Increased confusion, forgetfulness, urinary incontinence, change in normal behaviour, and even sudden falls — these are not just signs of ageing or even dementia, but could also be possible symptoms of an infection such as pneumonia.
Shared Dr Steve Yang, Consultant Respiratory Physician and Intensivist at The Respiratory Practice: “Pneumonia sufferers usually exhibit symptoms such as fever, cough, shortness of breath. But in elderly people, pneumonia can present in very different ways.”
Few 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 most common.
Pneumonia also plays a part in exacerbating the impact of heart conditions and cancers in patients. Death by pneumonia is more prevalent because the condition can increase the risk of death in cancer patients, and can even lead to heart attacks in severe pneumonia cases, said Yang.
Different types of pneumonia
Pneumonia can be caused by bacteria, viruses or fungi, among which the most common type is bacterial pneumonia.
Yang explained that bacterial pneumonia can develop 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 drops, these bacteria become more aggressive and affect the lower airway.
Viral pneumonia, which may be caused by Covid-19 or influenza viruses, is usually transmitted from person to person but with differing symptoms.
Said Yang: “In these cases, their presentations are usually different from bacterial pneumonia. They can present with a dry cough, low-grade fever, sometimes with 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 transplant or solid organ transplant patients.
Invasive pneumococcal pneumonia (IPD) & its severity
Yang also shared that there is a more severe form of bacterial pneumonia known as invasive pneumococcal disease, caused by the organism, Streptococcus pneumoniae. Patients who contract this bacteria can develop a severe infection as this bacteria may gain entry into the bloodstream.
Once this happens, patients often develop a severe inflammation which doctors call SIRS (Systemic Inflammatory Response Syndrome). SIRS then leads to a drastic drop in blood pressure, while oxygen absorption from the lungs is severely limited because patients develop ARDS (Acute Respiratory Distress Syndrome).
As such, they often need intensive care treatment.
According to Yang, patients can remain ill for a few months if this happens, and mortality is high even with modern medicines and therapeutics.
“I have encountered patients who developed invasive pneumococcal disease and ended up staying in the ICU for up to two months. Their recovery is often complicated by kidney failure, respiratory failure, and they sometimes end up with a tracheostomy [a hole in the neck to assist in breathing] to help them breathe. And if they do survive, they develop significant morbidity and weaknesses from the prolonged hospitalisation. These patients take many months to recover, and even then, not fully.”
One misconception about pneumococcal disease is how “people think that by just taking antibiotics, the bacteria will be killed and they will recover quickly”.
While it is true that antibiotics kill bacteria, the reality of pneumococcal pneumonia, according to Yang, is much more serious:
“Once you develop SIRS, the body undergoes a severe inflammatory reaction, which antibiotics cannot stop, and it is this inflammation that damages many organs in the body and leads to prolonged hospital recovery or even death. You cannot prevent SIRS once it develops, and thus the only way to prevent this from developing is to be vaccinated.”
People with respiratory issues due to lifestyle
“Smoking is also a risk factor as smoking impairs the lung and airway defence mechanisms against bacteria. Patients with Chronic Obstructive Pulmonary Disease or COPD, which causes breathing-related problems in smokers, are also more prone because their lung function is already compromised and their lung immunity weakened,” said Yang
However, there are some who are at a lower risk of developing pneumonia.
For example, patients who are vaccinated against pneumococcal pneumonia as well as against seasonal influenza.
Understandably, patients who have not received the pneumococcal vaccine are more susceptible to it, shared Yang.
He advocates that people in vulnerable groups should get vaccinated, as he has seen the pain and suffering that pneumonia causes to both patients and family members, and the financial burden it places on them.
“Hospital costs can run into the hundreds of thousands, and this is not even counting the physical impairment, time away from work or family, and the permanent damage faced as well as the social, economic and medical consequences.”
According to Singapore's National Centre for Infectious Diseases (NCID), children below the age of five, as well as seniors over the age of 65, are most vulnerable to developing invasive pneumococcal disease.
Thankfully, the pneumococcal vaccination is available to adults and children in Singapore. It is well tolerated and comes with little to no side effects.
“Vaccination with the pneumococcal vaccine rarely causes any significant side-effects other than pain at the injection site and a mild fever. The benefits clearly outweigh the risks,” said Yang.
He added that the two-step vaccination programme for adults is done over a year (or eight weeks for those who are immunocompromised), to reduce the risk of getting pneumococcal pneumonia.
And there is reason to take action to be protected.
“Some patients [who contract pneumococcal pneumonia] develop severe scarring in the lungs and end up being dependent on continuous oxygen therapy. Some even require a machine to breathe for the rest of their lives.
Prevention is definitely better than cure, according to Yang.
This article is sponsored by Pfizer Singapore.
Make a difference this world immunisation week. Head down to your nearest Guardian Pharmacy outlet to speak with the pharmacist or consult a doctor to find out if pneumococcal vaccination is suitable for you here.
The opinions expressed in this article are solely attributable to the expert(s)/ speaker(s)/participant(s) appearing therein and do not necessarily represent views of Pfizer Singapore and/or its affiliates. Neither Pfizer Singapore and/or its affiliates provide 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.