Pneumonia: symptoms & treatment
Pneumonia is an infection of the lung parenchyma from a variety of causes and is distinguished, depending on the origin of the patient, into hospital-acquired and community-acquired pneumonia.
Community-acquired pneumonia is defined as an acute infection of the lung parenchyma, which occurs in people who have not recently been hospitalized, do not frequently visit health facilities and do not have any immunodeficiency.
It is the most common infection that results in hospitalization and death in all age groups and especially in the elderly.
It occurs in 1-10/1000 adults each year. It is more common in children <5 years of age and adults >40 years of age, with a peak in the elderly. It is also more common in people with comorbidities such as COPD, bronchiectasis, heart and kidney disease, diabetes mellitus, immunocompromised patients, and patients receiving chemotherapy.
Causes of pneumonia
The most common causative agent is pneumococcus (but with a reduced frequency mainly due to vaccination), followed by mycoplasma, haemophilus influenzae, moraxella, various viruses, staphylococcus and pseudomonas (the latter two concern special cases of community-acquired pneumonia). However, most cases of community-acquired pneumonia lack a microbiological diagnosis even after thorough investigation.
During influenza epidemics, the influenza virus is a primary cause of pneumonia, while microbial infection by streptococcus or staphylococcus also occurs very often.
What is the clinical picture of a patient with pneumonia?
The clinical picture varies from patient to patient but usually presents with an acute onset of chills, fever and cough with yellow-green sputum. Chest pain during breathing is observed in 30% and mainly concerns pleural fluid collection. Other symptoms include shortness of breath, headache, while nausea and diarrhea are rarer.
The disease can of course invade more slowly within a few days with less noisy findings or be preceded by a viral infection of the respiratory system.
In the elderly In some patients, the first symptom of community-acquired pneumonia may be associated with confusion, unsteadiness, and urinary incontinence. Finally, a small percentage of patients may not have any chest discomfort at all, which makes it significantly more difficult to diagnose the disease outside of the hospital.
In more severe cases, oxygen may be required and if there is no response, the patient is taken to the Intensive Care Unit, where he is intubated.
The decision on whether hospitalization will be required in a patient with community-acquired pneumonia is made by the physician, who will evaluate the patient’s clinical – laboratory and imaging picture, age and any existing comorbidities.
How is pneumonia diagnosed & treated?
For the diagnosis of pneumonia, a physical examination, history, and chest X-ray are sufficient in most cases. Blood tests, sputum, and chest CT scan may also be required.
Treatment is usually empirical and rarely etiological. Antibiotics, rest, hydration, physiotherapy respiratory tract infections are effective in the vast majority of cases. The duration of treatment is usually 7-10 days.
Prevention of pneumonia
There are three main measures to prevent community-acquired pneumonia:
- vaccination against the influenza virus
- vaccination against pneumococcus
- quitting smoking
Author
