General pneumonia

Increased confusion, forgetfulness, urinary incontinence, change in normal behavior and even sudden falls – these are not only signs of aging or even dementia, but can also be possible symptoms of an infection such as pneumonia.

Dr Steve Yang, Consultant Respiratory Physician and Intensivist at The Respiratory Practice, said: “People with pneumonia usually have symptoms such as fever, cough, shortness of breath. But in older people, pneumonia can present in very different ways.

Dr. Steve Yang, consultant pulmonologist and intensivist at The Respiratory Practice

Few people may know that pneumonia is the second leading cause of death here in Singapore, with cancer being the most common and heart disease the third.

Pneumonia also plays a role in worsening the impact of heart disease and cancers in patients. Deaths from pneumonia are more common because the disease can increase the risk of death in cancer patients and can even lead to heart attacks in cases of severe pneumonia, Yang said.

Different types of pneumonia

Pneumonia can be caused by bacteria, viruses or fungi, the most common type of which is bacterial pneumonia.

Yang explained that bacterial pneumonia can develop in two ways – through transmission from person to person, or in some cases the bacteria may already be present in the upper respiratory tract of vulnerable people, and when their immunity wanes. , these bacteria become more aggressive and affect the lower respiratory tract.

Viral pneumonia, which can be caused by Covid-19 or influenza viruses, is usually passed from person to person, but with different symptoms.

Said Yang: “In these cases, their presentations are usually different from bacterial pneumonia. They may present with a dry cough, low fever, sometimes blood-tinged sputum, and shortness of breath.

Yang added that another class of pneumonia is caused by fungi, and these are usually found in immunocompromised patients, such as patients on chemotherapy, high-dose steroids for certain medical conditions, bone marrow transplants. or solid organ transplants.

Invasive pneumococcal pneumonia (IPD) and its severity

Yang also shared that there is a more serious form of bacterial pneumonia known as invasive pneumococcal disease, which is caused by the organism, Streptococcus pneumoniae. Patients who contract this bacteria can develop a serious infection because this bacteria can enter the bloodstream.

Once this happens, patients often develop severe inflammation that doctors call SIRS (Systemic Inflammatory Response Syndrome). SIRS then causes a drastic drop in blood pressure, while oxygen uptake by the lungs is severely limited as patients develop ARDS (Acute Respiratory Distress Syndrome).

As such, they often need intensive care.

According to Yang, patients can stay sick for a few months if this happens, and mortality is high even with modern drugs and therapeutics.

“I’ve met patients who developed invasive pneumococcal disease and ended up staying in intensive care for up to two months. Their healing is often complicated by kidney failure, respiratory failure, and they sometimes end up with a tracheotomy. [a hole in the neck to assist in breathing] to help them breathe. And if they survive, they develop significant morbidity and weakness due to the prolonged hospitalization. These patients take several months to recover, and even then, not completely. »

A common misconception about pneumococcal disease is that “people think that by just taking antibiotics, the bacteria will be killed and they will recover quickly.”

While it’s true that antibiotics kill bacteria, the reality of pneumococcal pneumonia, according to Yang, is far more serious:

“Once you develop SIRS, the body goes through a severe inflammatory reaction, which antibiotics cannot stop, and it is this inflammation that damages many organs in the body and leads to prolonged recovery in hospital or even death. You cannot prevent SIRS once it develops, and so the only way to prevent it from developing is to get vaccinated.

People with respiratory problems due to their lifestyle

“Smoking is also a risk factor because smoking impairs the defense mechanisms of the lungs and airways against bacteria. Patients with chronic obstructive pulmonary disease or COPD, which causes breathing problems in smokers, are also more susceptible because their lung function is already compromised and their lung immunity weakened,” Yang said.

However, some are less at risk of developing pneumonia.

For example, patients who are vaccinated against pneumococcal pneumonia as well as seasonal flu.

Naturally, patients who have not received the pneumococcal vaccine are more susceptible to it, Yang shared.

He advocates for people in vulnerable groups to get vaccinated, as he has seen the pain and suffering that pneumonia causes to patients and their family members, as well as the financial burden it places on them.

“Hospitalization costs can run into the hundreds of thousands, and that’s not even counting physical impairment, time spent away from work or family, and permanent damage suffered as well as social, economic and medical consequences.”

Pneumococcal vaccine

According to the National Center for Infectious Diseases (NCID) in Singapore, children under the age of five, as well as people over the age of 65, are most vulnerable to developing invasive pneumococcal disease.

Fortunately, pneumococcal vaccination is available for adults and children in Singapore. It is well tolerated with few or no side effects.

“Vaccination with the pneumococcal vaccine rarely causes significant side effects other than pain at the injection site and mild fever. The benefits clearly outweigh the risks,” Yang said.

He added that the two-step vaccination program for adults is done over a year (or eight weeks for those who are immunocompromised), to reduce the risk of contracting pneumococcal pneumonia.

And it is necessary to act to be protected.

“Some sick [who contract pneumococcal pneumonia] develop severe scarring in the lungs and end up dependent on continuous oxygen therapy. Some even need a breathing machine for the rest of their lives.

Prevention is better than cure, according to Yang.

This article is sponsored by Pfizer Singapore.

Make a difference this World Immunization Week. Go to the nearest Guardian Pharmacy to speak with the pharmacist or see a doctor to find out if the pneumococcal vaccination is right for you here.

The views expressed in this article are solely attributable to the expert(s)/speaker(s)/participant(s) featured therein and do not necessarily represent the views of Pfizer Singapore and/or its affiliates. Neither Pfizer Singapore and/or its affiliates make any representations or warranties regarding the accuracy of the content appearing in the material. This material is intended for educational purposes only and is not intended to replace consultation with the healthcare professional.

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