How does pneumonia differ in patients with medical conditions?
Pneumonia is a common and potentially serious infection of the lung. Individuals with chronic diseases such as diabetes, chronic obstructive pulmonary disease (COPD), heart disease, and weakened immune systems due to conditions like HIV/AIDS are particularly vulnerable.1
Pneumonia in persons with underlying medical conditions may have a higher risk of complications and longer recovery period.1 In this article we discuss the various vulnerable groups, the challenges and how to prevent the disease for these special populations.
Patients in the Vulnerable group
Aside from children and elderly, certain people with medical conditions are also prone to develop the disease.
These include the following medical conditions:1,2
- Cancer patients undergoing chemotherapy or radiation therapy
- Organ transplant recipients on immunosuppressive drugs
- Individuals living with HIV/AIDS
- Patients with severe malnutrition
- Patients with chronic medical conditions such as diabetes, chronic kidney disease (CKD), Chronic Obstructive Pulmonary Disease (COPD) or emphysema
- Patients with stroke, or taking sedating drugs or alcohol, or with limited mobility
- Patients who recently contracted a viral upper respiratory tract infection such as influenza
Causes of Pneumonia3
When people get pneumonia, it's usually because of common germs like bacteria or viruses. But if someone's immune system is not strong, they can get pneumonia from other germs that typically don't make healthy people sick.
For example:
- People with weakened immune systems (like in advanced HIV) can get pneumonia from a certain type of fungus.
- Some bacteriab can cause lung infections immediately after getting an organ transplant.
- If someone has latent or inactive tuberculosis, it might become active again if a person has a weakened immune system.
Symptoms and Signs of Pneumonia in the Vulnerable Group
Patients with weakened immune defenses are particularly susceptible to developing pneumonia rapidly.3 Symptoms and signs may be the same as those that occur with community-acquired pneumonia in patients with intact immune system. Symptoms may include:4,5
- Body pain, weakness
- Chills
- Fever
- Cough
- Difficulty in breathing
- Chest pain
- Loss of appetite
- Weight loss
- Abdominal pain
Challenges in Diagnosis and Management
1. Atypical Symptoms: Patients with long-term medical conditions may not present with the common symptoms of pneumonia. These patients may not show signs of pneumonia such as a high fever or productive cough making it challenging to diagnose and treat them.4
2. Increased risk of hospitalization and prolonged recovery: While most people recover from pneumonia with appropriate treatment, it poses a greater risk to patients with weakened immune systems. It may also take longer for them recover and require a longer duration of hospitalization.1
3. Managing Complications: Patients with chronic conditions are more susceptible to complications such as accumulation of fluids in the lungs, collection of pus in the lung, bloodstream infection or heart attacks. They are also at risk of long-term complications such as worsening of COPD or heart failure.1
4. Prevention: Preventing pneumonia in patients with medical conditions is an essential part of its management. Vaccination, particularly against influenza and pneumococcal bacteria, is recommended.3,4 Moreover, managing underlying medical conditions effectively, maintaining a healthy diet and lifestyle, complying with prescribed medications and regular follow-up with their physicians, can help reduce the risk of pneumonia.3
Conclusion
Pneumonia in patients with medical conditions is a complex and potentially life-threatening condition.1 Understanding the risks, causes, symptoms, diagnosis, and management of pneumonia in this vulnerable population is crucial not only for healthcare workers but more importantly, for patients, and caregivers. Preventive strategies, including vaccination and managing underlying conditions, play a key role in reducing the likelihood of pneumonia in this vulnerable population.3
NOTES:
a Fungi causing pneumonia in immunocompromised patients: Pneumocystis jirovecii, Aspergillus spp., Coccidioides immitis, Cryptococcus spp., Blastomyces dermatitidis, Histoplasma capsulatum
b Bacteria causing pneumonia after an organ transplant: Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species
REFERENCES:
- File, T. 2022. Patient education: Pneumonia in adults (Beyond basics). Accessed October 18, 2023 from https://www.uptodate.com/contents/pneumonia-in-adults-beyond-the-basics/print.
- NIH National Lung blood and heart institute. 2022. Pneumonia: Causes and risk factors. Accessed September 2023 from https://www.nhlbi.nih.gov/health/pneumonia/causes.
- Aleem M., et.al. 2023. Pneumonia in an Immunocompromised Patient. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan. Accessed September 2023 from https://www.ncbi.nlm.nih.gov/books/NBK557843/.
- Sethi, S. 2022. Pneumonia in Immunocompromised Patients Accessed October 2023 from https://www.merckmanuals.com/professional/pulmonary-disorders/pneumonia/pneumonia-in-immunocompromised-patients#
- Zhao, J. 2019. Pneumonia in Immunocompromised patients. Medscape. Accessed September 2023 from https://emedicine.medscape.com/article/807846-overview#a5 https://www.pidsphil.org/home/wp-content/uploads/2023/03/CHILDHOOD-IMMUNIZATION-SCHEDULE-2023-Edited.pdf.