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Pneumonia as a disease has remained indefinable, even for medical personnel.
The story has it that in the 16 century in the United Kingdom when the railway was newly introduced people usually shouted “please close the coach window before you give me pneumonia.”
Then in Nigeria we bastardised it. Anybody feeling cold will intone proudly “Doctor, I have pneumonia, I am feeling cold.”
Parents will shout at their children “please go and wear your clothes before you get pneumonia.”
Then the battles of medical clerking between doctors and patients have been on since time immemorial.
“Doctor I have pneumonia”
Are you coughing”
“No”.
“Do you have a fever?”
“No”.
“Do you have difficulty breathing?”
“No”.
“Then how do you know you have pneumonia?
“I was beaten by rain yesterday, my uncle advised me to see a doctor because I will develop pneumonia.”
Medically we know that pneumonia is an infection in one or both lungs. It can be caused by bacteria, viruses or fungi. Bacterial pneumonia is the most common type in adults.
Pneumonia causes inflammation in the air sacs in your lungs, which are called alveoli. When the alveoli are filled with fluid and pus it causes difficulty in breathing.
Pneumonia has been a common disease throughout human history. The word is from a Greek word – “pneumon” meaning lung.
The symptoms were described by Hippocrates C. 460 BC – 370BC. Edwin Klebs was the first to observe bacteria in the airways of persons who died of pneumonia in 1875.
Initial work identifying the two common bacterial causative agents – streptococcus pneumonia and Klebsiella pneumoniae, was performed by Carl Friedlander and Albert Fraenken in 1882 and 1884, respectively.
Friedlander’s initial work introduced the Gram Stain, a fundamental laboratory test still used today, to identify and categorise bacteria.
Christian Gram’s paper describing the procedure in 1884 helped to differentiate the two bacteria and showed that pneumonia could be caused by more than one microorganism.
One study estimated that nearly four million children died each year of acute respiratory infections in the period from 1980 to 1990. Because of this the World Health Organization (WHO) set up the Child Health Epidemiology Reference Group (CHERG) to further study the incidence of childhood Pneumonia.
CHERG performed systematic reviews to compile pneumonia statistics in children under age five for the year 2000. The group found that there were approximately 150 million new episodes of pneumonia in children under five years. Of these 150 million new cases approximately four million occurred in developed countries, while the rest 146 million occurred in developing countries like Nigeria.
The community acquired pneumonia (CAP) develops outside of the hospital or health care environment. It is more common than hospital acquired pneumonia. CAP is most common during cold weather like harmattan.
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Hospital acquired pneumonia (HAP) is acquired when an individual is already hospitalised for another condition. HAP is generally more serious because it develops in patients that are already ill; or hospitalised under medical care for another condition. Being on a ventilator for respiratory support, aggravates HAP.
As I mentioned earlier pneumonia can be caused by four different organisms – viz bacterial pneumonia, viral pneumonia, mycoplasma pneumonia and fungal pneumonia.
Those most at risk for pneumonia are those under 5 or above 65. And those who smoke tobacco, consume large amounts of alcohol, or both, who also have underlying conditions such as cystic fibrosis, chronic obstructive pulmonary disorder (COPD), asthma or conditions that affect the kidney, heart or liver.
If you have a weakened or impaired immune system, due to, for example AIDS, HIV or cancer.
Pneumonia symptoms can be mild or life threatening the most common symptoms of pneumonia include: coughing, that may produce phlegm (mucus), fever, sweating, chills, shortness of breath and chest pain.
Other symptoms can vary according to the cause and severity of the infection, as well as the age and general health of the individual.
Children under five years of age may have fast breathing. Infants may vomit, be weak, or have trouble drinking or eating. Older people may have a lower- than – normal body – temperature.
Typically pneumonia can be diagnosed with physical examination, or Chest X-ray. But depending on the severity of your symptoms your doctor may order other tests including – blood test, sputum test for microscopy, culture and sensitivity.
Pulse oximetry could be used to determine the oxygen content of your lungs. Urine tests can identify streptococcus pneumonia and legionella pneumophila.
A computerized tomography (CT scan) provides a clearer and more detailed picture of your lungs. A fluid sample from the pleural space of your chest may be taken using a needle, this can also assist in identifying the cause of the pneumonia. A bronchoscopy, to look into your airways and lungs to rule out obstruction and lung collapse.
Your treatment will depend on the type of pneumonia you have, how severe it is and your general health conditions.
Antibiotics, antiviral and antifungal drugs are used to treat pneumonia depending on the specific cause. Most cases of bacterial pneumonia can be treated at home.
If your symptoms are very severe or you have other health problems you may need to be hospitalised. Intravenous therapy, respiratory therapy or oxygen therapy, are used to manage serious pneumonia cases
Experts recommend immunization for children and adults. Children get the pneumococcal vaccine as part of their routine shots.
Two different types of pneumococcal vaccines are recommended for people above 65. If you smoke or you have a health problem, it is advisable to get a pneumococcal vaccine. It may not prevent you from getting pneumonia, but if you get pneumonia it will make recovering easier and faster.
There are also everyday precautions you can take to help reduce your risk of getting and spreading pneumonia.
Quit smoking, and avoid secondhand smoke. Smoking damages your lungs and makes you more likely to get an infection.
Wash your hands with soap and water before eating, before and after handling food and after using the restroom. If soap is not available use an alcohol – based hand sanitiser.
Avoid close contact and sharing items with other people, if either of you has a contagious disease, such as cough, TB, covid-19 or Ebola.
If you have to stay in a hospital or other healthcare facility, don’t hesitate to ask your doctor how to reduce the risk of acquiring hospital diseases.
You can also lower your chances of getting pneumonia by staying away from people who have cold, measles, or chicken pox.
Always be medically guided.
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