Pneumonia, deadly but preventable

Pneumonia is a form of acute respiratory
infection that affects the lungs. Scientists say
the lungs are made up of small sacs called
alveoli, which fill with air when a healthy
person breathes. “However, when an
individual has pneumonia, the alveoli are
filled with pus and fluid, causing cough with
phlegm or pus, fever, chills and difficulty
breathing. It makes breathing painful and
limits oxygen intake,” says General
Practitioner, Dr. Abiola Lanre-Iyanda.
The World Health Organisation notes that
pneumonia is the single largest cause of death
in children worldwide.

Mode of contact
Lanre-Iyanda says one can be infected with
pneumonia anywhere and at any time,
including in the office, school, or the
hospital. “In short, wherever there are
humans, the possibility of getting the
infection is there,” the physician warns.
Lanre-Iyanda says there are bacteria and
viruses that live in the nose, sinuses, or
mouth, but that they may spread to the lungs.
“You may breathe some of these germs
directly into your lungs. If this happens when
you are immunocompromised, then you may
end up with pneumonia,” she says
An individual is said to be in
“immunocompromised” state when his ability
to fight infection is greatly reduced because
of a weakened immune system.
People whose immune system is not working
well are less able to fight off germs, experts
say. “Because of this state, they are more
likely to become infected by germs that
typically do not cause disease in healthy
people. They are also more vulnerable to the
usual causes of pneumonia, which can affect
anyone,” Lanre-Iyanda adds.
Again, she says, bacteria may also spread via
air-borne droplets from a cough or sneeze.
“And that’s why it’s advisable to have clean
handkerchiefs on hand whenever you are in
public places, so that you can cover your nose
and mouth when people around you cough or
sneeze,” she counsels.
In addition, the physician warns, pneumonia
may spread through blood, especially during
and shortly after birth. “This is another
reason why pregnant women must not neglect
antenatal visits, so that these issues can be
taken care of as soon as they are detected,”
Lanre-Iyanda says.

What weakens immune system
Experts say the immune system may be
weakened as a result of many factors,
including when one undergoes bone marrow
transplant or chemotherapy. Again, HIV
infection, leukaemia, lymphoma, and other
conditions that harm the bone marrow may
provide the leeway for pneumonia, physicians
say.
Again, they warn, certain medications —
including steroids, and those used to treat
cancer and control autoimmune diseases —
can weaken the immune system. And those
who have undergone organ transplant —
including kidney, heart, and lung — may
suffer weakened immunity and thus be
susceptible to pneumonia infection.

Causes
The American Lung Association says
pneumonia is caused by a number of
infectious agents, including viruses, bacteria
and fungi. Physicians say pneumonia caused
by bacteria tends to be the most serious kind.
“In adults, bacteria are the most common
cause of pneumonia,” the association
enthuses.
It explains further, “The most common agents
of pneumonia are Streptococcus pneumonia,
which is the most common cause of bacterial
pneumonia in children; Haemophilus
influenzae type b (Hib) — the second most
common cause of bacterial pneumonia;
respiratory syncytial virus — the most
common viral cause of pneumonia.
“In infants infected with HIV, Pneumocystis
jiroveci is one of the commonest causes of
pneumonia, responsible for at least one
quarter of all pneumonia deaths in HIV-
infected infants.”

Presenting features
The presenting features of viral and bacterial
pneumonia are similar, scientists say.
However, the symptoms of viral pneumonia
may be more numerous than the symptoms of
bacterial pneumonia.
“In children under five years of age who have
cough and/or difficult breathing, with or
without fever, pneumonia is diagnosed by the
presence of either fast breathing or lower
chest wall in-drawing, where their chest
moves in or retracts during inhalation,”
Paediatrician and Public Health Specialist, Dr.
Rotimi Adesanya explains.
Adesanya adds that wheezing is more common
in pneumonia that is due to viral infections.
He also warns that infants that are severely ill
as a result of pneumonia attack may be
unable to feed or drink; while they may
become unconscious, or experience
hypothermia and convulsions.
The online portal, webmd.com notes that
symptoms of pneumonia caused by bacteria
usually come on quickly and they may include
cough, accompanied by mucus that is rusty,
green or tinged with blood. The victim may
also have fever, fast breathing and feeling
short of breath.
Shaking and teeth-chattering chills, as well as
chest pain that often feels worse when you
cough or breathe in, may also be experineced.
As time goes on, experts warn, the patient
may experience extreme tiredness, nausea and
vomiting, diarrhoea, lower than normal body
temperature in people older than age 65, and
in people with poor overall health or
weakened immune systems.
Worse still, the patient may experience fatigue
and muscle aches, headache, and excessive
sweating and clammy skin
Adesanya says newborns and infants may not
show any sign of the infection; or they may
vomit, have a fever and cough. “They may
also appear restless or tired and without
energy, or have difficulty breathing and
eating,” he adds.
Lanre-Iyanda says older people who have
pneumonia sometimes have sudden changes in
mental awareness, though they may have
different, fewer, or milder symptoms.
“They may not have a fever. Or they may have
a cough but not bring up mucus. The main
sign of pneumonia in older adults may be a
change in how well they think. Confusion or
delirium is common. Or, if they already have
a lung disease, that disease may get worse,”
she says.
She advises that those who have certain health
conditions, such as diabetes and asthma,
should get vaccinated against the flu and
bacterial pneumonia.

Risk factors
Experts say while most healthy children can
fight the infection with their natural defences,
children whose immune systems are
compromised are at higher risk of developing
pneumonia. Such children include those
whose immune system has been weakened by
malnutrition or undernourishment, especially
infants who are not exclusively breastfed.
“Pre-existing illnesses, such as symptomatic
HIV infections and measles, also increase a
child’s risk of contracting pneumonia,”
experts say.
Environmentalists also add that certain
environmental factors increase a child’s
susceptibility to pneumonia. And they include
indoor air pollution caused by cooking and
heating with biomass fuels (such as wood or
dung), living in crowded homes and smoking
by parents.

Save yourself
Experts say if you are 65 or older, if you
smoke, or have a heart or lung problem, you
should get a pneumococcal vaccine. “It may
not keep you from getting pneumonia, but if
you do get pneumonia, you probably won’t be
as sick,” they counsel.
You can also lower your chances of getting
pneumonia by staying away from people who
have the flu, colds, measles, or chickenpox.
More important, wash your hands often, as
this helps prevent the spread of viruses and
bacteria that may cause pneumonia.
Experts also advise against smoking, as it
damages the lungs and increases the chance
of infection.