12th of November has been established as World Pneumonia day since 2009 aiming to increase awareness on pneumonia, one of the leading causes of morbidity and mortality especially in children and the elderly.
What is Pneumonia?
Pneumonia is an infection of the lungs especially affecting the alveoli that fill with pus and fluid instead of air (alveoli are tiny air sacs that help to deliver oxygen from the air to the blood).
Based on where it was acquired, pneumonia is characterized as:
- Community-Acquired Pneumonia (CAP)
- Responsible for the highest rates of morbidity and mortality from infection among adults in Europe1
- Largest cause of death from infection among children worldwide2
- In the EU, CAP is responsible for 1 million hospital admissions every year1
- Nosocomial pneumonia
- Presents 48 hours after admission, Hospital Acquired Pneumonia –HAP
- Presents 48-72 hours after intubation, Ventilator Acquired Pneumonia-VAP acquired1
The most common cause of CAP is streptococcus pneumoniae (pneumococcus), although other bacteria, viruses or fungi can also infect the lungs3.
A special reference this year is dedicated to COVID-19, a new disease, manifested by pneumonia.
“Atypical pneumonia” refers to pneumonia specifically caused by chlamydia, legionella, mycoplasma or psittacosis due to the different clinical presentation and the fact that it requires different treatment3.
“Aspiration pneumonia” refers to the infection that occurs as a result of the inhalation of solid or liquid into the lungs (food, vomit, saliva, chemicals etc.). It is important to identify aspiration pneumonia as the treatment approach is different.
Risk factors for aspiration are:
- Any conditions that:
- Alter the swallowing function (brain injuries, strokes, neurological diseases)
- Alter the level of consciousness (drugs, alcohol abuse)
- Older age
- Rarely, complications of medical procedures
How is it Spread?
Pneumonia is usually spread through droplets in the air released by coughing and/or sneezing, including COVID-19. In young children, virus and bacteria commonly found in their noses or throat can potentially be inhaled and infect the lungs. It can also reach the lung via blood from other sites of infection.
- Age (young children and adults >65 years old)
- Presence of chronic conditions such as COPD, heart disease, or diabetes
- The time period immediately following a viral infection such as flu
- Smoking, alcohol and/or substance abuse
- Residing in crowded areas (for example shelters, residential care facilities or army bases)
In the case of COVID-19 risk factors include Older age, Obesity, Chronic Respiratory and Cardiovascular disorders, Diabetes, Cancer, Smoking, HIV, Immunodeficiency and specific ABO blood group.
Pregnancy & Breast feeding might present a slightly higher risk than same age non-pregnant women.
Symptoms of pneumonia last 3 to 4 weeks while activities of daily living may be impaired for longer.
The presence of a cough and at least one of the following characterize pneumonia:
- Fever (higher than 38 oC) that persists for more than 4 days
- Chest pain when taking a deep breath
- Trouble breathing or quickened breathing
- A fast heartbeat
- Shaking and chills
- Nausea, vomit or diarrhea
The viral pneumonia due to the SARS-CoV-2 infection, usually bilateral in chest images, shares the clinical manifestations of viral pneumonias and is only distinguished by specific laboratory tests. However, it may characteristically develop dyspnea a week from onset and may also be associated with ageusia and anosmia (loss of taste and smell). The clinical course of COVID-19 ranges from an asymptomatic infection to severe and life threatening respiratory and multiorgan failure.
Diagnosis is based on the symptoms and chest radiography findings. Microbiology testing to identify the microorganism and other more complex advanced tests are only needed in special circumstances (for example in severe disease or immunocompromised patient).
Reverse transcription polymerase chain reaction (RT-PCR) testing identifies the SARS-CoV-2 virus RNA in easily collected nasopharyngeal swabs.
In most cases, pneumonia can be successfully treated with broad spectrum antibiotics that target the most likely and frequent causes without the need for more complex interventional tests that are only performed when indicated. It is important that treatment is started as soon as possible. Follow-up with physician is recommended until both symptoms and radiologic findings return to normal.
Currently COVID-19 treatment includes the use of: Dexamethasone, Remdesivir, Convalescent plasma, Monoclonal antibodies, Immunomodulatory agents, Interferons and Azithromycin.
The most important means for prevention of pneumonia are:
- Seasonal influenza vaccination
- Pneumococcal vaccination
- Smoking cessation
- Frequent hand washing
- Good general hygiene
- Exclusive breastfeeding
- Healthy diet and nutrition
- Good management of chronic illnesses
The intense and ongoing research for a COVID-19 vaccine promises its availability in the beginning of 2021. Until then, keeping safe distance (more than 2 meters away from each other), social distancing, wearing face masks and frequently washing our hands are the only means of protection against COVID-19.
- European Respiratory Society. Pneumonia – ERS. https://www.erswhitebook.org/chapters/acute-lower-respiratory-infections/pneumonia/.
- World Health Organization. Pneumonia. http://www.who.int/en/news-room/fact-sheets/detail/pneumonia. Published 2016.
- US Center for Disease Control. Pneumonia | Home | CDC. https://www.cdc.gov/pneumonia/index.html. Published 2018
By Anna Tzortzi, MD, Pulmonologist
Scientific Director “George D. Behrakis Research Lab”
Associate Director “Institute of Public Health, The American College of Greece”
and Melpo Kapetanstrataki, Biostatistics Consultant & Technical Support