Pneumonia vs. Pulmonary Edema
Pneumonia is one of the leading causes of mortality in underdeveloped as well as developed countries with the majority stake being held by children and the elderly.
Pneumonia is an infection of the respiratory tract following which there are several complications that lead to other morbidities and malaise. Pneumonia is mostly bacterial in onset though it can also be caused by viruses. Pneumonia presents with symptoms that maybe mistaken for pulmonary edema as both are respiratory infections and share a similar progression. The major difference being that pneumonia is an infectious pathology while pulmonary edema is not usually caused by an infection. It is a marker for a more severe underlying systemic pathology like heart failure or volume overload states in the body. Pulmonary edema can also be a sequel of causes that fluid overload in the lung.
Pneumonia: causes and symptoms
Pneumonia is caused by a viral or bacterial infection and is an inflammation of the lung parenchyma and cavity. It follows a definite set of events and presents with typical symptoms. There is also a variant of pneumonia called as atypical pneumonia which does not present with the typical features and may remain asymptomatic for a long period of time. Pneumonia presents with typical symptoms like cough, difficulty in breathing and a massive production of sputum. The sputum is heavily used in the diagnosis of the causative organism and the colour of the sputum may even reveal the exact organism thus leading to better diagnosis and treatment. Pneumonia follows a specific set of events as it progresses in the body.
- Stage of congestion: the lungs are filled with fluid due to the inflammatory process and the leaky blood vessels cause a massive collection of fluid in the lungs. This is a striking similarity that causes people to be confused between pneumonia and pulmonary edema as both have collection of fluid in the lung.
- Stage of red hepatisation: now that the congestion resolves to some extent, the lung now becomes hard in consistency and become red in appearance due to the leakage of exudate and even a few blood cells. The lungs become as hard as the liver in texture hence the term hepatisation.
- Stage of grey hepatisation: there is increasing fibrosis and the lung appears like a fibrosedliver.
- Stage of resolution/complication: the lungs now either resolve the infection due to the immunity of the host or go into a complicated phase wherein they suffer even more superimposed infections and further increase in mortality.
Pulmonary edema: cause and presentation:
Pulmonary edema usually indicates underlying systemic pathology like heart failure but may also be caused due to unknown causes or fluid overload states. Pulmonary edema is mostly caused when the fluid in the lungs can’t drain out properly as seen in cases of heart failure. In cases of left heart failure the blood pools back into the lungs and causes massive collection of fluid thus causing breathing difficulty, cough and respiratory distress. Thus both pneumonia and pulmonary edema share similar clinical features. The essential difference being that pneumonia is an infectious cause. Pulmonary edema usually does not occur alone as the fluid overload state also causes loading of fluid in other parts of the body like liver and spleen and gives rise to an array of symptoms.
Can pneumonia cause pulmonary edema?
Yes. Pneumonia can cause pulmonary edema as the inflammatory state in pneumonia can cause leakage of fluid from the blood vessels and capillaries thus causing massive collection of fluid in the lungs that give an appearance like that of pulmonary edema.
Pneumonia can also be atypical which does not present with the usual signs and symptoms and can have very different presentation which includes
- Breakdown of red blood cells leading to anaemia
- Ataxia and movement disturbances
- Irritation of brain and neurological deficits.
- Rashes on the body
Similarities of pneumonia and pulmonary edema
- Present with respiratory distress
- Present with difficulty in breathing
- Cause exertion and fatigue
- Can cause bluish discolouration of skin due to improper oxygenation
Differences between pneumonia and pulmonary edema
- Pneumonia is bacterial or viral in origin. Pulmonary edema is usually due to systemic pathology or volume overload in heart failure.
- Pneumonia presents very early and causes severe respiratory distress earlier. Pulmonary edema presents later and most often in elderly and in heart failure patients
- Pneumonia can be acquired in the community or hospitals. Pulmonary edema usually does not occur acutely
Prevention of pneumonia
Pneumonia presents earlier and early identification of the disease can drastically improve the disease outcome. Early administration of appropriate antibiotics can cause relief and prompt treatment from this disease.
Prevention of pulmonary edema
Pulmonary edema can be relieved primarily using diuretics which cause more urine production and relieve the accumulated fluid; certain medications that cause the modulation of blood vessel wall help in the reduction of fluid leakage and thus reduce the edema and respiratory distress.
Pneumonia vs. pulmonary edema: target age group
Pneumonia finds its target in children and the elderly who are not so sound immunologically and thus are easy targets. Pulmonary edema does not follow any specific pattern and can occur in any age group if there is underlying systemic pathology like heart failure or leaky vessels in the lungs, etc.
Clinical presentation of pneumonia and pulmonary edema:
Both pneumonia and pulmonary edema have similar presentation and the patient complains of respiratory distress, cough and sputum. Pneumonia can have additional features like superimposed bacterial infections and if not treated with utmost precaution can have grave consequences. In fact, the most common complication includes superimposed infections which can be life threatening. In underdeveloped countries, pneumonia accounts for a major contributor of mortality for children under the age of 5 years as malnutrition and inadequate immune response pre dispose the child for infections.
Pulmonary edema can also be caused due to vessel pathologies which cause the leakage of blood and fluid into the tissue space inside the lungs and thus causing localised collection of fluid. This fluid may also become infected if the collection is not resolved by the immune process of the body.
Pulmonary edema is relived to a great extent if the body’s natural immune reaction is aided by simple medication like diuretics.
Home remedies: effective or not?
Home remedies have very limited application in pneumonia as it is an infectious disease. The only aid that they provide is that the nutrition and fluid status of the affected person is maintained and thus he is not exposed to dehydration and further infections.
In pulmonary edema home remedies can provide relief to some extent as posture, mild rest regulated fluid intake can relief the symptoms to a great extent.
Taking steam and clearing the respiratory passage in addition to bronchodilators as advised by the physician can relieve the respiratory distress to a great amount. The best mode of treatment for pneumonia is taking antibiotics like cephalosporin, macrolides and adequate dietary maintenance. Pulmonary edema on the other hand is relieved primarily by treating the underlying pathology (heart failure in most cases) and drugs like diuretics. Symptomatic treatment is given in both cases to relieve the patient of his malaise.
Can pulmonary edema be mistake for pneumonia?
Because of the similarities between the symptoms of pulmonary edema and pneumonia, it is very much possible for a general doctor to mistakenly treat a patient thinking he is suffering from pneumonia. It is only after a thorough examination that the presence of pulmonary edema is confirmed.
Are pulmonary edema, pulmonary hypertension and pulmonary embolism closely correlated?
There are similarities and difference between these three medical conditions. They are obviously related but hold enough differences to be categorized as separate ailments of respiratory system.
Cardinogenic pulmonary edema is a result of congestive heart failure. In this condition, the left ventricle of the heart cannot pump enough blood into the lungs to meet the requirements of the body of the victim.
Pulmonary hypertension is another disease that can be caused by congestive heart failure. This medical condition takes place when there is a clot in a large pulmonary artery.
Pulmonary embolism is a medical condition that takes place when a blood clot get caught in one of the arteries that go from the heart to the lungs of the individual.
Does pulmonary edema go away?
No. Pulmonary edema, once it takes place, cannot get treated on its own. Fluids inside the lungs must be removed through medications and surgical processes by trained and experienced doctors. No amount of rest can help in getting rid of water that gets inside the air sacs of lungs of the patient.
What are the complications of pulmonary edema?
Pulmonary edema can prove fatal for the patient when the attack is severe, and he does not get immediate medical help. The most common complications of cardiogenic pulmonary edema are respiratory fatigue and failure. These complications can arise even after prompt diagnosis and start of the treatment procedure. Therefore, the doctor has to remain prepared to provide assisted ventilation to the patient as soon as he begins to show signs of respiratory fatigue. These symptoms include lethargy, worsening anxiety, and diaphoresis. Another complication of pulmonary edema is sudden death because of cardiac arrhythmia. The doctor must monitor the heart rate of the patient continuously to make sure that the condition of the patient does not become out of control.
What are some preventions for these two diseases?
Prevention of both these diseases is very difficult as patients come to know about them only through their symptoms. Prompt diagnosis of pulmonary edema helps in its control and treatment of this disease. Doctors rely on diuretics to make sure there is no build up of fluid levels inside the lungs of the patient. In the case of pneumonia, nutrition and fluid intake is recommended by doctors to prevent its occurrence. However, once it has taken place, dosage of recommended antibiotics is the only way to get rid of symptoms of pneumonia.
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