Asymptomatic pneumonia: why is there no fever and cough?

Pneumonia can be suspected by its characteristic symptoms - high body temperature combined with a severe cough. However, this is not always the case. In some cases, the temperature does not rise, but the person continues to cough. This can confuse the patient and he puts off visiting the doctor. As a result, valuable time is lost. When contacting the Yusupov Hospital, the patient is immediately prescribed an examination, thanks to which it is possible to accurately diagnose and begin treatment on time.

Causes of pneumonia

Almost always, an inflammatory reaction in the lung tissue is caused by an infection. Pneumonia can be caused by many microorganisms - bacteria (most often), viruses, fungi and even some types of protozoa. In the vast majority of cases, the cause of pneumonia is:

• streptococcus pneumoniae - pneumococcus;
• chlamydia;
• haemophilus influenzae - hemophilus influenzae;
• respiratory syncytial virus is the most common cause of viral pneumonia
• other types of streptococci;
• staphylococci;
• mycoplasma.

Sometimes pneumonia can also be non-infectious and be caused by:

• toxic lesions of lung tissue;
• allergic reactions;
• autoimmune diseases;
• exposure to extreme temperatures;
• penetrating radiation (cancer patients undergoing radiation therapy to the lungs).

Risk factors

Predisposing factors for the occurrence of inflammation in the lung tissue are:

• chronic diseases of the endocrine, cardiovascular and respiratory systems;
• disturbances in the functioning of the immune system;
• bad habits (primarily smoking);
• malformations of the respiratory system;
• sedentary lifestyle.

Severe cases of the disease occur especially often in older people over the age of 65. Pneumonia is also extremely dangerous in newborns and children of primary school age. It is these categories of patients that account for the vast majority of deaths.

When and why can pneumonia occur in a child?

Pneumonia or pneumonia most often affects children in the first two years of life. Pneumonia in children occurs at different periods of their lives. A child can get sick in the first hours of life.

The main causes of pneumonia are infectious agents such as pneumococcus, chlamydia, mycoplasma, MS virus, Pseudomonas aeruginosa, etc.

The causes of pneumonia are specific to different ages, for example, newborns are more often affected by chlamydia found in the mother's birth canal.

Other causes of pneumonia are immunodeficiencies (primary and secondary, for example HIV), ingestion of amniotic fluid by the fetus due to lack of oxygen, choking on vomit with entry into the respiratory tract, prolonged exposure to mechanical ventilation, etc.

Pneumonia in children is one of the leading causes of death. Every year, about 1 billion children worldwide die from pneumonia.

Types of pneumonia

According to the prevalence of the process, pneumonia can be:

• focal, affecting only a small area;
• segmental, spreading to one or more segments of the lung;
• lobar, occupying the entire lobe of the lung;
• total, with damage to the entire lung.

The disease is classified according to its causes:

• bacterial pneumonia;
• viral pneumonia;
• mycopneumonia;
• mixed types, in which massive infection with various microorganisms leads to inflammation of the lung tissue.

In addition, there are unilateral (affecting one lung) and bilateral pneumonia (affecting both lungs). Based on the duration of the course, there are acute forms, lasting up to 3 weeks, and subacute forms, lasting from 3 to 6 weeks. Finally, depending on the severity of symptoms, pneumonia can be mild, moderate, or severe, and may or may not have complications (primarily heart and/or respiratory failure).

Diagnostics

The doctor focuses on the patient’s complaints and the data that he sees and hears. If the doctor listens to the chest with a phonendoscope, he will hear typical wheezing, changes in breathing and so-called crepitus (the noise of a lung affected by inflammation). Bacterial pneumonia can be confirmed by:

• blood tests indicating severe inflammation (leukocytosis, changes in protein levels, clotting);
• X-ray of the chest with areas of darkness where the lung is affected;
• CT scan of the lungs, if the diagnosis is not clear on a regular x-ray;
• culture of sputum for flora with identification of a specific bacteria (or several) and determination of sensitivity to antibiotics;
• saturation (oxygen saturation in the blood) less than 95%.

Additionally, if the case is complex, the doctor may order other tests.

Signs of pneumonia

The standard clinical picture of pneumonia is characterized by symptoms:

• Sudden onset.
• A sharp rise in body temperature above 38 0C.
• Rapid onset of cough with sputum production.

This is how almost all bacterial and viral pneumonias begin, including the most common variants caused by pneumococcus. As the disease progresses, the symptoms include shortness of breath and painful, often stabbing, sensations in the chest. Such symptoms can persist in the patient for up to 2 weeks.

The modern clinical picture of community-acquired pneumonia can vary widely and be “erased” due to the uncontrolled use of antibacterial drugs. Has symptoms of respiratory infections:

1. your health will deteriorate over several days;
2. dry cough with virtually no phlegm;
3. headache;
4. increased weakness and fatigue;
5. muscle soreness;
6. pain and sore throat.

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Expert opinion

More than 1 million cases of pneumonia are diagnosed annually on our planet.
Moreover, almost 8.5% of them are fatal. Of course, the vast majority of such adverse outcomes occur in groups at risk for pneumonia: children under 5 years of age and elderly people over 65 years of age. However, even if you are young and healthy, neglecting pneumonia is extremely dangerous. At the first manifestations of this disease, you should immediately consult a doctor and under no circumstances self-medicate. Pulmonologists at SM-Clinic will make a diagnosis as quickly as possible, determine what exactly caused pneumonia and prescribe the necessary therapy. It will include modern highly effective drugs and techniques, and will be built in accordance with the clinical recommendations of the Russian Respiratory Society and the Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy, approved by the Ministry of Health of the Russian Federation and WHO recommendations.

Savina Maria Yuryevna, pulmonologist at SM-Clinic in Ryazan

Treatment of pneumonia

The basis of treatment for pneumonia are drugs that act directly on the cause of the disease:

• antibiotics for bacterial infections;
• antiviral drugs for viral infection;
• antifungal agents for fungal invasion, etc.

The total duration of treatment of bacterial pneumonia with antibiotics averages from 7 to 10 days. For infection with mycoplasma or chlamydia, the course of treatment lasts at least 14 days. If pneumonia was caused by rarer pathogens (enterobacteria, legionella, etc.), then therapy can last 21 days or more. The criteria for stopping antibacterial treatment of pneumonia in adults are maintaining normal body temperature for 2-3 days, the absence of inflammatory symptoms and normalization of blood counts.

Also, for pneumonia, therapy is prescribed to alleviate the symptoms of the disease:

• drugs that dilate the bronchi and thin the sputum to clear the airways;
• corticosteroids;
• saline solutions to maintain water-salt balance;
• oxygen inhalation for respiratory failure;
• physiotherapy at the final stages of the disease (UV irradiation, vibration massage, physical therapy, etc.).

Prognosis and prevention

The best treatment for pneumonia is prevention. Vaccines are available for children from two months of age. It is important to take care of the diet of a patient with pneumonia. During treatment, rest, bed rest and plenty of fluids are recommended to prevent dehydration of the baby's body after the formation of a large amount of mucus and due to increased sweating.

Typically, at the onset of the disease, children experience loss of appetite, but as they recover, it returns to normal. A healthy and nutritious diet is recommended to avoid nutritional deficiencies that can lead to other disorders in the body.

It is necessary to control the environment in which the patient is located, whether in a medical facility or at home. Avoid the presence of smoke (such as tobacco) or other lung irritants that may aggravate the condition.

After discharge from the hospital, children require clinical observation and rehabilitation measures. It is also recommended to strictly follow the doctor’s recommendations after recovery, correct daily routine, and moderate intake of vitamins as a preventive measure. Dosed physical activity contributes to the overall recovery of children and can prevent recurrence of pneumonia.

Vaccination against pneumococcus

The most common cause of pneumonia is streptococcus pneumoniae (pneumococcus). A vaccine has already been developed against it and is widely used, which protects a person against 23 of the most common strains of pneumococcus. According to WHO, vaccination reduces the risk of developing pneumonia caused by this microorganism by more than 90%. In 2014, the PCV vaccine (pneumococcal conjugate vaccine) became part of the national vaccination calendar of the Russian Federation. Its effectiveness does not depend on age, so this vaccination is recommended for all those born before 2014.

List of scientific literature used:

• Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. International Journal of Antimicrobial Agents. March, 2020, 55 (3): 105924.
• Marchello CS, Ebell MH, Dale AP, Harvill ET, Shen Y., Whalen CC Signs and Symptoms That Rule out Community-Acquired Pneumonia in Outpatient Adults: A Systematic Review and Meta-Analysis.” Journal of the American Board of Family Medicine. April, 2021, 32 (2): 234–247.
• Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine. October, 2021, 200(7): e45–e67.
• Pneumonia. Mayo Clinic Staff. Patient Care & Health Information. Mayo Clinic. Last reviewed: August, 2, 2021.
• Who Is at Risk for Pneumonia? US Department of Health & Human Services. The National Heart, Lung, and Blood Institute. Last reviewed: March 3, 2021.
• Pneumonia. News bulletin. World Health Organization. July 25, 2021.
• Chuchalin A.G., Sinopalnikov A.I., Kozlov R.S., Avdeev S.N., Tyurin I.E., Rudnov V.A., Rachina S.A., Fesenko O.V. Russian Respiratory Society (RRO). Interregional Association for Clinical Microbiology and Antimicrobial Chemotherapy (IACMAC). Clinical guidelines for the diagnosis, treatment and prevention of severe community-acquired pneumonia in adults. Pulmonology. 2014, (4): 13-48.