PNEUMONIA: The child killer

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By Maimuna Jatta

Background
The United Nations Children’s Fund (UNICEF) estimates that pediatric pneumonia kills 3 million children worldwide each year. These deaths occur almost exclusively in children with underlying conditions, such as chronic lung disease of prematurity, congenital heart disease, and immunosuppression with most of the deaths occurring in the developing world.

Pneumonia kills more children than any other disease in the world. It kills more children than AIDs, malaria, and measles combined. Pneumonia is a disease that is usually under estimated by the general public, however, it is estimated that pneumonia kills nearly 2500 children a day worldwide.
Pneumonia is a leading cause of death and disability among children in The Gambia. Studies show that it accounts for about 20 percent of death in children under the age of 5years in The Gambia.

What is pneumonia?
Pneumonia can generally be defined as an infection of the lung parenchyma. The lungs are paired organs in the chest that are responsible for respiration (i.e. gaseous exchange). The infection in the lungs causes the alveoli (i.e. air sacs) of the lungs to fill up with fluid or pus, causing difficulty in breathing. The infection can be cause by bacteria, viruses, or fungi.

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Who is at risk?
Pneumonia can occur at any age, although it is more common in younger children. Pneumonia accounts for 13% of all infectious illnesses in infants younger than 2 years.
People who are at higher risk include:
1. Infants from birth to 2 years of age, and individuals ages 65years or older.
2. People who have stroke, have a problems swallowing, or are bedridden.
3. People with weakened immune systems because of disease such as AIDs, or use of medicine such as steroids or certain cancer drugs.
4. People who smoke, misuse certain types of illicit drugs, or drink excessive amount of alcohol.
5. People with certain chronic medical condition such as asthma, cystic fibrosis, diabetes, or heart failure.

What are the symptoms of pneumonia?
Pneumonia symptoms can range from mild to life-threatening. Symptoms can also vary according to the cause and severity of the infection as well as the age and general health of the individual.

Common symptoms and signs
· Coughing with or without sputum
· Fever, sweating, chills, nausea, vomiting and sometimes abdominal pain
· Shortness of breath
· Chest pain especially with breathing
· Rapid breathing

Symptom by cause
· Viral pneumonia may start with flu-like symptoms, such as malaise, fever and runny nose (rhinorrhea). A high fever may occur after 12-36 hours.
· In bacterial pneumonia, the symptoms may be of sudden onset and there is rapid progression of the illness.

Classification of pneumonia
Pneumonia can be classified according to the organism that cause the infection, the location the infected person acquired the infection, and how the person got infected.

Classification by the
germ causing infection
· Bacterial pneumonia: is the inflammation of the lungs due to some type of bacteria. It is most commonly caused by bacteria know as streptococcus pneumoniae. Other bacteria that cause pneumonia include Klebsiella, Staphylococcus aureus, chlamydopila pneumoniae and legionella pneumophila. The infected organisms are usually contracted via airborne droplets by breathing or when the nasal mucosa comes in contact with an infected surface.
· Viral pneumonia: respiratory viruses are often the cause of viral pneumonia, especially in young children and older people. Viral pneumonia is usually not serious and last for a shorter period of time than bacterial pneumonia.
· Mycoplasma pneumonia: mycoplasma organisms are neither bacteria nor virus but have traits common to both. Myoplasma generally cause mild cases of pneumonia, most often in older children and younger adults.
· Fungal pneumonia: fungi from soil or bird droppings can cause pneumonia in people who inhale large amounts of the organisms. They can also cause pneumonia in people with chronic diseases or weakened immune systems.

Pneumocystic jirovecii pneumonia (PCP) is a fungal pneumonia which usually affects people with weakened immune system such as people with AIDs. In fact PCP can be one of the first signs of infection in people with AIDs.

Classification by location
· Hospital-acquired Pneumonia (HAP): is defined as pneumonia that develops at least 48 hours after admission to a hospital and is characterized by increased risk to Multi-Drug Resistant Organisms.
· Community Acquired Pneumonia (CAP): Community-acquired pneumonia (CAP) is defined as pneumonia that develops in the outpatient setting or within 48 hours of admission to a hospital.

Classification by how they are acquired
· Aspiration pneumonia: this type of pneumonia occurs when you inhale bacteria into your lungs from food, drink, or saliva. This type is more likely to occur if you have a swallowing problem or if you become sedate from the use of medication, alcohol, or some types illicit drugs. In our setting, it is commonly seen in unconscious patients especially those who suffered from a stroke.
· Ventilator-associated pneumonia: when people get pneumonia using a ventilator. This is usually in hospitalized patients who require artificial ventilation because they cannot breathe for themselves for some other medical condition. This type of pneumonia is very uncommon in our setting because the machines required to get to that level of care are mostly unavailable.

Management
The management of pneumonia begins with an individual promptly recognizing the symptoms of the condition and immediately visiting a health facility for management. It should be noted that the symptoms aforementioned are not entirely suggestive of pneumonia. Therefore, if you or a family member experiences any of the symptoms should report to a health facility where the attending health worker will ask some questions and do an examination before ordering some investigations to help confirm or refute the diagnosis of pneumonia.

Some of the investigations that will help the health worker confirm the diagnosis includes a chest x-ray and blood and sputum cultures for microbiological investigation. The microbiological investigations will not only identify the offending organism but also the choice of appropriate antibiotics required to fight the infection. However, because microbiological investigation take time to have the results, the attending health worker usually starts treatment with broad spectrum antibiotics to help keep the infection under control.

In our setting where most of the investigations are not readily available, the diagnosis is usually based on clinical suspicion and chest x-ray findings suggestive of an infective process in the lung.
The procedure for treating pneumonia depends on the doctor’s diagnosis, type of pneumonia, how severe, and the general health of the patient. The doctor will decide if the patient should be admitted in the hospital or continue the treatment at home. Treatment will consist of antibiotics which should always be prescribed by the doctor. Pneumonia heals in about 2 weeks, if there are no complications.

 

Can pneumonia be prevented?
Although pneumonia vaccines can’t prevent all cases of pneumonia, it can lower your chances of catching the disease. In addition, pneumonia vaccines can prevent some of the serious complications of pneumonia, such as infection in the bloodstream (bacteremia) or throughout the body (septicemia), in the younger adults and those older than age 55 that have a healthy immune system.

Children younger than 2 years, adults older than 65, and people with certain medical conditions are at high risk of developing pneumonia. Therefore, these groups of people are recommended to take the vaccine. Children between the ages 2 to 5 can also get vaccinated.
You can also reduce the risk of getting pneumonia by practicing good hygiene, stop smoking, and keeping your immune system strong by regular exercise, eating healthy, and getting enough sleep.

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