DEFINITION.
Pneumonia is an infectious disease of lungs, mostly caused by bacteria, resulting in the formation of exudates in the lungs.
There are two types of pneumonia.
-Community acquired pneumonia refers to pneumonia which spreads in community
-Hospital acquired pneumonia refers to pneumonia which occurs at least two days after admission to hospital.
RISK FACTORS.
- cigarette smoking.
- upper respiratory tract infection.
-alcohol.
-steroid therapy.
-old age.
-recent influenza infection.
-indoor air pollution.
-Immunodeficiency.
-congenital anomalies in children.
-repeated aspiration.
-abnormalities in the clearance of mucus
CAUSES.
Mostly, it is caused by bacteria, the most common of which are Staphylococcus aureus and Streptococcus pneumonia. It may also be caused by viruses and protozoa.
CLINICAL FEATURES.
Pneumonia may present as an acute illness. Patient may present with fever, rigors, chills, shivering and malaise. Delirium may also be present. The appetite is lost and headache is also reported.
Symptoms involving the lungs include cough, which at first is characteristically short, painful and dry, but later is accompanied by the expectoration of sputum containing pus and mucus. Rust-colored sputum may be produced by patients, and sometimes the patient may also report hemoptysis.
Chest pain may also be present. On X-ray, we can see the lungs as radio-opaque.
TREATMENT.
The most important aspects of management include oxygenation, fluid balance and antibiotic therapy. In severe or prolonged illness, nutritional support may be required.
- oxygen should be administered to all the patients who have high heart rate, low oxygen levels in blood, low blood pressure or acidosis with the aim of maintaining oxygen saturation greater than 92%.
- intravenous fluids should be considered in those with severe illness, in older patients and those with vomiting. An adequate oral intake of fluid should be encouraged. Isotropic support maybe required in patients with shock.
- prompt administration of antibiotics improves the outcome. The initial choice of antibiotic is guided by clinical context, severity assessment, local knowledge of antibiotic resistant patterns and, at times, epidemiological information. Oral antibiotics are usually adequate unless the patient has a severe illness, impaired consciousness, loss of swallowing reflex or functional or anatomical reasons for malabsorption.
-It is important to relieve chest pain in order to allow the patient to breathe normally and cough efficiently. For the most patients, simple painkillers such as Paracetamol or other NSAIDs are sufficient.
- physiotherapy is not usually indicated in patients with CAP, although it may be helpful to assist expectoration in patients who suppress cough because of plural pain.
PROGNOSIS.
Most patient respond promptly to antibiotic therapy. Fever may persist for several days, however, and the chest X-ray often takes several weeks or even months to resolve, specially in old age. Delayed recovery suggests either that complication has occurred or that the diagnosis is incorrect. The mortality rate of adults with non-severe pneumonia is very low(less than 1%). Hospital death rates are typically between 5% and 10% but maybe as high as 50% in severe illness.
PREVENTION.
Current smokers should be advised to quit. Influenza and pneumococcal vaccination should be considered in patients at highest risk of pneumonia, such as those over 65 years of age or with chronic lung, heart, liver or kidney disease, diabetes or immunosuppression. In resource-poor environments, combating malnutrition and indoor air pollution and promoting immunization are particularly important for children.
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