A Simple Guide to Pneumonia

A Simple Guide to Pneumonia
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What is Pneumonia?
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Pneumonia is a serious medical disease which causes inflammation and infection of the lung tissues of one or both lungs.

The alveoli of the lungs are filled with exudates and white blood cells sent by the body to contain the infection.

Because of the congestion of the lungs there is difficulty in breathing and insufficient oxygen to the body thus posing a danger to the patient's life .

It is one of the top causes of death in the world.


What are the causes of Pneumonia?
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Bacterial Infections:
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1.Gram positive bacteria such as Streptococcus pneumoniae and Staphylococcus may be serious and fatal in some cases.

2.Gram negative bacteria such as Klebsiella, E.coli, Pseudomonas, Mycobacteria(including tuberculosis), Legionaire's Disease,chlamydia

Mycobacterium tuberculosis pneumonia are more common in developing countries and in people whose immune systems are impaired(e.g. AIDS) and are preceded by active tuberculosis infections elsewhere.

Viral infections:
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Influenza, arbovirus, Severe Acute Respiratory Syndrome(SARS) virus, coxsackie virus

Fungal infections:
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Cryptococcus neoformans

Non-infectious:
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1.chemicals such as asbestos can damage the lungs and cause pneumonia

2.Othostatic pneumonia occurs in people who are bedridden and are unable to get rid of the fluids accumulated in their lungs

3.Aspiration pneumonia occurs with saliva or fluids in the throat become sucked into the windpipe and the lungs.

This occurs in comatose patients and people having seizures or stroke.

What are Signs and symptoms of pneumonia?
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Symptoms:

1.cold or runny nose is usually the first symptom

2.Fever is usually high

3.cough with productive purulent sputum which can yellow, green or bloody

4.Breathlessness due to congestion of the lungs

5.chest pain especially the sides of the chest due to coughing and fever

6.Myalgia (bodyaches) and headache which may be related to the fever

7.abdominal discomfort

8.lethargy especially in small children

Signs:

1.creptitation sounds on auscultation with stethoscope due to large amount of phlegm in the alveoli of the lungs

2.rhonchi or wheezing sounds due to narrowing of the airways from pressure in the congested lungs

3.Reduced breath sounds - air movement is reduced in the lungs

4.Hyporesonance on percussion of the lungs

5.Cyanosis(blue color) of the lips and fingers if not enough oxygen is entering.

This will considered as a medical emergency.

Children and babies with pneumonia may not have signs of a chest infection.
They are however quite ill, with fever and lethargy.
Elderly people also do not have much symptoms except for fever and breathlessness

How is the diagnosis of Pneumonia made?
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1.Symptoms and signs of fever, breathless and productive cough

2.blood tests (complete blood count, ESR and blood culture) including viral and legionaire's disease

3.Sputum culture to determine the type of micro-organism

4.Chest X-rays to establish site and character of the lung infection

5.Pleural tap may be necessary if there is pleural effusion. The pleural aspirate is then sent for culture and microscopic examination.

6.CT or MRI of the lungs may be done if required especailly if there is suspicion of lung cancer.

What are the complications of Pneumonia?
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1.Pleural effusion

2.septic shock,

3.adult respiratory distress syndrome

4.seizures also more in children

5.Emphysema

6.Pericarditis

What is the treatment of pneumonia?
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1.Hospitalization should be immediate as pneumonia can be a life threatening condition.

2.Antibiotics depending on the organism found:

a.cephalosporin, penicillin, ampicillin, tetracycline, for most streptococci, staphalococci, hemophilus

b.cephalosporins, gentamycin for pseudomonas

c.Tetracycline or erythromycin for mycoplasma and chlamydia

d.Erythromycin and rifampicin for Legionaire's disease.

3.Antivirals such as Tamiflu for Influenza infection
Acyclovir may be given for herpes virus infection

4.High dosages of anti-fungals may be given for Fungal pneumonia for a prolonged period of time

3.corticosteroids is useful to reduce complications

4.High-flow oxygen

5.intravenous fluids

What is the prognosis of pneumonia ?
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This depends on the severity and type of infection.

Most cases if treated early and correctly recovered completely.

The elderly, babies and bedridden has a higher mortality.

What are the Preventive measures taken for pneumonia ?
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Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of pneumonia.

Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumonia.

Vaccinations are recommended in:

Adults age 65 or older

Patient over two years of age
1. with diseased lungs, heart, liver, or kidneys

2. health problems like diabetes, alcoholism, AIDS

3. taking any medications or therapy that can affect the body's immune system
e.g chemotherapy

A Simple Guide to Meningitis

A Simple Guide to Meningitis
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What is Meningitis?
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Meningitis is a serious medical disease which causes inflammation and infection of the meninges which are the protective lining of the spinal cord and brain.

What are the causes of Meningitis?
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The causes of Meningitis may be divided into:

Infections:
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1.viral infections are the most common and are usually mild
(enterovirus, herpes simplex virus 2 and mumps) except for Hand mouth and foot disease(enterovirus EV7)which can cause fatality in children

2.bacterial infections such as meningoccocus (Neisseria meningitidis) and pneumococcus (Streptococcus pneumoniae) can be serious and fatal in some cases.

Meningococcal meningitis can cause outbreaks(spread easily).

E.coli, Group B streptococus and Pseudomonas infection are common in neonates.

Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae are common in infants and children

Streptococcus pneumoniae, N. meningitidis, Mycobacteria are more common in adults.

Mycobacterium tuberculosis meningitis are more common in developing countries and in people whose immune systems are impaired(eg. AIDS) and are preceded by active tuberculosis infections elsewhere.

3.fungi
Cryptococcus neoformans is the most common cause of fungal meningitis

Non-infectious:
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Non infectious causes usually irritates the meninges through inflammation and auto immune reactions:

1.cancers,

2.systemic lupus erythematosus

3.drugs.

4.head injury

5.post neurosurgical procedures


What are Signs and symptoms of Meningitis?
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The triad of symptoms which often defines meningitis are:

1.Severe headache

2.Neck rigidity (unable to flex the neck forward),
A positive Kernig's sign means that the neck will painful when one hip is flexed to 90 degrees and the knee flexed to 90 degrees in a patient lying supine.

3.vomiting

Other symptoms are:

4.high fever

5.mental confusion.

6.Malaise

7.photo-phobia (inability to tolerate bright light),

8.phono-phobia (inability to tolerate loud noises),

9.irritability especially in small children

10.seizures .

11.swelling of the fontanelle may be present in infants

12.rash with numerous small, irregular red spots on the body, lower legs, soles of feet, palms

13.ulcers of the mouth (present in hand,mouth and foot disease).

How is the diagnosis of Meningitis made?
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1.Classical symptoms and signs as above especially neck rigidity

2.blood tests (complete blood count, ESR and blood culture)

3.X-rays of chest and brain

4.cerebrospinal fluid (CSF) analysis via lumbar puncture is examined for white blood cells, red blood cells, protein content, glucose level and micro-organisms.

This test should not be done if there is suspected cerebral mass lesion or raised intracranial pressure (head injury, localizing neurological signs)

A pressure of over 180 mm suggests bacterial meningitis.

5.CSF glucose is low,protein high and cells high in bacterial meningitis,
CSF glucose is normal,protein normal and cells high in viral meningitis
CSF glucose is low,protein high and cells high in fungal meningitis

6.CT or MRI of the brain and spine with MRI preferred over CT because it can detect more easily areas of cerebral edema,tumors, ischemia, and meningeal inflammation.

What are the complications of Meningitis?
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1.Neurological deficits

2.deafness

3.learning disorders in children

4.brain infarction,

5.septic shock,

6.adult respiratory distress syndrome

7.seizures also more in children

8.pneumonia especially in the elderly

What is the treatment of Meningitis?
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1.Hospitalization should be immediate as meningitis is an life threatening condition.

2.Antibiotics such as cephalosporin, ampicillin, chloramphenicol, intravenous vancomycin to be started even before doing lumbar puncture.

Acyclovir may be given for herpes virus infection

High dosages of anti-fungals may be given for Fungal meningitis for a prolonged period of time

3.corticosteroids is useful to reduce complications

4.High-flow oxygen

5.intravenous fluids

What is the prognosis of Meningitis?
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This depends on the severity and type of infection.

Viral infections except for enterovirus EV7 usually recover quickly.

Bacterial infections such as meningococcus and pneumococcus are more dangerous.

What are the Preventive measures taken for Meningitis?
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Vaccinations against Haemophilus influenzae in children and adults has reduced the incidence of this form of meningitis.

Vaccines against type A and C Neisseria meningitidis are used to prevent these types of meningitis especially in those who travel abroad.

Vaccines against type B Neisseria meningitidis have yet to be produced athough a drug company is doing research on the production of this vaccine.

Pneumococcal vaccine against Streptococcus pneumoniae has been given to newborns to prevent pneumococcal meningitis.

Mumps vaccination as part of Measles, mumps and rubella vaccine(MMR) has reduced the incidence of mumps related form of meningitis