What is it?
Pneumonia is an acute inflammation of the lung, caused by infectious agents, but can also be caused by physical or chemical agents or inhaled or aspiration of gastric contents when the level of awareness is low or there is any disorder of swallowing.
We distinguish three categories:
- Community-acquired pneumonia or community acquired: Occurs in people who have not been admitted to any institution.
- Hospital-acquired pneumonia or nosocomial acquired during the hospital stay, even so called, those that occur within 10 days after hospital discharge.
- Pneumonia in the immunocompromised host: We refer to them in those who show any degree of impairment of the immune system to facilitate the development of infection (diabetics, patients with cancer, chemotherapy, or liver cirrhosis patients infected with the AIDS virus ).
For the presentation we distinguish:
- Typical Pneumonia: Having to conduct clinical, radiological and evolutionary very well defined.
- Atypical pneumonia: The clinical picture is less definite and more latent.
What causes it and how is it produced?
The most common causes of typical pneumonia are caused by bacteria, especially Streptococcus pneumoniae responsible for 20 to 70% of them. Other germs responsible are Mycoplasma pneumoniae, Chlamydia pneumoniae, Haemophilus influenzae, influenza virus, Coxiella burnetii and Legionella pneumophila. The germs involved in atypical pneumonias are the M. Pneumoniae, C. Pneumoniae, Legionella and viruses. TB can also occur as pneumonia and must be taken into account in diagnosis.
Pneumonias are more severe in patients with chronic diseases like chronic bronchitis, diabetes, elderly, alcoholic liver disease (cirrhosis), kidney failure and tumors. In patients over 65 years is more common in addition to S. Pneumoniae, Haemophilus influenzae, Gram-negative bacteria from urine, Staphylococcus aureus, Legionella and viruses.
You should tell your doctor if you traveled to the Basque Country (Q fever) or Valencia (Legionella), if you have had contact with animals or have been in closed institutions (prisons, asylums, etc.)..
When suspected pneumonia?
If you have an abrupt fever, followed or not by chills, cough with purulent expectoration and pain in one side or chest that is accentuated with deep breathing, that she even takes your breath, you may have pneumonia.
At other times the symptoms may be more insidious with cough, fever (temperature below 38 ° C.), muscle aches, diarrhea, impaired general condition, headache, and what he should alert a progressive shortness of breath , you can be with an atypical pneumonia and should be addressed to a health center.
How to know or confirm that I have pneumonia?
- Once suspected pneumonia and evaluated by his doctor, is the most profitable test and lateral radiograph of the chest that value will be threefold:
- Diagnosis: Confirms the presence of pneumonia.
- Forecast: It’s more serious if it affects several lobes of the lung or if it affects the whole (like frosted glass), is the case of atypical pneumonia.
- Evolutionary: To monitor the healing. Sometimes it may be normal radiographs and then appear the injury 24 or 48 hours after the start of the clinical picture.
If a patient is young and without major diseases, in good general condition has not much sense continue testing as only etiologic diagnosis is reached (the cause) between 30 to 50% of pneumonias.
- Both sputum and blood cultures are not cost-effective techniques and of course, more low profitability if antibiotics are taken before collecting the samples. Basically is required in severe pneumonia admitted to the hospital or where we want to rule out TB.
- In addition to farming techniques available rapid diagnostic methods such as direct immunofluorescence (DFA) for Legionella, a technique that can be performed in various body fluids (urine, sputum etc.), And serological techniques for Chlamydia, Mycoplasma, etc. . But surely the incorporation of genetic enlargement techniques: PCR reaction (polymerase chain), currently represent a boon for the rapid diagnosis of pneumonia.
- The more aggressive techniques such as bronchoalveolar lavage, CT (computed tomography), transthoracic needle aspiration or catheter telescoping used in those difficult to diagnose pneumonia or for patients who require intubation complicated evolution and entry into surveillance units intensive.
- Also in severe cases or diseases described above, you should order a complete blood workup to assess the presence of anemia and WBC (white blood cells) to identify extreme leukocytosis (more than 25,000 leukocytes per cubic millimeter) or leukopenia (less than 3,500 cells per cubic millimeter), coagulation in order to mislead disseminated intravascular coagulation (DIC) would have an ominous prognosis, arterial blood gases to assess the oxygen in blood and kidney function to rule out acute renal failure. Including glucose and ions as certain pneumonias can cause hyponatremia (low sodium).
Tags: Atypical pneumonia, patient, Pneumonia, Typical Pneumonia
