• A New Pneumonia

  • Health authorities in China are reporting 60 cases or more of a previously unknown viral pneumonia that has put dozens in the hospital. Officials note that victims exhibit fever up to 105 degrees Fahrenheit, difficulty breathing, and abnormal findings on chest X-rays.  

    Nothing gets my attention like a mysterious, probably viral, pneumonia showing up in some foreign land. In the last decade or so, killers like Sudden Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) have entered the scene. The current infection doesn’t seem to be either of these, and lab studies have already eliminated influenza, avian flu, most bacteria, and other possible culprits. A number of victims were found to have attended a seafood market in the area.

    The word “pneumonia” is defined as a lung inflammation usually caused by bacterial or viral infection. Occasionally, fungi or parasites may give rise to it. It’s a very general term and doesn’t identify the specific microbe that’s causing the problem.

    It’s important to know that inflammation of the lungs may occur as a result of reasons other than infection, such as inhaling food, drink, or vomit into the lungs. This is called “aspiration pneumonia” and can be life-threatening.

    Although pneumonia kills about 50,000 people annually in the United States, most of these cases are in the elderly, the very young, or those with poor immune systems. One infection that is clearly passed from one human to another is influenza. This year’s flu season is becoming one of the worst in recent memory, according to the Centers for Disease Control and Prevention (CDC). The last serious viral influenza outbreak in the U.S.  was 2017.

    HOW LUNGS WORK

    Alveolar anatomy

    Your lungs are part of the respiratory system, the part of the body that controls breathing. Inhaling fresh air brings oxygen to tiny air sacs in the lungs called “alveoli”. Little blood vessels in the alveoli absorb oxygen from inhaled air and remove waste gases like carbon dioxide during exhalation.  This vital process of oxygen in, carbon dioxide out is called “gas exchange”. Anything that interferes with it can become life-threatening.

    PNEUMONIA

    normal alveoli vs. pneumonia

    In pneumonia, the alveoli fill with pus and inflammatory fluid, preventing the proper absorption of oxygen. Milder cases of pneumonia may affect just a small section of the lung but severe cases may affect the entirety of both lungs (what was commonly known as “double pneumonia”).

    Pneumonia may also be primary, that is, an occurrence in and of itself in an otherwise normal patient. It may be secondary, in response to a weakened system due to other infections, heart disease, asthma, chronic obstructive pulmonary disease (COPD), or other condition. Patients with secondary pneumonia tend to have worsening shortness of breath, continued fever, or thicker mucus over the course of time despite the usual therapy. 

    Symptoms of Pneumonia

    Symptoms of pneumonia include:

    • Coughing that produces mucus
    • Fever and chills
    • Fast breathing and heart rate
    • Shortness of breath
    • Chest pain
    • Exhaustion
    • Muscle aches

    In some cases, victims experience loss of appetite, nausea and vomiting, or diarrhea. Severe cases may cough up blood (called “hemoptysis”) or turn blue around the mouth (known as “cyanosis”). Cyanosis is a sign that the body isn’t able to transport enough oxygen to the tissues.

    Lots of germs can cause pneumonia, including different types of viruses, bacteria, fungi, and parasites. So many microbes can cause pneumonia that it may take a while to discover the offending organism, even in normal times and with modern technology.

    As the cause of the current group of cases is still unknown, it’s uncertain how this pneumonia spreads. If there’s evidence that it can be transmitted from one human to another, you have the makings of an epidemic.

    Health authorities are usually slow to sound the alarm, and the Wuhan Municipal Health Commission states “no clear evidence” of human-human transmission. They don’t rule out the possibility, however.

    TREATING PNEUMONIA

    Antibiotics work only for bacterial infections

    Antibiotics are commonly used to treat pneumonia, as many cases are bacterial in origin and the potential consequences are so dire. Often, the treatment is intravenous therapy, but some oral drugs include:

    •             Amoxicillin

    •             Doxycycline

    •             Azithromycin

    •             Cephalexin

    •             Erythromycin

    •             Ampicillin

    •             Clindamycin

    The choice depends on the microbe involved and the available drugs. It’s important to know that the above medicines have no beneficial effect on viral causes of pneumonia.

    More information (including dosages) on each of these drugs, plus veterinary equivalents, can be found in various articles at doomandbloom.net or in the book “Alton’s Antibiotics and Infectious Disease: The Layman’s Guide…” Due to overuse, cases of antibiotic-resistant bacteria have been reported for a number of the medications listed.

    Occasionally, the organism that causes pneumonia may be a fungus. One example is Coccidiomycosis, also known as Valley Fever. Common in the Southwestern U.S., symptoms include persistent cough, fever, headaches, fatigue, and shortness of breath. The treatment most often used is the oral antifungal drug Fluconazole (Fish-Flucon) 400mg-800mg/day. 

    The medications listed above have no beneficial effect on viral causes of pneumonia. In cases of influenza, the administration of antiviral medications such as Oseltamivir (Tamiflu), Zanamivir (Relenza), or baloxavir marboxil (Xofluza) will shorten the course of the infection if taken in the first 48 hours after symptoms appear.  After the first 48 hours, less medicinal effect is noted. These drugs are not known to be effective against pneumonia caused by other viruses, however. Other treatments involve alleviating the symptoms: Acetaminophen (Tylenol) for fever, for example.

    Cough suppressants may sometimes (but not always) be helpful. Coughing helps remove thick mucus and should not be suppressed unless it is so severe that breathing is difficult, causes vomiting, or prevents sleep. 

    PREVENTION OF RESPIRATORY INFECTIONS

    Face masks help prevent airborne transmission

    Good respiratory hygiene is necessary to prevent patients with respiratory infections from transmitting germs to others. If you are the caregiver:

    •             Perform rigorous hand hygiene before and after contact. Wash soiled hands with soap and warm water for 15 seconds or clean your hands with alcohol-based hand sanitizer.

    •             Wash down all possibly contaminated surfaces, such as kitchen counters or doorknobs, with an appropriate disinfectant (dilute bleach solution will do).

    •             Isolate sick individuals in a specific quarantine area, especially those with a high fever.

    •             Wear gloves and a mask at all times when treating someone with a contagious respiratory illness.

    •             Don’t self-medicate, especially with antibiotics, unless modern medical care is not accessible for the foreseeable future.

    If you are the patient:

    •             Cover your mouth and nose with tissues and dispose of those tissues safely.

    •             Use a mask is you’re coughing or sneezing a lot. Although your caregivers may wear masks, it’s more important for you to wear one.

    •             Keep at least four feet away from healthy people. This is the average distance that air droplets will spread during a cough or sneeze, although some go much further.

    Many people think that they can avoid respiratory infections by staying inside out of the cold. Actually, being in crowded, closed spaces increases the germ count in the air and, therefore, your chances of being infected.

    Others believe that Vitamin C and zinc will prevent colds and flus. Indeed, they might decrease the duration of the illness, but don’t do anything to prevent exposure to the virus.

    Time will tell whether the new pneumonia will pan out to be a concern in the U.S., but it’s important to always recognize the signs and symptoms and do all you can to prevent it or any other respiratory infection.

    Joe Alton MD

    Joe Alton MD

    Find out more about pneumonia and 150 other medical topics in our award-winning Survival Medicine Handbook’s Third Edition and also in our latest book “Alton’s Antibiotics and Infectious Disease: The Layman’s Guide to Available Antibiotics in Austere Settings“!

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