Friday, November 30

Pneumonia in elderly people - Causes, symptoms & treatment

Home > Pneumonia in children and infants - Signs, symptoms & causes > Causes, symptoms and treatment of pneumonia in elderly people
Pneumonia in elderly people, unlike younger patients, may have very subtle symptoms and by the time diagnosis is done and treatment is commenced the situation may become very serious and life threatening. Pneumonia is an inflammation of the lungs followed by fluid accumulation in alveoli air sacs and is usually caused by viruses, bacteria, fungi, parasites and other organisms. The inflammation and fluid accumulation in alveoli causes reduced blood flow to the affected part as well as reduced oxygen uptake.

In general elderly patients have feeble organ level and body level responses to any infection. Unfortunately, most of the elderly people and their caregivers are unable to understand the symptoms of pneumonia and by the time action is taken the condition turns serious.

Causes of pneumonia in elderly people

Though pneumonia is caused by viruses, bacteria, fungi and other organisms, in elderly, Streptococcus pneumoniae bacteria account for most of the infections and are the major cause of death. The infection can start with flue like symptoms of the upper respiratory tract and can spread fast to the lower respiratory tract and the lungs. Damage of lung tissue can occur and the infection may spread to the blood causing bacteremia. If most areas of the lungs are involved acute respiratory distress syndrome (ARDS) may be caused.

The complications of pneumonia in the elderly can be life-threatening, apart from the possibility of bacteremia, meningitis, kidney failure and heart failure can occur. The lung infections triggered by viruses are generally milder but there is always the risk of opportunistic bacterial infections including Streptococcus pneumoniae.

In elderly people, aspiration pneumonia is caused by difficulties in swallowing leading to mouth secretions and food going to the lungs and causing infection and pneumonia. Issues with swallowing are common in elderly patients which require treatment.

Symptoms of pneumonia in elderly people

General symptoms of pneumonia are:
  • week feeling
  • lethargy
  • productive cough
  • greenish or yellowish sputum
  • chills
  • difficulty in breathing
  • symptoms of shallow breathing
  • chest pain
  • muscle pain
  • fever
  • symptoms of skin and nails turning bluish
  • confusion
  • nausea
  • abdominal pain and diarrhea
  • decreased level of consciousness.
In elderly persons the pneumonia symptoms may be fewer and fever may not be present. Symptoms like Chest pain, shallow breathing, decreased appetite, feeling cold and difficulty in breathing may be observed. All the symptoms may not be present and observed symptoms can be pieced together to get a clearer picture of the situation. Symptoms like slightly confused state of mind together with changes in their behavior and appearance can also indicate the underlying problem.

Pneumonia - Tests and diagnosis
Simple diagnosis by listening to the patient's lungs can confirm pneumonia. Typical rales (clicking, rattling, or crackling noises) and rhonchus ( coarse rattling sound) can be picked up by a stethoscope signalling lung infection and inflammation. A chest x-ray or CT scan can confirm the disease and give us the location of inflammation. Blood and sputum analysis can tell us about the pathogen involved in pneumonia so that it can be treated.

Treatment of pneumonia in elderly people

Medical care must be sought for treatment if in the elderly person symptoms like have breathing problem or lung infection is suspected.
The cause of the pneumonia has to be found out for the treatment. Bacterial pneumonia is treated with antibiotics. Antibiotic treatment should carried out as per the advice of the doctor.

In rare cases antiviral medication is given for viral pneumonia. For the treatment of aspiration pneumonia corticosteroids may be prescribed. To reduce the fever antipyretic medicine may be prescribed. Unless necessary cough suppressants are avoided in the treatment.

Sufficient rest can help in alleviating the symptoms and also help in the treatment of pneumonia. Drinking plenty of fluids helps in loosening the lung secretions and their removal by coughing. With proper treatment the patient will recover in about two weeks.

Pneumonia - Risk factors in elderly people

Many habits and health conditions increase the risk of lung infections and pneumonia. Some of the risk factors are:
  • chronic obstructive pulmonary disease (COPD), cystic fibrosis, asthma, bronchiectasis
  • heart, lung, spleen or kidney diseases
  • health conditions like stroke, diabetes, dementia and Alzheimer's, amyotrophic lateral sclerosis (ALS)
  • untreated illness
  • decreased ability to cough
  • decreased productive cough
  • bad oral hygiene
  • inactivity
  • spending too much time in bed
  • malnutrition
  • use of narcotics, antihistamines
  • intoxication
  • alcohol
  • weakened immune systems
  • long-term use of immunosuppressant drugs
  • chemotherapy treatment for cancer
  • smoking
  • using inhaled corticosteroids
  • exposure to air pollution or toxic fumes
  • HIV/AIDS

Pneumonia - Prevention with vaccination

Yearly vaccination for seasonal flu can go a long way in the prevention of pneumonia in elderly. Influenza virus can predispose an elderly person for developing bacterial pneumonia. Influenza itself can move on to the lungs and cause viral pneumonia.

As for bacterial lung infection, doctors recommend a one-time shot of pneumococcal polysaccharide vaccine (PPSV) against Streptococcus pneumoniae for elderly people above 65 years. The prevention vaccination may have to be repeated after 5-6 years.

In the United States, PPSV is recommended for elderly people above 65 years of age as a prevention. Adults having symptoms of poor health and also long-term serious health problems are also advised to get vaccinated with PPSV as prevention. PPSV is recommended as prevention for smokers and children above two years of age having serious health problems. Adults and elderly people suffering from  asthma, COPD, congestive heart failure, Severe renal problems,  liver diseases, diabetes requiring medication, HIV/AIDS and asplenia do require vaccination as prevention and protection against pneumonia.

Very important: If an elderly person under your care appears to have symptoms like difficulty in breathing, cough, chest pain or lethargy immediately seek medical help without delay for proper treatment to prevent complications and save life.

Related topics in Daily Health News & Tips:
Pneumonia in children and infants - Signs, symptoms & causes.

Reference:
1. Höffken G, Halank M, Gillissen A. Treatment of severe pneumonia--community-acquired and "early onset" nosocomial Med Klin (Munich). 2004 Jul 15;99(7):362-71.
2. Schmidt-Ioanas M, Lode H. Treatment of pneumonia in elderly patients. Expert Opin Pharmacother. 2006 Apr;7(5):499-507.

Current topic: Causes, symptoms and treatment of pneumonia in elderly people

Thursday, November 29

Pneumonia in children and infants - Signs, symptoms & causes

Home > Pneumonia - Signs and symptoms and causes of pneumonia in children and infants
Pneumonia in children and infants is a very debilitating medical condition and is sometimes fatal. The symptoms of pneumonia depend on the causes and the age of the affected child. The common origin of pneumonia in children are lung infections and inflammations caused by viruses, bacteria or fungi.

According to WHO, pneumonia kills an estimated 1.2 million infants and children under the age of five years, accounting for 18% deaths among this age group. It is estimated that one in three newborn infant die due to this disease. Of these deaths 85% occur in South Asia and sub-Saharan Africa. Simple interventions and timely treatment, care and preventive measures can stop loss of life.

Causes of pneumonia in infants and children

Pneumonia is inflammation of the lungs. Often, it begins as an upper respiratory tract infection affecting nose and throat which subsequently affects lower respiratory tract (lungs). The microscopic air sacs (alveoli) in the lungs bring about gas exchange, resulting in exhalation of CO2 and absorption of oxygen. In lung inflammation/infection primarily alveoli get affected. The inflammation causes alveoli to accumulate fluids and the surface area for gas exchange gets reduced. This results in respiratory distress and connected symptoms.

The lung inflammation and infection is usually caused by a variety of microorganisms, including bacteria, viruses, parasites or fungi. Bacterial lung infection in children and infants is usually caused by Streptococcus pneumoniae (or pneumococcus). Other common pneumonia causing bacteria are Haemophilus influenzae, Chlamydophila pneumoniae, and Mycoplasma pneumoniae, Staphylococcus aureus, Moraxella catarrhalis, Legionella pneumophila and Gram-negative bacilli. In infants and children affected by HIV, the incidence of this disease caused by Pneumocystis jiroveci is high and 25% of pneumonia deaths are due to P.jiroveci.

The viral lung infection in infants is commonly caused by Influenza virus A and B, Respiratory syncytial virus (RSV),Human parainfluenza viruses, rhinoviruses, human metapneumovirus and human bocavirus.

Fungal pneumonia in children is rarer and is mostly caused by Histoplasma capsulatum, blastomyces, Cryptococcus neoformans, Pneumocystis jiroveci, and Coccidioides immitis.
Parasites in human, which can affect the lungs, like Toxoplasma gondii, Strongyloides stercoralis, Ascaris lumbricoides, and Plasmodium malariae some times lead to fluid accumulation in lungs and pneumonia.

Pneumonia - Symptoms in infants and children

Viral and bacterial infections have similar symptoms and the viral infections are more numerous.
The common symptoms of pneumonia in infants and children include:
  • productive cough
  • nasal congestion
  • fever 
  • chills 
  • shortness of breath and difficult breathing
  • rapid breathing
  • increased respiratory rate
  • loss and lack of appetite
  • decreased activity and lethargy
  • wheezing
  • sharp or stabbing chest pain during deep breaths
  • abdominal pain
  • conjunctivitis due to chlamydia in infants

Symptoms of severity of pneumonia include:
  • lower chest wall in-drawing during inhalation in children
  • skin and nails becoming bluish,
  • inability to feed or drink in infants
  • decreased thirst
  • convulsions
  • nausea or persistent vomiting
  • Extremes of body temperature (fever or hypothermia)
  • decreased level of consciousness.
In children and infants with bacterial infections set in fairly quickly whereas the viral infections set in gradually.
Malnutrition or undernourishment, compromised immune systems and pre-existing illnesses increase susceptibility of infants and children and can cause pneumonia. Environmental factors like air pollution, crowded homes and parental smoking also increase the risks.

Treatment of bacterial lung infection involves administration of antibiotics and patient care. Viral infection may resolve after some time as the patient develops immunity. For severe cases and young infants hospitalization is necessary. According to WHO, vaccinations against Haemophilus Influenzae Type b (Hib), pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia in infants and children.

Related topics in Daily Health News & Tips:
Pneumonia in elderly - causes, symptoms, prognosis and treatment.

References:
1.http://www.who.int/mediacentre/factsheets/fs331/en/index.html

Images:
1.Image source:
http://en.wikipedia.org/wiki/File:PneumonisWedge09.JPG
Image author: James Heilman, MD
License: CC BY-SA 3.0
2.Image source:
http://en.wikipedia.org/wiki/File:Symptoms_of_pneumonia.svg
Image author: Mikael Häggström
License: Public domain

Current topic: Symptoms and causes of pneumonia in children and infants