A.Griguolo Bacterial Pneumonia

Generality

Bacterial pneumonia is the infection of the pulmonary alveoli supported by the action of a bacterium.

Bacterial pneumonia is the most feared form of pneumonia, as it can lead to life-threatening complications.

Among the bacteria that cause bacterial pneumonia, stand out: Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, plus a number of atypical pathogens.

Typical symptoms of bacterial pneumonia are: cough with phlegm production, dyspnea on exertion, high fever, chills and noisy breathing.

For the diagnosis of bacterial pneumonia, the following are fundamental: the narration of symptoms, medical history, physical examination, chest X-ray and laboratory analysis of blood and sputum.

An infection such as bacterial pneumonia requires the use of a causal therapy, based on antibiotics, and a symptomatic and supportive therapy, based on rest, hydration and the use of antipyretics and painkillers.

Brief review of the medical meaning of the term pneumonia

In medicine, " pneumonia " refers to any lung disease characterized by the inflammation of the alveoli . Also known as pulmonary alveoli, the alveoli are the small sacs located at the end of the bronchial tree, in which the air introduced with the inspiration and in which the extraction, by the human organism, of the oxygen contained in the aforementioned air.

What is Bacterial Pneumonia?

Bacterial pneumonia is the form of pneumonia due to all those bacteria capable of entering the airways, through the nose or mouth, reaching the alveoli and infecting the latter. Bacterial pneumonia is therefore an example of lower airway infection sustained by the action of a bacterium.

Bacterial Pneumonia is the best known form of pneumonia

In addition to bacterial pneumonia, there are viral pneumonia and fungal pneumonia .

Of these three forms of pneumonia, however, bacterial pneumonia is the best known and the only one for which there is in fact a specific causal agent (see the chapter on causes).

What is viral pneumonia?

Viral pneumonia is the medical expression indicating a pneumonia due to a virus.

As a rule, viral pneumonias are mild forms of pneumonia, which arise from more trivial viral infections, such as the common cold or the flu .

Is it serious?

When it is due to certain bacteria (and, unfortunately, these bacteria are also its most frequent causes), bacterial pneumonia is a serious medical condition, which, in the absence of adequate treatments and when the patient is particularly "fragile", can even have a fatal outcome .

In general, bacterial pneumonia is considered to be the most severe and most feared form of pneumonia.

Causes

The list of bacteria capable of causing bacterial pneumonia is rich and includes two distinct groups of pathogens: the group of so-called typical bacteria and the group of so-called atypical bacteria .

Bacterial pneumonia due to so-called typical bacteria is an example of typical pneumonia, while bacterial pneumonia due to so-called atypical bacteria is an example of atypical pneumonia .

Bacteria Typical of Bacterial Pneumonia

As can be understood from the term "typical", the group of bacteria typical of bacterial pneumonia includes the most traditional and common causes of such lower airway infection.

Specifically, in this group of bacteria associated with bacterial pneumonia, they include:

• Gram-positive bacteria Streptococcus pneumoniae (or Pneumococcus ) and Staphylococcus aureus ;

is

• Gram-negative bacteria Haemophilus influenzae, Moraxella catarrhalis, Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli .

Importance of Streptococcus pneumoniae

• Streptococcus pneumoniae is, by far, the most important and frequent cause of bacterial pneumonia, so much so that the latter is often and improperly identified only with the aforementioned bacterium (as if it were the only possible responsible agent).
• Given its close correlation with bacterial pneumonia, Streptococcus pneumoniae can be considered a specific causal agent of this lower airway infection.
• Bacterial pneumonia from Streptococcus pneumoniae is a very feared condition, which if not treated properly, can have very serious complications (including death).

Atypical Bacteria of Bacterial Pneumonia

The group of atypical bacteria of bacterial pneumonia includes the most unusual causes of this infectious condition.

In detail, this group of bacterial agents includes:

• Mycoplasma pneumoniae ;
• Chlamydophila pneumoniae ;
• Legionella pneumophila ;
• Coxiella burnetii ;
• Chlamydophila psittaci .

The atypical bacteria of bacterial pneumonia are responsible for a mild infection, which rarely causes relevant symptoms and even less frequently gives rise to complications.

What are the preferred targets of Bacterial Pneumonia?

Anyone can develop bacterial pneumonia; however, statistics and medical studies report that this particular form of pneumonia has a predilection for:

• People over the age of 65;
• People with chronic respiratory diseases (eg, COPD and asthma);
• Immunosuppressed, that is, subjects with reduced immune defenses (eg: AIDS patients and patients with cancer undergoing chemotherapy);
• People with a smoking habit ( smoking );
• Sufferers from viral pneumonia;
• Diabetes patients and heart disease carriers.

In general, a healthy person who leads a healthy lifestyle in full strength is resistant to bacteria of bacterial pneumonia and this explains why, even when it comes into contact with it, it does not develop any infection.

Contagiousness and Transmission

Bacterial pneumonia is a contagious infectious disease, as it depends on bacteria that are capable of transmitting from an infected individual to a non-infected individual.

However, it should be pointed out that the level of infectiousness of bacterial pneumonia is limited, because the phenomenon of the transmission of the responsible agents is successful only a susceptible persons, so to say "fragile" from the immune and health point of view.

TRANSMISSION MODE

The transmission to a healthy individual of the bacteria that cause bacterial pneumonia generally occurs through contact with contaminated objects or the inhalation of infected saliva droplets, emitted by a patient, during sneezing, coughing or when speaking.

Symptoms and Complications

The symptoms and signs of bacterial pneumonia vary depending on the causative agent, the patient's general state of health and his age.

The symptoms of bacterial pneumonia are more severe, when the condition is due to so-called typical bacteria, when the patient's general state of health is poor (eg he suffers from AIDS and is immunosuppressed) and / or when the affected person is very young or of advanced age.

The most common manifestations of a generic bacterial pneumonia include:

• Fever at least 40 ° C;
• Cough with phlegm production of yellow or greenish color and sometimes containing traces of blood;

• Chills ;
• Dyspnea from exertion, or difficulty in breathing during more or less intense efforts;
• Wheezing or rattling emission .

Among the manifestations present in some situations, instead, fall:

• Chest pain (or chest pain), sometimes acute or stabbing, which tends to worsen during deep breaths or when coughing;
• Headache;
• Excessive sweating and damp skin;
• Decreased appetite, lack of strength and a sense of recurrent fatigue;
• Confusion;
• Increased heart rate and palpitations;
• Cyanosis at the level of the lips (blue lips) and on the tips of the fingers.

Curiosity: on what do respiratory difficulties and cyanosis depend?

The respiratory difficulties and cyanosis observed during bacterial pneumonia are the consequence of the inability of the inflamed alveoli to draw oxygen from the inhaled air.

When should I go to the doctor?

Especially in an individual at risk of bacterial pneumonia, it is a valid reason to contact a doctor or go to the nearest hospital for respiratory symptoms, such as coughing and wheezing, combined with disorders such as high fever, chills, chest pain, fatigue, lack of strength, confusion, cyanosis and decreased appetite.

Complications

In patients who do not receive the right treatments and / or who present a fragile immune system, bacterial pneumonia (especially when it is due to Pneumococcus) can cause various complications, including:

• Severe breathing difficulties . The extent of respiratory difficulties that can result from severe bacterial pneumonia is such as to require the use of mechanical ventilation;
• Bacteremia or, worse, sepsis . In medicine, the term "bacteremia" indicates the presence of bacteria in the blood; the word "sepsis", on the other hand, designates an abnormal inflammatory response, put in place by the body after the passage of pathogenic micro-organisms (such as bacteria);
• Pleural effusion . It is the abnormal accumulation of liquid in the pleural cavity (or pleural cavity), ie the empty space present between the pleura adhering to the lungs and the pleura adherent to the chest wall;
• Lung abscess . It is a necrotic process that leads to the formation, at the level of the lung parenchyma, of a cavity filled with pus.

Diagnosis

To formulate the diagnosis of bacterial pneumonia, the following is fundamental: the patient's account of the symptom picture, medical history, physical examination, chest X-ray and blood laboratory analysis and sputum for the purpose of establishing with precision the bacterium responsible for the infection.

history

A medical history useful in identifying bacterial pneumonia involves a careful examination of the symptoms, combined with an investigation on topics such as: the age of the patient, his past and present clinical history, his habits and his general state of health.

Physical examination

An objective examination useful for the detection of bacterial pneumonia includes: measurement of body temperature, measurement of respiratory rate and pulse, and auscultation of the chest in order to assess the quality of the breath.

The physical examination in a person with bacterial pneumonia leads to the discovery: wheezing and abnormal noises during breathing, the possible presence of a rapid heartbeat and rapid breathing.

Chest X-ray

Chest radiography is the diagnostic confirmation of what is only assumed with previous investigations. The chest X-ray, in fact, allows to recognize an inflammation of the alveoli and distinguish it from all the other pulmonary pathologies that, in spite of the different nature, cause very similar symptoms.

Blood and Sputum Analysis for the Discovery of the Cause

The analysis on blood and sputum of a patient with bacterial pneumonia is essential to identify the bacterium responsible for the infection. Knowing precisely what the bacterium that supports ongoing pneumonia is essential for planning the most appropriate treatment.

Other Diagnostic Exams useful for further study

Sometimes, on the occasion of a bacterial pneumonia, the doctors follow the classic diagnostic tests with other examinations and tests, useful mainly to deepen the situation.

These tests and exams include:

• Oximetry and blood gas analysis, to know the levels of oxygen and carbon dioxide in the blood;
• A magnetic resonance imaging ( MRI ) or chest CT scan, to obtain even more detailed images than those provided by the RX-chest;
• Bronchoscopy . It is used very rarely and, only, when doubts remain about the current condition.

Therapy

The presence of bacterial pneumonia requires the implementation of a causal therapy, to "break down" the triggering cause, and a symptomatic and supportive therapy, to alleviate the symptoms and prevent any complications.

Causal Therapy of Bacterial Pneumonia: what does it consist of?

The causal therapy of bacterial pneumonia is based on the administration of an antibiotic capable of eliminating from the infected organism the bacterium responsible for the infection affecting the pulmonary alveoli.

The choice of the antibiotic to be administered varies according to the bacterial pathogen identified during blood and sputum analysis.

Among the possible antibiotics used in the presence of bacterial pneumonia, deserve a mention: amoxicillin, erythromycin, cefuroxime, flucloxacillin, doxycycline, ciprofloxacin and cefaclor.

Symptomatic Therapy of Bacterial Pneumonia

As a rule, symptomatic therapy useful in the presence of bacterial pneumonia includes:

• Rest until the complete disappearance of fever and cough;
• Taking NSAIDs, aspirin or paracetamol, to mitigate symptoms such as fever, chest pain, etc. It is recalled that aspirin is contraindicated in children;

• Consumption of a lot of water, to dissolve phlegm and mucus, and to avoid dehydration (which is a possible consequence of very high fever).

What to do in severe cases or at the onset of complications?

When it has degenerated into complications (eg: severe respiratory difficulties) or when it affects a "fragile" subject from the point of immunity (eg: an elderly person), bacterial pneumonia requires hospitalization and a series of treatments - including mechanical ventilation - that only in a specialized structure can they take place.

Did you know that ...

Among the so-called atypical bacteria of bacterial pneumonia, the most dangerous is Legionella pneumophila .

Prognosis

The prognosis in the case of bacterial pneumonia depends on numerous factors, which are:

• The type of bacteria responsible for the infection. Bacterial pneumonia due to Pneumococcus is more difficult to treat than bacterial pneumonia due to a so-called atypical bacterium; moreover, it is easy to face complications.
• Timeliness of diagnosis and subsequent treatment. Any bacterial pneumonia not subjected to timely treatment is more likely to lead to complications.
• The patient's general health and age. If the general state of health is compromised and / or age is advanced, the treatment of bacterial pneumonia is decidedly more complex and its results are more uncertain.

What are the Healing Times?

To completely cure a bacterial pneumonia, it can take a few months .

The same factors that influence the diagnosis affect the duration of the resolution of bacterial pneumonia (therefore, type of infectious bacterium, timeliness of diagnosis and treatment, general state of health of the patient and age of the latter).

Prevention

Those at risk of bacterial pneumonia (eg: elderly, immunosuppressed subjects, etc.) have the possibility of counting on some preventive measures, which are:

• Vaccination against Streptococcus pneumoniae ;
• Vaccination against influenza;
• Wash your hands regularly;
• Avoid smoking;
• Eat healthy;
• Stay away from people with bacterial pneumonia or infections associated with bacterial pneumonia.