Pneumonia is when there is inflammation of the lung caused by a viral or bacterial infection. In this case, the air sacs in the lungs fill with pus and might even become solid. When the inflammation affects both lungs, the condition is called double pneumonia; and when it affects only one lung it is called single pneumonia.
1. What is Lobar Pneumonia?
Lobar pneumonia is a lung disease caused by a type of bacteria called streptococcus pneumoniae. It can affect one or both lungs or one lobe of a lung.
It is more of a community-acquired type of pneumonia and attacks mainly the age groups of children younger than 20 to the age older than 50 years with impaired immunity but is more prone to attack you if you drink excessive alcohol, smoke, or in any way weaken your body’s immunity system.
For people with this kind of pneumonia, the air sacs in the lungs fill up with pus from the bacteria and cause severe cough and difficulty in breathing.
There are essentially 3 types of pneumonia based on the site of infection.
I. Interstitial Pneumonia
In this kind of pneumonia, the infection is just outside the alveoli, in the interstitium. This kind of pneumonia is also called Atypical pneumonia.
In this kind of pneumonia, the infection is found throughout the lungs including the bronchioles and the alveoli.
III. Lobar Pneumonia
In this kind of pneumonia, the infection causes consolidation of one complete lobe of the lung, filling it with liquid.
In this article, we’ll focus more on the third type of pneumonia, that is, Lobar Pneumonia.
2. What Causes Lobar Pneumonia?
Typically, lobar pneumonia is a localized infection caused by streptococcus Pneumoniae. It is inhaled from the air we breathe, in the form of tiny droplets when people have flu sneezes.
If the causative bacteria for the lobar pneumonia is known, it is coded to that specific type of bacterial lobar pneumonia otherwise it can be viral pneumonia or fungal lobar pneumonia as well.
2.1. Community-Acquired Pneumonia
Lobar pneumonia is a community-acquired bacterial pneumonia and has over 30 variants. They can be grouped into:
In Viral pneumonia, the virus infects the cell walls of red cells in the alveoli and releases genetic material which replicates and spreads throughout red cells in the alveolar spaces.
This triggers the immune cells which secrete enzymes that acquire the fluid in the capillary tube to enter the alveoli causing inflammation of the lung, congestion, and cough. Examples of pneumonia-causing viruses include the syncytial virus and the influenza virus.
In bacterial pneumonia, the bacteria enter the lungs and into the alveoli consisting of macrophages. The macrophage recognizes the bacteria and secretes certain enzymes. The enzymes will once again get the fluid in the capillary tube to enter the alveoli resulting in congestion.
Examples of microbes that cause lobar pneumonia
In fungal pneumonia, the fungal spores enter the alveolar spaces and create a “fungal ball” made of mucus, fungi, and cellular debris, filling up space in the lungs cause congestion.
Examples of pneumonia-causing fungi include Histoplasma and Coccidioides.
2.2. Hospital-Acquired Pneumonia
People already admitted to the hospital are at a greater risk of catching this type of pneumonia as the pneumonia-causing microbe is more resistant to antibiotics as the people there are likely to have weak immunity systems.
Any type of pneumonia acquired by a person within 2 days after being admitted to a health care unit is termed HAP or Hospital-acquired pneumonia.
2.3. Aspiration Pneumonia
This kind of severe form of pneumonia occurs when you inhale or allow food, vomit, saliva, or any drinks to enter your lungs.
2.4. Healthcare-Acquired Pneumonia
Healthcare-acquired pneumonia is the infection most likely to affect people who work and live in long-term care facilities. It is also called Nosocomial pneumonia.
image by Vidal Balielo Jr. / Pexels / Copyrights 2020
3. Symptoms of Lobar Pneumonia
Common symptoms are as follows:
Fever ( over 105 F/ 40.5 C)
Productive cough – pus or bloody sputum
Chills or sweating
4. Risk Factors
Adults are more at risk of contracting the pneumococcal disease if they are:
Of old age.
Indulging in abusive alcohol consumption.
Having an immunity-weakening disease like AIDS/HIV.
Children at greater risk of pneumonia are those of age 2 and below and those with
Chronic heart, lung, or kidney disease.
A sickled cell disease.
5. Stages of Lobar Pneumonia
5.1. Stage 1: Congestion
The first stage, congestion, which is a consolidation of the affected lung parenchyma generally occurs within the first 24 hours after inflammation in the lung or vascular engorgement. The alveolar spaces in the lungs swell up and fluids from the capillary tube enter the lungs making them feel congested and heavy.
Doctors can most likely detect pneumonia in the first stage after recognizing symptoms such as cough, wheezing, chest pain, etc.
5.2. Stage 2: Red Hepatization
This is the second stage which begins 2-3 days after the infection and lasts for about 3-4 days. The vascular congestion persists but the immune cells travel to the alveoli to fight off the infection and due to the crowding of red blood cells the lungs turn red. The lungs become dry, firm, and airless showing a resemblance to the liver.
5.3. Stage 3: Grey Hepatization
This is the third stage which begins at 4-6 days and lasts for about 5-8 days. The red cells disintegrate, changing the color of the lung from red to gray, but the liver-like consistency of the lung remains. Macrophages, a type of white blood cells that fight infection-causing microbes start to form inside the lungs.
The blue colour of nails and lips, dizziness, and difficulty in breathing are symptoms that appear in this stage. If the shortness of breath is very severe, a breathing machine or a ventilator will be of help for those who might need to visit the hospital.
5.4. Stage: Resolution
In the final of the four stages, the complete recovery of the lung disease is observed. It lasts from about 8- 10 days. Cell debris and nucleophiles are cleared with the help of macrophages and the fluids are reabsorbed into the body.
The alveoli of the lungs return to their normal functions and the lung returns back to normal. However, any leftover swelling inside the lung may also lead to chronic lung disease which may narrow the air pipes.
6. Diagnosis of Pneumonia
To start with the diagnosis of pneumonia, the patient’s clinical records and physical exam results should be taken into clinical suspicion and the first test is most likely to be a chest X-Ray.
Key points to be noted after the physical exam include:
- Chest pain
- In lobar pattern
- Bronchial breathing.
Findings during physical test results indicating pneumonia are:
c. Deceased breath sounds
According to the Infectious Diseases Society of America guidelines, a chest X-Ray is necessary and is considered to be one of the best ways to diagnose pneumonia.
- Chest X-Ray or chest radiography gives a clear analysis of the infection that is present in the lungs. It also gives a clue whether the pneumonia is lobar, interstitial, or bilateral. The identification of the infecting microbe is important for the treatment of pneumonia.
- A CT scan is highly preferable due to its detailed analysis of the disease. The anatomical patterns of distribution can help in selecting the correct type of antibiotic therapy or antibiotics.
- Blood tests such as Complete blood count (CBC) are indicated to confirm the presence of inflammation and assess the severity of the infection.
- Pulse oximetry is a test to measure the amount of oxygen content in blood as pneumonia-causing agents can prevent oxygen supply to the lungs.
- A sputum culture test is conducted to find out the causative agent of pneumonia. In this test, a sample of your sputum or mucus from your cough is taken with a swab of needle and is sent to the lab for testing of bacteria.
- Bronchoscopy is another test done to take a look inside the airway path or the bronchioles for infection.
- A pleural fluid culture test (Thoracentesis) can be taken in which a sample of pleural fluid in between your lungs, alveolar spaces, and chest wall is tested for bacteria.
6.1. Differential Diagnosis of Pneumonia:
Lung abscess (pockets of pus formed inside and outside the lungs)
7. Prevention of Pneumonia
7.1. Healthy Diet:
Keeping your diet in check and leading a healthy lifestyle is very important to keep yourself away from various kinds of diseases.
The pneumococcal vaccine is available for children younger than 5 and adults older than 65. Vaccinations for pneumonia will give a boost to your immune system and help it fight any kind of pneumonia-causing agent with ease.
7.3. Avoid Smoking:
Smoking results in organ failure of the lung and makes it an effortless target for bacterial pneumonia, viral pneumonia, and more.
7.4. Keep your Immune System Strong:
Keep your body and immune system fit and strong by exercising daily, healthy habits, proper diet, and proper sleep.
7.5. Wash Hands with Soap:
Sanitizing hands and washing them regularly will kill germs and microbes. Coughing and sneezing into a tissue or towel.
8. Treatment of Pneumonia
Treatment depends on the type of pneumonia contracted. Most cases of pneumonia can be treated at home with proper rest and medications. Antibiotics can help deal with pulmonary infections even with non-severe cases of pneumonia. Cough supplements and pain medications can be of help as well.
In severe pneumonia cases, hospital treatment is required. Viral pneumonia doesn’t specifically have a treatment yet. But getting good sleep, increasing fluid intake and more may help reduce symptoms, the severity of pneumonia symptoms and cure symptoms of the viral infection itself.
Patients with chronic lung disease, cancer, and liver disease are usually treated with IV medications. Depending on clinical response, necessary antibiotics, and therapy is advised.
9. Carriers and Transmission of Pneumonia
Streptococcus Pneumoniae spreads through direct interaction between people, respiratory droplets, and autoinoculation in individuals with upper respiratory tract bacteria.
The pneumococcal serotypes that are most frequently discovered in carriers are those that are most usually responsible for the infection. Despite the fact that carriage does not always result in disease, it is a crucial step in the development of pneumococcal disease.
When respiratory illnesses are more widespread, such as in the winter and early spring, pneumococcal infections are more frequent.
It is unknown how long pneumococcal illness is contagious. Transmission is possible as long as the organism is present in respiratory secretions.
10. Facts About Pneumonia
Among the most infectious diseases, pneumonia ranks next to tuberculosis in terms of the most common cause of mortality rate. About 55,000 people die each year in the US due to pneumonia.
Is Pneumonia Contagious?
Well, the answer to that question is no, not necessarily contagious. A small cold or flu can develop into pneumonia after prolonged exposure to an unhealthy environment or other organisms, but that doesn’t mean that everybody who has flu has pneumonia.
Pneumonia is known to be the most common cause of sepsis complications. There isn’t just a single cause for bacterial pneumonia either. Hence the determination of the exact agent involved in causing bacterial pneumonia is a little hard to find out.
Breastfeeding can help prevent pneumonia in babies. Breastmilk is said to have high immunity which helps protect the baby’s lungs, and nose from pneumonia germs.
Pneumonia can easily be treated at home with necessary medications and precautions but at the same time, it also can be very deadly.
In the case of lobar pneumonia, the lower lobes of both lungs are more prone to get attacked compared to the other lobes
The pneumonia-causing organism is an inhabitant of the nasopharynx of a person with chronic sinusitis.
Sometimes, the cause of pneumonia was said to be more than just one organism. One of the frequently found combinations was of the pneumococcus and the influenza bacillus.
1 in 20 people who contract pneumococcal pneumonia dies from it.
Click here to learn more about pneumonia.
Click here to learn more about the 4 stages of pneumonia.
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