Pneumonia is a fairly common respiratory tract disease, not only in children but also in adults. Pneumonia is a preventable disease, including through vaccination.
Pneumonia is an infection of the respiratory organs, namely the lungs. The lungs play a crucial role in the respiratory system. As a vital organ, they play a role in respiration, which exchanges oxygen needed by all body cells with carbon dioxide, which must be removed from the body.
In addition to respiration, the lungs also play a crucial role in maintaining the balance of blood acidity or pH. They also play a role in regulating the humidity and temperature of air entering the body, thus protecting against pathogens. Pneumonia can be caused by a variety of pathogenic infections, from viruses and bacteria to fungi. The underlying cause of pneumonia will significantly influence treatment and the severity of symptoms.
Reason
Pneumonia can be caused by a variety of microorganisms, from viruses, bacteria, fungi, and parasites. Viral pneumonia is most commonly caused by influenza viruses, parainfluenza viruses, adenoviruses, rhinoviruses, and respiratory syncytial virus.
Meanwhile, bacterial pneumonia can be triggered by infections with Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, and Staphylococcus aureus. Fungal pneumonia is usually closely related to a weakened immune system, such as in people with HIV/AIDS. Fungal infections that can cause pneumonia include Pneumocystis jiroveci, Histoplasma, Blastomyces, and Coccidioides.
Unlike pneumonia in children, which is more often caused by viruses, pneumonia in adults is more often caused by bacterial infections, particularly Streptococcus pneumoniae and Haemophilus influenzae b. However, in cases of COVID-19 infection, adults at risk of complications can develop pneumonia. Besides viruses, bacteria, and fungi, pneumonia can also be caused by parasitic infections. Although this type of pneumonia tends to be less common.
Symptom
Because pneumonia is an infection of the lungs, its symptoms are closely related to the respiratory system. Symptoms can vary widely, from mild to very severe. This can be influenced by the microorganism causing the pneumonia and the immune system.
A common symptom of pneumonia is a high fever. This condition may be accompanied by sweating easily. Furthermore, a cough may be present, with or without phlegm. A cough with phlegm tends to be greenish in color. In severe cases, pneumonia can cause shortness of breath and chest pain.
If shortness of breath persists for a long time, it can affect blood oxygen levels. If left untreated, this condition can lead to respiratory failure. Other accompanying symptoms of pneumonia include decreased appetite, weakness, and fatigue. Abdominal pain and vomiting may also occur. However, these symptoms are not typical for pneumonia.
Risk Factors
Pneumonia is highly influenced by the immune system and the risk of exposure to various microorganisms that can cause pneumonia. Older adults, especially those over 65, are more susceptible to infection due to declining immunity.
Additionally, people with a history of other medical conditions can experience a weakened immune system. This is especially true for people with HIV/AIDS, who are more susceptible to infections and pneumonia. Various other comorbidities can also increase the risk of infection and pneumonia, such as in people with chronic obstructive pulmonary disease (COPD), asthma, heart disease, and diabetes.
Stroke survivors who experience neurological impairment and limited mobility can be at increased risk of infection, including pneumonia. This is especially true in cases requiring prolonged hospitalization. Diabetics are 1.5 to 1.7 times more likely to develop pneumonia than non-diabetics. The risk of being hospitalized for pneumonia increases if they have diabetes complications and a history of very high blood sugar levels, leading to increased body acidity or ketoacidosis.
Common viral infections can lead to pneumonia if not properly treated and if the immune system lacks the necessary strength to fight the infection. Improper use of antibiotics can also increase the risk of antibiotic resistance. Certain bacterial infections that should be treated with antibiotics become ineffective due to resistance. This can lead to worsening conditions and complications such as pneumonia.
Exposure to microorganisms can also increase the risk of pneumonia. Living in an area with poor sanitation, exposure from a nursing home, or having a family member with a respiratory infection can increase the risk of transmission and even trigger pneumonia.
Furthermore, immunization plays a crucial role in helping minimize pneumonia symptoms. Failure to receive complete vaccinations, such as those against pneumococcal and Haemophilus influenzae type b (Hib), can increase the risk of developing pneumonia with more severe symptoms. This can occur because the body's immune system has not yet developed resistance to these microorganisms. However, if vaccinated, antibodies have already developed and can fight these microorganisms if they enter the body.
Diagnosis
Anamnesis
During the initial examination, the doctor will conduct a medical interview or history taking to understand the course of the disease and the various symptoms experienced and complained of. During the history taking, the doctor will ask detailed questions about the signs and symptoms experienced to identify the possible underlying cause of the current complaint and determine appropriate and effective therapy.
If a fever is present, you will be asked more in-depth questions about its duration, characteristics, pattern, body temperature, and whether it can be treated with fever-reducing medication. Pneumonia can be accompanied by a cough, either dry or productive.
In bacterial pneumonia, sputum is typically greenish in color. Furthermore, shortness of breath is a common accompanying symptom of pneumonia. It's important to determine its duration, any previous triggers, its characteristics, and any signs of respiratory failure.
Physical examination
During the physical examination, vital signs will be checked, including blood pressure, heart rate, respiratory rate, and oxygen saturation. In pneumonia, the heart rate tends to increase, as does the respiratory rate. Oxygen saturation tends to decrease. A thorax, or chest, exam will also be performed. The chest will be inspected for retractions and the characteristics of breathing, such as whether it is deep or shallow but rapid.
Palpation and percussion of this area will also be performed, especially if pneumonia is suspected, accompanied by complications such as pleural effusion or empyema, which can occur with bacterial infections. The doctor will also perform auscultation using a stethoscope. This is done to assess breath sounds and determine whether there are wheezing or other abnormal breathing sounds.
Supporting investigation
A routine supporting test for pneumonia is a complete blood count. This test will check for signs of infection, indicated by an increase in leukocytes or white blood cells. If necessary, the doctor may also recommend a blood culture to confirm the bacteria causing the pneumonia.
In addition to blood cultures, doctors may also recommend sputum cultures if they suspect a specific microorganism and can provide appropriate therapy. Arterial blood gas testing may also be performed, particularly in cases of pneumonia accompanied by respiratory distress and cyanosis. This test can assess blood oxygen, carbon dioxide, and pH levels.
Another supportive examination that may be performed is a chest X-ray. This test allows the doctor to visualize the lungs, which may show typical signs of pneumonia. If necessary, the doctor may also recommend a CT scan or bronchoscopy. These tests aim to examine the lung tissue more clearly.
Therapy
Therapy and management of pneumonia in children are greatly influenced by the cause and severity of symptoms. Doctors will provide supportive therapy based on the patient's symptoms. For fever, they will prescribe antipyretics to help lower the body temperature. Furthermore, adequate rest is crucial for a faster recovery. Maintaining a healthy diet is also crucial to ensure adequate nutritional needs are met, including daily fluid intake to prevent dehydration.
Oxygen therapy is given for pneumonia accompanied by shortness of breath and decreased oxygen saturation. If there is a tendency toward respiratory failure, mechanical ventilation using a ventilator may be considered. Additionally, if wheezing and phlegm are present, the doctor may recommend nebulization therapy. The frequency of therapy is greatly influenced by the current condition and severity of symptoms.
For definitive therapy, it is crucial to identify the primary microorganism causing pneumonia. If it is caused by bacteria, antibiotics will be prescribed. If it is caused by fungi, antifungals may be given. For viral infections, antivirals may be given if necessary. For bacterial pneumonia, if antibiotics are given but symptoms do not improve, antibiotic resistance should be suspected. Therefore, further testing can be performed to identify alternative antibiotics for more effective therapy.
Prevention
Vaccination plays a crucial role in preventing pneumonia. In addition to the mandatory basic immunizations recommended by the government for childhood, there are several other vaccinations that can be given to adults:
Pneumococcus
One bacterial infection that can trigger pneumonia is pneumococcus. Therefore, this vaccination is important to help develop antibodies against pneumococcus.
Influenza
Influenza is a fairly common type of virus that causes infections. While it tends to cause mild symptoms, it can also cause severe symptoms if the immune system is compromised. Furthermore, this virus changes shape or mutates very quickly, so annual boosters are recommended to maintain protection.
COVID-19
This virus can cause mild to severe symptoms, including pneumonia, if it infects someone. Therefore, if you meet the criteria or are susceptible to infection, it's important to receive the COVID-19 vaccination.
In addition to vaccinations, you can protect your body from various infections by maintaining personal and environmental hygiene. One simple way to do this is by washing your hands regularly.
It's important to keep your hands clean by washing them with running water and soap, especially before eating and after coughing or sneezing. However, if this isn't possible, using hand sanitizer is an option.
It's also important to teach proper coughing and sneezing etiquette in public places to minimize the risk of infection. Furthermore, a healthy lifestyle also significantly influences immunity. Maintaining a balanced diet, drinking enough water according to fluid needs, and exercising regularly are crucial.
Complications
Pneumonia is a complication of a respiratory tract infection. Furthermore, if left untreated, pneumonia can lead to various complications.
Pleural effusion
Pneumonia caused by bacterial infections, if left untreated, can lead to fluid buildup in the lining of the lungs. This can worsen shortness of breath, requiring further intervention to remove the fluid from the cavity.
Empyema
In addition to fluid in the space between the lung and its membrane, the area can also fill with pus in severe infections. This requires more intensive antibiotic therapy and prompt drainage of the pus before the infection spreads.
Sepsis
If left untreated, lung infections in pneumonia can spread to the bloodstream and trigger an inflammatory reaction. This condition can worsen to shock and can be life-threatening.
respiratory failure
One of the symptoms of pneumonia is shortness of breath. This occurs due to a lack of oxygen needed by cells throughout the body. If prolonged, this not only causes cyanosis but can also lead to respiratory failure.
Developmental disorders
In cases of recurrent pneumonia in children, the nutrients from food consumed are used more to combat infection and inflammation. This condition results in children lacking the nutrients necessary for growth and development.
When to See a Doctor?
If you experience typical symptoms of pneumonia, such as fever, cough, and shortness of breath, especially accompanied by cyanosis, you should immediately see a doctor for evaluation and further treatment. Furthermore, if you experience persistent fever, cough, and cold, even if your symptoms are mild, further evaluation is crucial to prevent the disease from progressing to pneumonia.
It is strongly advised against taking antibiotics without a doctor's prescription or not taking them according to the doctor's recommendations, including the recommended frequency and duration. Improper use of antibiotics can increase the risk of antibiotic resistance and worsen pneumonia symptoms, as they are difficult to treat once resistance has developed.
It's crucial to receive a complete basic immunization regimen at the recommended age to build immunity with the antibodies produced by vaccination. Additionally, additional vaccinations can be given to reduce the risk of developing severe symptoms when experiencing pneumonia.
This is highly recommended, especially in cases at high risk of developing severe pneumonia. This high risk is found in people with low immunity, suboptimal immunity, and exposure to various microorganisms that can cause pneumonia.
Written by Dr. Valda Garcia Reviewed by Dr. Ernest Eugene
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