Pneumonia is an infection of the lower respiratory system and is included in the 10 most frequent causes of loss of life of all age groups, while it is the first cause of death from infectious diseases.

Although the lungs are constantly exposed to microbial agents from inhaled air, but also from microaspirations from the upper respiratory tract, the lower airways remain microbially sterile due to the multilayered respiratory defense system. Defense mechanisms include a range of both anatomical, chemical, and cellular factors.

“Pneumonia is created by a deficiency of the immune mechanism, exposure to a highly virulent agent, with the pathogen entering the lungs through aspiration of microbial flora from the upper respiratory tract, less often through inhalation of micro-droplets and rarely through blood-borne spread.

It can affect one or both lungs and is caused by inflammation of the alveoli and their filling with inflammatory material, resulting in difficulty in transporting oxygen to the blood.

The main symptoms are fever, cough accompanied by sputum, shortness of breath, which, if they persist, should lead the patient to visit the doctor for early diagnosis and treatment”, points out Mr. Dimitris Mitromaras Pulmonologist – Tuberculosis, Director of the E’ Pulmonology Clinic of the Metropolitan General.

Diagnosis

Diagnosis is confirmed through clinical examination, in which characteristic findings such as crackles may precede radiological changes. These findings are usually absent in viral or atypical pneumonias. In addition, the diagnosis is confirmed by radiological control with a chest X-ray, as it is extremely rare to present pneumonia with a normal X-ray.

“The role of microbiological tests is important, as markers of inflammation are elevated and their fall during treatment means that the treatment received is appropriate.

Sputum culture will help isolate the specific pathogen and give targeted antibiotic therapy, as well as potentially identify rare pathogens that are not covered by standard antibiotic therapy.

The test remains with low sensitivity due to the inappropriateness of the sample and difficult expectoration of the patient. Detection of antibodies in the serum are used to diagnose usually atypical pneumonia, while detection of specific antibodies in the urine are useful for the diagnosis of specific pathogens.

The main pathogens are pneumococcus or viruses such as COVID-19, influenza type A and B and more rarely fungi.

Everyone is at risk of pneumonia, but people with underlying diseases such as respiratory, cardiac, malignancies, immunosuppressed, are more vulnerable, as well as older people and children”, emphasizes the expert.

Treatment

Treatment is determined based on the severity of the pneumonia, according to the doctor’s judgment, that is, whether it will be treated at home or hospitalization will be required.

Home treatment, in addition to antibiotic treatment, requires adequate rest, fluid intake and antipyretic treatment in case of fever. Hospitalization requires intravenous antibiotic treatment, oxygen therapy and support of other systems, while admission to an intensive care unit is not excluded, if deemed necessary.

Prevention

Prevention is very important and is achieved by vaccination against the pneumococcus, the flu every year, the corona virus – annual as well, and recently, against the respiratory syncytial virus (RSV) which is done every two years and concerns people over 75 and from 60-74 years old with underlying diseases.

Pneumococcal vaccination is recommended for all ages 65 and older and ages 18-65 with underlying diseases, such as immunosuppressed people, chronic lung disease, chronic heart disease (excludes hypertension), diabetes mellitus, chronic renal failure, alcoholism and in “heavy” smokers.

Influenza vaccination is recommended for all persons aged 60 and over, as well as for persons aged 18-60 with underlying diseases (asthma, chronic obstructive pulmonary disease, pregnant women of any gestational age, morbidly obese persons with a body mass index > 40 kg/m² , closed populations, workers in healthcare facilities, people in close contact with children < 6 months or living with people with an underlying disease).
“In summary, when we follow a healthy lifestyle, avoid smoking, do not underestimate the symptoms when they are severe or persistent and visit the doctor in time, we protect ourselves and others from pneumonia”, concludes Mr. Mitromaras.