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Learn About Pneumonia

Bronchial Pneumonia

CAUSES | SYMPTOMS | DIAGNOSIS | TREATMENT

Bronchial pneumonia happens when the pneumonia spreads to several patches in the lungs. Bronchial pneumonia is prevalent in infants, young children and aged adults and it is usually caused by Streptococcus pneumonia. Bronchial pneumonia also called as bronchopneumonia involves inflammation of the bronchial tubes due to infection. Bronchial pneumonia is not confined to a single anatomic location. Whatever the case maybe, the symptoms are typical, which causes cough (with or without mucus), rapid breathing, chest pain, and shortness of breath. In addition to these symptoms, fever, headaches, sweats, and weakness are usually present.

The cells in the body, need oxygen to survive and when one breathes, the oxygen travels through the nose or mouth into the lungs via air canals known as bronchi.

Both left and right lungs are spongy in nature and are located underneath the rib cage on either side of the chest cavity. Pneumonia causes inflammation (irritation, swelling) or infection of the lungs that leads to formation of fluid and pus to fill a section (Lobar pneumonia) or form patches in both lungs (Bronchial pneumonia.), thus interfering with the uptake of oxygen.

Bronchial pneumonia is triggered in people with immune defense system that is weak, and most often by a simple viral upper respiratory tract infection or a case of influenza.

Bronchial pneumonia that is caused by a cold or flu is known as ‘walking pneumonia’. If your immune system is already compromised, pneumonia can be life-threatening. Viruses or bacteria usually cause pneumonia, however, some types of fungi and parasites can also cause it. Breathing in chemical fumes can also cause pneumonia.

Bronchial Pneumonia Causes

Pneumonia is more than just a single disease.

Different type of pneumonia infections:

1. Bacteria (B.P.) or wet p. – when the natural immune response of the body is lowered due to age, disease, malnutrition or alcoholism, the normal bacteria of the mouth and the throat multiply and attack one or all 5 lobes of the lungs. The infected lobe then fills with pus and fluid and thus affects the lung’s normal capacity for oxygen exchange.

  • The infection could then gradually spill into the blood stream and invade the whole body. Bacteria can get into the lungs form the air or from other sites. Infections could be community acquired or could be caught while in hospital.
  • The most common cause of bacterial (Lobar pneumonia) is streptococcus pneumonia.
  • Other pneumonia causing bacteria include H.influenza (usually active in early spring and winter), Chlamydia, Moraxella catarrhalis (smokers), Legionella (summer and fall in water delivery systems, air conditioning units), Staphylococcus aureus (Intravenous drug abusers – IVDA), and gram-negative bacteria such as Pseudomonas aeruginosa, anaerobes and Klebsiella.

2. Aspiration pneumonia occurs when contents of the stomach are accidentally inhaled into the lungs. It is more likely to happen when the normal swallowing mechanism is impaired due to the person being unconscious from seizure, or stroke, or from acid reflux or vomiting (alcoholics). Several types of bacteria can infect the lungs in the following manner

  • Empyema- referring to the pus formed between the layers of the covering over the lungs called as the pleura.
  • Viruses- are caught by being exposed to airborne infected virus droplets from somebody sneezing and coughing. Virus accounts for 50% of all pneumonias and are responsible for causing upper respiratory illness (airways near throat and mouth). These virus may also spread lower to the lungs and produce a patchy type of pneumonia that usually cures of its own accord. Some of the viruses are Influenza (A, B, C – most prevalent in adults), paraInfluenza (1,2,3,4), RSV (most common in infants), Chicken Pox, adenovirus, CMV and measles.
  • Mycoplasma pneumonia(walking pneumonia). This constitutes a small organism between a virus and bacteria and causes pneumonia with an irritating dry cough that comes on in aggressive spells.

3. Pneumocystis carinii (PCP) – this is believed to be a fungus and often causes pneumonia in persons infected with AIDS or lowered bodily defenses.

4. Tuberculosis (TB) caused by an organism called Mycobacterium Tuberculosis (i.e M bovis and M africanum). It is contagious, and could also infect the lungs and other organs like brain, spine, kidney etc.)

5. Rickettssaie- These are tiny organisms which cause diseases like Rocky Mountain spotted fever. This could mildly or severely affect the lungs.

6. Parasites – ascariasis (round worm) mainly in children

7. Others – Sometimes certain substances can enter the lungs and cause a blockage of the air passages, promoting bacterial growth and infecting the lung tissue. These substances could be:

  • Food- swallowing of a small object like a peanut or a pea.
  • Gases- furniture polish.
  • Dust – often dust, fungus, mould inhalation usually prevalent in farmers, mushroom pickers or miners (nickel dust)
  • Liquids – gasoline, kerosene
  • Foreign body ( swallowing of a coin or tooth).

Bronchial Pneumonia Symptoms

Bacterial Pneumonia :

  1. Fever is usually > 38.3 degrees Celsius or 100 degrees Fahrenheit
  2. sudden onset of chills
  3. Cough is usually dry and may produce sputum that is rusty color. It may be thick, having pinkish tone or blood streaks (Streptococcus Pneumonia). In Aspiration Pneumonia sputum may have a bad odor and may be green in color. Pseudomonas pneumonia may produce greenish sputum and in Klebsiella pneumonia, the sputum looks like current jelly.
  4. Chest pain is sharp, and especially intense upon inhalation (pleurisy)
  5. Rapid shallow breathing
  6. Shortness of breath (SOB) usually happens with even small amount of activity
  7. Headache, vomiting, nausea, diarrhea, and weakness may occur and is more persistent with pneumonia caused due to Legionella
  8. Abdominal pain and fatigue

Viral Pneumonia:

  1. Begins with upper respiratory symptoms like headache, dry cough, nasal congestion, low-grade fever (< 100 degrees Fahrenheit), sore throat, along with muscle and joint aches
  2. Skin rash like measles may appear
  3. Cough can be dry or can even produce sputum
  4. Chest pain is experienced , especially with breathing, and on one side
  5. Chills
  6. Shortness of breath is experienced, especially with activity, nausea, vomiting, diarrhea

Mycoplasma Pneumonia:

  1. Slow progression of symptoms
  2. Headache and low-grade fever
  3. Cough could be dry and may have violent runs of coughing
  4. Nasal Congestion and sore throat
  5. Muscle and joint pain and wheezing sound when breathing

Pnemocystis carinii Pneumonia:

  1. Often first presentation in HIV Infection or AIDS and symptoms may develop suddenly.
  2. Cough is characterized with white and clear sputum
  3. Shortness of breath (SOB) happens initially only with activity, but then advances to SOB even at rest
  4. Weakness and fatigue
  5. Chills and weight loss
  6. Loss of appetite

Bronchial Pneumonia Diagnosis

The diagnosis of bronchial pneumonia depends on the type of pneumonia contracted.

History:

  1. Symptoms
  2. Illnesses
  3. Surgeries
  4. Medications
  5. Habits
  6. Travel
  7. Hobbies
  8. Allergies
  9. Occupation

Physical symptoms :

  1. Rash on skin
  2. Increased respiration (number of breaths per minute) and heart rate
  3. Blood pressure may be low
  4. Presence of fever
  5. The rib cage may experience difficulty in expanding
  6. Abnormal or altered breath sounds (friction rub, rales, crackles, wheezing) due to the damage to lung tissue, presence of fluid or pus and the narrowing of airways
  7. Change in mental state – anxiety, mood swings, confusion.

Tests:

  1. Sputum samples may be needed to be collected and sent to the lab for microscopic analysis by treating with special stains to reveal the particular bacteria.
  2. Sputum could be tested for growth of cultures and sent for microscopic analysis to identify the organism and check for sensitivity to antibiotics by using special stain tests.
  3. Cultures may take from 48 hours in case of bacteria to several weeks (TB).
  4. Viral cultures can also be taken
  5. Blood samples would be collected and tested for bacterial cultures (show as positive in 8-20% of B.p)
  6. 6. Blood test may reveal high ESR (viral), although white blood cell count may be normal in the elderly and low in viral pneumonia, low Sodium levels (empyema or lung Abscess), high LDH (PCP), low oxygen levels (hypoxia), and acidity (acidosis)
  7. In case of mycoplasma pneumonia, high levels of IgM antibodies would be detected 1-2 weeks after infection in almost 80% of the patients.
  8. Organisms like viruses (herpes, Influenza, RSV) can be identified by doing throat swabs using a sterile Q-tip. They can also be detected by performing tracheal aspiration consisting of sucking secretions from the trachea with a suction tube.
  9. In case of PCP, an HIV test will be advocated – in case of the presence of an HIV infection, CD4 cell count falls to below 200.
  10. Pictures of lung could be recommended
  11. Chest x-rays may reveal infection in the lobes of the lungs (B.p.), may show diffused pattern of infection (PCP, V.p, M.p), and effusions.
  12. Unless cancer or abscess is suspected, a CAT scan or MRI is rarely required
  13. Your doctor may consult an infectious diseases specialist or a pulmonologist for a second opinion.

Recommendations of the pulmonologist may include:

  1. Bronchoscopy- A flexible tube with a camera at the tip is inserted through the mouth into the lungs, to take a sample of secretions ofr biopsy or culture.
  2. Thoracentesis is carried out by inserting a needle between the ribs to extract a sample of the fluids for analysis. This is performed in case of effusions and empyema.

Bronchial Pneumonia Treatment

  • Depends on the type of pneumonia
  • The patient might be hospitalized, if he has a high fever, shortness of breath, or is in shock.
  • If treating an outpatient, care has to be taken to monitor his condition and thus ensuring that it improves gradually.
  • For mild uncomplicated cases, recommended treatment is bed rest, plenty of fluids, and Tylenol for pain.
  • Antibiotic pills can be given if the patient does not appear too sick.
  • General antibiotics like erythromycin may be given till the laboratory culture tests are done. The antibiotic can then be changed as per the type of pneumonia.
  • Antibiotics are not given for virus infections, as antibiotics have no effect on viruses.
  • Antivirus medications such as Ribavirin (RSV, hanta virus), Amantadine (Influenza A and B) or and Ganciclovir (CMV, herpes) are given to those whose infections have been identified and typed.
  • Severe cases of pneumonia require the patient to be admitted to the hospital.
  • Intravenous (IV) fluids are started and oxygen is given if levels are low.
  • IV antibiotics are started.
  • If the patient has TB or other dangerous forms of Pneumonia, it is best to isolate the patient from other patients.
  • If the patient has difficulty in breathing, respiratory support is provided via mechanical ventilation (machine breathes for you).
  • A respiratory therapist may work with the patient.
  • To check the treatment whether it is effective, follow up laboratory tests and X-Rays are done.
  • After discharge of the patient, medical follow up and repeat X-ray in 6-9 weeks are done.