Conditions Pneumonia

Pneumonia is an inflammation of the air sacs and the surrounding tissue. The infection often causes a strong feeling of illness, with typical symptoms including a sudden high fever, chills, cough, and shortness of breath.

Pneumonia is often caused by bacteria. In that case, it can usually be treated effectively with antibiotics. There are also specific vaccines against particular types of pathogens.

People who are otherwise in good health usually recover from pneumonia after a few weeks. However, it should be noted that it can take several months for the body to recover its full strength.

Pneumonia can sometimes lead to life-threatening complications, especially if the patient is already weakened by another illness. Infants and older people are also in the at-risk groups.

Typical indications of pneumonia are:

• high fever and shivering
• weakness and feeling very ill
• coughing and sputum
• breathlessness and rapid breathing
• rapid pulse

But symptoms may only occur singly, or atypical symptoms such as diarrhea, stomach ache or impaired consciousness may be the main complaint. This is particularly the case with children and older people.

Pneumonia is often caused by bacteria. Which bacteria are involved usually depends on where the infection occurs. If the patient becomes ill in a domestic environment, pneumococci are usually the cause. Other pathogens, more difficult to treat, particularly occur with infections in hospitals.

Viruses and, less frequently, fungi can also be responsible for pneumonia.

Pneumonias that are not caused by germs but rather, for example, by radiation or inhaled toxins, an allergic reaction or circulatory disorders, do not occur very often.

The risk of developing pneumonia is particularly increased in infants and people over the age of 65. The same applies to people with a weakened immune system – for example, due to diabetes, kidney dysfunction or cancer.

Other risk factors include lung diseases such as asthma or COPD, heart disease, smoking and certain viral infections such as flu (influenza).

People who are bedridden or who have altered consciousness or swallowing difficulties due to conditions like dementia or stroke are particularly at risk of a condition known as aspiration pneumonia. In the process, germs from the mouth and throat, food particles, or stomach contents can enter the airways and lead to pneumonia.

It remains unclear whether certain medications increase the risk of pneumonia, for example drugs that inhibit gastric acids.

Over 500,000 people per year get pneumonia in Germany, of whom around 250,000 are treated in hospital. More than 20,000 people die from pneumonia each year – these are mostly older people over the age of 65 and those weakened by other illnesses. As a result, pneumonia is one of the ten most common causes of death in Germany.

Pneumonia is even more common in poorer countries, particularly in infants and children.

A sudden high fever and shivering are characteristic of pneumonia. Then symptoms such as coughing, breathlessness and sputum develop, and patients feel very ill. But the inflammation can also evolve slowly and stealthily, and begin with few or mild symptoms. This is particularly the case with older people.

If the fever is left untreated, it takes around one week until the body temperature returns to normal values. This is the critical “defervescence” or “crisis”. This usually involves outbreaks of heavy sweating and a dilation of the blood vessels in the skin: this enables the body to lose heat more easily. Because people with pneumonia are often very weak, this phase can be very stressful for the heart and circulation, and lead to complications.

Once the crisis phase has passed, the person’s general health slowly improves again. Over the next approximately 4 weeks the pneumonia then usually fades away completely. However, you may continue to feel worn out and tired for quite some time. The cough can also linger on stubbornly.

However, this course of pneumonia is rare today, as the illness is usually treated immediately. Taking antibiotics usually brings the fever down more quickly and you feel better fast. Even so, it is important not to overexert yourself too soon when you have pneumonia, as this can lead to a relapse or other complications.

Consequences

With pneumonia, the costal pleura can become inflamed, which leads to severe pain when coughing and breathing. Breathing can become even more difficult if fluid collects between the lungs and the chest wall. A lung abscess – the formation of a pus-filled cavity – may also occur.

Sometimes, life-threatening complications can also occur. These include cardiac arrhythmias, circulatory collapse, respiratory or heart failure, and sepsis (commonly known as “blood poisoning”).

The following factors increase the risk of complications:

• age under 2 or over 65 years
• a weakened immune system
• pre-existing illnesses such as heart or kidney disease
• artificial ventilation
• hospital-acquired infection
• treatment with antibiotics in the months before the pneumonia

To prevent infections of the airways, simple hygiene measures are usually recommended, including regular hand washing and maintaining physical distance.

If there is an increased risk of pneumonia or its complications, vaccinations may also be considered. For children, for example, these are vaccinations against the bacterium Haemophilus influenzae and against pneumococci. Vaccinations against influenza, pneumococcal disease, and COVID-19 are recommended for older people aged 60 and over.

The typical symptoms described above usually indicate pneumonia. The doctor diagnoses the illness by thoroughly listening to the lungs with a stethoscope and measuring the heart rate and blood pressure.

The lungs are frequently X-rayed to see where and to what extent the lung tissue is inflamed. In some cases, a computed tomography scan is performed as an advanced X-ray examination. Ultrasound enables changes in the outer area of the lungs to be identified.

Blood is taken to determine the inflammation levels and other values. An inflamed lung no longer works well. So the oxygen content of the blood may be monitored, too. This also works without taking blood, rather by using so-called pulse oximetry, which determines the oxygen content through an optical method. To do this, a clip with a light sensor is attached to the finger.

Blood, urine and phlegm samples can be examined in the lab to identify the specific pathogens.

The infection is usually caused by bacteria. So in most cases pneumonia is treated with antibiotics, based on the type of bacteria.

If the pneumonia is severe, anti-inflammatory cortisone is also sometimes injected. If there is a shortage of oxygen a nasal mask is normally used. Ventilation is required less often.

If viruses, for example the SARS-CoV-2 coronavirus, cause the pneumonia, the drugs used differ from those used for a bacterial infection. With the flu, so-called virostatics that act specifically against viruses may be considered.

For more detailed information, for example on pneumonia types and their treatment, go to gesundheitsinformation.de.