Pneumonia

Introduction

Pneumonia is an acute infection of the lung parenchyma, most commonly of bacterial or viral origin. It manifests as a fever, cough, sputum, and shortness of breath. It is a major cause of hospitalization and mortality, particularly among the elderly and fragile patients. Pneumonia is the leading cause of infectious death worldwide. Early management, based on adapted antibiotic therapy, transforms the prognosis.

If you have a feverish cough, shortness of breath, or chest pain, first contact your attending physician. If they are unavailable, Docadom offers an emergency consultation by a doctor at home: call 021 845 45 45 or use our application available on the App Store and Google Play.

Who is at risk?

Anyone can contract pneumonia, but certain profiles are more exposed to severe forms: elderly people (> 65 years old), infants, patients with COPD, asthma, heart failure, diabetes, chronic kidney disease, cancer, immunocompromised patients, chronic alcoholics, smokers, bedridden patients, or nursing home residents. Viral epidemics (flu, COVID-19, RSV) promote secondary bacterial pneumonias.

Symptoms of Pneumonia

The clinical picture varies according to age, the pathogen, and the patient's condition. The diagnosis should be considered in the presence of any fever associated with respiratory signs.

Main Symptoms

• High fever, often > 38.5 °C, with chills.

• Cough, initially dry and then productive.

• Purulent sputum (yellow, green), sometimes hemoptoic (blood-tinged).

• Chest pain, described as a "sharp stitch in the side," worse with deep inspiration.

• Dyspnea: shortness of breath during exertion, then at rest.

• Tachypnea (rapid breathing rate).

• Deterioration of overall health status, asthenia, loss of appetite.

• In the elderly: often atypical symptoms (confusion, falls, decompensation of a comorbidity, absent fever).

• In infants: fever, refusal to eat, intercostal retractions, grunting, sleepiness.

When to seek emergency advice?

An emergency consultation is necessary in the following situations:

• Significant dyspnea, respiratory rate > 25/min.

• Cyanosis, oxygen saturation < 92%.

• Confusion, disorientation.

• Pneumonia in an elderly person, an infant, a pregnant woman, a fragile or immunocompromised patient.

• Signs of sepsis: hypotension, tachycardia, mottled skin — call 144.

• Poor general tolerance, vomiting preventing oral intake.

What to do before calling Docadom? Rest, hydrate, take paracetamol, and contact your attending physician first. If they are unreachable or if you need a home doctor outside of opening hours, call Docadom at 021 845 45 45 or make your request directly from our smartphone application (App Store and Google Play). In case of serious signs (cyanosis, confusion, extreme dyspnea, hypotension), call 144 without delay.

Causes of Pneumonia

Bacterial Pneumonias

The most common in medical practice. The primary germ is Streptococcus pneumoniae (pneumococcus), responsible for half of community-acquired acute pneumonias. Other germs include: Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumophila (legionellosis, often contracted in hotels or hospital settings), Staphylococcus aureus, Klebsiella.

Viral Pneumonias

Increasingly recognized: influenza virus, respiratory syncytial virus (RSV), coronaviruses (including SARS-CoV-2), adenovirus, metapneumovirus, parainfluenza. They can be severe in fragile patients and can be complicated by a secondary bacterial infection.

Other Pneumonias

• Aspiration pneumonia: after accidental inhalation of food or liquid, in the elderly or neurological patients.

• Fungal pneumonia in immunocompromised patients (Pneumocystis jirovecii, Aspergillus).

• Nosocomial pneumonias contracted in a hospital setting.

• Non-infectious pneumonias: inflammatory (sarcoidosis), drug-induced, post-radiotherapy.

Diagnosis of Pneumonia

Diagnostic Methods

• Anamnesis (medical history): duration of symptoms, past medical history, vaccinations, travel, epidemiological context.

• Physical examination: respiratory rate, oxygen saturation, lung auscultation (crackles, focus of consolidation), checking for signs of severity.

• Chest X-ray: the key examination. It visualizes a focus of consolidation, sometimes bilateral, or pleural effusion.

• Chest CT scan in case of doubt or severity.

• Laboratory blood tests: CBC, CRP, procalcitonin, kidney function, arterial blood gas if signs of severity exist.

• Blood cultures before starting antibiotic therapy in hospitalized or severely ill patients.

• Sputum culture (cytobacteriological examination of sputum), pneumococcal and legionella urinary antigen tests, multiplex PCR.

• Influenza and COVID-19 PCR tests.

Alternative Diagnoses

• Acute bronchitis.

• Exacerbation of COPD or asthma.

• Heart failure with pulmonary edema.

• Pulmonary embolism with pulmonary infarction.

• Bronchial cancer with atelectasis.

• Isolated pleurisy.

• Pulmonary tuberculosis.

Treatment of Pneumonia

Antibiotic Therapy

Antibiotic therapy is probabilistic in the first instance, adapted to clinical suspicion, age, and individual health background:

• Amoxicillin: first-line for ambulatory adults without signs of severity.

• Amoxicillin-clavulanic acid or cephalosporins in case of comorbidities.

• Macrolides (azithromycin, clarithromycin) or doxycycline if atypical pathogens are suspected.

• In case of hospitalization: ceftriaxone alone or combined with a macrolide.

• Duration: 7 days on average (5 days in uncomplicated outpatients).

Associated Measures

• Rest, hydration.

• Antipyretics and analgesics (paracetamol).

• Oxygen therapy in case of hypoxia.

• Chest physiotherapy in case of congestion.

• Monitoring: improvement expected within 48-72 hours under antibiotics. In the absence of improvement, emergency medical re-evaluation is imperative.

• Hospitalization according to the CRB-65 score (Confusion, Respiratory rate, Low Blood pressure, Age ≥ 65 years).

Viral Pneumonias

Treatment is essentially symptomatic. Oseltamivir for influenza, specific antivirals in certain forms of COVID-19 or respiratory syncytial virus pneumonia. A bacterial secondary infection must be systematically investigated.

Prevention of Pneumonia

• Pneumococcal vaccination: recommended for people at risk (due to age, comorbidities, or immunosuppression).

• Annual influenza vaccination.

• COVID-19 and RSV vaccination for fragile individuals.

• Smoking cessation.

• Hand hygiene, wearing a mask during epidemic periods.

• Management of swallowing difficulties (aspiration risk) in neurological or elderly patients.

• Good oral hygiene (reduces aspiration pneumonias).

• Rigorous management of chronic illnesses.

• Avoidance of inappropriate self-medication with antibiotics (which promotes resistance).

Possible Complications

Pneumonia can be complicated in several ways: pleurisy or pleural empyema, lung abscess, acute respiratory failure, septicemia and septic shock, acute respiratory distress syndrome (ARDS), decompensation of a chronic illness (heart failure, diabetes, COPD), venous thrombosis, and, in elderly people, loss of independence. Mortality is low in young, ambulatory adults but can reach 30% in patients admitted to intensive care.

When to Contact a Doctor for Pneumonia

Any prolonged feverish cough or cough associated with shortness of breath justifies a medical opinion:

• As a first resort: contact your attending physician, who can examine you, prescribe a chest X-ray, and start antibiotic therapy if necessary.

• If your attending physician is unavailable (evening, weekend, holidays), Docadom offers an emergency consultation by a doctor at home. Call 021 845 45 45 or make your request via our mobile application, available for free on the App Store and Google Play.

• In case of serious signs (cyanosis, confusion, extreme dyspnea, hypotension), dial 144 without delay.

Conclusion: Do Not Delay, Vaccinate to Prevent

Pneumonia remains a serious infection, particularly in fragile individuals. It is characterized by fever, productive cough, chest pain, and dyspnea, which can lead to complications such as acute respiratory failure, sepsis, or decompensation of a chronic disease. Diagnosis is based on a chest X-ray, and treatment on an adapted empirical antibiotic therapy. Pneumococcal and influenza vaccination, smoking cessation, and the management of comorbidities constitute the pillars of prevention.

If in doubt, contact your attending physician first. If they are not available, Docadom provides you with an emergency doctor at home 7 days a week: call 021 845 45 45 or use our mobile application (App Store, Google Play) to request an emergency consultation.