health to a great extent because of our strong immune system. But the possibilities are always there; as it is quite evident that all of us may not have a real strong immune body to fight with those unwanted trespassers. The result is also very clear – we get caught into the prey of such microbes. But it is also true that not all of those trespassers are contagious in nature. However, some of them are. They have the ability to multiply and are able to cause fatal damages, such as the case with pneumonia. But in this context, we must remember that the onset of pneumonia doesn’t necessarily follow this way only. They can be spread through blood stream or from infected areas to lungs. But more interestingly one may catch pneumonia not just because of his exposure to the germs, but more importantly his immunity system – the stronger the immune system is, the lesser the susceptibility.
The symptoms may differ on the way one has developed pneumonia. More precisely, it will depend on what contaminate the disease. In case of bacterial infection, the resulting pneumonia has been characterized by chills, chest pain, high fever, and a severe rust colour cough. It can be treated with antibiotics. On the other hand, viral infection leads to fever, dry cough, headache, muscle pain and weakness associated with increasing breathlessness.
But the question arises how far or how much contagious pneumonia is. Certainly the actual intensity is far less than an ordinary person think of it is. In the initial stage, the virus responsible for an individual to be filled with cough is of course highly contagious. However, the virus or bacteria responsible for spreading the infection down to the lungs is comparatively much less contagious. Hence, mixing up with people with pneumonia may lead to an individual to catch the normal cough and cold symptoms of the virus, but whether it will progress to pneumonia or not is dependent on the person’s immunity system. It is very worthy to know that the development of the pneumonia is not resolute by the particular cold virus or bacteria, but rather by each person's strong immune base leading to susceptibility in their own lungs. And there is a great individual differences noticed all over the world regarding the susceptibility to pneumonia in question.
To avoid the contagious property of pneumonia, a vast awareness with sufficient knowledge among the mass need to be developed. Also general people must be encouraged to adopt few basic self-care strategies, like cleaning, washing hands, regular medical check up, proper nutrition, etc in order to stay clean and spend a disease free life.

Pneumonia and asthma

Pneumonia is caused from the infection of lungs. The attack is prevalent among people of any age and sometimes it can be so fatal that may cause to death even. The treatment of this disease primarily depends on the type of pneumonia, patient’s age, co-morbidity if any, general health condition, etc. On the other hand, asthma is considered as one of the deadly respiratory disease which may develop in people at any ages. According to Pathophysiology of asthma, it is found that the bronchoconstriction affirms that the asthma can be developed by the effect of bacterial infection, which may lead to the chronical symptoms for a prolonged period of time.
Research suggests that long-term bacterial pneumonic infection causes chronic asthma. Especially, infection caused due to Mycoplasma pneumonaie can remain with its post-pneumonic effect even after long times of the intensity of the disease. Researchers developed a hypothesis about a high correlation among pneumonia and asthma by asserting that the availability of pneumonic bacterial content is much higher in the case of asthma than in the sample collected from people without asthma. While doing laboratory experimentation at UT Southwestern Medical Centre in Dallas to analysis the validity of the hypothesis, the researchers used mice infected with pneumonia developed bronchial constriction considered as an important trigger for the onset of asthma at a greater number. The researchers concluded with a great emphasis on their findings by affirming the association between asthma and pneumonia. Also the researcher suggested that only the anti-microbial treatment against Mycoplasma pneumonaie can treat the pulmonary respiratory infection, hence may improve the poor lung function and also help in reducing the future asthma attacks. Reseasch further suggested the relation among the post pneumonic effect to the onset of asthma by citing the statistical example of six years follow-up studies, where it is quite evident that the children developed asthma as a post effect of pneumonia. The researchers thus concluded their experiment as “We believe that the high proportion of children with asthma identified in this study confirms our original conclusion that these children are worthy of careful follow up as a group at increased risk of developing asthma. It is to be expected that the prevalence of asthma will rise over time in any cohort, and adult onset wheeze is common and often missed. The declining temporal relation, however, supports our hypothesis that children with undiagnosed or "latent" asthma may first present with pneumonia.”
In order to find and establish a strong correlation among pneumonia and asthma, a great deal of scientific research is going on throughout the world. For example, it is hypothesized that there is a strong correlation between eosinophilic pneumonia and asthma. There are several types of eosinophilic pneumonia - Loffler's pneumonia, which occurs in temporary onset and pulmonary infiltrates with eosinophilia (PIE), which is considered as more vital and life-threatening also prolonged duration leads to develop asthma.
Pneumonia and pregnancy

Pneumonia is considered as the most common reason of non-obstetric infection during pregnancy. It is observed that it produces more devastating effect in pregnant women rather than non-pregnant women. The onset of pneumonia comprises of a vital complication for pregnancy. This is considered as the third most widespread cause of indirect obstetric death.

Due to the physiological and hormonal change in the system during pregnancy, a woman becomes more vulnerable to various kinds of diseases which may affect vastly both the mother and child, contributing to morbidity and death. As the women’s immune status gets changed during pregnancy, so this change leads the women to become more susceptible to pneumonic infections.

The risk of pneumonia for mothers is definitely a dreadful phenomenon as it involves two lives at a time and of course interrelated with future consequences as well. Thus prompt and supportive care are very much needful for the mother as well as for the fetus. Any kind of antimicrobial therapy depends on the maternal risk factors, nature and intensity of the disease.

Due to the delicacy of the situation carrying baby, a pregnant woman is not suggested to go for any medication for treating pneumonia which is available in the market. During pregnancy drugs affect the fetus in several ways by affecting its growth and development. For the pre-antibiotic phase, the mortality rate among pregnant women is about 32%, but there is a significant reduction in the mortality rate with the advancement of antibiotic medicinal treatments.

Any kind of infectious agent causing pneumonia complicates the situation to a great extent, because the inciting pathogen in most of the cases is unidentified, like Mycoplasma, and Legionella pneumonias are very difficult to measure without the use of extensive serological testing procedures. Moreover the impact for the prevalence of infectious agents like mumps, swine influenza, influenza A, Chlamydia pneumoniae, coccidioidomycosis, and other fungal pathogens is still unknown to the researchers, but certain pathogens create a great deal of harm to pregnant women as because they are less-immune than they were while not pregnant.

For the prevention purpose the pregnant women and her family member especially spouse need to go under training so that they may be able to arrest the critical situation and thus ask for help from the doctor concerned. The common symptom follows as:

• Cough,

• Phlegm

• Nasal stuffiness or discharge,

• Breathing problem – especially shortness of breath.

Without proper guidance the symptom of breathing problem may make the normal person confused by terming it as dyspnea which is physiologic and the onset of it is very normal during pregnancy. With a good deal of awareness the patient’s family must ask an immediate help from doctor for any possible pulmonary pathology for the pregnant woman. Lack of it or any kind of under-estimation about the prevalence of the disease may cause a criticial situation indeed often leading an undesired event at last.

In treatment session, once the specific pathogen is identified, therapeutic treatment can be followed. In common cases, community-acquired pneumonia patients may be treated by using ampicillin or cephalosporin, which provide a great coverage against pneumococcus, H influenzae, M catarrhalis, K pneumoniae, H influenzae, and E coli etc.
Pneumonia cure
In general the medications used in the treatment of pneumonia comprises of antibacterial medication as the most common cause of this disease is bacteria. Doctors usually suggest to take antibiotics for 5 to 14 days, but in some cases it may linger to more of the time depending on the severity of the disease and the status of the patient’s immune system.
The type of prescribed antibiotic will depend on various factors –
· age,
· symptoms
· severity
· whether need hospitalization or not, etc
There are various opinions among experts in this area for suggesting any particular antibiotics to the treatment. But it seems that almost all antibiotics affect profoundly in the treatment of the disease.
The treatment mode usually includes two forms:-
· Home care
· Hospitalization
In case of home care, patients may be suggested by the doctor to use any of the following antibiotics:
Macrolides
Macrolides helps in prevent the further growth of bacteria and also it works against several numbers of bacteria. People who are allergic to penicillin are suggested to undergo the Macrolides treatment. Macrolides are also used by people older than 60-65 and people with chronic health problems which may be considered as one uncommon cause of the pneumonia.
Apart from its so much importance, it is also associated with few common side effects like:
· Diarrhea.
· Nausea.
· Upset stomach.
· Vomiting.
· Sore mouth.
Examples include: Ery-Tab, Biaxin, Biaxin XL, and Zithromax.
Tetracyclines

It works well against few bacteria like Mycoplasma pneumoniae, Streptococcus pneumoniae, Chlamydial pneumoniae, and Haemophilus influenzae, but there are also bacteria which are resistant to this medicine.
The common side effects include the following:
· Got sunburn easily
· Stomach upset
· Nausea
· Dizziness.
· Sore mouth.
Examples include: doxycycline (Vibramycin, Doryx)
Fluoroquinolones
This type of medicine is used for people suffering from other lung problem and also recommended for people above 18.
The common side effects are:
· Nausea
· Headache.
· Dizziness.
· Rash.
· A metallic taste in the mouth.
Examples include: Levaquin, Avelox, and Tequin.
In hospital setting the following medicines may be prescribed to the patient depending on the situation and event handled:
• Cephalosporins,
Examples include: Ceclor, Duricef, Ceftin, and Lorabid.
• Penicillins,
Examples include: Amoxil, Biomox, Omnipen, Augmentin, Veetids, and Timentin.

For the youngsters as well as healthy people with strong immune systems, the antibiotic treatment goes very nicely. The usual symptom of improvement is noticed within 2 to 3 days. If the situation runs smoothly towards positive direction, the doctor will keep continuing the medication for next few days. But in case, if the situation goes poorer within 2-3 days, the patient may need to be hospitalized along with different diagnostic modules like blood test, chest x-ray, sputum culture etc. It will help to identify the agent behind the problem and appropriate medication should be suggested depending on the type of bacteria identified. Also it helps in determining whether the bacteria is resistant to the medication or not.
Pneumonia in children
Pneumonia is essentially a lung infection which comes along with cough and difficulty in breathing. The occurrence of pneumonia is prevalent in children especially children below 5 years of old. To organize an effective diagnosis, children’s age is a very important factor to be counted on. The infection in neonats or children below 4 weeks of age is generally the outcome of maternal infection inherited into the child at the time of birth. When a child is a pre-schooler, the main attack of pneumonia comes from Streptococcus pneumoniae, whereas for adolescents, Mycoplasma pneumoniae and Chlamydia pneumoniae be the primary reason. Statistics say that the mortality rate for the children below 5 years of age who are suffering from pneumonia in developing countries is 30%.
One of the major symptoms in pneumonia is acute respiratory infection caused by bacteria – becomes one of the major mortality factor among children, especially in infants and toddlers. The prevalence of the disease can be so devastating that the onset of the disease, the development and death can take only 2-3 days altogether. Hence the cough and difficulty in breathing in a child should be taken care of very carefully and instantaneously. If it is diagnosed earlier, it may be treated inhouse, but if the intensity gets higher, then hospitalization is highly recommended. Proper timing and effective medication help to save the children lives with a real success. Immature death due to pneumonia occurs primarily due three reasons:-
1) Appeared for effective treatment, but not in time
2) Appeared for treatment in time, but receive inadequate treatment
3) Not at all appear for treatment
Along with those above factors, malnutrition also plays an important role in the mortality rate of the children suffering from pneumonia.
The other symptoms of pneumonia in children include very high fever, cough, headache, body ache, nasal flaring, lethargy, poor appetite and last but not the least fast breathing rate.
The diagnostic testing comes into account to determine the etiology of the disease. It is also determined whether it is developed through community outbreak. Older children go for gram stain and culture of sputum. Chest radiographs are also obtained from children with pneumonia suspected for the treatment. Also oxygen saturation level is also measured by pulse oximetry with severe condition in breathing.
Being less expensive and few side-effects Catrimoxazole is used one of the important medication in treating pneumonia. The Catrimoxazole must be used for 48 hours, after that the condition of the child must be reassessed. If there is not any significant change in the condition, say, neither good nor bad, the medicine may be continued for next 3 days. But if the situation gets worse, the child must be hospitalized in no time.

For the treatment of children, the mothers’ roles are enormous. A mother should be guided as how to take care of his child, including handling the child properly, providing antibiotic dosages in proper time, monitoring symptoms carefully, sufficient feeding (including breast feeding for younger children). The mother should be informed and trained to notice the danger symptoms, like rapid breathing, chest-in drawing, refusal of taking food, eating or drinking insufficient amount, excessive sleepiness or convulsions – which needs hospitalization with an immediate effect. If the mother is properly guided and trained to take care of her own child properly, this also helps in lowering the mortality rate in children due to pneumonia.
Pneumonia in elderly

Though pneumonia is prevalent in children but it sometimes attacks elderly as well and it is considered as one of the fourth leading causes of elderly death around the world. The cause and the development of the disease greatly vary in two cases. Pneumonia is a kind of lung disease, infected by microplasma, virus or bacteria. The intensity of the disease gets higher in winter season so as the mortality rate for those elderly who suffer from pneumonia.
There are various factors involved in the development of pneumonia in elderly. For example,
• Bacterial Infection:
The most commonly found bacteria responsible for spreading pneumonia in elderly are Streptococcus pneumoniae, Gram-negative bacilli, Anaerobic bacteria, Haemophilus influenzae, Legionella sp and there are numbers of viruses responsible for this to occur.
• Co-morbid diseases:
One of the major causes for the development of pneumonia in elderly people is the presence of other serious kind of illness. In addition, the correlation among the pre-existence of serious disease to mortality rate due to pneumonia in elderly has a strong relation.
• Host defense:
The body has a natural tendency to fight with foreign body, but age decrease the ability of doing so in such an effective manner. Delayed hypersensitivity to lymphocytes, one of the blood cell content responsible for immunity, leads to the individual to become more vulnerable towards pneumonia, tuberculosis types of disease.
• Aging lung:
The aging lung loses its ability to function at its optimum level. There are many factors responsible for that – loosing elasticity of lungs, decreasing number of alveoli, decrease in lung capillaries, change in maximal force for inhalation and exhalation, etc. This changes the condition of lung in such a way that it becomes more susceptible to disease.

In case of preventive measure, an elderly can follow few basic rules to stay well, like
• Visit doctor regularly for checkup
• Avoid cold as far as possible
• Eat nutritious food
• Drink plenty amount of water
• Do light exercise
• If possible, take antibacterial vaccine
In case of treatment for the elderly patients with pneumonia, there are usually two types patients come into question –
Out-house patients
The patients with out any kind of associated disease along with pneumonia are considered as out-house patients.
In-house patients
Patients who have one or more than one co-morbid disease along with pneumonia are called in-house patients.
While treating the elderly, the caregiver should be remembered that he / she has to take the case with good understanding of the problem and he / she must be able to provide service in a compassionate way.

On the onset of pneumonia in elderly patients, it is observed that it is accompanied with increased rate of delirium and poor adherence to drug usages.

The pneumonia in elderly becomes more complicated with life-threatening co-morbid diseases such as diabetics mellitus, heart failure, malignancy, dementia etc. So comfort measure in the treatment of elderly should be facilitated with medicinal treatment.
Pneumonia prevention
Prevention is always better than cure – This is an old proverb, but very useful at least in the case of pneumonia. The severity and pain of the disease is just intolerable most of the times. But you can simply avoid them if you follow few health care strategies. Here are few guidelines that may help you to think further:
• Stop smoking
The most essential resolution you must first take if you would like to avoid pneumonia in your life. Simply quit smoking. Because statistics say that the smokers are more susceptible to pneumonia.
• Selective avoidance
We are social elements. This is true. But disease never comes on your way by showing empathy on it. So the second most important step is just avoid the contact with people having respiratory tract infections, such as colds and influenza or flue. Because you should know that the pneumonia may follow these diseases.
Though most of the people suffer from measles or chickenpox in their childhood, but if you haven’t had yet, please keep a great distance with people who have these infections. Put your all empathy for them, but better if you can preserve some sympathy for yourself also, especially when you seem to be concerned about pneumonia. These disease can come as co-morbidity factor on the onset of pneumonia, so getting in touch means you are putting yourself in a great stake.
• Use hand as much as required
Try to stay clean. Our hands are very susceptible to spread infection. So clean your hand after blowing nose, coming from bathroom, before eating or preparing foods etc.
• Use mask in dirty area
Wear a mask or wrap your nose and mouth if you don’t have a ready mouse in front of your hand while cleaning dusty area.
• Vaccinations
There are vaccines for pneumonia (pneumococcal vaccine) available. But there is not sufficient research in this area, which may turn into a universal vaccine to eliminate the disease from all over the world.
The vaccine called pneumococcal polysaccharide vaccine (PPV) is considered useful to prevent pneumonia in healthy younger people. But this vaccine shows its futility in the case of older people or people with weaken immune systems.
Also, in addition, this vaccine does not lessen the chances of getting pneumonic attack in future in adults, but it can only prevent few serious difficulties of pneumonia, like infection in the bloodstream or throughout the body, in case of younger adults.
Also research found one adverse effect of this vaccine, which demonstrates that people having chronic problem or elderly people of more than 65 years old, it increases the likelihood of the occurrence of the disease.
This vaccination along with the varicella-zoster vaccine (chickenpox vaccine) can help in avert viral infection.

The zinc content food may help decrease the risk of pneumonia in children. Zinc is common in certain foods like red meats, seafood, beans, cereals etc. So the child diet chart must comprise any of these food in order to refrain from pneumonia.

Signs of Pneumonia

The symptoms or signs of pneumonia start with cold in general, which is followed by severe fever, shivering with chill feelings, cough with sputum. Sometimes blood may accompany sputum. The patient will suffer from shortening of breath which is usually associated with chest pain. This pain is in general very intense and the patient fees very weak while taking a deep breath. This pain is known as pleuritic pain.

In some cases the worsening condition may be delayed with a gradual deterioration in cough condition with acute headaches as well as body aches may come as initial symptom. For some people with pneumonia it is observed that their skin colour change into dusky or purplish because of lacking of the oxygen in their blood stream. This condition is known as cyanosis.

Children and infants generally show symptoms of poor apetite, high fever, cough and tired. For older people they seem very confused in addition to other symptoms. So in summary, we ca list up the following criterion as the sign of pneumonia:-

• Cough, often comes with sputum directly from the lungs. The colour of the mucus or sputum may vary from white, colourless to rusty or green or shaded with blood.

• Fever, which is very common in infants and toddlers, but not that much prevalent in adolescents or elderly.

• Trembling, with teeth-grinding in chills, may even continue for a long time.

• Very fast breathing and feeling like there is a scarcity of oxygen all around.

• Intense chest pain, increases with coughing.

• Fast heartbeat

• Feeling of acute fatigueness.

How is pneumonia diagnosed?

• Using stethoscope

The Pneumonia may be diagnosed by hearing the crackling sounds when listening to a portion of the chest of the suspected individual with a stethoscope. The crackling sound usually is accompanied by wheezing breathing noise.

• Chest X-ray

In general, chest x-ray is usually done to determine the diagnosis of pneumonia.

• Sputum Test

In case the pneumonia is not caused by virus rather it is caused by bacteria, the sputum sample test will serve the best to identify the agent.

• Blood Test

Specific kind of blood test helps in determining the quantity white blood cell available in a given quantity of blood stream. It helps in identifying the severity of the pneumonia and the underlying infectious agent of it.

• Using Bronchoscopy

In this method, a thin, flexible and illuminated lighting tube is inserted into the nose or mouth. Before that, local anesthesia is implemented on the patient to refrain him from any uncomfortable incidence. Now the doctors examine the nasal passage in order to collect the sample directly from the infected part of the lung.
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