Community-acquired pneumonia (CAP) is the most common type of pneumonia. It occurs outside of hospitals or other health care facilities.
By Dr. Gautam Wankhede
Pneumonia is a serious, potentially life-threatening lung infection that can strike both children and adults. It is the single biggest infectious killer of adults and children, with an annual mortality rate of roughly 2.5 million adults and children globally. India accounts for 23 per cent of global pneumonia burden with fatality rates between 14 and 30 per cent. This infection is increasingly common among children, the elderly and those with comorbidities like COPD, diabetes mellitus, renal failure, congestive heart failure, chronic lung disease, etc.
Pneumonia can be caused by a wide variety of bacteria, viruses and fungi in the air we breathe. The infection causes inflammation in the air sacs of the lungs which leads to cough with phlegm or pus, fever, chills, and trouble breathing. Both viral and bacterial pneumonia are contagious.
Majorly, there are two types of Pneumonia – Community-acquired pneumonia (CAP) and Hospital-acquired Pneumonia (HAP).
Community-acquired pneumonia
Community-acquired pneumonia (CAP) is the most common type of pneumonia. It occurs outside of hospitals or other health care facilities. CAP is one of the leading causes of morbidity and mortality in India and worldwide and one of the most serious respiratory illnesses among various infections causing sepsis. Approximately 4 million cases of CAP occur annually in India, with 20% of them requiring hospitalization. Typical bacterial pathogens that cause CAP include Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.
It is important to determine whether the cause of CAP is a bacterium, atypical bacterium, fungi or virus, because they require different treatments.
Hospital acquired pneumonia
Hospital acquired pneumonia (HAP) is defined as occurring >48 h after admission to a healthcare facility. It is caused by a different spectrum of more antibiotic resistant bacterial pathogens than those occurring in the community.
Pneumonia Diagnosis
Effective diagnosis and treatment of pneumonia is critical to improve survival rate. Diagnosis of pneumonia is a challenge as this condition closely resembles the common cold or flu. Appropriate medical history and physical examination are an important part of making pneumonia diagnosis. Further, often pneumonia prevention is compounded by the increasing prevalence of antibiotic resistance that impends to make the treatment of bacterial causes of pneumonia more challenging and expensive in countries such as India.
Most of the pneumonia cases are diagnosed with chest X-ray, blood culture test and a CT scan of the chest in some cases. Bronchoscopy is advised in a few cases if the initial symptoms are severe or not responding well to antibiotics.
Microbiological tests are not completely reliable in identifying the cause of pneumonia, and in 40-70% of pneumonia cases, the cause is never determined. Molecular diagnostic tests for pneumonia has been a major advance in the microbiological diagnosis of respiratory pathogens in recent years.
Comprehensive molecular testing significantly improves pathogen detection in pneumonia. Molecular tests like RT PCR identify a specific pathogen, help to distinguish between bacterial and viral infection and some newer molecular tests also provide information about antibiotic susceptibility. PCR is a molecular diagnostic technique based on DNA detection and offers the advantage of providing results within a few hours. Furthermore, it is a sensitive and very specific diagnostic test for identifying patients with pneumococcal pneumonia.
An important factor in the management of pneumonia is the early diagnosis of the causative pathogen based on which appropriate anti-bacterial, anti-viral or anti-fungal treatment can be started soon. A delay in identifying the infectious agent and subsequent delay in starting targeted therapy is often the cause of fatality in pneumonia.
The quick results of PCR is beneficial in the management of critical patients especially in the quick commencement of appropriate antimicrobial therapy. Furthermore, the new age RT-PCR based molecular diagnostic kits look for the presence of 15-30 different pneumonia causing pathogens at the same time and provide answers within 2-3 hours unlike the traditional culture methods which take 3-5 days. Besides, as our knowledge of genetic origins of drug resistance increases, the rapid identification of antibiotic resistant in these pathogens helps in selecting the correct treatment regime for the patients.
Prevention
In most cases, pneumonia can be prevented by improving hygiene, vaccinations, adequate nutrition and by addressing environmental factors such as air pollution. When it comes to preventing pneumonia in children, immunization against HIB, pneumococcus, measles and whooping cough (pertussis) is very effective besides the factors mentioned above.
This World Pneumonia Day, let’s raise awareness of the importance of diagnosis, prevention and treatment of pneumonia.
(The author isDirector of Medical Affairs, Mylab Discovery Solutions.Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com.)
