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Pneumonia is an infection of the lungs involving the lung air sacs.  These air sacs are the portion of the lungs that contain the air exchanged during breathing.  Pneumonia is a very common disease, in one form of the other it continues to be a leading cause of death in the United States and the world.  Pneumonia infections which occur in the community excluding those acquired in the hospitals or term care facilities are called community acquired Pneumonia.  It is the sixth leading cause of death in the United States.  Pneumonia is most  common among people of older and younger ages, usually those less than 5 years and older than 60 years.  The major symptoms of Pneumonia are cough, fever, chest pain and difficulty breathing.  It most often begins after a mild cold or upper respiratory tract infection like sinus infection or even ear infection.  Most patients complain of weakness or feeling not well.  Cough usually lingers on, along with chills and some severe cases, mild confusion may also occur.  The single most important tool to assist the physician in the diagnosis of pneumonia is a chest X-ray.  It is very important to diagnose the presence of pneumonia but to

also make sure pneumonia is not present. The physician would often listen to the lungs to hear typical sounds called rales and bronchial breath sounds.  Other signs includes dullness in the chest, fever and other signs of infection.  Some laboratory tests are helpful including, complete blood count (CBC), sputum cultures, and analysis, blood cultures and serum electrolytes.  In more unusual cases other special types of blood tests for chlamydia, legionella may be helpful.  Treatment depends on the bacteria causing the particular pneumonia in eahc patient. A family of bacteria called streptooccus pneumonia are most common.  Most infections are quite responsive to antibiotic treatment especially if treated early.  However, resistant strains are becoming increasingly common, especially in late treated or hospitalized cases.  The rate of death for patients treated in doctors offices and out patient clinic are generally low, at less than one percent.  However, for late treatment and hospitalized cases it rises from 2% to 30% and up to 50% in intensive care units patients.  These rates are especially prevalent in elderly patients, diabetics, patients with chronic disease like sarcoidosis, immune deficiency disease, morbid obesity, malignancies and patients in extreme ages.  Early recognition of sysmptoms in probably the single most important intervention in the treatment of pneumonia.  It is important to recognize that pneumonia is a potentially fatal disease.  Prevention for patients at risk is available in vaccines.  Flu vaccines are also quite helpful to prevent flu which can often attack patients before pneumonia.  Once any of the symptoms of pneumonia is suspected, early diagnoses and treatment by a physician is imperative.

1. Take the pneumonia and flu vaccine before the flu season especially for patients at high risk like diabetics immune deficient patients, elderly patients, and other chronically ill patients.
2. Avoid exposure to extreme cold, dress warm and avoid expending much time in areas with increase cold temperatures.
3. At the first sign of upper respiratory tract infection, increase intake of vitamin C and take liberal amounts of fruits also rich in vitamin C.
4. Once symptoms have occurred, avoid any strenuous exercise especially in extreme cold temperatures, take liberal amounts of fluids like juices and obtain as mush rest as possible.
5. Once symptoms persist, seek medical treatment early, do not wait until you have to be assisted to seek medical care.

  By Dan E. Austin M.D.  Staff Physician, Internal Medicine  Cignet Health Center, Temple Hills Maryland

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