Pneumococcal Pneumonia

Definition

Pneumococcal pneumonia is a common but serious infection and inflammation of the lungs. It is caused by the bacterium Streptococcus pneumoniae.

Description

The gram-positive, spherical bacteria, Streptococcus pneumoniae, is the cause of many human diseases, including pneumonia. Although the bacteria can normally be found in the nose and throat of healthy individuals, it can grow and cause infection when the immune system is weakened. Infection usually begins with the upper respiratory tract and then travels into the lungs. Pneumonia occurs when the bacteria find their way deep into the lungs, to the area called the alveoli, or air sacs. This is the functional part of the lungs where oxygen is absorbed into the blood. Once in the alveoli, Streptococcus pneumoniae begin to grow and multiply. White blood cells and immune proteins from the blood also accumulate at the site of infection in the alveoli. As the alveoli fill with these substances and fluid, they can no longer function in the exchange of oxygen. This fluid filling of the lungs is how pneumonia is defined.

Those people most at risk of developing pneumococcal pneumonia have a weakened immune system. This includes the elderly, infants, cancer patients, AIDS patients, post-operative patients, alcoholics, and those with diabetes. Pneumococcal pneumonia is a disease that has a high rate of hospital transmission, putting hospital patients at greater risk. Prior lung infections also makes someone more likely to develop pneumococcal pneumonia. The disease can be most severe in patients who have had their spleen removed. It is the spleen that is responsible for removing the bacteria from the blood. Cases of pneumonia, which is spread by close contact, seem to occur most often between November through April. If not treated, the disease can spread, causing continually decreasing lung function, heart problems, and arthritis.

Causes and symptoms

Symptoms of bacterial pneumonia include a cough, sputum (mucus) production that may be puslike or bloody, shaking and chills, fever, and chest pain. Symptoms often have an abrupt beginning and occur after an upper respiratory infection such as a cold. Symptoms may differ somewhat in the elderly, with minimal cough, no sputum and no fever, but rather tiredness and confusion leading to hypothermia and shock.

Diagnosis

The presence of symptoms and a physical exam that reveals abnormal lung sounds usually suggest the presence of pneumonia. Diagnosis is typically made from an x ray of the lungs, which indicates the accumulation of fluid. Additional tests that may be done include a complete blood count, a sputum sample for microscopic examination and culture for Streptococcus pneumoniae, and possibly blood cultures.

Treatment

Depending on the severity of the disease, antibiotics are given either at home or in the hospital. Historically, the treatment for pneumococcal pneumonia has been penicillin. An increasing number of cases of pneumococcal pneumonia have become partially or completely resistant to penicillin, making it less effective in treating this disease. Other effective antibiotics include amoxicillin and erythromycin. If these antibiotics are not effective, vancomycin or cephalosporin may alternatively be used.

Symptoms associated with pneumococcal pneumonia can also be treated. For instance, fever can be treated with aspirin or acetaminophen. Supplemental oxygen and intravenous fluids may help. Patients are advised to get plenty of rest and take increased amounts of fluids. Coughing should be promoted because it helps to clear the lungs of fluid.

Alternative treatment

Being a serious, sometimes fatal disease, pneumococcal pneumonia is best treated as soon as possible with antibiotics. However, there are alternative treatments that both support this conventional treatment and prevent recurrences. Maintaining a healthy immune system is important. One way to do this is by taking the herb, echinacea (Echinacea spp.). Getting plenty of rest and reducing stress can help the body heal. Some practitioners feel that mucus-producing foods (including dairy products, eggs, gluten-rich grains such as wheat, oats, rye, as well as sugar) can contribute to the lung congestion that accompanies pneumonia. Decreasing these foods and increasing the amount of fresh fruits and vegetables may help to decrease lung congestion. Adequate protein in the diet is also essential for the body to produce antibodies. Contrast and constitutional hydrotherapy can be very helpful in treating cases of pneumonia. Other alternative therapies, including acupuncture, Chinese herbal medicine, and homeopathy, can be very useful during the recovery phase, helping the body to rebuild after the illness and contributing to the prevention of recurrences.

Prognosis

Simple, uncomplicated cases of pneumococcal pneumonia will begin to respond to antibiotics in 48 to 72 hours. Full recovery from pneumonia, however, is greatly dependent on the age and overall health of the individual. Normally, healthy and younger patients can recover in only a few days, while the elderly or otherwise weakened individuals may not recover for several weeks. Complications may develop which give a poorer prognosis. Even when promptly and properly diagnosed, such weakened patients may die of their pneumonia.

Prevention

Vaccination

Recently, a vaccination has become available for the prevention of pneumococcal pneumonia. This vaccination is generally recommended for people with a high likelihood of developing pneumococcal infection or for those in whom a serious complication of infection is likely to develop. This would include persons over the age of 65, as well as those with:

• chronic pulmonary disease
• advanced cardiovascular disease
• diabetes mellitus
• alcoholism
• cirrhosis
• chronic kidney disease
• spleen dysfunction, or removal of spleen
• immunosuppression (cancer, organ transplant or AIDS)
• sickle cell anemia

Unfortunately, those people for whom the vaccination is most recommended are also those who are least likely to respond favorably to a vaccination. Therefore, the overall effectiveness of this vaccine remains questionable.

Antibiotics

The use of oral penicillin to prevent infection may be recommended for some patients at high risk, such as children with sickle cell disease and those with a spleen removed. This treatment, however, must be weighed with the increased likelihood of developing penicillin-resistant infections.

Resources

ORGANIZATIONS

American Lung Association. 1740 Broadway, New York, NY 10019. (800) 586-4872. 〈http://www.lungusa.org〉.

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. 〈http://www.cdc.gov〉.

KEY TERMS

Acetaminophen— A drug used for pain relief as well as to decrease fever. A common trade name for the drug is Tylenol.

Aspirin— A commonly used drug for pain relief and to decrease fever.

Bronchi— Two main branches of the trachea that go into the lungs. This then further divides into the bronchioles and alveoli.

Sputum— A substance that comes up from the throat when coughing or clearing the throat. It is important since it contains materials from the lungs.