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| |    Pneumonia: An Overview by Lynn Cates, M.D., F.A.A.P. reviewed by Laura Jana, M.D., F.A.A.P. Most parents don't realize it, but there is a strong likelihood that someone they know has had at least a mild case of pneumonia. This disease is quite common and, with appropriate treatment, usually is cured quite handily. However, the diagnosis of pneumonia instills fear in many parents because somewhere along the way they have probably heard that someone died from this disease. While there is no question pneumonia needs to be taken seriously, it is most threatening to special populations like the elderly, children in developing countries who do not have access to antibiotics, and people with decreased immunity (e.g., people receiving treatment for cancer). Another group at risk for serious pneumonia is young infants and children, so it is important that parents know to seek advice when their child seems sicker than usual with his cold or flu, or when he develops a fever and trouble breathing. What is pneumonia? Pneumonia is inflammation of the lungs. Normally, when air is breathed into the lungs through the nose or mouth, the lungs transfer oxygen to the bloodstream. The oxygen is then transported in the blood to vital organs (like the brain, heart, and kidneys) throughout the entire body. When pneumonia causes a sufficient amount of fluid and pus to accumulate in the lungs, the lungs can't transfer oxygen as easily. The result is a low level of oxygen in the blood (hypoxia). A child can compensate for mild hypoxia by simply breathing faster and taking more air into his lungs. Causes of pneumonia Pneumonia has many kinds of causes. The most common kind of pneumonia--that caused by infection--can result from any variety of organism, including viruses, bacteria, fungi, and parasites. It often follows common upper respiratory infections like colds, middle ear infections, and sore throats. Some types of pneumonia are highly contagious and are spread by sneezes, coughs, and respiratory secretions on tissues and surfaces like countertops. Other kinds are rarely transmitted. Diagnosing pneumonia The diagnosis of pneumonia is made by evaluating a child's symptoms and doing a physical examination; it also may require blood tests and a chest X-ray. Symptoms commonly include fever, coughing, and rapid breathing. Sometimes vomiting, stomach aches, decreased appetite, chills, headace, wheezing, or chest pain occur as well. On rare occasions, young children can have a great increase in sputum (phlegm) production. The physical examination may show rapid breathing, flaring of the nostrils with each breath, retractions of the chest wall (or sucking in of the skin above and below the rib cage and between the ribs), and abnormal sounds in the lungs (called r?s) that can be heard only with a stethoscope. In extreme cases, when there is poor oxygenation of the blood, the skin--particularly around the lips and fingernails--may appear blue (cyanosis). Laboratory tests are not always needed to diagnose pneumonia, but they may be helpful in some instances. Blood cultures, for example, are extremely important in serious cases because they can definitively establish the cause of the pneumonia and help guide the healthcare provider's selection of appropriate treatment. Similarly, a chest X-ray is not always necessary to confirm a case of pneumonia, but it can help in several circumstances:
Depending on the type and severity of pneumonia, treatments can range from no treatment at all to routine antibiotics, supplemental oxygen therapy, or even machine-assisted breathing. While bacterial pneumonias can be treated with antibiotics, there are no anti-viral therapies for most viral pneumonias. In the event of a serious pneumonia of any cause, a child may have to undergo oxygen therapy. In extreme cases, a child may need assisted breathing with mechanical ventilation to help overcome this disease. Recovering from pneumonia Access to good health care and availability of appropriate treatments play an important role in how likely (and how quickly) children are to recover from pneumonia. The vast majority of children in developed countries recover completely if they are diagnosed promptly and treated appropriately. Because of the wide array of kinds and severity of pneumonia and the variable availability of treatment throughout the world, however, the outcome of this disease ranges from full recovery to death. Unfortunately, there is a very high mortality rate from pneumonia in developing countries. Pneumonia can also be particularly severe in children whose immune systems are not functioning normally, including premature infants, children with congenital immunodeficiency diseases or sickle cell anemia, and those on chemotherapy for cancer.
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