Breath deep - pneumonia facts

Column by Dr. Tim Moser

By Dr. Tim Moser, Denver House Calls in Denver
Posted

Mark was shaking with chills. It was a warm day outside, so there was no reason to feel cold. Mark went indoors to wrap a blanket around his shoulders. The chill made his entire body shake, and a hint of body aches were also present. After about 15 monutes, the chill seemed to go away. Since it was late afternoon, Mark ate a light dinner and went to bed.

Early in the morning he awoke with nausea, body aches, and a nagging pain in his right lower chest. Despite sleeping for almost seven hours, Mark did not feel refreshed. Soon nausea and vomiting developed, followed by body aches and headache. His instincts told him something was very wrong, although he had never experienced an illness like his before. Mark texted a friend, who left work to take him to the emergency room. A nurse with a concerned look on her face listened to his lungs. An X-ray was done, which confirmed the diagnosis of pneumonia.

Pneumonia is a common infection that can affect newborns to the very old. It may be associated with a less serious infection that worsens over time, or be caused by food or secretions entering the lung that should have remained in the throat or stomach. If left untreated, pneumonia can be fatal.

Pneumonia is an infection of the small air sacs in the lung. It is in these areas that oxygen is delivered to the bloodstream, and carbon dioxide is removed. When infected, the air sacs fill with fluid, mucous, and bacteria. This interferes with the body's ability to obtain oxygen and eliminate carbon dioxide.

Causes of pneumonia

Most pneumonias are caused by bacteria or viruses that are inhaled from the environment. In most cases, the bacteria are killed before an infection develops. Depending on risk factors such as tobacco use, a serious infection could develop. The most common bacteria in the community that causes pneumonia is Streptococcus Pneumoniae, which is a distant relative of the bacteria that causes strep throat. This bug causes so many cases of pneumonia every year that a special vaccine has been developed to protect those at highest risk.

In addition to other airborne bacteria, pneumonia may also be caused by aspiration, which is the medical term for stomach or oral fluids getting past the protective gag reflex and ending up in the lung. Since such fluids are laden with bacteria, a serious infection may develop. Persons at the highest risk for aspiration pneumonia are those that have an impaired gag reflex, or problems with swallowing, to include the very elderly, stroke victims, or those that have impaired consciousness due to head trauma or intoxication with alcohol or drugs.

Symptoms

Most patients with pneumonia will have a fever, although this may not be present in the elderly. Often, a shaking chill is seen early. Other symptoms include chest pain, shortness of breath, body aches, loss of appetite, and vomiting. If the lower portion of the lung is affected, then the pain may be present in the abdomen upper abdomen. Without treatment, the symptoms usually worsen.

Diagnosis

Often, pneumonia can be diagnosed based on symptoms. The majority of cases are detected based on a chest X-ray. As the lung tissue becomes infected, the collected fluid in the small air spaces makes these areas of the lung more visible on X-ray. In some cases, the infection extends to the outside of the lung, forming a layer of pus between the lung and the chest wall. This very serious condition is called an empyema, and requires intervention to drain the infection and prevent loss of lung function later in life.

Treatment

The cornerstone of treatment for bacterial pneumonia is antibiotic therapy. If pneumonia is caused outside of the hospital, it is known as a community acquired pneumonia, and usually responds to a variety of oral antibiotics. If pneumonia occurs while staying in the hospital, the bacteria responsible for the infection are often resistant to all but the strongest medications, making it harder to treat successfully.

Besides antibiotics, supplemental oxygen is often needed to keep the blood oxygen level greater than 90 percent.

Cough may be a major concern, especially as the patient recovers from the infection. This is caused by the previously trapped fluids in the lung being mobilized and brought out of the lung. At times cough suppressants are prescribed to allow for sleep, and to help alleviate the pain associated with a severe cough.

Want more information about pneumonia?

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001200/

http://www.mayoclinic.com/health/pneumonia/DS00135

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