Underestimated danger: pneumonia

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35,000 deaths from pneumonia annually

In Germany, around 680,000 people develop pneumonia every year. An estimated 35,000 patients die of it each year. Infectious diseases are often not correctly diagnosed or treated incorrectly.

Pneumonia is an underestimated disease As a rule, the dismay of others is usually great when someone has a heart attack. In contrast, hardly anyone responds to pneumonia, as Tobias Welte from the Hannover Medical School (MHH) said according to a report by the "Welt". "Pneumonia is an underestimated disease," said the doctor. According to his estimates, around 35,000 people die in Germany every year from pneumonia outside of a hospital. There are no precise statistics on pneumonia as the cause of death. However, the lung specialist describes the information provided by the Federal Statistical Office of a total of just under 19,500 deaths from pneumonia and flu for the previous year, 2011, as clearly too low.

Paths of infection at home and in the clinic differ The deputy director of the clinic for pneumology at the University Medical Center Schleswig-Holstein, Klaus Dalhoff, agrees. He goes even further and says that the numbers of the world are too conservative. In his opinion, these could be even higher if one also includes the pneumonias that patients have only contracted in a hospital. The two routes of infection, at home or in a hospital, differ fundamentally in the type of pathogen. Pneumococcal bacteria are primarily responsible for outpatient pneumonia. With such an infection, treatment with antibiotics is usually not a problem. The situation is different for hospital pneumonia, for which bacteria such as enterococci or staphylococci are often responsible. Since these bacteria are resistant to numerous antibiotics, such an infection is particularly dangerous.

Frequent infections in intensive care units Because patients in intensive care units are weakened by their illness and their organisms can hardly defend themselves against pathogens, infections with multiresistant pathogens often occur there. In addition, the risk of infection is increased drastically by some treatment measures, such as mechanical ventilation via a tube in the trachea, because pathogens from revenge and nose can migrate into the lungs. This is because the cough reflex does not work properly in anesthetized patients and the tube does not completely seal the trachea.

Situation in Greece particularly bad According to press reports, around 680,000 people in Germany develop pneumonia every year. The mortality rate of the 230,000 patients who therefore have to be treated in hospital is around ten percent. "Resistance and antibiotic consumption are interrelated," said Welte. The more antibiotics are used, the more bacteria develop immunity to the different types of the active ingredient. When it comes to the development of such resistant types, Germany remains in the European midfield. In Eastern Europe and the southern European countries, on the other hand, the situation is “dramatically bad.” The situation in Greece since the economic crisis has been rated particularly badly. He complains that antibiotics are not used properly there. Therapy of several days would often be started, but not then brought to an end. In addition, antibiotics are all too often prescribed without a foundation. Both can make bacteria resistant to these agents.

One of the deadliest diseases worldwide According to the World Health Organization (WHO), poor treatment for pneumonia is a problem, particularly in African and Asian countries. Every year around 1.1 million children worldwide die from pneumonia before the age of five. So pneumonia is one of the deadliest diseases worldwide. The multi-resistant pathogens that arise in other parts of the world are also a problem for Germany because the dangerous bacteria are brought here by travelers. However, Dalhoff believes that even simple pneumonia is not always correctly recognized by private doctors. He blames the often practice-free training of medical students. While they would learn the theoretical basis for this in their training, the students would have to have seen pneumonia a few times for a correct diagnosis. However, this is not always the case.

Diagnosis in older patients more difficult Dalhoff points out that it is also quite difficult to distinguish pneumonia from the numerous simple viral infections. In pneumonia, the lung tissue is inflamed acutely or chronically, which in most cases is caused by an infection with bacteria, more rarely also by viruses, fungi, pollutants, allergic diseases or radiation exposure. The question: How do I recognize pneumonia? proves to be particularly difficult in the elderly. Because while symptoms of fever, chills, and difficulty breathing are usually clear in younger people, seniors often lack individual symptoms. Due to the generally higher frailty of the elderly, signs are sometimes not interpreted correctly. According to Dalhoff, it is nevertheless important not to use antibiotics on suspicion. Otherwise, the development of resistance cannot be curbed.

Politics are required In order to be able to deal with the resistant types of bacteria in the future, it is necessary to develop new, effective antibiotics. However, this is not really lucrative for the pharmaceutical industry, since funds for chronic diseases can make a lot more money than antibiotics. "Politics are required here," said Dalhoff. For example, government co-financing of the development of such drugs would be conceivable. The lung specialist Welte also sees new antibiotics as key in order not to "lose the fight against rapidly changing pathogens." (Sb)

Photo credit: Dieter Schütz / pixelio.de

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