Pneumonia Treatment in Delhi, India

Pneumonia is a respiratory infection in which both lungs' air sacs become inflamed or filled with fluid or pus. This results in a cough with phlegm or pus, difficulty breathing, fever and chills. 

Various organisms, such as bacteria, viruses and fungi, can cause pneumonia. It can range from mild to life-threatening conditions. The condition is more severe in children and people older than 65 years. A compromised immune system has a low chance of survival.

Types of Pneumonia 

Pneumonia is divided into the following types based on its cause:

• Hospital-acquired pneumonia (HAP)
• Community-acquired pneumonia (CAP)
• Ventilator-associated pneumonia (VAP)
• Aspiration pneumonia

Stages of Pneumonia 

Based on the area of the lungs affected, pneumonia may be classified into:

• Bronchopneumonia: This type indicates the involvement of the bronchi.
• Lobar pneumonia: Lobar pneumonia involves one or more lobes of the lungs. Based on its progression, it can be further classified as:

• Congestion
• Red hepatisation
• Grey hepatisation
• Resolution

Symptoms of Pneumonia 

Pneumonia may range from mild to severe depending on the bacterial activity, age and overall health of the patient. Some characteristic symptoms of pneumonia include:

• Fatigue
• Fever, sweating, and shaking chills
• Nausea, vomiting, or diarrhea
• Chest pain on breathing or coughing
• Confusion or changes in mental awareness affecting the aged population
• Loss of appetite
• Headaches
• Productive cough
• Cold skin and lower-than-normal body temperature
• Shortness of breath
• Newborns and infants may be asymptomatic or may show symptoms such as vomiting, fever, cough, restlessness or tiredness, and difficulty breathing and eating.

Causes of Pneumonia 

Pneumonia is caused by various bacteria, fungi and viruses. The infection occurs in the lungs, leaving them inflamed and making it difficult for the person to breathe. Some of the agents responsible for causing this condition include:

• Bacterial pneumonia: Streptococcus pneumoniae commonly causes bacterial pneumonia. 

Other organisms are:

• Mycoplasma pneumoniae
• Haemophilus influenzae
• Legionella pneumophila

• Viral pneumonia: Respiratory viruses that cause pneumonia include:

• Influenza (Flu)
• Respiratory Syncytial Virus (RSV)
• Rhinoviruses (Common Cold)
• Human Parainfluenza Virus (HPV) infection
• Human Metapneumovirus (Hmpv) infection
• Measles
• Chickenpox (Varicella-Zoster Virus)
• Adenovirus infection
• Coronavirus infection
• SARS-CoV-2 infection (the virus that causes COVID-19)

• Fungal pneumonia: Fungi from soil and bird droppings may cause pneumonia. Some organisms responsible for it include:

• Pneumocystis jirovecii
• Cryptococcus species
• Histoplasmosis species

Diagnosis of Pneumonia 

Pneumonia is often diagnosed with the patient's medical history and performing a physical exam. Often, doctors look for abnormal bubbling or crackling sounds in the lungs when breathing, which may suggest pneumonia.

If the doctor suspects pneumonia, further tests that are advised include:

• Blood tests: These are advised to confirm an infection and to identify the causative organism. This helps formulate a treatment plan.
• Chest X-ray: This helps diagnose pneumonia and assess the extent and location of the infection.
• Pulse Oximetry: This study measures the amount of oxygen in the bloodstream since pneumonia lowers oxygen levels.
• Sputum test: A sample of fluid from the lungs, often sputum, is sampled after a deep cough and analyzed to evaluate the cause of infection.
• CT scan: If pneumonia is not healing at an expected rate, a chest CT scan will help obtain a clearer and more detailed image of the lungs. 
• Pleural fluid culture: This test helps analyze the type of infection.
• Bronchoscopy: This test helps when the case is severe, the individual is hospitalized, or when the person is not responding to antibiotic treatment.

Treatment for Pneumonia 

Treatment is formulated depending on the type of pneumonia, its severity, and the patient's general health.

Prescription Medications

Medicines are the first line of treatment. The medicines prescribed depend upon the cause of pneumonia. Most often, oral antibiotics are prescribed for treating bacterial pneumonia. It is essential to complete the entire course of antibiotics to see the desired results.

On the contrary, antibiotics do not work on viral pneumonia. Therefore, an antiviral drug may be given with at-home care instructions. On the other hand, antifungal medicines can be prescribed to treat fungal pneumonia.

OTC Medications

These contain anti-inflammatory and analgesic medications to relieve pain and fever, as needed. Some examples include aspirin, ibuprofen and acetaminophen.

Hospitalization 

If the symptoms are severe, and if patients have comorbidities, hospitalization may be essential. It helps doctors track heart rate, temperature, and breathing.

Hospital treatment may include:

• Injecting IV antibiotics: Respiratory therapy involves the administration of specific medications directly into the lungs and breathing exercises to improve oxygenation.
• Maintaining healthy oxygen levels throughout the body using the nasal tube, face mask, or ventilator, depending upon the severity of the condition

Indications of Hospital Admission

While each case is unique, here are common indications for hospital admission in cases of pneumonia:

• Severity of Symptoms

• High fever: A persistent high fever may indicate a more severe infection.
• Severe cough: Persistent and severe coughing, especially if accompanied by the production of thick, greenish or bloody sputum.
• Shortness of breath: Difficulty breathing or rapid breathing is a sign that the infection may be affecting the oxygen exchange in the lungs.

• Age and Underlying Health Conditions

• Very young children and elderly individuals may be more vulnerable and may need hospitalization.
• Underlying health conditions: Patients with chronic diseases (e.g., heart disease, diabetes) or weakened immune systems may require hospitalization.

• Vital Signs

Abnormalities in vital signs such as high heart rate, low blood pressure, or low oxygen saturation may warrant hospital admission.

• Radiographic Findings

Radiographic evidence of extensive lung involvement or complications may necessitate hospitalisation.

• Blood Tests

Blood tests with high levels of inflammatory markers like C-reactive protein (CRP) or elevated white blood cell count may suggest a severe infection.

• Inability to Take Medications Orally

If a patient is unable to tolerate oral medications or is not improving with oral antibiotics, hospital admission may be considered for intravenous antibiotic therapy.

Dehydration

Pneumonia can lead to fluid loss through fever and increased respiratory effort. If the patient is unable to maintain adequate hydration orally, hospital admission may be necessary for intravenous fluids.

Failure of Outpatient Management

If a patient's condition does not improve with outpatient treatment or worsens despite treatment, hospital admission may be required for closer monitoring and more intensive care.

Complications of Pneumonia 

Pneumonia may cause complications in complex cases, such as those with a weak immune system or chronic conditions. These complications include:

• Worsened chronic conditions: Often, pre-existing conditions worsen with the superinfection of pneumonia—for example, congestive heart failure and emphysema. Additionally, there is an increased risk of having a heart attack.
• Bacteremia: Pneumonia-causing bacteria may spread to the bloodstream. This may result in low blood pressure, septic shock, or multi-organ failure.
• Lung abscesses: With untreated infection, pus-filled cavities, known as lung abscesses, may develop in the lungs. These require antibiotic treatment and sometimes surgery or drainage.
• Breathing difficulties: Getting enough oxygen may make it difficult to breathe, and ventilator support may be needed.
• Acute respiratory distress syndrome: This condition is a medical emergency and a severe type of respiratory failure.
• Pleural effusion: Untreated pneumonia may lead to the accumulation of fluid around the lungs, a condition known as pleural effusion. This fluid may become infected and require drainage.
• Kidney, heart, and liver damage: Damage to these organs may worsen the condition further.
• Death: Pneumonia can be fatal if not treated on time.

Risk Factors Associated with Pneumonia 

Pneumonia can develop in any age group. However, children and the geriatric age group carry the highest risk. Other risk factors include:

• Weakened immune system: Individuals with weaker immune systems are at a greater risk of developing pneumonia. For example, people with AIDS/HIV, organ transplant cases, cancer, and others.

• Smoking: Smoking impairs the natural defenses of the lungs against respiratory infections, making it easier for bacteria to colonize.

• People with co-existing medical conditions, such as:

• Asthma
• Cystic fibrosis
• Diabetes
• COPD
• Heart failure
• Sickle cell disease
• Liver disease
• Kidney disease

• People with brain disorders that impair coughing and swallowing abilities, such as:

• Stroke
• Head injury
• Dementia
• Parkinson's Disease
• Exposure to lung irritants, like air pollution and toxic fumes, especially occupational hazards.
• Living in a crowded environment, like a prison or nursing home.
• Alcohol and drug abuse.

Prevention of Pneumonia 

Pneumonia can be prevented in the following ways:

• Vaccination: Vaccines for some types of pneumonia and flu are available that will help prevent these diseases. Both children and adults should be vaccinated. It is essential to discuss it with the healthcare provider about it. A separate pneumonia vaccine is available for children younger than two and those between two and five years of age. This vaccine is particularly for children who are at risk of developing pneumococcal disease. This vaccine should be administered to children over six months of age and those who visit childcare centers.
• Practicing good personal hygiene: Maintaining healthy personal hygiene helps prevent many diseases, including respiratory disorders. A simple act of washing hands provides protection against infection-causing bacteria.
• Avoid smoking: Smoking impairs the natural defenses of the lungs against respiratory infections. Hence, it should be avoided.
• Having a strong immune system by sleeping well, exercising and eating healthy helps fight infections better.

Review

Reviewed By Dr. Inder Mohan Chugh, Senior Director, Pulmonology