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 Measles

A Simple Guide to Measles
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What is Measles?
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Measles is usually a contagious childhood infection caused by the measles virus, one of the paromyxovirus.
It is characterised by typical prodromal symptoms, generalised rash and Koplik's spots in the mouth.

Who is at risk for Measles?
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Any one at any age can contract measles but it usually occurs in childhood.
Spread is usually by infected persons either from mucous discharges from their coughing and sneezing, or from contact with their skin rash,contaminated items and surfaces.
Usually a person is contagious for about two days before symptoms appear, and up to five days after appearance of the rash.


What are the Symptoms of Measles?
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There is a prodromal peroid of 5 to 7 days after contact with a infected person.
Early symptoms include:
1.high fever

2.coughing,

3.runny nose, stuffy nose,

4.tiredness,

5.red eyes, tearing. ,

6.Koplik's spots (white spots with a red background , located on the inside of the cheeks near the back molars start to appear 2-4 days after the fever.

7.measles rash usually occurs after the appearance of the Koplik's spots.
The rash is typically red,maculopapular, and starts from behind the ears and face, then spreads downward to the neck, trunk, limbs, and soles. Once it reaches the soles, the rash begins to fade in about four days , first the head and neck, then trunk and limbs. There may be a brownish discoloration in areas of affected skin rashes but this is only temporary.

8. enlarged lymph glands may be felt in the neck and groins

9.inflammation of the eyes (conjunctivitis) with tearing may also occurs.

10. diarrhoea and vomiting may occurs in some patients.

Adults tend to suffer more severe symptoms than children do.

People who have had measles develop a natural immunity and cannot contract it again.

What are the Complications of Measles?
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1.Ear infection (Otitis Media) is a common complication of measles.

2.pneumonia in very young children and older patients may be dangerous.

3.encephalitis (brain infection)may ocur in 1 out of 600 patients putting them at risk of suffering seizures, coma or dying.

4.the digestive organs (including the liver),the heart muscle or the kidneys may be damaged in rare cases

A pregnant woman who develops a measles infection has
1.an increased risk of premature labour,

2.miscarriage

3.delivery of a low birth weight baby.

What is the Treatment for Measles?
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There is no cure for measles.
Treatment is therefore symptomatic.
Fever symptoms are treated with Paracetamol.
Children should not be given aspirin due to the risk of Reye's Syndrome which affects the brain

Itch may be controlled by antihistamines which can also help to relieve the runny nose.

Antibiotics may be given if there is superimposed secondary bacterial infection such as otitis emdia and pneumonia.

Cough mixtures may be given to relieve the cough.

Plenty of bed rest is necessary.

Lots of fluids helps to prevent dehydration.

A cool-mist humidifier to soothe respiratory passages may help.

Most patients recover completely from measles.

Death is extremely rare (one out of every 1000 cases), usually from pneumonia or encephalitis.

How do You prevent Measles?
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Measles can be prevented with the measles vaccine, which is usually given to children at the age of 15 months as part of the MMR (measles, mumps and rubella) combination.

A second MMR vaccine is now given at the age of 12 years.