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Pneumonia is an infection in one or both lungs. It can be caused by bacteria, viruses, fungi or parasites. Bacterial pneumonia is the most common type in adults. Pneumonia causes inflammation in the air sacs in your lungs, which are called alveoli. The alveoli fill with fluid or pus, making it difficult to breathe. Pneumonia symptoms can be mild to life-threatening. The most common symptoms of pneumonia include:

• Coughing that may produce phlegm
• Fever, sweating, and chills
• Shortness of breath
• Chest pain
• Haemoptysis

Other symptoms can vary according to the cause and severity of the infection, as well as the age and general health of the individual.

Pneumonia may be classified by:

• The organisms:
  • Bacterial pneumonia
  • Viral pneumonia
  • Mycoplasma pneumonia
  • Fungal pneumonia

• Where it is acquired
  • Hospital-acquired pneumonia (HAP): This type of bacterial pneumonia is acquired during a hospital stay. It can be more serious than other types, because the bacteria involved may be more resistant to antibiotics.
  • Community-acquired pneumonia (CAP): This refers to pneumonia that is acquired outside of a medical or institutional setting.

• How it is acquired
  • Aspiration pneumonia: This type of pneumonia occurs when you inhale bacteria into your lungs from food, drink, or saliva. This type is more likely to occur if you have a swallowing problem or if you become too sedated from the use of medications, alcohol, or some types of illicit drugs.
  • Ventilator-associated pneumonia (VAP): When people who are using a ventilator get pneumonia, it is called VAP.

• Anyone can get pneumonia, but certain people are at higher risk:
  • Infants from birth to age 2 years, and individuals ages 65 years or older
  • People who have had a stroke, have problems swallowing, or are bedridden
  • People with weakened immune systems because of disease or use of medications such as steroids or certain cancer drugs
  • People who smoke, misuse certain types of illicit drugs, or drink excessive amounts of alcohol
  • People with certain chronic medical conditions such as asthma, bronchiectasis, fibrosis, diabetes, or heart failure

Diagnosis

History of the illness and physical examination are important. Listening to your lungs with a stethoscope may reveal abnormal sounds, such as crackling. A chest x-ray will be ordered. Typically, pneumonia can be diagnosed with the physical examination and the chest x-ray. But depending on the severity of your symptoms and your risk of complications, one or more of the following tests may be ordered:

• Full blood count. This test can confirm an infection, but it may not be able to identify what is causing it.
• Sputum culture. This sample from your lungs may identify the organism.
• Secretions for Respiratory viral or pneumonia multiplex PCR.
• A urine test which may identify the bacteria Streptococcus pneumonia and Legionella pneumophila.
• A CT scan thorax. This test provides a clearer and more detailed picture of your lungs.
• A fluid sample from the pleural space if there is pleural effusion.
• A bronchoscopy. This test looks into the airways in your lungs. It does this using a camera on the end of a flexible tube that is gently guided down your throat and into your lungs. Samples of fluid aspirated will be sent for tests.

Treatment

Antibiotic, antiviral, and antifungal drugs are used to treat pneumonia, depending on the specific cause of the condition. Most cases of bacterial pneumonia can be treated at home with oral antibiotics, and most people respond to the antibiotics in one to three days. If your symptoms are very severe or you have other health problems, you may need to be hospitalized. At the hospital, heart rate, temperature, blood pressure, oxygen saturation and breathing will be monitored. Treatment may include:

• Intravenous antibiotics. The antibiotics are injected into your vein.
• Chest Physiotherapy. The therapist helps you to clear your phlegm and teach you or help you to perform breathing exercises to maximize your oxygenation.
• Oxygen therapy. This treatment helps maintain the oxygen level in your bloodstream. You may receive oxygen through a nasal tube or a face mask. If your case is extreme, you may need a ventilator (a machine that supports breathing).

Most people respond to treatment and recover from pneumonia. However, for some people, pneumonia can worsen chronic conditions or cause complications. Like your treatment, your recovery time will depend on the type of pneumonia you have, how severe it is, and your general health.
A younger person may feel back to normal in a week after treatment. Others may take longer to recover and may have lingering fatigue. If your symptoms are severe, your recovery may take several weeks.
If you have certain health problems already, pneumonia could make them worse. These conditions include congestive heart failure and emphysema. For certain people, pneumonia increases their risk of having a heart attack. Pneumonia may cause complications, especially in people with weakened immune systems or chronic diseases such as diabetes. Complications can include:

• Bacteraemia
  • Bacteria from the pneumonia infection may spread to your bloodstream. This can lead to dangerously low blood pressure, septic shock, and in some cases, organ failure.

• Lung abscesses
  • These are cavities in the lungs that contain pus.

• Impaired breathing
  • You may have trouble getting enough oxygen when you breathe. You may need to use a ventilator.

• Acute respiratory distress syndrome
  • This is a severe form of respiratory failure. It is a medical emergency.

• Pleural effusion
  • If your pneumonia is not treated, you may develop fluid around your lungs in your pleura. The pleura are thin membranes that line the outside of your lungs and the inside of your rib cage. The fluid may become infected and need to be drained.

• Death

In many cases, pneumonia can be prevented.

Pneumonia vaccine

The first line of defence against pneumonia is to get vaccinated. There are two pneumonia vaccines, which can help protect against bacterial pneumonia. Pneumonia can often be a complication of the flu, so be sure to also get an annual flu shot. The pneumonia vaccines would not prevent all pneumonia. But if you are vaccinated, you are likely to have a milder and shorter illness, and a lower risk of complications. Two types of pneumonia vaccines are available:

Prevnar 13: This vaccine is effective against 13 types of pneumococcal bacteria.
Pneumovax 23: This vaccine is effective against 23 types of pneumococcal bacteria.

Other prevention tips:

In addition to vaccination, there are other things you can to avoid pneumonia:

• If you smoke, try to quit. Smoking makes you more susceptible to respiratory infections, especially pneumonia.
• Wash your hands regularly with soap and water.
• Cover your coughs and sneezes, and dispose of used tissues promptly.
• Maintain a healthy lifestyle to strengthen your immune system. Get enough rest, eat a healthy diet, and get regular exercise.

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