Tuesday, 26 July 2011

Community Acquired Pneumonia

Published in City Times

Community Acquired Pneumonia … not to be taken lightly

Community Acquired Pneumonia (CAP) also called Pneumonitis or Bronchopneumonia, affects about 3 – 4 million people in the USA every year and is quoted to be the number 6 killer in the country, reveals Dr.Ahmed Abdullah, Pathologist, Zulekha Hospital, Sharjah. The serious proportions that the disease can assume makes it a condition that needs to be taken seriously and medical help sought on time.

What is CAP?
Simply stated, it is a disease of the lungs or of the lower respiratory tract. There is inflammation of one or both lungs which causes the bronchial tubes and air sacs in the lungs to fill with fluid, thus interfering with the functions of the lungs. .

How is this different from Hospital Acquired Pneumonia (HAP)?
The use of the word “community” simply implies that the infection was not contracted while the patient was in the hospital. The infection has to be acquired in the community at large and the patient must not be residing in any long term care facility for a minimum of 14 days before onset of the symptoms. Patients who are already in the hospital for some other illness are vulnerable to bacterial infections and may contract pneumonia, resulting in HAP.

What are the causes of CAP?
Most often, the organism responsible for the spread of infection are bacteria, most commonly called pneumococcus. But CAP can also be brought on by viral or fungal infection. Bacterial pneumonia can attack people of any age, from infants to the elderly and can also be fatal if not treated promptly. In some people, particularly the elderly and those who are debilitated, bacterial pneumonia may follow influenza even a common cold.

Is CAP contagious? Yes; the disease is air-borne. It spreads predominantly when infected people sneeze or cough.

Who are the individuals at risk of being infected with CAP?
While people of any age can develop CAP, incidence rates are highest at the extremes of life. Persons between 4-45 years of age have a 1 in a 1000 chance of getting CAP. Between the age of 46-65 the rate increases to almost 3 per 1000 person and then rises exponentially to as high as 17 per 1000 in those over the age of 65. Also, individuals with co-morbid conditions like diabetes, chronic heart disease or chronic renal failure, smokers, alcoholics and those with lowered immunity, are more susceptible to CAP.

What are the symptoms of CAP?
People with CAP usually come down with fever that can be acute and associated with cough. This cough may or may not be productive of sputum. Patients may have chest pain, experience difficulty in breathing, feel fatigue, have muscle pain, abdominal pain, headache, chills, rigors and sweating.

But these symptoms mimic symptoms of influenza and other diseases as well. So how is diagnosis of CAP made?
Yes, that’s precisely why as soon as these symptoms appear in a patient, he/she is advised to seek medical help and not brush it aside lightly as any ordinary fever. Diagnosis involves routine clinical examination of the patient, doing blood and blood culture tests, sputum investigation, chest X Ray, lung function test and MRI if necessary. These results are then matched together and analysed.

Once diagnosis of CAP is made, what is the line of treatment?
Depending on the severity of infection, treatment may be on outpatient basis or involve hospitalization of the patient. Treatment is usually with antibiotics for bacterial causesor other appropriate agents, example, antiviral or antifungal therapy as indicated.

At its worst, what can CAP result in?
Untreated CAP can lead to serious consequences and even death of the patient on occasions.

Can CAP be prevented?
Yes, with respect to certain infective agents. Today there is a vaccine against 23 strains of Pneumococcal bacteria which can cause CAP and it is available in most hospitals. In fact it should be given to all people falling in the high risk category, namely the old and elderly, those with deficient immune system and those with other co-morbid conditions which are most often age-related. The vaccine can be given to anybody who has got chronic chest problem, especially if they are above 60 years of age. In addition to those at risk, the vaccine can also be given to anybody who comes with CAP and gets admitted to the hospital. Patients should be revaccinated every 6 years. There is also influenza vaccine that can be administered annually to the same group of individuals at high risk.

You mean to say that the vaccine can be administered even after a person has actually contracted the infection and also manifests its symptoms?
Yes. They can indeed be given the vaccine after the infection has been treated and controlled. I would advise that every individual falling in the risk category should voluntarily visit the vaccination centres and get himself/herself vaccinated against CAP.


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