Killer Pneumonia Is on the Rise

If the recent flu seasons are typical, an estimated 30 million Americans will come down with the illness. That's bad enough-but many of these people will go on to develop secondary pneumonia a much more serious condition.

Pneumonia, whether it follows another infection or occurs on its own (primary pneumonia), is the sixth leading cause of death in the US. More than 60,000 Americans die from it annually, and many more require hospitalization.

Recent danger: A rare-but particularly lethal-form of pneumonia is resistant to standard antibiotics. It is caused by the bacterium methicillin-resistant Staphylococcus aureus (MRSA), which has appeared in recent years in hospitals and increasingly in the wider community. The death rate from MRSA pneumonia is roughly double that of other pneumonias. Viral you need to know...

WHO GETS PNEUMONIA?

Pneumonia is an illness of the lungs and respiratory system in which the alueoli (tiny sacs in the lungs) become inflamed and flooded with fluid. Pneumonia can be caused bacteria, viruses or fungi. The viral form is the most common.

People get pneumonia in the same ways that they get the flu-by touching their eyes, nose or mouth after shaking hands, for example, with someone who has the virus on his/her hands-or through airbome droplets from coughs or sneezes.

Bacterial pneumonia is usually the most serious form. It is most commonly acquired by inhaling or aspirating bacteria. Hospital patients have a high risk of contracting bacterial pneumonia- their immune systems tend to be weakened, and germs are prevalent in this setting. Other vulnerable people include those with diabetes, heart or lung disease...adults age 55 and older...young children...and anyone who abuses alcohol or smokes.

Surprising new risk factor: people who take acid-suppressing heartburn drugs, such as cimetidine (Tagamet), ranitidine (Zantac), omeprazole (Prilosec) and esomeprazole (Nexium), have been found to be 27% more likely to develop pneumonia-especially hospital acquired pneumonia-than people not taking such medication.

Researchers theorize that these drugs may increase a person's vulnerability to infection by reducing stomach acid, a major defense mechanism against pathogens ingested through the mouth. People should not use over-the-counter acid-reducing drugs for more than a few weeks unless they are prescribed by their doctors.

HOW IT'S DIAGNOSED

It can sometimes be difficult for patients to distinguish the symptoms of pneumonia from those caused by a cold or the flu. Therefore, anyone with a high fever (102" F or higher. . .chills. . .a persistent cough...shortness of breath. ..and/or pain when inhaling should see a doctor right away.

What the doctor will look for...

• Abnormal chest sounds heard through a stethoscope. The doctor will listen for crackling sounds (rales) or rumblings (rhonchi), caused by air passing through mucus and/or other fluids in the lungs.
• X-ray showing a cloudy area, caused by fluid in the lungs.

Caution: An X-ray often will look normal in patients with early-stage pneumonia. A second X-ray is typically taken if symptoms do not improve in two to three days or worsen, especially if the first X-ray looked normal. A sputum test is also recommended to identify the cause of the pneumonia-and help the doctor choose the best treatment. After an Xray, it's the best test for diagnosing pneumonia, but only 20% to 25% of patients are able to bring up sputum (by coughing) for analysis.

TREATMENT

An antiviral drug, such as oseltamivir (Tamiflu), is sometimes prescribed for viral pneumonia. In viral pneumonia patients who are otherwise healthy, doctors may recommend the same therapy as for the flu-rest, plenty of liquids (up to one gallon daily) and medication to reduce fever and/or pain.

Because bacterial and viral pneumonia can appear quite similar doctors typically er on the side of caution and assume that it's bacterial in origin when uncertain and prescribe antibiotics.

Studies show that older patients as well as those with underlying health problems do better when they're given antibiotics. promptly—preferably within four to eight hours of the initial diagnosis. Most bacterial pneumonias are treated (orally or intravenously) with a penicillin antibiotic, such as amoxicillin/clavulanic acid (Augmentin). . . a cephalosporin antibiotic, such as cefaclor or ceftriaxone (Rocephin)...and/or a z it b ro my c in (Zithromax).

At home treatment: Patients with pneumonia are sometimes advised to use an incentive spirometer (a tubelike device that patients breathe into, as hard as they can, at least two to three times a day). It increases pressure in the bronchial tubes and helps maintain open breathing passages.

Preventive: An incentive spirometer also can be used by patients who don't have pneumonia but who have under$ing lung disease, such as chronic bronchitis, emphysema or some other obstructive lung disease. It helps keep the airways open and less vulnerable to pneumonia.

AN EMERGING THREAT

MRSA is primarily a skin infection that can enter the body through cuts or scrapes. MRSA was originally found only in health-care settings. In the 1990s, it began showing up in the general community. This form of infection has the prefix CA, denoting community-acquired.

CA-MRSA pneumonia isn't as dangerous as the hospital-acquired form. It's usually treated with the antibiotics sulfamethoxazole and trimethoprim (Bactrim). Hospital patients with MRSA-related pneumonia require a much stronger antibiotici an comy cin (Vancocin), given intravenously.

Self-protection: CA-MRSA is spread by airborne droplets. It also can be present on drinking glasses, toothbrushes, etc' In community settings, such as health clubs, people should never share their personal items.

In the hospital: Patients should wash their hands after touching any object. MRSA can survive on doorknobs, faucet handles, bedrails, remote controls, telephones, food trays, etc. Patients also should wash after using the bathroom and before eating. For convenience, a62o/o alcohol hand sanitizer gel can be used. Patients should insist that all medical personnel wash their hands before and after performing any procedure-and even before and after touching any object in the room.

PREVENTION

Not smoking and frequent hand-washing help prevent pneumonia.

Also important... .

Annual flu vaccine. People who don't get the flu are far less likely to get pneumonia. The Centers for Disease Control and Prevention (CDC) recommends the flu vaccine for adults 46 age 50 and older...children ages six months to five years old...women who are pregnant during flu season (typically October to as late as Mar...and health-care workers or others who have close contact with people in a high-risk group. However, flu vaccine, if available can help most people reduce risk.

Important: The FluMist nasal vaccine, which has been approved for healthy people ages five to 49, may be more effective than conventional flu shots. There appears to be a greater immune response in the nose, where the vaccine is administered. This can make it harder for an inhaled flu virus to cause infection.

Cautlon: FluMist is not recommended for people with asthma or lung disease.
Pneumococcal vaccine. It's recommended for adults age 65 and older as well as for those with pneumonia risk factors, such as cardiovascular or lung disease, cancer or a previous illness with pneumonia. People with certain illnesses, such as kidney or severe lung disease, may need a second dose after five or more years.