Inflammation Of The Lungs (Pneumonia)

Inflammation of the lungs (pneumonia) is an infection of the lungs that is treated with antibiotics. Pneumonia causes more hospitalizations than heart attacks or strokes. Read more about the symptoms, causes and treatment of pneumonia here.

Definition

Pneumonia is an infection of the alveoli (alveoli, alveolar pneumonia) and / or the lung tissue in between (interstitium, interstitial pneumonia).

But what actually happens when the lungs become inflamed? In most cases, pneumonia is caused by bacteria or viruses, and rarely by fungi and parasites. The pathogens spread from the upper respiratory tract into the lungs, especially into the alveoli and the lung tissue in between. This invasion of the pathogen inflames certain areas of the lungs.

In addition, the body’s own immune system reacts: Certain immune cells (lymphocytes) produce proteins (cytokines) and fluid flows into the alveoli. The combination of inflamed cells and fluid entry into the vesicles, which are involved in gas exchange, means that less oxygen can be absorbed from the lungs into the blood. At the same time, less used carbon dioxide is released from the blood through the lungs and breath. Shortness of breath, paleness and other symptoms are the result.

Frequency

Pneumonia is a widespread disease, but its frequency is often underestimated by the public. It is true, however, that more people have to go to hospital with pneumonia than with heart attacks or strokes. Almost 280,000 (2014: 278,783) people in Germany are admitted to hospital with pneumonia every year, and there are even more in the case of influenza epidemics.

Most people with pneumonia are children under one year of age and adults over 65 years of age because their immune systems are not fully developed or are weakened with age. If the course is uncomplicated, pneumonia usually lasts two to three weeks, but it can lead to death if the immune system is severely weakened.

Pneumonia Deaths

The exact number of deaths from pneumonia in Germany is not known. The main problem: inaccurate information on death certificates. For example, old people often die of cardiac arrest. Then it is entered in the death certificate and counted as cardiac death in the statistics. You could just as easily list flu or pneumonia as the cause of death. Because this exemplary patient actually “only” had the flu. In the course of this, he acquired pneumonia and only went to the doctor when there was no other way. And in the hospital the already weakened heart stopped for good.

The Federal Statistical Office reports deaths from flu and pneumonia. These numbers vary a lot. In 2011 there were almost 12,000, in 2014 around 8,500. According to experts, the real number is likely to be at least twice as high. Some pulmonologists estimate up to 35,000 deaths.

A cough with a suddenly high fever of up to 40 degrees and a pronounced feeling of illness is one of the first symptoms of bacterial pneumonia (also called typical pneumonia). In addition, there are often fatigue, loss of appetite, chills, pain in the limbs and head as well as chest pain when breathing. Rapid, shallow breathing with occasional breathlessness is another symptom of pneumonia. If the lower lungs are affected, abdominal pain can be the only sign of the disease.

The lack of oxygen due to pneumonia can be recognized by blue lips and fingernails and a pale complexion. When there is a lack of oxygen, the body tries to compensate for this by increasing breathing and increasing the heartbeat. This can be recognized by accumulating breaths and an increased pulse. From about the 2nd day of pneumonia, a dry cough with little sputum develops, which can be rust-brown in color because it contains blood.

Inflammation Of The Lungs (Pneumonia)

Atypical Pneumonia

In addition to bacterial or typical pneumonia, there is atypical pneumonia. This form is less common and is usually caused by viruses (or rare bacteria such as mycoplasma, legionella, or chlamydia). Atypical pneumonia is usually much milder than typical pneumonia. It does not begin acutely, but rather insidiously. The symptoms only appear after a few days. Often headache and body aches, coupled with fatigue, are the only symptoms. High fever and chills rarely occur. The cough also differs from the typical form. It is often described as excruciating and dry. Sputum is produced very rarely.

Causes

It is often pathogens such as bacteria or viruses that cause pneumonia, less often fungi or parasites. The pathogens penetrate the protective mechanisms of the lungs because the immune system of the person affected is weakened or because the pathogens are very aggressive. The infection usually takes place via droplet infection, for example when speaking, coughing or sneezing. The pneumonia can also be the result of the flu or bronchitis.

Overview Of Causes

    • Infection with bacteria (Pneumococci, Haemophilus, Legionella, Mycoplasma, Pseudomonas)
    • Infection with viruses (such as flu viruses), fungi (often Candida and Aspergillus species), and parasites (such as toxoplasma)
    • Effects of chemical irritants, dust particles and toxic gases (e.g. gasoline or flour)
    • allergic diseases such as asthma
    • Inhaled foreign objects such as bites of food or stomach acid
    • Circulatory disorder in individual sections of the lung, for example in the case of heart failure or pulmonary embolism
    • Tumors or foreign bodies that block a trunk of air (bronchus).

These factors promote pneumonia:

    • Weak immune systems as in children under three years of age or adults over 60 years of age
    • Conditions such as heart failure, asthma, chronic bronchitis, diabetes, liver and kidney diseases, leukemia
    • Organ transplants, spleen removal, HIV infection
    • Flu, bronchitis
    • Smoke
    • Alcohol addiction
    • severe neurological diseases
    • immune suppressive therapies such as B. Immunosuppressants (corticosteroids), chemotherapy, radiation therapy
    • artificial respiration
    • Bedridden, hospitalization, operations

Examination

The characteristic noises when listening to the chest give the doctor an initial clue to the diagnosis of pneumonia. If in doubt, the lungs are x-rayed to determine the extent and location of the inflamed areas of the lung tissue. Finally, a blood test can determine the type and extent of the inflammation. In bacterial pneumonia, for example, the number of white blood cells is significantly increased (leukocytosis). An examination of the sputum serves to identify the pathogen and the inflammatory cells involved.

Bronchoscopy

In rare cases of pneumonia without expectoration, tissue must be removed when the bronchi are rinsed (bronchoalveolar lavage) in order to determine the causative agent of the pneumonia. Because determination is important for choosing the right medication. For bronchoscopy, a bronchoscope (a tube-shaped or tubular device) is inserted through the mouth. Depending on the type of procedure, the patient is given a local or general anesthetic.

Treatment

The medical treatment of bacterial pneumonia is comparatively easy. As a rule, so-called broad spectrum antibiotics are used right from the start. In the vast majority of cases, they turn out to be very effective. Such broad spectrum antibiotics are, for example, aminopenicillins or cephalosporins, possibly in combination with macrolides (another group of antibiotics).

If the symptoms of pneumonia do not improve within 2 to 3 days with broad spectrum antibiotics, the causative agent of the disease is determined more precisely. And then prescribed an antibiotic that specifically switches off this pathogen.

Acetylcysteine ​​and ambroxol are particularly suitable for dissolving the mucus. Pronounced dry coughs are dampened with pentoxyverine or codeine, for example.

Therapy Of Atypical Pneumonia

The treatment of atypical pneumonia is much more difficult. It starts with the search for the right medication. Depending on the pathogen, special antibiotics against non-typical bacteria (such as ciprofloxacin, doxycycline, erythromycin or levofloxacin), antifungal agents (such as caspofungin or fluconazole) or anti-virus agents (such as acyclovir or ganciclovir) are given. In the case of pneumonia caused by inhaled foreign bodies, inhaled secretions must first be sucked off or the foreign body removed.

Inpatient Treatment

Whether bacterial causes or others: In the case of pneumonia, hospitalization is often necessary. This applies, for example, to complicated processes or when large parts of the lungs are affected. For example, it is not uncommon for pneumonia drugs to be infused directly into the bloodstream. That alone requires stationary monitoring. Artificial ventilation is another reason why pneumonia often requires hospital treatment.

Self-Help With Pneumonia

If your family doctor or pediatrician agrees, you can cure pneumonia at home. You should take care of the weakened body and keep strict bed rest. It is helpful if you drink a lot to help dissolve the inflammatory secretions in the lungs. In addition, you compensate for the fluid loss caused by fever and sweating.

Many patients find inhalations (with table salt) or steam baths with anise, camphor, menthol, eucalyptus, thyme and chamomile helpful. In any case, you should make sure that the air in the hospital room is not too dry. Here, scented bowls with the essential oils mentioned can also bring moisture into the room air.

Medicinal plants for coughs and colds help relieve the annoying symptoms. The guidebook “Many herbs are grown against colds” offers further suggestions for gentle help.

No Fragrance Oils In Young Children

Caution: Aromatic oils, herbs and herbal bath additives can sometimes be dangerous for babies and toddlers. Agents containing menthol, for example, irritate the child’s airways and can even cause life-threatening larynx cramps.

Course of Disease

Pneumonia heals in an otherwise healthy person in about two to three weeks if treated. The fever usually subsides after 7 to 9 days. With typical pneumonia, patients feel significantly sicker than with the atypical form.

With or after pneumonia, secondary diseases can occur. These are, for example, pleurisy or pleurisy. Sometimes capsules of lung tissue form in the lungs in which pus collects (lung abscesses). Changes in the lung tissue (pulmonary fibrosis) become noticeable as severe breath-dependent pain.

However, the consequences of pneumonia need not be limited to the lungs. If bacterial pathogens causing pneumonia spread through the blood in the body, they can cause meningitis, otitis media, heart inflammation (endocarditis) or pericarditis. Even brain abscesses are possible.

Special Forms Of Pneumonia

    • Nosocomial pneumonia: Infection occurs in hospitals, especially in intensive care units, often through germs that could develop resistance to antibiotics.
    • Fungal pneumonia: Severely immunocompromised people are affected, such as those suffering from AIDS and leukemia or people who take drugs that suppress the body’s immune system (immunosuppressants, corticosteroids).
    • Pneumocystis carinii pneumonia (PCP): This pneumonia is caused by a hose fungus. There is a highly acute and a creeping form. Early diagnosis can save lives. In HIV-positive patients, the so-called Pneumocystis carinii is a typical causative agent of pneumonia. In this form, both lungs are usually affected, often with a very severe course.
    • Aspiration pneumonia: Foreign bodies can get into the lungs in different situations and cause infections there. Patients with impaired consciousness (therefore never give them anything to drink) or people with reflux – i.e. acidic belching of stomach acid – have an increased risk.
    • Chronic pneumonia: Pneumonia can become chronic. This particularly affects patients with a weakened immune system and existing changes in the lungs such as COPD, bronchitis, chronic bronchitis or other lung diseases. Alcoholics and patients with diabetes are also prone to chronic disease.

Prevention And Vaccination

The best protection against pneumonia is vaccination against influenza and vaccination against pneumococci, one of the widespread pathogens causing pneumonia.

Why Does The Flu Shot Protect Against Pneumonia?

The real flu, influenza, is not the harmless common cold that many people confuse this infection with. In particular for small children, the elderly, people with chronic illnesses and weakened immune defenses, the flu is a life-threatening illness. Because the flu viruses often severely weaken the body and the immune system. Then bacteria and other pathogens causing pneumonia have an easy job – and often conjure up very complicated infections.

Vaccination Against Pneumococci

The pneumococcal vaccination protects against one of the common pathogens causing pneumonia. This vaccination can save the lives of old and sick people in particular. The risk of dying as a result of pneumonia drops by more than 90 percent after the pneumococcal vaccination.

Vaccination Recommendations

The Standing Vaccination Commission (STIKO) recommends the pneumococcal vaccination for all children (from the 2nd month of life) as well as for adults over 60 years. The recommendation also applies to patients with cardiovascular diseases, asthma, chronic bronchitis, diabetes, liver and kidney diseases as well as people with organ transplants, people without or with a functionally impaired spleen, people infected with HIV or leukemia patients.

Vaccines

Various vaccines are available for the pneumococcal vaccination. So-called conjugate vaccines are usually used in infants and young children. This conjugated vaccine contains antigens bound to a protein – mostly from fragments of the bacterial shell of the respective pathogen. The 10-valent pneumococcal conjugate vaccine (PCV10) protects against 10 pneumococcal subsets (1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F). PCV13 is also effective against serogroups 3, 6A, and 19A. An adult polysaccharide vaccine protects against 23 types of pneumococci.

Vaccination Schedule

  • Infants: Since 2015, the STIKO has generally only recommended 3 instead of the previously usual 4 vaccination appointments: 1st vaccination at 2 months, 2nd vaccination 2 months later and the 3rd vaccination 6 months later at the earliest. According to the latest STIKO recommendation from August 2020, the STIKO recommends an additional vaccine dose for premature babies at the age of 3 months, i.e. a total of 4 vaccine doses. The basic immunization should ideally be completed before the age of 2 (U7).
  • Adults aged 60 and over who are not or not fully vaccinated should be immunized once with the 23-valent polysaccharide vaccine.

Contraindications / Vaccination Bans

  • Hypersensitivity to active substances or other components
  • The pneumococcal vaccination should be postponed in the event of severe illnesses requiring treatment. Other vaccinations can be given at the same time as the PCV vaccination.

Side Effects

In the vast majority of cases, there are no side effects of the pneumococcal vaccination. However, among other things, redness and swelling at the puncture site and allergic reactions in the form of hives are possible. Fever, tiredness or gastrointestinal complaints are also typical vaccination reactions, which usually go away by themselves after 2 to 3 days. If not, or if symptoms are severe, please contact your doctor.

Infants and young children rarely develop febrile seizures after vaccinations, which usually go away quickly.

Endoscopy: Reflection of Body Cavities

During an endoscopy, the doctor inserts a probe and optics into a body cavity. Depending on the region, for example, there are lung, stomach, intestinal or abdominal reflections

Endoscopes are rigid or flexible depending on the cavity

Depending on the body region, either rigid probes or flexible tubes are suitable as endoscopes. The optics at the top can in the simplest case consist of a mirror as in the indirect laryngoscope reflection. Often these days, however, these are high-quality miniature cameras that transmit the image to a monitor in real time during the procedure.

There are types of endoscopy in which the doctor introduces the endoscope through a natural body opening: he can control the larynx, lungs and stomach via the nose or mouth, the large intestine via the anal opening, the bladder via the urethra. Other types of endoscopy require small cuts in the skin to reach the area. Examples include joints or the abdominal cavity.

Interventions by endoscopic tools possible

An endoscopy is not only for the examination, but the doctors can also perform interventions: In tube-like endoscopes they introduce tools such as pliers and milling directly through the tube. In the context of joint reflections and laparoscopy, the doctor creates a skin incision a second or third access, in order to use his tools effectively. Physicians can use a bronchoscope to flush the lungs, a so-called bronchial lavage, and then aspirate the liquid used again.

The procedures in detail:

    1. Laryngoscopy (laryngoscopy)

The doctors distinguish between indirect and direct laryngoscopy. In indirect laryngoscopy, the doctor holds a small mirror and style in the pharynx while the patient is awake. In this way he can look at the vocal folds. The direct laryngoscopy, the doctor can perform only in an unconscious or anesthetized patient. Depending on the project, he uses either an intubation or a surgical laryngoscope. The spatula-shaped intubation laryngoscope is used for the correct placement of a breathing tube. With the tubular surgery laryngoscope the doctor performs interventions on the larynx.

    1. Lung reflection (bronchoscopy)

If x-ray and computed tomography of the lungs do not provide sufficient information, pulmonary mirroring is a possible diagnostic method. It also plays a role in the treatment, for example to extract viscous mucus. During lung reflection, the doctor inserts the endoscope over his nose or mouth. This endoscope consists of a soft, flexible tube with two to six millimeters in diameter. At the top of the hose sits a camera with light source.

    1. Gastroscopy (gastroscopy or esophago-gastro-duodenoscopy)

A gastroscopy is a method of examination, with the help of which complaints of the esophagus (esophagus), the stomach (Gaster) and the duodenum (duodenum) can be clarified. The gastroscope used in this case is an optical device in the form of a flexible plastic tube. In addition to the camera and the light source, the hose also has additional working channels. Using these channels, for example, the doctor can take tissue samples with pliers, so-called biopsies. He can also spray on the gastroscope dyes on the mucous membranes to make changes more visible. If the doctor also injects contrast medium from the duodenum into the bile ducts and the pancreatic duct, and then makes an X-ray, the procedure is called ERCP. This abbreviation stands for Endoscopic Retrograde Cholangiopancreaticography).

    1. Laparoscopy

During the laparoscopy, the doctor inserts a tubular endoscope into the abdominal or pelvic cavity through the abdominal wall to assess the internal organs. In addition to the diagnosis, laparoscopic surgery is also possible in the same procedure. In contrast to an open surgery on the abdomen, the so-called laparotomy, only a few small incisions are necessary for procedures with the laparoscope. Through these small cuts, the doctor can bring both the endoscope and the surgical equipment in the abdominal cavity. Because of the small access, one also speaks of keyhole surgery.

    1. Small intestinal reflection (capsule endoscopy)

capsule-endoscopy

The small intestine is difficult to reach by tube. Therefore, there is a special form of endoscopy with the help of a camera capsule. This capsule is only about 2.5 inches long and has a diameter of just over one centimeter. The patient ingests the capsule, which then passes naturally through the gastrointestinal tract. Meanwhile, she sparks photos outside. These images record a receiver worn by the patient during the examination. The patient can therefore move freely during the examination. Subsequently, a trained doctor evaluates the automatically recorded images. Capsule endoscopy is used primarily when it comes to the question of bleeding in the small intestine or chronic inflammatory bowel disease (Crohn’s disease).

    1. Colonoscopy (colonoscopy)

colonoscopy

A colonoscopy reveals various diseases on the colon (colon) and at the end of the small intestine (terminal ileum). In addition, it is a very reliable method to detect colon cancer and its precursors. The precursors are benign mucosal growths and are called polyps. The doctor can also remove these polyps by means of colonoscopy. To prepare for the exam, the patient must remain sober the day before at noon and take laxative as prescribed by the physician. If the examination only covers the lowest sections of the colon, no oral laxatives are necessary. Depending on the extent of the examination, the doctor then talks about proctoscopy, rectoscopy or sigmoidoscopy

    1. Bladder reflexion (cystoscopy)

In the case of cystoscopy, the doctor examines the lower urinary tract with a special examination device (cystoscope). The lower urinary tracts include the urethra and the bladder. With cystoscopy, the doctor can detect and assess changes such as urethral narrowing, enlargement of the prostate, changes in bladder sphincter function, tumors or bladder stones. If necessary, minor surgical interventions in the context of a bladder reflex are possible with anesthesia. In ureteroscopy, the doctor also examines the ureters, which transport the urine from the kidneys to the bladder.

    1. Articulation (arthroscopy)

Joint Surgery is a surgical procedure in which the physician inserts an endoscope into the joint cavity. This intervention can serve both the diagnosis and the treatment. However, the need for diagnostic arthroscopy has declined significantly due to the further development of magnetic resonance imaging. Therapeutic arthroscopy, on the other hand, can often replace major surgery, for example when replacing a torn ACL in the knee joint.

    1. Endoscopy of other parts of the body

endoscopy-of-other-parts-of-the-body

Also, a reflection of the salivary glands is possible, the ENT specialist then speaks of a sialendoscopy. He can examine the nose and paranasal sinuses by means of a sinus copy. He examines the ear by ear funnels and calls it otoscopy. He can clarify the causes of snoring by means of somnoendoscopy (a kind of pharyngeal reflection) under anesthesia.

The examination of the ocular fundus is called ophthalmoscopy, although the ophthalmologist uses only a concave mirror, magnifying glass or slit lamp in front of the eye.

Gynecologists reflect vagina and cervix with a colposcopy. The uterus is examined by hysteroscopy and the breast ducts by a ductoscopy.

Bronchoscopy: Reflection Of The Lungs

The doctor can use the bronchoscope to examine the lungs and airways. In addition, the method helps in the treatment, for example, to extract viscous mucus. During lung reflection, the doctor introduces a bronchoscope into the airway via the mouth or nose. Modern bronchoscopes consist of a soft, flexible tube with a diameter of two to six millimeters. At the top of the tube sits a camera with light source. This camera sends its images in real time to a monitor on which the doctor examines the patient’s airways.

In addition, the bronchoscope can inject and aspirate liquid and thereby perform a so-called bronchial lavage. In addition, very small pliers or brushes can be advanced through the tube and tissue samples taken. These biopsy specimens will be examined later by the doctor under a microscope. In addition, a miniature ultrasound head can image the environment of the airways.

For what reasons does the doctor perform a bronchoscopy?

A bronchoscopy may be necessary for both treatment and diagnosis, for example if there is suspicion of lung cancer in the room or if treatment is to be scheduled for a known lung tumor. Doctors can also use this method to introduce radioactive substances into the lungs in order to irradiate tumors locally. Restrictions of the respiratory tract can be clarified by bronchoscopy. Similarly, the doctor can investigate reduced ventilation of partial areas of the lung, so-called atelectasis. With the lung reflection and bronchial lavage cells and germs can also be extracted from the lungs.

bronchoscope-to-examine-the-lungs

Doctors also use lung plasmas to look for and remove foreign bodies. In ventilated patients, the position of the breathing tube can also be corrected with it. In addition, secretions such as mucus plugs can be washed away with the bronchoscope and inserted so-called stents, which seemed to the airways from the inside and keep them open.

How is an examination with the bronchoscope going?

On the day of the examination the patient comes sober. He receives a spray that stuns the throat and suppresses the gagging. Then, the patient is virtually always injected with a short narcotic into the vein, so that he feels nothing at all from the examination. If necessary, sedatives are also used.

The doctor introduces the bronchoscope through the mouth or nose into the trachea. Afterwards, he examines the mucous membrane of the airways, which can be imagined as a “bronchial tree” with more and more ramifications. The doctor examines all bronchi to a maximum of the third or fourth diversion. This usually takes 10 to 15 minutes. The airways themselves are insensitive to pain.

If a bronchial lavage is needed, the doctor injects about 20-100 milliliters of sterile fluid into the lower respiratory tract and then sucks it off. It extracts bacteria and cells from the surface of the respiratory tract and subsequently examines them in the laboratory.

After the examination, the patient should abstain from eating and drinking for about two hours until the anesthetic of the throat has subsided. Otherwise there is a risk of swallowing. If the patient has been given tranquilisers or anesthesia, they are not allowed to drive the same day.

What other types of bronchoscopy are there?

In addition to the lung reflection with a flexible tube, there is still the investigation with a rigid tube. This tube can, for example, better remove foreign matter from the lungs. Even if a tumor severely restricts the airways, rigid bronchoscopy has advantages. Sometimes the doctor can remove tumors directly using laser devices or argon bombers. Argon beamer are coagulation devices that transfer energy via argon gas and soil the tissue two to three millimeters deep. The doctor uses them to destroy tissue and stop bleeding. If he has to use stents to stretch a constriction, it works better with the rigid bronchoscope.

Is a bronchoscopy dangerous?

The bronchoscope may cause nosebleeds or sore throat with difficulty swallowing, hoarseness or coughing, and very rarely injure the larynx. Even short-term fever sometimes occurs afterwards, especially in lavages. Severe incidents are very rare in bronchoscopy.

Removing the tissue samples may cause slight bleeding. Therefore, one should expect in the first two days that you abhustet blood to a small extent. Every now and then, the bleeding is so severe that they have to be breastfed by the endoscope.

In some cases, injury to the alveoli causes the lungs to leak and form a so-called pneumothorax. This means that air flows into the space between the lungs and the surrounding lung cavity and causes the feeling of being short of air. Then, if necessary, the application of a chest tube is necessary: ​​This plastic tube through the chest wall conveys the infiltrated air to the outside.

Possible exclusion reasons

A bronchoscopy can be problematic in generally very poor condition or serious comorbidities: If a heart failure or an acute myocardial infarction present, the function of the lungs massively reduced or the blood clotting are disturbed, you should consider the need for the investigation carefully and together with the doctor benefits and consider possible disadvantages.

Possible exclusion reasons

A bronchoscopy can be problematic in generally very poor condition or serious comorbidities: If a heart failure or an acute myocardial infarction present, the function of the lungs massively reduced or the blood clotting are disturbed, you should consider the need for the investigation carefully and together with the doctor benefits and consider possible disadvantages.