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.

Frequent Infections And Inflammation Of The Lungs

Respiratory Diseases As the days get shorter again and autumn and winter bring down cold, wind and rain, our immune system is under heavy strain. Added to this is dry heating air, which irritates and dehydrates our mucous membranes.

In the winter, many people bustle together in warm, closed rooms, buses and subways, which increases the risk of infection.

So bacteria and viruses are particularly easy to penetrate our body. When many people gather in warm, closed rooms, buses and subways in winter, the risk of infection is also increased: winter time is therefore also the time of acute respiratory infections. The spectrum ranges from a simple cold over the real flu to acute bronchitis or adult pneumonia.

The most harmless form of respiratory infections is a cold. Incidentally, it is sometimes referred to as a flu infection. Compared to the real flu but it runs harmless. Predominantly, a cold is triggered by viruses that affect the upper respiratory tract. Therefore, treatment with bactericidal antibiotics does not help here either. Usually, the disease begins two to four days after infection by droplet infection and usually lasts at most one week.

Typical signs of real influenza, influenza, are sudden high fever, dry cough, muscle and headache, and fatigue. The flu outbreaks that pass through Germany every winter are caused by influenza viruses. A vaccine can protect against infection. However, you should get vaccinated again every year against the flu, because the viruses are very versatile and the vaccine must be adjusted regularly. The Robert Koch Institute recommends vaccinations especially for pregnant women, elderly people and people with chronic illnesses.

If the pathogen penetrates deeper into the respiratory tract, as a result of a cold or flu, the mucous membranes of the bronchi can also become acutely inflamed. One speaks then of an acute bronchitis. In more than 90 percent of cases, viruses are the trigger, rarely bacteria. Since acute bronchitis can also become chronic, it is important to treat this condition properly and adequately.

One of the most serious respiratory infections is pneumonia. The most common causes of the disease are bacteria of the species Streptococcus pneumoniae. But other bacteria, viruses or fungi can lead to inflammation of the lung tissue. The treachery of pneumococcal pneumonia is that it can often lead to very severe symptoms without warning. It is also possible to get vaccinated against pneumococci, as in the case of influenza, people from risk groups are recommended to have a vaccine.

In recent years, the number of whooping cough cases increased again. This is mainly due to the fact that the vaccine against this highly infectious infectious disease gradually decreases and adults would have to refresh him. Pertussis, as the whooping cough in technical language is called, is a bacterial infection. The disease can be very tedious and life threatening especially for small children. It begins like a harmless cold with a cold and cough, but changes in the course of the typical bouts of attacks of coughing that occur especially at night.

The bacterial infectious disease that still causes most deaths worldwide is tuberculosis. In 2014, about 9.6 million people worldwide fell ill. In Germany, the rate of newly diagnosed tuberculosis infections is comparatively low, but in 2015 the Robert Koch Institute observed an increase to 5,865 cases compared to 4,533 cases in the previous year. Above all, people whose immune system is weakened are at risk. Contagion occurs through close contact with patients, usually by droplet infection via the lungs. In most cases, the body succeeds in successfully controlling the bacteria or isolating them. These inflammatory sites (tubercles), which are enclosed by the immune system, can be visualized on the x-ray and also give their name to the disease. An infection can now be treated well with a combination of antibiotics, however, multidrug-resistant tuberculosis pathogens have been a growing problem in recent years.

Inflammation in the lungs naturally also plays a central role in chronic lung diseases such as asthma or Chronic Obstructive Pulmonary Disease (COPD).