Lets talk about Pneumonia
We’ve been together now for what, about a year and a half? I can’t believe I haven’t yet logged an entry about pneumonia. In large part it’s because I don’t mind elaborating on why I do NOT LIKE THAT WORD, but also because it’s a pretty common problem with a lot of voodoo that surrounds it. So I’ll get the complaints about the name out of my system first, then we can move on to some myth busting and truth telling about this lower respiratory infection. I’d also like to register that I’m working on this entry while I sit in the doctor’s office awaiting my SECOND plantar wart acid treatment. #multitasking.
In my mind, the word pneumonia has some flaws. First of all, a ‘p’ and an ‘n’ shouldn’t be next to each other. I don’t care why. It just begs people to get intimidated and pronounce it wrong. “Ammonia.” “Lamonya.” I’ve heard them all. Once someone gets intimidated by the word, the cache of scary meaning that goes along it comes right away. That’s what happens with pneumonia. Everyone gets all freaked out. It’s kind of like when people used to call TB “consumption.” Scary, right? And I’m sure it was. Before there was a treatment for pulmonary tuberculosis, the body wasted away or was “consumed” by the infection. Yuck. Bad imagery. I do not dig. The word and meaning association may be accurate but it gives me the creeps.
Ok, time to move on. Pneumonia. Strictly defined, this is an infection of the lower respiratory tree, the smaller diameter airways. Germs that are typically in the air are inhaled and invade the lower airway cells and cause an inflammatory response there. It’s just like getting infected anywhere else. Boom. Now then, how about a FAQ?
What causes pneumonia?
Pneumonia can be caused by any microorganism, but the most common ones are viruses and bacteria. Common viruses that cause pneumonia in kids are respiratory syncytial virus and adenovirus. You’ve probably heard of the bacteria Streptococcus pneumonia, “fondly” known as strep pneumo. This has traditionally been one of the most common bacterial causes of pneumonia and we now have a vaccine against this bug, so soon it’s going to be much less common. Most of the microorganisms that cause pneumonia are all over the place on the planet, and hence we call the typical case of pneumonia “community acquired pneumonia.” Viral pneumonias tend to be more diffuse, with findings in both lungs, and bacterial pneumonias are often more focal, just on one side.
I want to be clear that pneumonia is NOT caused by exposure to the cold or by going outside with your hair wet. A lot of people still think this. Let’s bust this myth. And because I can’t help myself, I need to add here that lung injury due to an inhaled chemical or a mechanical reason is NOT called pneumonia, but rather pneumonitis. Aren’t we tricky with our codespeak?
What do patients with pneumonia look like?
I absolutely love this question because there really are a million answers. Everyone who has pneumonia is unique. Many people seem to think that if you have pneumonia you are barely hanging on at death’s door, but this is most often not the case. The textbook description is that of a loose, productive cough, fever, and crackles (formerly known as rales) in the lung sounds when listened with a stethoscope. Younger children will occasionally have an increased respiratory rate and signs of respiratory distress- nasal flaring, and extra rib movement that we call “retractions.” Given those signs and symptoms, there’s a lot of variation. Some people have sky high fever (over 103F) and a fairly unremarkable cough whereas others look like they feel ok but have a cough that sounds like it’s about an 8 on the Richter scale. Not everyone with pneumonia appears toxic and ill; in fact some people with pneumonia look fine and just describe feeling a bit “run down.” That’s where the term “walking pneumonia” comes from. That run down feeling frequently causes children to get dehydrated. They feel weak, so they don’t drink as much. And of course, that compounds the problem.
How do you diagnose pneumonia?
Classically pneumonia is diagnosed in one of two ways: X-ray and clinical exam. Pneumonia shows up on X-ray as an area of opaque white in the lung fields, which normally look black and filled with air. There’s some subtlety in making the diagnosis on X-ray, which is of course why we have RADIOLOGISTS. They are trained to notice the details, but most good general clinicians can diagnose the majority of pneumonias on X-ray. That often gets put together with the clinical exam, which sounds like crackle sounds in the lungs instead of the clear movement of air on inhalation and exhalation. An X-ray isn’t necessarily required for diagnosing pneumonia: in the setting of fever, cough and crackles on the physical exam, I don’t need to expose a patient to radiation to confirm what their body is already telling me. And sometimes the crackles can appear before any obvious visual changes on the X-ray.
Check out the white area over the ribs on the upper left side. That’s what pneumonia looks like on an x-ray.
What do you do about it?
Again, here’s the fascinating part and what keeps me intellectually charged up about my profession: there are many answers to this question. For a suspected bacterial pneumonia, antibiotics are needed to treat it, whereas for viral pneumonias the treatment is simple supportive care. Hydration is key, as is making sure that the oxygen level is good. So for some kids, a course of oral antibiotics, some chicken soup and apple juice are all that’s needed, and occasionally for others, hospital admission, oxygen therapy, and IV antibiotics are required.
So what is pneumonia, really?
It’s an infection of the lower airways that’s caused by many of the same germs that cause ear infections. Nothing more dramatic than that.
Can it cause a child to be seriously ill? Yes.
DOES it cause MOST children to become seriously ill? No.
But “pneumonia”sounds scary and awful, doesn’t it? It’s just a yucky word. Feel free not to like it.