Health :Pneumonia- All you need to know about the infectious killer

Pneumonia is an infection that inflames the air sacs in one or both lungs, which can range in seriousness from mild to life-threatening. In order to shed light on it, The Pioneer’s K. Ramya Sree connects with a few experts, who explain and share insights about the same, its symptoms and also possible lines of treatments.

Did you know that lung infection was one of the major reasons that led to increase in mortality rate during the pandemic times?

The leading cause of infectious death in both children and adults is pneumococcal illness. On an average, it claims more lives among children than AIDS, measles, and malaria put together. Around 2.5 million people died from an acute respiratory infection known as pneumonia in 2019, including 6,72,000 kids. Pneumonia affects 23 percent of the world’s population overall, and case mortality rates range from 14 to 30 per cent.

India is responsible for 20% of those deaths among children and has the highest incidence of paediatric pneumonia worldwide.

“Pneumonia is a form of acute respiratory infection that affects the lungs. Lungs are made up of small sacs called alveoli, which gets filled with air when a healthy person breathes. When an individual has pneumonia the alveoli is filled with pus and fluid which makes breathing painful and limits oxygen intake. Pneumonia results from growth of microbial pathogens (bacteria, viruses, fungi, protozoa) at the lungs alveoli, and bodies respond to those pathogens.The most common route of spread is via airborne droplets from a cough or sneeze or secretion from close contact with an infected person,” said Dr. Kanika Khanna, MD Medicine, Internal Medicine and Consultant, Rural Healthcare, Medyseva.

Talking about the tests that are available for Pneumonia, Dr. Niranjan Patil, Associate Vice President (AVP), Scientific Business head- Infectious diseases, Microbiology and Molecular biology- Head and Biosafety officer, Metropolis Healthcare Ltd said, “Depending upon the cause of pneumonia whether bacterial, viral, fungal, or parasitic pneumonia, the list of tests and findings may differ accordingly. However, for the vast majority, the following tests may be used.”

Pulse oximetry: This is used to measure how much oxygen levels are in the circulating blood. In pneumonia as there is inflammation of lung tissue, it prevents the lung from providing enough oxygen into the blood.

X Ray Chest to look for the inflammation of lung tissue referred to as consolidation is one of the first and commonest tests used in medical practice.

Computed tomography scan (CT scan) shows the extent of the lung affected by pneumonia. It may also show the presence of complications such as lung abscesses or pleural disorders. A CT scan provides more detailed information compared to a Chest X RAY.

A Bronchoscopy  to look inside the lungs and the airways using an endoscope with fiber optic cable connected to a screen.

Complete Blood Count (CBC) which includes total white blood cells (TLC) and differential count ( DLC) to screen and assess the body’s response to pneumonia. It is used as a baseline to assess severity at the beginning as well as to monitor response to treatment.
Culture and antimicrobial susceptibility testing of sputum, respiratory secretions and blood especially for bacterial and fungal causes of pneumonia is done to identify the exact organism involved and to identify which antimicrobials to be administered whether anti-bacterial, antiviral or antifungal depending upon the identified organism based on antimicrobial susceptibility test results obtained.

PCR test: Polymerase chain reaction (PCR) test quickly identifies the DNA or the RNA of the causative pathogenic micro-organism. It is of value, especially where the organism is difficult to grow on culture-based tests. Such a PCR test may be a single micro-organism specific one that looks for only one specific pathogenic organism at one time.

For example: COVID 19 RT PCR or it could be a multiplex meaning that multiple pathogens may be looked for at one go is Filmarray multiplex PCR where either a nasal swab or sputum, respiratory secretions may used as the sample to be tested. It is quick and saves time due to the syndromic approach. Results are available within hours on the same day including genetic markers of antimicrobial drug resistance.

Arterial blood gas test: This is done in very sick patients to measure the blood oxygen levels from the blood in the arteries in the wrist.

Pleural fluid culture to identify the causative pathogenic microorganisms is performed by culturing the fluid collected by doctors using special needles from the pleural space present in between lungs and chest by a procedure termed as thoracocentesis.

Symptoms
.Symptoms may vary from mild to severe.
.Fever with increased pulse rate chills/sweats.
.Cough: Dry or productive
.Hemoptysis: Blood in cough
.Breathlessness or fast breathing
.Chest pain
.Other symptoms: Fatigue, headache, muscle or joint pain
.Pneumonia in infants may present with inability to feed or drink, unconsciousness, hypothermia and convulsions.

Dr. Kanika Khanna further lists a few treatment for the same:
.Appropriate Antibiotics
Adjunctive measures:
.Adequate Hydration, Nutrition and Rest
.Oxygen Therapy for Hypoxemia
.Antipyretics and Analgesics for fever and pain relief
.Cough relief medication may be required
.Critically Ill Patient- Vasopressors and Assisted Ventilation when necessary are critical to successful treatment.
“The main preventive measure is vaccination. Recommendations of the advisory committee on immunisation practices should be followed for influenza pneumococcal and covid vaccines,” concluded the doc.