How Serious Is Pneumococcal Pneumonia?

Four reasons why pneumococcal pneumonia is considered a serious and lethal bacterial lung disease include:

1. Incidence
   • Pneumococcal pneumonia is the most common type of pneumococcal disease in adults. It affects approximately 175,000 Americans each year. 
   • Each year, it causes thousands of hospitalizations and over 10,000 deaths in the United States. According to studies, it kills about 1 in every 20 people who become infected.
   • Hospitalized people with pneumococcal pneumonia have a high mortality rate (12 to 30 percent).
2. Age and antibiotic-resistant
   • Pneumococcal pneumonia is a potentially fatal disease, especially in older people even with appropriate antibiotics.
   • According to the CDC, it is one of the most common and severe causes of pneumonia in older adults. Pneumococcal pneumonia has a high case fatality rate, particularly in people who are 65 years and older.
   • Older people with chronic illnesses are more vulnerable to severe infections, complications, and death, especially when complications such as bacteremia are present.
3. Pathogen
   • S. pneumoniae are infectious bacteria that have caused millions of fatalities worldwide. Diseases caused by these bacteria are known as pneumococcal diseases. 
   • They initially colonize the nasopharynx of their host without causing any symptoms, but they have the potential to spread to healthy tissues and organs and eventually cause infections.
   • Pneumococcal pneumonia is a global health concern that primarily affects children younger than five years, older people, and people with preexisting medical disorders. 
   • S. pneumoniae possesses a diverse set of virulence characteristics that increase adhesion, invasion of host tissues, and resistance to host immune responses.
4. Several complications
   • Can disrupt your life for weeks
   • Symptoms can hit quickly and without warning
   • Constant fatigue
   • Affect your ability to work
   • Requires hospitalization
   • Sepsis
   • Organ failure 
   • Meningitis (inflammation [swelling] of the protective membranes covering the brain and spinal cord)
   • Septic arthritis (painful infection of a joint caused by bacteria that travel through your bloodstream)
   • Empyema (infection around the lungs and in the chest cavity)
   • Peritonitis (inflammation of the peritoneum [a silk-like membrane that lines your inner abdominal wall and covers the organs within your abdomen])
   • Endocarditis (a life-threatening inflammation of the inner lining of the heart's chambers and valves)
   • Pericarditis (inflammation of the outer lining of the heart)
   • Endobronchial obstruction (blockage of the airway that allows air into the lungs), with atelectasis (collapse within the lungs) and abscess (collection of pus) in the lungs
   • Infections at other sites
   • Death

Pneumonia is currently the most common pneumococcal disease, which needs prompt diagnosis and appropriate treatment to avoid complications.

Pneumococcal pneumonia symptoms can appear suddenly, with a general feeling of being unwell.

Common symptoms of pneumococcal pneumonia may include:

• Fever (higher than 100.4°F [38°C])
• Chills and shaking
• Sweats
• Aches and pains
• Headache
• A general sense of feeling unwell
• Chest pain
• Rapid breathing
• Shortness of breath
• Cough
• Blood-stained or “rusty” colored phlegm
• Drowsiness or confusion
• Vomiting
• Fatigue

Pneumococcal pneumonia occurs when pneumococci that colonize the upper respiratory tract are transported to the alveoli and replicate, causing an inflammatory response and leading to several symptoms.

Streptococcus pneumoniae causes pneumococcal illness. Bacteria enter the body through the nose and mouth. Droplets in the air from coughing or sneezing might transmit the virus. 

Moreover, they can be transmitted by contacting surfaces or objects infected with the bacteria and then touching the nose or mouth. When germs enter the lungs, they can cause part of the air sacs to become irritated and fill with mucus.

This infection is more common in infants, young children, and individuals 65 years and older.

The following children may be at a high risk of pneumococcal pneumonia:

• Younger than two years 
• Belong to childcare in a group setting
• With underlying health conditions such as sickle cell disease, HIV, or chronic heart or lung conditions
• With cochlear implants or leaks of cerebrospinal fluid (CSF)
• Lack of breastfeeding
• Exposure to indoor air pollution

The following people may be at a high risk of pneumococcal pneumonia:

• With severe and chronic illnesses
• Previous influenza and other respiratory virus infection
• Coexisting allergies
• With weakened immune systems
• Living in nursing homes or other long-term care facilities
• With cochlear implants or CSF leaks
• Who smoke cigarettes 

The failure to develop an antibody response, whether congenital or acquired, is the most critical risk factor for invasive pneumococcal infection. People with compromised neutrophil function, such as those with alcoholism, diabetes, liver cirrhosis, prolonged corticosteroid medication, or decreased renal function, are at increased risk.

Treatment options for pneumococcal pneumonia include:

• Rest
• Hydration
• Antibiotics
• Medicine to control the fever and pain
• Intravenous (IV) fluids to prevent dehydration
• Supplemental oxygen, if necessary

Antibiotics are used to treat pneumococcal infection; however, certain strains of the bacteria have acquired resistance to medications. Drug resistance can complicate treatment and lengthen hospital stays.

Antibiotics prescribed to treat pneumococcal pneumonia

• For mild pneumococcal pneumonia infections
  • Amoxicillin, second or third-generation cephalosporins, or oral levofloxacin are advised.
  • Amoxicillin is the first line of treatment for healthy children with mild to moderate pediatric pneumococcal pneumonia caused by penicillin-sensitive strains.
  • Third-generation cephalosporins, such as ceftriaxone or cefotaxime, are the next alternatives. 
• For mild community-acquired pneumonia in adults
  • Macrolides: Azithromycin, erythromycin, or clarithromycin
  • Respiratory fluoroquinolone: Moxifloxacin, gemifloxacin or levofloxacin
• In severe cases
  • For life-threatening infections, ceftriaxone or cefotaxime are used initially, followed by vancomycin.
• In case of resistance
  • A combination of antibiotics may be recommended rather than a single-drug regimen

Antibiotics are often administered orally as pills or liquids. A severe infection may necessitate hospitalization and IV antibiotics. If you have difficulty breathing, your treatment strategy may involve using supplemental oxygen.

As bacteria are getting more resistant to drugs, prevention should be an important factor in pneumococcal pneumonia. Important prevention options may include:

• Get a pneumococcal vaccination (shot). Consult your doctor about whether you should have a pneumococcal vaccination and, if so, which vaccine may suit you.
• Having the flu is a risk factor for pneumococcal pneumonia, so don’t miss your yearly flu shot.
• Avoid people who have the flu or pneumonia (especially if you have children and older people at home).
• Regularly follow hand hygiene.
• Keep hands away from your face, eyes, and mouth, especially during flu season.
• Cough and sneeze into a tissue, discard it immediately, and wash your hands.
• Do not share cups or kitchen utensils with others.
• Stay home when sick and limit contact with other people.
• Follow treatment as directed by your healthcare provider.
• Always finish the antibiotics course.

Preventing pneumococcal pneumonia is a crucial component of a mortality reduction strategy. Adequate nutrition is essential for strengthening natural defenses. Addressing environmental factors such as indoor air pollution and encouraging good hygiene in overcrowded homes and hospitals reduce the number of people with pneumonia.

The following vaccinations are available to prevent pneumococcal pneumonia:

• Conjugate 7-valent (PCV7)
• 13-valent (PCV13) 
• Pneumococcal polysaccharide (PPSV23)

PCV77 and PCV13 are indicated for children younger than two years and individuals with specific medical disorders.

The PPSV23 vaccine is indicated for people older than 65 years, with particular genetic (sickle cell illness) and medical problems (impaired splenic function), and who smoke.

Furthermore, people with sickle cell disease, who are predisposed to invasive pneumococcal illness, are advised to get penicillin prophylaxis in addition to vaccination during the first five years of life.

Although vaccination cannot protect against all strains of S. pneumoniae, pneumococcal vaccines can protect against the most common strains. They are safe and effective, with mild side effects such as swelling and soreness at the injection site, fever, and muscle pain. Experts believe that the benefits of vaccination outweigh the risks.