The diagnosis and treatment of pneumonia involves not just detecting the disease but also the causative microorganism responsible. Once the infectious agent is isolated, a more focused and effective treatment can be prescribed.
Cases of pneumonia complications have to be diagnosed and treated in a more aggressive manner because they are known to be fatal, especially in young children, the elderly, and those with a weakened immune system.
Diagnosis
Your doctor will suspect pneumonia when he takes your medical history and looks for the classic signs of high fever with chills (up to 1040 F), chest pain, cough with yellowish, green sputum possibly blood-tinged, shortness of breath with rapid shallow breathing.
He will then auscultate your chest with a stethoscope and look for breath sounds that could suggest pneumonia such as decreased breath sounds, short, high-pitched rales (fine crackles), wheezing, pleural rub, etc.
Once he has completed taking your history and finished his physical examination, he will proceed to order lab and imaging tests.
Blood tests. A complete blood count may show increased WBC count indicating an infection in the body.
Chest X-ray can very much indicate pneumonia. The chest radiograph in pneumonia shows unilateral or bilateral opacities mostly at the periphery, (white pulmonary spots called infiltrates) that indicate an infection. The chest x-ray will also help to identify any pneumonia-related complications such as abscesses or pleural effusion, if present. However, the chest x-ray cannot tell whether it is bacterial, viral, or fungal pneumonia, for which more detailed investigations are required.
Pulse oximetry. The pulse oximeter measures the oxygen level in your blood. Oxygen saturation of <94% with other matching indications is suggestive of pneumonia.
Arterial blood gases are measured in the lab and the test shows the levels of oxygen, carbon dioxide, and other gases in the blood. Low oxygen levels can be another pointer to pneumonia.
Sputum test. Sputum that has been expectorated after a deep cough is analyzed for the causative organism of the infection.
Other deeper investigations may be ordered if you show signs of any complications or if you belong to any high–risk group such as if you are older than 65 years.
These investigations may be ordered when complications are suspected:
CT scan. A CT scan can give a more detailed image of your lungs than a chest X-ray and may be recommended if your pneumonia symptoms are not resolving as expected. It will show the extent of damage to the lungs caused by pneumonia and whether any complications have set in such as lung abscesses or pleural disorders.
Pleural fluid culture. A pleural fluid sample is taken with the help of a needle attached to a syringe and analyzed to help determine the type of organism causing the pleural infection. This procedure is called thoracentesis.
A blood culture test can identify the organism causing your pneumonic infection and will also show whether the bacterial infection has spread to your blood.
A polymerase chain reaction (PCR) test of your blood or sputum sample helps to detect the DNA of the viruses or bacteria directly. Once the causative organism is identified, focalized treatment can then be given.
A bronchoscopy is a minimally invasive procedure in which a bronchoscope with a camera attached is inserted down your throat into the airways. It gives a direct vision of the inside of your lungs and airways. This procedure may be required if the ongoing treatment does not give the expected results. At the same time, your pulmonologist may also collect samples of mucus or tissue to help find the cause of your infection and remove blockages such as mucus or an aspirated foreign body for treating narrowed areas in your airways.
Treatment
Treatment and management of pneumonia depends on the type (whether bacterial, viral, or fungal), its severity, and whether any complications have set in.
Once the causative organism has been identified through diagnostic procedures, focused drugs against the identified pathogen can be given.
Bacterial pneumonia is usually treated with antibiotics along with supportive treatment. In uncomplicated pneumonia, azithromycin is the initial antibiotic of choice. Other first-line antibiotics include clarithromycin and erythromycin. Most people need a 7-day course of antibiotics. For hospital-acquired pneumonia, NICE recommends broad-spectrum intravenous penicillins, cephalosporins, or carbapenems as the first line of treatment for severe cases or those at higher risk of resistance to antibiotics.
Viral pneumonia usually requires only supportive treatment, but antiviral medications may be prescribed if pneumonia is a fallout of influenza. Antivirals such as such as oseltamivir, zanamivir, or peramivir may be prescribed.
Fungal pneumonia is treated with antifungal medications. They can include fluconazole, itraconazole, flucytosine, and ketoconazole.
Home remedies
Take plenty of rest. Avoid exerting yourself with household chores until you recover.
Eat healthy
Drink plenty of fluids to help loosen respiratory secretions and bring out the respiratory mucus.
Take oxygen therapy if shortness of breath is present due to low oxygen levels, but only on the advice of the doctor.
Take medicine to control fever and pain. Do not give aspirin to children and teenagers under age of 16 years.
Coughing out lung mucus is one way your body works to get rid of the infection and clear the airways. However, if your cough is bothering you too much, take cough relief medicine only if recommended by the doctor.
Drink warm beverages and use a humidifier to clear your airways and ease your breathing.
Stay away from all types of smoke to avoid aggravating the infection.
Some cases recover and can return to their normal duties within 1 to 2 weeks. Other cases may take a month. Weakness in most people persists for about a month.
Hospitalization
Severe cases of pneumonia require hospitalization. They may require parenteral and oral antibiotics and IV fluids along with oxygen therapy if oxygen levels are low. Very serious cases may be required to be put on a ventilator.
The following conditions in people with pneumonia usually require hospitalization:
Have tachypnea (abnormally rapid breathing, more than 30 times a minute)
You require oxygen therapy to maintain oxygen levels
Have hypothermia (low body temperature)
Have bradycardia or tachycardia. (heart rate is below 50 or above 100)
Children with the following conditions may require hospitalization:
Age below 2 months of age
Are excessively drowsy
Suffer from shortness of breath
Have hypoxia (low blood oxygen levels)
Are dehydrated
How to prevent pneumonia in adults and kids?
Vaccines offer good protection against pneumonia. Despite them being available, pneumonia remains the leading cause of death in developing countries, among the very old, the very young, and those with chronic ailments.
The following measures will go a long way to help prevent pneumonia:
Get vaccinated against pneumonia for adults
There are three pneumonia vaccines that offer protection. They include the pneumococcal conjugate vaccines (PCV15, PCV20) and the pneumococcal polysaccharide vaccine (PPSV23).
The pneumonia vaccines are recommended for children and adults over age 65. Between the ages of 19 to 64, they are recommended for people who fall in the high-risk group such as those with suppressed immunity, chronic smokers, those with alcohol abuse disorder, and those with chronic pulmonary and systemic diseases.
Take the flu vaccine
Taking the annual influenza vaccine helps to protect against the flu. This protection against the flu also protects you against pneumococcal pneumonia, since having influenza increases the risk of getting pneumococcal pneumonia.
Make sure children get vaccinated against pneumonia and influenza.
All babies and young children should receive a pneumococcal conjugate vaccine (PCV15 or PCV20).
The Centers for Disease Control and Prevention (CDC) recommends pneumococcal vaccination for all children younger than 5 years old and those children between 5 and 18 years old with certain high-risk conditions.
The CDC also recommends the annual flu shot for children older than 6 months.
Take the Covid vaccine
Viral pneumonia is a common complication of SARS-COV-2. Therefore, protecting yourself against COVID with the Covid vaccine offers protection to you of developing pneumonia as a complication of SARS-COV-2
Practice good hygiene.
To protect yourself against respiratory bacterial and viral infections that can lead to pneumonia,
wash your hands with soap or an alcohol-based hand sanitizer
do not touch objects and surfaces unnecessarily
maintain a safe distance from people who have a cold or other respiratory illness.
Do not smoke.
Smoking damages the lung parenchyma and decreases the potential of the immune response, both systemically and locally within the lungs to fight infection.
Limit alcohol intake
Chronic alcohol intake contributes to malnutrition, which further leads to a lowered immune system and lowered capacity of the lungs to fight respiratory infection.
Long-term alcohol use also independently doubles the risk for acute respiratory distress syndrome. Stay within safe drinking limits.
Keep your immune system strong
Following the guidelines below will help to keep your immunity strong.
