The pneumonia is an inflammation of the tissue of the lungs . Generally it is caused by a bacterial infection, however, it can also be caused by viruses, fungi or the aspiration of a foreign body.
Among the viral infections that cause pneumonia, the new corona virus SARS-CoV-2, a new strain of corona virus, which is capable of causing the disease called COVID-19 has also been added in recent months .
In summary, pneumonia is manifested by coughing, difficulty breathing, fever , sometimes even chest pain and mental confusion.
Although it can affect people of all ages, in infants and children it represents one of the most serious and frequent infections , to the point of constituting the main cause of infant death in the world. In particular, in Europe there is an incidence of almost 40 cases per 1000 children.
Although it is a disease that in most cases can be cured and from which it is cured, in elderly people or with other pathologies already present , it can manifest itself in a serious way and also lead to death.
Pneumonia: what it is
It is an infection of the small pulmonary cavities, called alveoli, and surrounding tissues.
In fact, due to the effect of pneumonia, the pulmonary alveoli become inflamed and filled with liquid . But what are pulmonary alveoli? Imagine tiny elastic balloons that perform the function of extracting the oxygen necessary for the cells of our body from the air. At the same time, they release carbon dioxide, which is the waste product of cellular activity . As a consequence of this inflammation, gas exchange becomes difficult as it becomes difficult to breathe .
In particular, two types of pneumonia are distinguished :
- alveolitis : inflammations that mainly affect the alveoli and are mainly caused by bacteria
- acute interstitial : they affect the interstitial lung tissue and are caused by viruses and some bacteria.
It should be emphasized that this disease is among the most common causes of death worldwide. Furthermore, often in people who are affected by other serious chronic diseases, pneumonia is the last pathology that occurs and causes death , as for example is happening in this period with pneumonia caused by coronavirus .
Finally, it is also the most frequent cause of death among infections that contract when you are hospitalized.
According to the latest data, around 2.5 million people die from pneumonia worldwide . Of these, almost a third are children under the age of 5. In fact, according to the World Health Organization ( WHO ), pneumonia causes the death of 1.2 million children under 5 every year. A good percentage of these deaths are also related to malnutrition.
Pneumonia causes the death of about 11 thousand people in Italy every year and is the leading cause of death from infectious diseases in western countries.
However, according to the Ministry of Health , despite not having much data available, it is estimated that the incidence of pneumonia in Italy is less than two cases per 1000 inhabitants , but it is still responsible for over 136,000 hospitalizations.
Furthermore, it is important to emphasize that in almost all death cases, these are people over the age of 70 .
Known since ancient times, the disease is mentioned for the first time by the ancient Greeks . But it is only in 1881 that streptococcus pneumonia was discovered , a bacterium responsible for most cases of pneumonia worldwide.
To make this important discovery were the French Louis Pasteur and the American George Sternberg , both biological. In fact, independently of each other, the two scientists identified this bacterium in saliva .
Later, while trying to develop a vaccine, sulfapyridine , the first antibacterial agent, was introduced in the 1930s . Despite the success this drug had in curing Winston Churchill in 1942 , it was soon put aside with the discovery of penicillin in the early 1940s . However, this antibiotic was used for all types of pneumonia , even those not of bacterial origin, so much so that it ended up causing the development of antibiotic resistance .
Discovery of the vaccine
Finally, in 1977 the first vaccine capable of protecting against pneumococcal pneumonia was developed , although it is only able to act against a limited number of streptococcal serotypes .
In addition, a second vaccine was introduced in 2000, which offers protection against many more serotypes , including those that have proven resistant to antibiotics.
Types of pneumonia
It is generally caused by a bacterium, Streptococcus pneumonia , also known by the name of pneumococcus. In this case we speak of bacterial pneumonia .
But there are also other bacteria that can cause it , such as:
- Haemophilus influenzae
- Staphyloccocus aureus
- Legionella pneumophila.
Other types of pneumonia
In addition to that of bacterial origin, there are other types of pneumonia:
- viral : frequently caused by respiratory syncytial virus (RSV), especially in children under one year of age. It is manifested by a “bronchiolitis” that affects the bronchioles. In addition, viral pneumonia can also be caused by type A and B flu viruses and coronaviruses. However, they are rarer than bacterial ones.
- Fungal : it is a very rare form and which generally affects people with weakened immune systems. Among the most common pathogens that cause it are the ‘ Histoplasma capsulatum, the Coccidioides immitis , and Blastomyces dermatitidis.
- Aspiration (or ab ingestis) : this form is also very rare, as it is caused by aspiration in the first respiratory tract and subsequently in the lungs of foreign substances (solid, liquid or gaseous). Generally these are mainly food or gastric juices, or foreign objects, toxic substances such as smoke or chemicals. Finally, aspiration pneumonia is more frequent in those people who have difficulty swallowing due to degenerative diseases or brain stroke.
- Obstructive pneumonia : occurs when there is an obstruction of the airways in the lungs, caused for example by a tumor. In this case bacteria accumulate behind this obstruction.
- Hospital : also known as nosocomial, it affects people hospitalized for the treatment of other diseases or undergoing surgery. In particular, those who are hospitalized in intensive care and subjected to artificial respiration are at risk. However, this type of pneumonia is also caused by bacteria, such as Pseudomonas eruginosa, Acinetobacter, Klebsiella pneumoniae.
The COVID-19, that is, the disease caused by the novel coronavirus , can manifest with milder symptoms, such as fever, fatigue, dry cough, nasal congestion, sore throat, muscle pain.
Conversely, in severe cases, the infection can also cause pneumonia. About 1 in 5 people with COVID-19 become seriously ill , presenting with breathing difficulties.
Among the people most at risk of developing serious forms of the disease, there are the elderly and those who have other pathologies , such as:
- high pressure
- heart disease
Pneumonia: causes and risk factors
Usually, the germs are transmitted from one person to another or by touching objects or surfaces where the germs are present and then placing their hands on the mouth or nose.
Fortunately, our body is able to eliminate these germs almost always , before they reach the lungs and cause an infection.
In the case of full blown pneumonia, bacterial pneumonia is not contagious . However, those with pneumonia should avoid contact with family members or other people who have weak immune systems, because they are more likely to get sick.
There are some people who are more likely than others to get pneumonia:
- infants or very young children
- Senior citizens
- people suffering from certain respiratory diseases, such as asthma, cystic fibrosis or heart, kidney or liver disease
- people who have weakened immune systems (for diseases such as flu, HIV, AIDS, because they are doing chemotherapy for a tumor or because they are taking anti-rejection drugs after a transplant).
The signs of pneumonia can appear suddenly, within 1 or 2 days and be very serious : in this case we speak of severe pneumonia . On the contrary, they can occur even more slowly, over several days . In the event that the symptoms are mild, it is called atypical pneumonia .
However, the most common symptoms are:
- cough : dry or with the presence of dense phlegm, yellow-green, brown or light, possibly with blood streaks
- breathing difficulty : the person breathes more quickly and superficially and has the sensation of “shortness of breath”, as occurs during physical activity
- accelerated heart beat
- general malaise, with headache, nausea and vomiting
- chills and sweating
- lack of appetite
- chest pain, which is accentuated with breathing or coughing
- confusion (especially in older people).
Rarely, hemoptysis, or coughing up blood , can also occur .
In general, the most serious symptoms occur in young children, the elderly and in people who already suffer from other lung disorders , such as COPD, that is, chronic obstructive pulmonary disease .
Symptoms in children
Children who have pneumonia exhibit symptoms similar to adults , such as fever, tachypnoea (increased respiratory rate) and dyspnoea (difficulty breathing), cough, wheezing and chest pain. To these are added other signs not related to the respiratory system, such as:
- lack of appetite
- vomiting and diarrhea, possibly also with abdominal pain
Symptoms in the elderly
Again, the symptoms may be the same as in younger people, but in some cases they may be atypical and make diagnosis more difficult.
In particular, the elderly may experience less confusing mental pain, chest pain and fever than in young adults. In addition, they may present with cardiac complications and cardiac stroke , and even overlapping viral and bacterial pneumonia .
If one of the symptoms described above occurs, it is good to go to the doctor who will carry out the diagnosis by listening to the chest with a stethoscope , to detect any noises that occur if the lungs are not healthy. In fact, in the presence of pneumonia, the air generates particular noises because it passes through areas of the lung that are full of liquid.
In the event that the doctor thinks pneumonia is severe or if the symptoms do not improve after 48 hours after the treatment was started, an X-ray of the lungs should be taken.
In fact, this test is used to evaluate how extensive the infection is and above all to distinguish between pneumonia and bronchitis, given that the two diseases have similar initial symptoms.
In addition, other tests may also be needed , such as blood test (blood culture) and / or sputum microbiological test to identify pathogens and choose the most appropriate cure.
However, if you experience more severe symptoms right away, such as difficulty breathing and chest pain , you should go directly to the emergency room.
Complications that can trigger pneumonia
In some cases of particularly weak people, because very young, elderly or suffering from other pathologies, for example diabetes, pneumonia can give rise to complications.
Pleurisy is the most common of all. It occurs when the pleura becomes inflamed , that is, the thin membrane that lines the lungs and the inside of the chest.
In addition, it can also be accompanied by pleural effusion, or by the increase in the liquid contained in the space between the lungs and chest. As a result, the lung is compressed and breathing becomes difficult , to the point that this complication can result in respiratory failure .
In the event that the infection also extends to the liquid and the pleural cavity (empyema), it is necessary to intervene surgically with a drainage or with more invasive interventions.
In this case the bacteria responsible for pneumonia pass into the blood causing a serious and general infection to the whole body.
Lung abscess is a rare complication that can occur in people who already have other diseases or have abused alcohol . It manifests itself as a sac of pus that forms in the lungs . It is treated with antibiotics and only rarely is surgery necessary to drain the abscess and remove the part of the lungs involved.
Respiratory failure occurs when the amount of oxygen in the blood decreases or that of carbon dioxide is too high. It manifests itself with labored breathing, cyanosis and confusional state. To treat it, oxygen is administered and in severe cases artificial respiration may be necessary, until the pneumonia that caused it can be treated.
Generally for the treatment we use:
- antibiotics that act against the type of germ that caused the infection . In practice it is a question of giving a narrow spectrum antibiotic. Instead, a broad-spectrum antibiotic is administered (which kills not only the pneumonia bacteria, but also those of the intestine, for example) only if the pneumonia is severe or the person has a weak immune system. In fact, the aim is to immediately reduce the severity of the disease and the risk of complications.
- Antivirals : in the case of pneumonia of viral origin, for example caused by flu or chicken pox, in which antibiotics are not effective.
- Antifungals or antiparasitics : are used for pneumonia caused by fungi or parasites, however very rare cases.
- Medicines to relieve fever and pain.
- If necessary, administration of fluids via intravenous and / or oxygen , the latter through a tube that slips into the nostrils.
Also, in some cases a chest x-ray may be needed 6 weeks after treatment to verify that the pneumonia has disappeared.
If the symptoms are not severe, those with pneumonia can be treated at home, under medical supervision, following antibiotic or viral therapy. Either way, drinking a lot and resting is recommended. However, one must not constantly stay in bed but get up and sit down.
When to go to the hospital
Only if the symptoms are more severe and the patient does not respond to therapy may hospitalization be necessary. The same thing also applies in case of serious health problems or other pathologies, or if the patients are very small or elderly.
If pneumonia develops into respiratory failure , interventions that assist breathing may be needed.
Generally, pneumonia responds well to treatment and the person heals, although the cough may persist after the other symptoms disappear.
It is not possible to eliminate all the risks of contracting pneumonia because the disease can be caused by many causes.
But there are some actions that can be taken to reduce risk. Among these:
quit smoking, because smoking facilitates respiratory infections;
avoid alcohol abuse: in fact, excessive and prolonged use of alcohol has been shown to weaken the immune system, which is therefore unable to defend the body from
In addition, it is important to adopt common hygiene practices to avoid the transmission of germs, and therefore contagion, between the sick and healthy people, such as:
- cover your nose or mouth when sneezing or coughing, preferably with a disposable tissue.
- throw away the used tissue because the germs can survive even several hours outside the body.
- wash your hands regularly with soap and water to avoid transferring germs to other people or onto objects or contact surfaces.
Also effective in preventing certain types of pneumonia or reducing the risk of contracting it, are also some vaccines.
It is particularly recommended for children under 6 years of age , adults over 65 years of age and in general for people with certain health problems, such as diabetes.
However, in Italy, the pneumococcal vaccine is free for people over 65 and for newborns (to whom it must be carried out within the first year of life in three doses).
In addition, you only need to get vaccinated once to be covered for life.
Getting vaccinated against flu every year reduces the risk of getting pneumonia that can be caused by seasonal flu.
In fact, the flu can weaken the lungs and put them at risk of bacterial pneumonia .
This vaccine is recommended for people over 65, people at risk (such as those with diabetes or other chronic conditions), health workers and those who work in the community .
Haemophilus influenzae type B vaccine
It is a specific vaccine that can prevent pneumonia caused by the Haemophilus influenzae type B strain (which also causes meningitis).
In particular, this vaccine is recommended for all children from two months of age , especially if they attend kindergartens and / or nurseries , because they are more exposed to infection.
Since this viral infection can also have respiratory complications (such as pneumonia, albeit rare, especially in adults), chickenpox prophylaxis (free and mandatory in Italy for children from 2017), it can also be recommended for adults .
Pneumonia: convalescence diet
Recovery times depend on the type of pneumonia, the severity and age of the person.
In any case, you should not be in a hurry to return immediately to your activities , but instead give the body time to recover energy.
In fact, one can feel debilitated and fatigued, as often happens after important illnesses that have forced us to bed for a long time.
During this period of convalescence, it is a good idea to start slowly:
- have regular meals
- getting out of bed
- do some movement
- expose yourself, even from the window or balcony, to sunlight, obviously avoiding getting cold.
If antibiotics have been taken, the intestine may be affected, so consult your doctor to evaluate whether to take supplements based on probiotics and lactic ferments to restore the balance of the bacterial flora.
It is equally important to follow a healthy and nutritious diet , especially if you have lost weight during the illness.
Eating little and often can be a good strategy to recover your appetite and take in the necessary amount of calories.
Finally, don’t forget to drink enough : plain water, or tea, herbal teas, infusions, juices or juices from fruit and vegetables.
External Link: Coronavirus Pneumonia