Pneumonia

The signs and symptoms of pneumonia can have a common presentation or vary from person to person depending on the type of pneumonia, age, and overall health. Some of the common pneumonia symptoms in adults include:

• Cough with sputum
• Fever
• Shaking and chills
• Rapid shallow breathing
• Shortness of breath
• Chest pain
• Low energy
• Loss of appetite
• Nausea and vomiting

The symptoms of pneumonia in adults above 65 years of age may include confusion, changes in mental awareness, and lower than normal body temperature. Pneumonia symptoms in children may include intercostal breathing (where the child uses the chest muscles to breathe), refusal to feed, and high-grade fever. Additionally, children with very severe pneumonia may exhibit symptoms such as unconsciousness, hypothermia (dangerously low body temperature), and convulsions.

Furthermore, the symptoms also vary based on the cause of the infection. For example, bacterial pneumonia can cause symptoms such as a very high-grade fever (around 105 degrees F) along with severe sweating and increased breathing and pulse rate. In some cases, bluish coloration of the lips and nails may be observed due to a lack of oxygen in the blood. In contrast, viral pneumonia symptoms usually develop over a period of time and are similar to influenza symptoms, which include fever, headache, weakness, muscle pain, and dry cough. These symptoms often worsen within a day or two.

Pneumonia is caused by a number of infectious agents and is classified based on the organisms that cause the infections. The common causes and types of pneumonia include:

• Bacterial pneumonia, caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae type b (Hib), and Klebsiella pneumoniae.
• Viral pneumonia, caused by viruses such as the respiratory syncytial virus and coronavirus.
• Fungal pneumonia, caused by fungi such as candida, aspergillus, and mucor.
• Atypical pneumonia or mycoplasma pneumonia, caused by mycoplasma (organisms that have traits similar to bacteria and viruses but do not belong to either category).

Pneumonia can spread via airborne droplets when a person coughs or sneezes. These droplets, when inhaled, can infect the lungs. It can also be transmitted through saliva and blood.

Pneumonia causes more than a million hospitalizations each year. It is one of the most common infectious killers in children, claiming one child every 39 seconds. Anyone can get pneumonia; however, the risk is higher in people:

• Above 65 years of age
• With chronic lung diseases like COPD, cystic fibrosis, bronchial obstruction, or lung cancer, or those with a previous episode of pneumonia
• Suffering from conditions that cause any alteration in level of consciousness (e.g., stroke, seizure, anesthesia, drug or alcohol intoxication) or dysphagia
• With immunocompromised conditions like HIV infection, organ/stem cell transplantation, diabetes, or those on immunosuppressive medications
• Suffering from metabolic disorders like malnutrition, uremia, and acidosis
• With lifestyle risk factors such as smoking, alcohol, and toxic inhalants
• With intubation or bronchoscopy
• With viral respiratory tract infections like influenza

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Based on your symptoms and clinical history, your doctor will perform a physical examination and may order several investigations. Typically, pneumonia can be diagnosed with a physical exam (to hear the sound of your breathing) and X-ray. However, depending on the severity of the symptoms, your doctor may order other tests such as:

• Sputum test: Recommended to detect various respiratory tract diseases caused by fungi or bacteria, including pneumonia.
• Chest X-ray: Used to diagnose problems such as infections, inflammations, or abnormal growths in the lungs.
• Complete blood count (CBC): May be required to evaluate if the patient is suspected of having a severe infection or inflammation.
• Pulse oximetry: Checks the oxygen levels in the blood non-invasively and quickly.
• Arterial blood gas: Measures the acidity (pH) and the levels of oxygen and carbon dioxide in the blood from arteries.
• Bronchoscopy: Provides direct visualization of the lungs, including the bronchioles and airway passages, to detect infections or tumors.
• Urine test: Used to check for the presence of the bacteria Streptococcus pneumoniae in the urine.
• Imaging tests: Tests such as chest CT scan and lung ultrasound may be recommended to check for any damage in the lungs.
• RT-PCR: The most reliable and accurate test to diagnose COVID-19 infection complicated with pneumonia, detecting the genetic material of the virus in a sample (usually a throat or nasal swab).
• Viral serology: Helps detect viral pneumonia and confirm the presence of antibodies targeted against the virus, as well as measure the quantity of viral antigens in the blood sample.

Pneumonia can be prevented in many cases. There are several ways to prevent pneumonia:

• Washing your hands frequently, especially before touching your face and handling food.
• Using hand sanitizer if soap and water aren’t available to clean your hands.
• Quitting smoking and avoiding secondhand smoke.
• Covering your mouth when coughing or sneezing.
• Getting adequate sleep, exercising regularly, and eating a well-balanced diet.
• Avoiding close contact with people who have pneumonia or other contagious illnesses.
• Getting vaccinated if you belong to a high-risk group, such as being over 65 years of age or being over 18 years of age with several risk factors for pneumonia.

Pneumococcal Vaccine

The pneumococcal vaccine protects against pneumococcal diseases caused by Streptococcus pneumoniae bacteria. This vaccination can help prevent respiratory infections caused by these bacteria. The pneumococcal vaccine is indicated for special high-risk groups, including:

• People who underwent splenectomy.
• People with low immunity.
• People suffering from diabetes.
• People with chronic organ failure.

Note: Pneumonia vaccination won’t prevent all cases of pneumonia; however, it can lead to a milder and shorter course of the disease and lower the risk of complications. The pneumococcal vaccine can be given to children below 5 years of age. It is administered in three doses, starting at 1.5 years. The second and third doses, also known as booster doses, are recommended one month and two months after the first dose, respectively. Consult your child’s doctor to ensure which vaccines are best for your child. Remember, vaccinations given at the right time can help provide the best quality healthcare for your child.

The treatment for pneumonia depends on the type, severity, and overall health. In most cases, antibiotics, antiviral, or antifungal medications are prescribed to treat pneumonia based on its type along with other medications to treat symptoms like fever and cough.

1. Antibiotics

Your doctor might recommend antibiotics if he/she suspects a bacterial infection. Some of the commonly prescribed antibiotics include:

• Amoxicillin + clavulanic acid
• Ciprofloxacin
• Cefepime
• Cefuroxime
• Azithromycin
• Levofloxacin

2. Antifungals

These medicines are recommended if you have a fungal infection along with pneumonia, which is mostly seen in patients with comorbidities such as diabetes.

• Fluconazole
• Itraconazole
• Amphotericin B

3. Antivirals

These medicines help to fight the viruses that are responsible for worsening the condition, thereby improving the effectiveness of the treatment.

• Oseltamivir (influenza virus)
• Remdesivir (COVID-19)

4. Mucolytics

Acetylcysteine is one of the commonly used mucolytics that helps to treat respiratory diseases with excessive mucus such as pneumonia, COPD, and bronchitis. It loosens and thins mucus in the respiratory tract or airways, making it easier to cough out.

In severe cases, most people respond to treatment and recover from the condition. However, in some cases, such as diabetes, a weak immune system, or heart failure, complications can arise. This is why it is important to consult your doctor the moment you spot the symptoms of pneumonia.

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Most cases can be treated at home by taking the prescribed drugs, getting enough rest, and drinking plenty of water. However, if it’s not being managed at home, your doctor may advise hospitalization for appropriate treatment. Some common measures to follow at home to treat and manage pneumonia include:

• Take antipyretics and painkillers to control fever and pain. Do not take any medications without consulting your doctor first.
• Drink plenty of fluids as this helps keep your body temperature in control, loosens secretions, and aids in managing cough.
• If you suffer from a severe cough or if your cough is preventing you from sleeping, talk to your doctor about medications that can help.
• Use a humidifier, take warm baths, and drink warm beverages to open up your airways and ease your breathing.
• If you smoke, stay away from smoking, including secondhand smoke or vehicular smoke, as smoke can further impair your lungs and hinder your healing process.
• Get sufficient rest and eat a healthy diet. Limit your daily chores and avoid overexerting yourself until you feel fully recovered.
• Try some chest exercises to help clear mucus from the respiratory tract and improve your breathing.
• Incorporate simple breathing exercises to increase your oxygen levels. Watch the video to learn more.

The common complications due to pneumonia include:

• Impaired breathing
• Acute respiratory distress (a severe form of respiratory failure)
• Lung abscesses (pus in the lungs)
• Bacteremia (bacteria in the blood)
• Pleural effusion (fluid in the lungs)
• Septic shock
• Empyema
• Renal failure
• Respiratory failure
• Pneumothorax

COVID-19 and Pneumonia

The second wave of COVID-19 in India has resulted in significant consequences nationwide. The number of positive cases increased dramatically, leading to a drastic reduction in essential treatment supplies and a significant rise in hospitalizations due to lung complications. One of the severe complications observed during this phase was COVID-19 related pneumonia, particularly in individuals with chronic diseases and pre-existing lung problems. This situation also led to an increased demand for various medications and the use of novel treatment options to enhance overall lung function and reduce viral load.

Some commonly used medications include:

• Fabiviravir
• Ivermectin
• Tocilizumab
• Steroids
• Montelukast
• Levocetirizine

Treatment options such as remdesivir, plasma therapy, antibody cocktails, and 2-deoxy-D-glucose (2-DG) were also utilized to manage COVID-19.

To learn more about COVID-19, its treatment, and the latest updates, please check our coronavirus section.

As cough is one of the most common symptoms of pneumonia, here are a few remedies for cough, other than your conventional medicines.

• Lavanga (clove) can be fried in ghee and kept in the mouth for sucking. This preparation is quite useful for relieving cough.
• For relieving cough, take 60 mg of powdered fruit of pippali (long pepper) and 120 mg of saindhava namak (rock salt). Mix it with hot water and take it twice a day.
• Take 3-6 g of fruit and root of pippali (long pepper) and shunthi (dried ginger) in equal proportions. Mix this with honey and take this mixture twice a day.
• Prepare ghrta, also called ‘ghee’, from equal parts of fruit of maricha (black pepper), ardraka (ginger), and sharkara (raw sugar). It should be taken twice a day in a dose of around 12-24 g.
• Taking 1-3 g of sitopaladi churna with 4 to 6 g of honey twice a day may also help.
• You can take 300 mg of karpooradi churna along with equal parts of sugar candy, twice a day.
• You may take a juice of ardraka (ginger) 14 ml with an equal quantity of honey, twice a day.
• The decoction of tamarind leaves (14 to 28 ml) should be taken with 2 g of saindhava namak (rock salt) and 500 mg of hing (asafoetida) fried in ghee. This preparation can be taken twice a day.