By DR ASHRAF ALI KHAN
Pneumonia is a serious infection of the lungs. This usually requires treatment with antimicrobials. People with weakened local or systemic defences are at particular risk. For example, there is a higher risk of pneumonia in smokers. The reason is that with the irritation associated with cigarette (and other sources) smoke, the ciliary function is damaged and bacteria gain entry into the lungs more avidly.
Similarly, children under the age of two, diabetics and people with certain immune disorders, asthma, COPD and adults over the age of 65 are at risk of getting pneumonia that may be severe and life-threatening.
Usually patients with pneumonia present with fever and cough. A cough may be dry or productive of sputum. It is important to try to find out if a person truly has pneumonia by doing a chest X-ray, which, in most cases, will identify the infection in the lungs as some form of unusual opacification. Coming from the community the patients can have one of a variety of organisms causing pneumonia. It is up to the clinician, when they see these patients, either in the outpatient setting or in the A&E to decide what diagnostic studies to send immediately and then to prescribe an antibiotic(s) based on the suspected bacterial cause.
Cases of pneumonia are usually treated with 7 to 10 days therapy with antibiotics – the choice of which are highly specific and should only be prescribed by a physician in attendance of patients with symptoms of pneumonia. Some people with pneumonia will need to be admitted to the hospital and even to the ICU if the doctor making the diagnosis feels that their illness is severe enough.
Diagnostic tests, besides a chest X-ray, helpful in reaching a correct diagnosis and hence the correct antibiotic treatment, include blood cultures, sputum culture and certain antigen/antibody tests for specific bacteria.
At Shaukat Khanum Hospital, we provide management of pneumonia in our cancer patients as well as all-comers. As far as prevention is concerned, we provide counselling through our psychology department regarding quitting smoking. Our clinicians also provide education to the patients about their risks. These include risks like cigarette smoking or exposure to other harmful pollutants.
At Shaukat Khanum Hospital, we also provide influenza and pneumonia vaccinations. The influenza vaccine is an annual vaccine that helps prevent influenza. The flu often leads to pneumonia and worsening of heart/lung conditions that often lead to hospitalization and could be life-threatening in the frail and immune-compromised individuals.
The pneumonia vaccine PCV13 provides protection against a fairly wide variety of pneumonia organisms. There are indications for this vaccine in children younger than 2 years, individuals between the ages of 2 and 64 with certain immune-compromising medical conditions, adults between the ages of 19 and 64 who smoke cigarettes and in all adults over the age of 65. One shot should be sufficient for life in most adults. Another variety of pneumonia vaccine is also indicated in people at risk. This latter variety called PPSV23 can be had a year after the receipt of the PCV13 vaccine.
The writer is consultant infectious diseases and general medicine at SKMCH&RC.