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Pneumonia
May 22, 2023

Pneumonia

Pneumonia

What is Pneumonia?

Pneumonia is an infection of the lungs especially affecting the alveoli that fill with pus and fluid instead of air (alveoli are tiny air sacs that help to deliver oxygen from the air to the blood).
Based on where it was acquired, pneumonia is characterized as:

  • Community-Acquired Pneumonia (CAP)
  • Responsible for the highest rates of morbidity and mortality from infection among adults in Europe1
  • Largest cause of death from infection among children worldwide2
  • In the EU, CAP is responsible for 1 million hospital admissions every year1
  • Nosocomial pneumonia
  • Presents 48 hours after admission, Hospital Acquired Pneumonia –HAP
  • Presents 48-72 hours after intubation, Ventilator Acquired Pneumonia-VAP acquired1

ΑΝΝΑ ΤΖΩΡΤΖΗ PNEUMON CENTER ΠΝΕΥΜΟΝΙΑ

Causes

The most common cause of CAP is streptococcus pneumoniae (pneumococcus), although other bacteria, viruses or fungi can also infect the lungs3.

A special reference this year is dedicated to COVID-19, a new disease, manifested by pneumonia.

“Atypical pneumonia” refers to pneumonia specifically caused by chlamydia, legionella, mycoplasma or psittacosis due to the different clinical presentation and the fact that it requires different treatment3.

“Aspiration pneumonia” refers to the infection that occurs as a result of the inhalation of solid or liquid into the lungs (food, vomit, saliva, chemicals etc.). It is important to identify aspiration pneumonia as the treatment approach is different.
Risk factors for aspiration are:

  • Any conditions that:
    • Alter the swallowing function (brain injuries, strokes, neurological diseases)
    • Alter the level of consciousness (drugs, alcohol abuse)
  • Older age
  • Drowning
  • Rarely, complications of medical procedures

How is it Spread?

Pneumonia is usually spread through droplets in the air released by coughing and/or sneezing, including COVID-19. In young children, virus and bacteria commonly found in their noses or throat can potentially be inhaled and infect the lungs. It can also reach the lung via blood from other sites of infection.

Risk factors

  • Age (young children and adults >65 years old)
  • Presence of chronic conditions such as COPD, heart disease, or diabetes
  • The time period immediately following a viral infection such as flu
  • Smoking, alcohol and/or substance abuse
  • Residing in crowded areas (for example shelters, residential care facilities or army bases)

In the case of COVID-19 risk factors include Older age, Obesity, Chronic Respiratory and Cardiovascular disorders, Diabetes, Cancer, Smoking, HIV, Immunodeficiency and specific ABO blood group.
Pregnancy & Breast feeding might present a slightly higher risk than same age non-pregnant women.

Symptoms

Symptoms of pneumonia last 3 to 4 weeks while activities of daily living may be impaired for longer.
The presence of a cough and at least one of the following characterize pneumonia:

  • Fever (higher than 38oC) that persists for more than 4 days
  • Fatigue
  • Chest pain when taking a deep breath
  • Trouble breathing or quickened breathing
  • A fast heartbeat
  • Shaking and chills
  • Nausea, vomit or diarrhea

The viral pneumonia due to the SARS-CoV-2 infection, usually bilateral in chest images, shares the clinical manifestations of viral pneumonias and is only distinguished by specific laboratory tests. However, it may characteristically develop dyspnea a week from onset and may also be associated with ageusia and anosmia (loss of taste and smell). The clinical course of COVID-19 ranges from an asymptomatic infection to severe and life threatening respiratory and multiorgan failure.

Diagnosis

Diagnosis is based on the symptoms and chest radiography findings. Microbiology testing to identify the microorganism and other more complex advanced tests are only needed in special circumstances (for example in severe disease or immunocompromised patient).
Reverse transcription polymerase chain reaction (RT-PCR) testing identifies the SARS-CoV-2 virus RNA in easily collected nasopharyngeal swabs.

Treatment

In most cases, pneumonia can be successfully treated with broad spectrum antibiotics that target the most likely and frequent causes without the need for more complex interventional tests that are only performed when indicated. It is important that treatment is started as soon as possible. Follow-up with physician is recommended until both symptoms and radiologic findings return to normal.

Currently COVID-19 treatment includes the use of: Dexamethasone, Remdesivir, Convalescent plasma, Monoclonal antibodies, Immunomodulatory agents, Interferons and Azithromycin.

Prevention

The most important means for prevention of pneumonia are:

  • Seasonal influenza vaccination
  • Pneumococcal vaccination
  • Smoking cessation
  • Frequent hand washing
  • Good general hygiene
  • Exclusive breastfeeding
  • Healthy diet and nutrition
  • Good management of chronic illnesses

The intense and ongoing research for a COVID-19 vaccine promises its availability in the beginning of 2021. Until then, keeping safe distance (more than 2 meters away from each other), social distancing, wearing face masks and frequently washing our hands are the only means of protection against COVID-19.

ANNA S. TZORTZI MD, FCCP
PNEUMONOLOGIST

References

Legionnaire’s Disease
May 22, 2023

Legionnaire’s Disease

Legionnaire’s Disease

 

What is Legionnaire’s disease?

A bacterium called Legionella that causes an acute respiratory infection and be found in freshwater environments or in other complex water systems such as:

  • Water supply systems
  • Water pipes (pipes with a little water, with corrosion and salts, shower heads)
  • Heating and cooling systems
  • Hot or cold water tanks such as swimming pools, hot tubs, fountains but also natural hot water tanks for example thermal baths etc.
  • Mechanical devices such humidifiers or medical devices that use running water

Environments with temperatures of 20-45°C are ideal conditions for Legionella to grow and multiply. Of the many different strains of the bacterium, legionella pneumophila is the strain associated with the human illness, presenting in two clinical forms called Legionnaires’ Disease and Pontiac Fever.1,2

Legionnaire’s disease can present

  • Sporadically: when it is not connected to a particular source
  • In outbreaks: when two or more people are sick in the same area at the same time.

Depending on the environment in which it presents, it can be distinguished as:

  • Hospital Legionnaires’ disease: when hospitalized for the past 2-10 days
  • Traveler Legionnaire’s disease: when a trip has taken place over the previous 2-10 days.

Modes of transmission2

  • By inhalation of contaminated water droplets
  • By ingestion of contaminated water, although this is rare
  • Human-to-human transmission is extremely rare

Risk Factors2

Not everyone who is exposed to Legionella will get ill. People at risk for getting sick from Legionella include:

  • Ages> 50 years old
  • Smoking: Smokers and ex-smokers
  • Chronic respiratory disease for example, Chronic Obstructive Pulmonary Disease
  • Diabetes
  • Renal, Hepatic insufficiency
  • Cancer
  • Immunosuppression due to disease or treatment (ie. chemotherapy, radiotherapy)

Legionnaire’s Disease (Legionella Pneumonia)1,2

Incubation period of this illness is ~2-10 days. Legionella Pneumonia is a serious pneumonia that requires hospitalization with a mortality rate of 1-10%. However, early treatment with antibiotics has significantly improved the prognosis and outcome of the disease.
SYMPTOMS: fever, cough, shortness of breath, headache and nausea, diarrhea, confusion. Symptoms begin 2-10 days after exposure.
DIAGNOSIS: Chest X-ray, urine test, bacterial culture in sputum (prior to antibiotic treatment)
TREATMENT: antibiotics with macrolides or fluoroquinolones while also treating the symptoms

Pontiac Fever1,2

Less severe, it usually resolves in 3-5 days. Symptoms may begin within a few hours of exposure, with flu-like symptoms such as fever and muscle aches. No specific medical treatment is needed except for symptoms treated with antipyretic analgesics.

Prevention1,2

Prevention is based on regular management and treatment of complex water systems to keep Legionella from growing. The following is important for controlling outbreaks:

  • Regular cleaning and management of all complex water systems
    • With use of water disinfectants (ie. chlorination, ionization, hydrogen peroxide, ultraviolet radiation)
  • Search for the source of the original outbreak and treat immediately with either:
    • Chlorine treatment or
    • Heat shock

Monitoring and Surveillance1

In Greece there is a diligent system for monitoring and controlling the quality of water resources and water supply facilities through multiple parameters including the search for toxic substances and pathogenic microorganisms. Audits of water systems are made systematically throughout the country and especially in tourist areas. The recent cases of Legionnaire’s disease in Greece are the first ever reported and are considered sporadic and not attributed to a specific source. The European Centre for Disease Prevention and Control is also regularly updated.3

Recording, monitoring and reporting Legionnaire’s Disease is obligatory in Greece and is completed by a special form of the Ministry of Health and the Hellenic Center for Disease Control and Prevention (HCDCP) for the effective epidemiological surveillance of the disease.

ANNA S. TZORTZI MD, FCCP
PNEUMONOLOGIST

References

  1. Κέντρο Ελέγχου & Πρόληψης Νοσημάτων. ΝΟΣΟΣ ΤΩΝ ΛΕΓΕΩΝΑΡΙΩΝ/ΛΕΓΕΩΝΕΛΛΩΣΗ. http://www.keelpno.gr/el-gr/νοσήματαθέματαυγείας/λοιμώδηνοσήματα/νο%CF. Accessed August 2, 2018.
  2. Centers for Disease Control and Prevention. Legionella (Legionnaires Disease and Pontiac Fever). https://www.cdc.gov/legionella/about/index.html. Published 2018. Accessed August 2, 2018.
  3. European Centre for Disease Prevention and Control. European Legionnaires’ Disease Surveillance Network (ELDSNet). https://ecdc.europa.eu/en/about-us/partnerships-and-networks/disease-and-laboratory-networks/eldsnet. Accessed August 2, 2018.

Τuberculosis
May 22, 2023

Τuberculosis

Τuberculosis

 
Tuberculosis (TB) is an infectious disease caused by the Mycobacterium Tuberculosis, that most commonly affects the respiratory system, but disease can also manifest in other organs, called extrapulmonary Tuberculosis.

Globally, Tuberculosis is considered among the 10 major causes of death and first cause of death among HIV/AIDS patients1. The economical and disease burden of the current pandemic is expected to reverse the progress made in TB prevention, by aggravating the poverty and malnutrition in the developing world1.

Inhalation of infected aerosol droplets, usually exhaled by a patient, is the route of disease transmission. This first contact may lead either to immediate elimination by the host defenses, either to the gradual onset of pulmonary disease, or to a latent infection that bears the potential to be activated at any time in the future1.

Epidemiology:

25% of the global population is estimated to be infected, mostly in the developing countries1.

In Greece, the prevalence among citizens of Greek nationality is declining, however there is an increasing prevalence of cases observed among other nationalities, mainly refugees and immigrants2.

Symptoms3:

Persistent cough, weight loss, fever, night sweats, lymphadenopathy.

Diagnosis3:

  • Imaging tests (Radiography, CT scan)
  • Tuberculin skin testing
  • Interferon-gamma release assay (IGRA)
  • Culture of Mycobacterium tuberculosis in sputum, bronchoalveolar lavage and pleural fluid
  • Pleural or lung biopsy
  • Sputum acid-fast bacilli (AFB) smear
  • Nucleic acid amplification (NAA) testing

Treatment3:

Active pulmonary disease is treated for 6 months, starting with a four-drug regimen for the first 2 months and continuing with two drugs for the remaining 4 months. During treatment patients are monitored for possible side effects and for their adherence to treatment as interruptions may lead to treatment failure and /or drug resistance. A special disease entity among types of drug resistant TB is the multidrug resistant TB representing a major and public health threat.

Prevention:

The bacille Calmette–Guérin (BCG) vaccine, offers partial protection, especially from severe forms of TB in children3.

Research for the development of a more successful vaccine, effective across all age groups, is ongoing, and some promising candidates are used in the course of clinical trials.4

ANNA S. TZORTZI MD, FCCP
PNEUMONOLOGIST

References

  1. https://apps.who.int/iris/bitstream/handle/10665/337538/9789240016095-eng.pdf
  2. https://eody.gov.gr/wp-content/uploads/2019/01/tuberculosis2004_2010.pdf
  3. https://www.uptodate.com/contents/table-of-contents/infectious-diseases/tuberculosis
  4. https://www.who.int/teams/global-tuberculosis-programme/vaccines

World Immunization Week 24-30 April 2023
May 22, 2023

World Immunization Week 24-30 April 2023

Η Παγκόσμια εβδομάδα εμβολιασμού 2021, έχει υψηλό ειδικό βάρος και ιδιαίτερη σημασία, καθώς η παγκόσμια κοινότητα διέρχεται τα διαδοχικά κύματα της πανδημίας SARS-CoV-2.

Smoking: A Chronic Epidemic
May 22, 2023

Smoking: A Chronic Epidemic

Smoking: A Chronic Epidemic

 

Smoking has been the most common human addictive behavior for nearly four centuries. The harmful effects of smoking began to be gradually recognized around 1950. Today, the complex detrimental impact of both active smoking and passive exposure to other people’s smoking is widely known and scientifically documented.

Nicotine, the primary ingredient in tobacco products, ranks second among addictive substances, only after heroin. It is the reason why smokers remain bound to its use.

The use of any kind of tobacco product, including the newer electronic and heated nicotine-releasing products, inevitably leads to addiction and dependency. Contrary to current unsubstantiated claims flooding the internet, there is no safe level of smoking, and no tobacco product is safe.

Each year, approximately 8,000,000 people worldwide die from smoking, 1,200,000 of whom die from passive smoking, including 65,000 children.

As terms like epidemic, pandemic, morbidity, and mortality rates have recently become prominent in our lives, we understand that these figures essentially describe a continuous epidemic—predictable, treatable, and preventable. This epidemic has quietly persisted for decades, differing mainly in that it is not transmitted from person to person and thus does not disrupt the constant rhythm of modern, primarily Western, society and its systems. However, the morbidity and mortality caused by passive smoking—the exposure to the smoke of fellow citizens, colleagues, and parents—could be considered to have a transmissible dynamic from smoker to non-smoker via smoke.

The World Health Organization classified smoking as a chronic disease in 2008, correctly labeling it as the greatest epidemic of all time.

Smoking is a multisystem disease, as its impacts are not limited to the respiratory system. The micro-particle pollution generated by smoking, enters into the bloodstream, damaging even distant organs.

The effects on pregnant women, fetuses, infants, and children are particularly significant, as is the environmental impact. Pollution from cigarette butts, chemicals, pesticides, and tobacco industry waste, leaves a negative mark on ecosystems and water sources.

Especially today, in the context of the COVID-19 pandemic, smokers are even more vulnerable. Chronic obstructive pulmonary disease (COPD) and its frequent comorbidities make smokers prone to infections in general, and SARS-CoV-2 in particular, increasing the risk of complications and adverse outcomes of the disease.

The classic hand-to-mouth motion of smokers is believed to facilitate the transfer of SARS-CoV-2 to the entry points (mouth, nose), raising the risk of infection. Moreover, staying at home as part of protective measures against COVID-19, combined with the accompanying anxiety, increases the likelihood of passive exposure for family members.

Smoking cessation, although challenging and strenuous, is the only way forward for smokers, who will enjoy the benefits from the very first moment, gaining symptom reduction and well-being as they move further away from their last cigarette.

Many smokers attribute their smoking to stress, claiming it calms them, an argument also used by many teenagers. The truth is that they indeed feel some relief when they smoke, not due to stress reduction, but due to the alleviation of withdrawal symptoms satisfied by the effect of nicotine on the deprived brain of the smoker.

Since prevention is better than cure, and smoking cessation, though feasible, involves difficulties, it is crucial to act proactively and invest in prevention. We must start early, from childhood, to equipp young children and teenagers with knowledge, enhance their self-esteem, teach them creativity and stress management and highlight the role of physical exercise in their lives. By offering them a multifaceted education on an academic, social, and personal level, we will provide them the necessary tools to consciously make healthy choices, and effectively solve problems rather than create them.

The SMOKE FREE GREECE Initiative has been carrying out this work to date, having developed a methodology for smoking prevention interventions in the school community, successfully applied in schools across country since 2009. It is planning for the future: “The new generation is coming, smoking is leaving.”

ANNA S. TZORTZI MD, FCCP
PNEUMONOLOGIST