How does community-acquired pneumonia differ from hospital-acquired pneumonia and how are they treated?.

Published 7 months ago

Pneumonia is very dangerous. Therefore, it is important to seek help in time.

What is pneumonia and why is it so often referred to as community-acquired?

Pneumonia is an inflammatory disease of the lungs. The lungs consist of alveoli - small air chambers that fill with air when you inhale and from which oxygen enters the blood. Through them, the blood gets rid of carbon dioxide. When the alveoli become inflamed, they fill with fluid or pus. There is no room for air in them, which means that a sick person cannot breathe fully.

Inflammation does not necessarily damage the entire organ. Individual foci, segments, lobes of one (unilateral) or both (bilateral pneumonia) lungs may suffer. In extreme cases, the lung tissue is completely affected - then they say that the pneumonia has become total.

There are other classifications. For example, depending on the place where a person caught pneumonia. This is important, and here's why.

Community-acquired pneumonia is any pneumonia that occurs outside of a hospital or less than 48 hours after a person is admitted to hospital. Everything else is classified as hospital-acquired (hospital-acquired) pneumonia.

The difference between them is the degree of danger of the pathogen. In hospital settings, the lungs are under attack from nosocomial bacteria , often resistant to antibiotics. Treating such pneumonia is more difficult and longer than that caused, for example, by an influenza virus that has descended into the lungs.

Why does pneumonia occur?

Pneumonia can result from many different causes. The severity of the disease and the method of its treatment largely depend on which factor caused the pneumonia.

Viral pneumonia

This type of pneumonia most often occurs in children under 5 years of age.

The causative agents are influenza viruses, herpes, adenoviruses (causing colds) or, for example, coronaviruses - the same SARS‑CoV‑2. Whatever virus causes pneumonia, the signs of pneumonia will be the same.

Bacterial pneumonia

There are many bacteria that can attack the lungs. For example, pneumococci (Streptococcus pneumoniae) or staphylococci.

Bacterial pneumonia is the most common type of pneumonia in adults.

Typically, bacterial pneumonia occurs when the body is weakened for some reason: after an illness (for example, ARVI), surgery, due to poor nutrition, age, bad habits (these include smoking and alcohol abuse) or immune disorders .

Mycoplasma pneumonia

Mycoplasmas are bacteria without cell walls. They usually cause pneumonia with mild, almost imperceptible symptoms, similar to a cold.

The unofficial name for this type of pneumonia is “ walking pneumonia ”: the disease is often carried on the legs, without even thinking about the need for bed rest.

Fungal pneumonia

This type of pneumonia most often occurs in people with chronic illnesses or severely weakened immune systems (such as HIV), and in those who regularly inhale spores of certain fungi from contaminated soil or bird droppings.

Aspiration pneumonia

Occurs when foreign substances accidentally enter the lungs - food, drink, vomit, saliva. Most often, this happens to people who have something (for example, brain damage, alcohol or drug intoxication) that disrupts the normal functioning of the gag or cough reflex.

How to recognize pneumonia

Pneumonia, including that caused by SARS‑CoV‑2, does not always manifest itself with clear symptoms. The disease may look like a regular acute respiratory viral infection or be noticeable only on a computed tomography (CT) scan.

However, there are some signs by which you can still suspect pneumonia and seek help in time.

When to call an ambulance

Urgently dial 103 or 112 if the following signs are added to the symptoms of ARVI.

Breathing has increased to 30 or more breaths per minute (one breath every 2 seconds or more).
Systolic (top) pressure dropped below 90 mmHg. Art., and diastolic (lower) - below 60 mm Hg. Art.
Confusion of consciousness appeared: lethargy, sluggish reaction to the environment, inability to answer simple questions.
A foreign substance may have entered the lungs.

Even one or two of the listed signs may indicate severe pneumonia, and it is deadly. The more symptoms, the higher the risks.

When to see a doctor

Pneumonia often develops as a complication after a recent acute respiratory viral infection. But this is not a prerequisite. In any case, consult your physician as soon as possible if you observe the following symptoms:

The discomfort almost disappeared, but then reappeared.
The same thing happened with the cough. Or it didn’t go away, but you started coughing harder and more often.
When you cough, you produce sputum that is yellow, yellow-brown, greenish, or streaked with blood.
Against this background, the temperature has risen to 39–40 °C and is very difficult to break down.
Chills and severe sweating appeared.
When trying to take a deep breath or just breathing, a stabbing pain is felt in the chest.
The skin turned pale.
Shortness of breath occurs easily. You have to breathe more often, even if you are lying in bed.
You feel incredibly weak.

You don’t need to look for all your symptoms at the same time. Two or three are enough to suggest pneumonia and be sure to call a doctor.

How will the doctor confirm the diagnosis?

In some cases, your GP will be able to diagnose pneumonia based on your recent medical history (for example, if you just had the flu or have been in contact with someone confirmed to have COVID-19) combined with severe symptoms. But additional research may be required, for example:

Pulse oximetry. A special sensor will be attached to your finger to measure the level of oxygen saturation in your blood. Normally it is 95–100%. An oxygen level below 92% is an indication for urgent hospitalization.
X-ray. This test will help to see damage to the lungs.
CT scan of the chest. Computed tomography allows you to look at the lungs in more detail than an x-ray.
Blood analysis. It will confirm the inflammatory process and, possibly, identify the causative agent of the disease.
Analysis of sputum , which is released when coughing. This test helps determine if there is an infection in the lungs.
Analysis of urine. It helps to quickly identify antibodies to certain bacteria that can cause inflammation.

Where is pneumonia treated?

This decision is made by the doctor, based on the symptoms listed above, test results and risk factors (age and the presence of concomitant diseases or pregnancy).

If pneumonia occurs in a mild form, that is, the person feels well, is in clear consciousness, and does not have severe shortness of breath , it can be treated at home. Of course, a person must be observed by a therapist, follow his recommendations and take all medications prescribed by the doctor. Most of these patients recover within two weeks. However, for some, the symptoms of pneumonia last for 3-4 weeks, and subsequently chronic forms of bronchitis or pneumonia may develop.

For moderate to severe pneumonia, hospitalization is indicated. Especially for those who are in one of the risk groups:

people over 65 years of age;
those who have concomitant serious diseases (for example, cardiovascular, diabetes, bronchial asthma, chronic obstructive pulmonary disease);
pregnant women.

A hospital is needed because the patient’s condition can rapidly deteriorate at any moment. It is important to have specialists nearby. In addition, patients in serious condition require specific supportive therapy, which is only available in intensive care settings.

How is pneumonia treated?

Under the supervision of a doctor. When choosing therapy, he will focus on the causes of the disease and its severity.

Thus, there is no cure for viral pneumonia. It is treated as a regular acute respiratory viral infection - with plenty of fluids, rest (even bed rest), a healthy diet, and taking expectorants and over-the-counter antipyretics, for example, paracetamol. Antiviral drugs may sometimes be prescribed and in some cases they can reduce the duration and severity of symptoms.

For fungal pneumonia, antifungal drugs are prescribed. For bacterial and other types of pneumonia, in which a bacterial complication is added to the original pneumonia, antibiotics will be needed : these medications will destroy the microbes that caused pneumonia or led to complications. Antibiotics are selected individually depending on the type of bacteria. An inappropriate drug will only worsen a person’s condition and the disease will become more dangerous.

At the same time, doctors are trying to alleviate the patient’s condition with symptomatic treatment.

If the lungs are so severely affected that the patient cannot breathe, supportive therapy is carried out: the patient is connected to artificial ventilation and prescribed a number of additional drugs to help the body.