Pneumonia

Overview

Inflammation of the air sacks (alveoli) is called as pneumonia.

Alveoli are little air sacks in the lungs, which helps you to breath. Once these air sacks gets inflamed, the physical property (elasticity) gets restricted and you develop the symptoms such as breathlessness and coughing.

This is either due to microorganisms, viruses or fungi. When not taken care properly it can be life threatening condition.

Infant and children are mostly affected. Elderly people, more than 65 years of age may have delayed and poor recovery.

Causes

Bacterial infection

Most common bacteria is Pneumococci
H. influenza
Mycoplasma pneumoniae
Legionella pneumophilia

Viral infection

Influenza
Respiratory syncytial virus
Legionella pneumophilla

Fungal infection

It is common in those who have suppressed immunity. Though otherwise it is not easily develop.

Pneumocystis jirovecii
Cryptococcus species
Histoplasmosis species

Risk factors

Age above 65 years
Having co morbidities such as; Diabetes mellitus, hypertension, Kidney failure, cancer.
Chronic smokers
Chronic pulmonary obstructive disease
Medicine induced (Iatrogenic)
In bed-ridden patient; aspiratory pneumonia is most common.

Symptoms

High fever and chills
Cough with sputum
Breathlessness on least physical activity or even on lying down
Fatigue
Decrease appetite
Rapid pulse and rapid breathing
Nausea and vomiting
Chest pain; due to inflammation
Headache

Types

Hospital acquired pneumonia (HAP): Long-term hospital stay; increases the possibility of developing pneumonia due to several infection in hospital.
Community acquired pneumonia (CAP): It is most common. Pneumonia develop outside the hospital, i.e. through community spread.
Ventilator associated pneumonia (VAP): Patients who are on artificial respiration (on ventilator), may catch the infection.
Aspiratory pneumonia: Inhalation of food, drink or saliva. Commonly seen in sedated patient; i.e. who is intoxicated or on medication.

Stages

Lobar pneumonia

Entire lobe is involved and there is diffuse consolidation. It represents in 4 stages:

Stage of congestion: Grossly heavy and bloggy appearing lung tissue, diffuse congestion, vascular engorgement and alveolar fluid accumulation.
Red hepatization: Marked infiltration of red blood cells, neutrophils and fibrin into alveolar fluid. Lung appears red and firm; just like liver.
Gray hepatization: Red blood cells of red hepatization breaks down and is associated with fibro purulent exudates, causing red to gray color transformation.
Resolution: Clearing exudates by resident macrophage with or without residual scar tissue formation. Productive cough helps to eject remaining fluids.

Bronchopneumonia

Suppurative inflammation localized in patches around bronchi.

Diagnosis

During physical examination, your doctor will auscultate your lungs for abnormal sound like; crackling or bubbling.

Chest X-ray: Suggestive of inflammation. It helps to find the localization of infection.

Blood tests: WBC is usually high. Increased CRP is observed.

Sputum culture: To determine the type of infection.

Pulse oximetry: Detection of oxygen level in the body.

CT scan: For more detailed image of lungs.

Pleural fluid examination helps to know the type of bacterial infection.

Bronchoscopy

When one should be advised for hospitalization?

Age over 65

Underlying disease:

Diabetes
Kidney failure
Congestive cardiac failure
Alcoholism
Cancer
Depressed immunity
Splenectomy

Altered mental stress

Signs

Respiratory rate more than 30/minute
Systolic blood pressure less than 90 mmHg
Diastolic blood pressure less than 60 mmHg
Meningitis, Arthritis

Laboratory parameters

White blood cell < 4000 or > 30,000/mm2
PaO2 < 60 mmHg on air
Kidney failure
Haematocrit < 30%
Multilobar involvement on chest X-ray

Complication

Bacteremia (Bacteria inn blood stream): Spread of infection to other organs through blood stream. Organ failure is the worst outcome.
Pleural effusion (Collection of fluid in lungs): Inflammatory cells increases capillary permeability and as a result fluid is collected in between two layers of lungs covering.
Lung abscess: Pus formation in the lung cavity.
Acute respiratory distress syndrome: It is an emergency condition.
Decrease oxygen level
Death

Homeopathic treatment for Pneumonia

1. Aconite:

Indicated in first stage of pneumonia.
High fever preceded by chills, pulse is full, hard and tense.
History of exposure, dry and cold wind.
Skin is hot and dry. Teasing and painful cough with some expectoration.
Great restlessness, tossing about, anxiety and fear of death.
Great indication in pulmonary congestion, with sudden onset in young and plethoric person.
It is not recommended in advance or in further progression of disease. Thick expectoration indicates that exudation is commencing.

2. Ferrum Met:

Pneumonia senilis.
First stage of pneumonia. In secondary pneumonia, especially in aged and debilitated.
Expectoration: Thin, watery and blood streaked.
High fever, oppressed and hurried breathing and bloody expectoration.
Very little thirst, extensive rales.

3. Iodine:

Pneumonic crouposa. Beginning of plastic exudation.
For first and second stage of pneumonia.
High fever and restlessness; tendency to rapid extension of hepatization.
Difficulty in breathing. Sputum blood streaked.
Also indicated in later stage when resolution does not progress.
According to Dr. Kafka, Iodine should be prescribed as soon as physical symptoms appear and has capacity to arrest process of hepatization; within 24 hours. He even considered that Aconite is entirely unnecessary in pneumonia.

4. Veratrum Viride:

Indicated in violent congestion, in first stage of disease.
Great arterial excitement, dyspnea, chest oppression.
Nausea and vomiting.
High fever, violent action of heart; pulse is hard, rapid and full.
Tongue: Red streak down the center.
Strike out anxiety, alarm, ugly delirium with deeply flushed bloated face and headache.
Avoid the remedy if person have cardiac depression already.

5. Brayonia Alba:

Pleuro-pneumonia. Indicated after Aconite; when hepatization or stage of exudation has set in. Pulmonary oppression with feeling of anxiety, heavy pressure on sternum.
Bruised feeling and shooting pain in chest aggravation by every motion, pain more bearable when lying or on affected side.
Cough hard and painful, but expectoration viscid, tenacious of a brisk dust color. Thirst for large quantity of water.

Treatment with modern medicine

Antibiotics are prescribed according to the type of bacterial infection. Usually treatment lasts for 5 to 7 days.
In viral pneumonia; no need of antibiotics. Plenty of fluids and rest is required and symptomatic treatment is done.
In fungal infection; it requires antifungal medication. However, fungal infection takes longer time to recover.

Generally, recovery from pneumonia takes from 7 days to one month. Proper rest is mandatory.