What is pneumonia?
Pneumonia, popularly known as pneumonia, is an inflammation of the lungs detected clinically and radiologically. Pneumonia, which is a high risk disease, ranks fifth in deaths and first in infectious diseases in our country .
What are the types of pneumonia (pneumonia)?
There are 3 types of pneumonia.
- Community-acquired pneumonia
- Hospital-acquired pneumonia
- Pneumonia in the immunocompromised patient
What is pneumonia (pneumonia) occurring in daily life?
Pneumonia that occurs in daily life is called “Community-Acquired Pneumonia“. It is generally caused by bacterial infection. According to the clinical course, community-acquired pneumonia is divided into 2 groups as typical pneumonia and typical pneumonia.
What are the symptoms of pneumonia or pneumonia?
Typical symptoms of pneumonia and A typical pneumonia are different.
Typical Pneumonia Symptoms :
It is pneumonia that starts with an acute and noisy picture. Fever that rises with chills and chills, cough, yellow green or rust-colored dark sputum, side pains while breathing and shortness of breath are among the first symptoms of typical pneumonia. Respiratory failure may be the typical sign of pneumonia. Lobar involvement occurs on chest radiography. Leukocyte (WBC-White blood cell) and CRP increase in the blood, left shift in the formula The agents are usually Streptococcus Pneumoniae, Hemophilus Influenza, gram negative aerobes and anaerobic bacilli.
Typical Pneumonia Symptoms:
There is a subacute and insidious start. Preliminary symptoms such as joint and muscle pain, weakness and loss of appetite are observed. Complaints such as dry cough, wheezing, headache and abdominal pain due to involvement of extrapulmonary organs are among the A typical symptoms of pneumonia. Patchy infiltration and paracardiac involvement are seen in radiology. Leukocytes (WBC) in the blood are normal or low. The agents are Mycoplasma Pneumoniae, Chlamydia Pneumoniae (TWAR), Legionella Pneumoniae, viruses (Influenza, RSV, Adenovirus, Coronavirus).
In which patients chest radiography can be seen normal?
- In the first 24 hours of pneumonia, pneumonia
- In dehydration (fluid and electrolyte balance disorder)
- In the neutropenic patient
- Chest radiography may appear normal in the initial stage of Pneumocystis Jiroveci pneumonia.
Causes of pneumonia (pneumonia), what are its factors?
It usually happens when body resistance drops. The main causes of pneumonia are bacteria, viruses and fungi. The most common pathogen is the bacteria called Streptococcus Pneumoniae. Mycoplasma Pneumoniae pneumonia can be seen in school-age children. The cause of pneumonia in children and teenagers is mostly viral pneumonia. (66%). This rate is around 13% in adults. Bacterial pneumonias are more common in adults. Differentiation of viral and bacterial pneumonia is difficult. Therefore, antibiotics should be started within the first four hours. Typical and atypical distinction is made by the doctor according to its factors, laboratory and radiological findings and clinical course, and the treatment is arranged accordingly.
What are the risk factors for pneumonia?
The presence of accompanying diseases is among the risk factors for pneumonia.
- Chronic lung diseases such as COPD, Bronchiectasis, cystic fibrosis, bronchial asthma, Interstitial lung disease
- Diabetes Mellitus, popularly known as diabetes
- Heart failure
- Kidney failure
- Liver failure
- Presence of immunosuppressive diseases
- Cancer patients
- Child age and age over 65
- Nursing home or homelessness
- Travel with recent accommodation
- Smoking and alcohol use
- Bedridden patients
- Patients receiving intensive care
- Major operations are the most important risk factors for pneumonia.
Besides these;
- Problems of aspiration of food and beverages, especially in the elderly
- Impaired oral and dental health
- Surgical removal of the spleen
- HIV positive patients and AIDS patients
- Drug and drug addiction
- Alcoholism
- Long-term cortisone use
- Muscle diseases
- Paralyzed patients
- Organ transplant patients
- Past operations are situations that lead to pneumonia.
What should be done for contagiousness and prevention in pneumonia?
Especially if there are viral agents, pneumonia can easily be transmitted. Closed and crowded areas, schools, dormitories, prisons, barracks, nursing homes are risky areas for pneumonia. It is usually transmitted by droplet infection. Cough, mouth and nasal secretions, air conditioners, dirty water, water systems can pose a risk. Hand hygiene is very important.
Hand cleaning, use of masks, smoking cessation, influenza and pneumonia vaccines, antiviral drugs, especially avoiding crowded places during epidemic periods, gain importance in protection from pneumonia.
What are pneumonia (pneumonia) vaccines?
It is used to protect against bacteremia caused by Streptococcus Pneumoniae, the most common agent. There are two types of pneumonia vaccine:
Polysaccharide vaccine: It is protective for 5 years and affects B cells. It does not affect memory cells. It is mildly effective. It is done intramuscularly.
Conjugate vaccine: It is a life-long vaccine. It affects B cells and memory T cells. In people over 65 years of age, conjugated vaccine for once and polysaccharide vaccine, once every 5 years after 6 months, is administered into the Deltoid muscle for people with high risk factors.
Who is the pneumonia vaccine given?
All people over the age of 65, chronic lung, heart, liver, kidney patients, diabetes patients, CSF (cerebrospinal fluid) leakage, patients with cochlear implant implantation, patients with splenectomy, HIV-positive and AIDS patients, alcoholism, smokers, people with nutritional deficiencies , hemoglobinopathies, long-term steroid users should have pneumonia vaccine
Who is the flu vaccine given?
Flu outbreaks are a high risk factor for pneumonia. Flu vaccine is recommended for people over the age of 65, chronic lung, heart, kidney and liver patients, and high-risk people due to their duties (healthcare workers, security guards, cleaners).
How is pneumonia diagnosed?
- The doctor’s medical history and physical examination from the patient
- Sputum and blood cultures for agent detection
- Checking Legionella antigen in urine
- Viral panels
- Infection markers (leukocyte count in blood, CRP, Procalcitonin)
- Blood count
- Liver and kidney function tests
- Determination of serum electrolytes, serum proteins and albumin level
- Radiological examinations (chest radiography, computerized thoracic tomography, thoracic ultrasound) are the most important methods in the diagnosis of pneumonia.
What diseases can pneumonia be confused with?
- Heart failure
- Pulmonary embolism
- Tuberculosis
- Lung cancer and diseases that metastasize to the lung
- Foreign body aspiration
- A disease group called vasculitis
- Interstitial lung diseases
- Hydatid cyst
- Pulmonary involvement of systemic diseases should be considered in differential diagnosis.
How is pneumonia treated?
- First of all, the patient should be informed about the definition, course, and complications of the disease. Taking a good history of the disease and physical examination are important. During outpatient treatment of pneumonia;
- If symptoms worsen or become obvious
- If new findings arise
- If there is no improvement within 3 days
- If the patient feels unwell, he should consult a doctor immediately.
- Pneumonia treatment is done on an outpatient basis, in hospital or in intensive care. Some international scoring methods are used in determining the severity of the disease and the risk of death, the decision of hospitalization and the course of the disease. The most important ones are PSI, CRB 65, CURB 65, A-DROP, SMART-COP2. The patient’s confusion, respiratory failure findings, high urea and creatinine, advanced age, low blood pressure, respiratory rate are important criteria. In addition, the social status of the patient is also important. The homeless, those living in a nursing home, those who live in difficult places, people with physical and mental disabilities, people living alone constitute an important risk group.
- Hospital stay and intravenous antibiotic use should be kept as short as possible. These decisions will be made by the clinician. Longer hospitalizations bring additional infection risk.
- The doctor will make the decision to change antibiotics. If necessary, an infectious disease specialist is consulted.
- It should be known that no antibiotic is completely innocent. Every drug has side effects and risk of allergies. 10% of the society claims to be allergic to penicillin. He attributes this to the post-medication rash as a child. However, less than 10% of those said have penicillin allergy. Care should be taken in individuals with an acute allergic reaction to penicillin. These people are also allergic to cephalosporins and beta lactam group antibiotics.
- At the doctor’s decision, antibiotics, antiviral drugs, fluid and electrolyte support, pain relievers and fever reducers, nutritional supplements are applied. Bed rest should be done. In the treatment of pneumonia, outpatient treatment can be applied, as well as hospitalization, intensive care admission, and mechanical respiratory support. The doctor will decide on these.
- Disease information, regional antibiotic resistance, influenza, Mycoplasma rates, social status of the person, recent antibiotic use, accommodation travel are important information in treatment.
- Antibiotics should be started in the first 4 hours. If there is a suspicion of sepsis or other high risk criteria, antibiotherapy should be started within one hour.
- If the patient has an oral intake and the disease is not severe, oral antibiotics should be given. If intravenous antibiotics are initiated, it should be evaluated within 48 hours and oral antibiotherapy should be started if the situation is appropriate.
- If possible, research should be done for the determination of the agent (such as sputum culture, blood culture, Legionella antigen in urine, viral panels).
- Patients and their relatives should be informed about the course of the disease and drug side effects.
- If the general condition of the patient is good, conscious, cooperative, the disease is stable, there is no resistant bacteria, if there is no fever for 48 hours, if the patient is not hypotensive, there is no respiratory failure, pneumonia treatment may be sufficient for 5 days. However, the patient’s doctor will make the best decision on the duration of pneumonia treatment. The doctor may extend the pneumonia treatment up to 3 weeks, depending on the clinical situation.
