Pneumonia is an infection of the lungs especially affecting the alveoli that fill with pus and fluid instead of air (alveoli are tiny air sacs that help to deliver oxygen from the air to the blood).
Based on where it was acquired, pneumonia is characterized as:
The most common cause of CAP is streptococcus pneumoniae (pneumococcus), although other bacteria, viruses or fungi can also infect the lungs3.
A special reference this year is dedicated to COVID-19, a new disease, manifested by pneumonia.
“Atypical pneumonia” refers to pneumonia specifically caused by chlamydia, legionella, mycoplasma or psittacosis due to the different clinical presentation and the fact that it requires different treatment3.
“Aspiration pneumonia” refers to the infection that occurs as a result of the inhalation of solid or liquid into the lungs (food, vomit, saliva, chemicals etc.). It is important to identify aspiration pneumonia as the treatment approach is different.
Risk factors for aspiration are:
Pneumonia is usually spread through droplets in the air released by coughing and/or sneezing, including COVID-19. In young children, virus and bacteria commonly found in their noses or throat can potentially be inhaled and infect the lungs. It can also reach the lung via blood from other sites of infection.
In the case of COVID-19 risk factors include Older age, Obesity, Chronic Respiratory and Cardiovascular disorders, Diabetes, Cancer, Smoking, HIV, Immunodeficiency and specific ABO blood group.
Pregnancy & Breast feeding might present a slightly higher risk than same age non-pregnant women.
Symptoms of pneumonia last 3 to 4 weeks while activities of daily living may be impaired for longer.
The presence of a cough and at least one of the following characterize pneumonia:
The viral pneumonia due to the SARS-CoV-2 infection, usually bilateral in chest images, shares the clinical manifestations of viral pneumonias and is only distinguished by specific laboratory tests. However, it may characteristically develop dyspnea a week from onset and may also be associated with ageusia and anosmia (loss of taste and smell). The clinical course of COVID-19 ranges from an asymptomatic infection to severe and life threatening respiratory and multiorgan failure.
Diagnosis is based on the symptoms and chest radiography findings. Microbiology testing to identify the microorganism and other more complex advanced tests are only needed in special circumstances (for example in severe disease or immunocompromised patient).
Reverse transcription polymerase chain reaction (RT-PCR) testing identifies the SARS-CoV-2 virus RNA in easily collected nasopharyngeal swabs.
In most cases, pneumonia can be successfully treated with broad spectrum antibiotics that target the most likely and frequent causes without the need for more complex interventional tests that are only performed when indicated. It is important that treatment is started as soon as possible. Follow-up with physician is recommended until both symptoms and radiologic findings return to normal.
Currently COVID-19 treatment includes the use of: Dexamethasone, Remdesivir, Convalescent plasma, Monoclonal antibodies, Immunomodulatory agents, Interferons and Azithromycin.
The most important means for prevention of pneumonia are:
The intense and ongoing research for a COVID-19 vaccine promises its availability in the beginning of 2021. Until then, keeping safe distance (more than 2 meters away from each other), social distancing, wearing face masks and frequently washing our hands are the only means of protection against COVID-19.
ANNA S. TZORTZI MD, FCCP
PNEUMONOLOGIST
References