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Pneumonia not just ‘the old man’s friend’

SINGAPORE — It started with a fever, sniffles and cough, symptoms that seemed no different from that of a common childhood cold. But what eight-year-old Luqman Nur Hakim Imran had was more sinister.

Pneumonia is the top killer of children under five, according to the World Heath Organization. Photo: Reuters

Pneumonia is the top killer of children under five, according to the World Heath Organization. Photo: Reuters

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SINGAPORE — It started with a fever, sniffles and cough, symptoms that seemed no different from that of a common childhood cold. But what eight-year-old Luqman Nur Hakim Imran had was more sinister.

Diagnosed with pneumonia, Luqman was hospitalised twice at ­National University Hospital (NUH) last year for the serious lung infection, which left him with breathing difficulties, chest pains and body aches. He spent a total of about three weeks in hospital.

It was a trying time for the entire family, said his mother, Mdm Norlizam Subari, 46.

“He started complaining of chest and back pains, and also had very bad body aches. I felt sad (to see him suffering). During that period, I didn’t get to see my other kids for a few weeks as I had to take care of Luqman,” said the homemaker.

An infection of the lungs caused by a virus or bacteria, pneumonia is the No 2 killer across all ages in Singapore after cancer, causing about 19 per cent of deaths here. It is often thought to ­afflict mainly the elderly and chronically ill — and is known as “the old man’s friend” — but younger children are equally vulnerable.

Dubbed the silent killer because many symptoms are not obviously distinguishable from the common cold or flu, pneumonia is the top killer of children under the age of five, according to the World Health Organization (WHO). The paediatric ward at NUH sees an average of 20 to 30 admissions due to severe pneumonia each month, a figure that excludes those seen in the outpatient clinics and children’s emergency.

One of the earliest telltale signs of pneumonia is fast breathing. The child may appear to be working hard to breathe by sucking in their tummy or neck muscles, said Dr Mahesh Babu Ramamurthy from the Division of Paediatric Pulmonary and Sleep at NUH.

At the same time, the child may experience a high fever. In more severe cases, the child may be very agitated and cry inconsolably, or become drowsy and not respond to normal cues by caregivers, he added. If a child complains of chest or shoulder pain, parents should seek medical attention quickly.

PNEUMONIA CAN KILL

When not detected and treated promptly, the disease can kill — by causing lung failure or massive total body inflammation that may lead to multiple organ failure, warned Dr Charles Wiener, vice-president of Academic Affairs at Johns Hopkins Medicine International and professor of Medicine and Physiology at Johns Hopkins School of Medicine, who is currently in town for an educational visit at Johns Hopkins Singapore.

Younger children, especially those who are malnourished and have other chronic illnesses, are at a higher risk of dying from the infection because they have poorer immunity compared with adults, said Dr Mahesh.

Pneumonia can spread via airborne droplets when an infected person coughs or sneezes, or by contact.

A recent study in the United States found that the culprit for pneumonia in children is now more likely to be viruses than bacteria. About two-thirds (66 per cent) of pneumonia in over 2,000 children studied was caused by viruses alone, unlike previously, where bacterial causes were more common, according to the study which was published last February in the New England Journal of Medicine.

The viruses typically cause cold symptoms, but can also lead to more severe infections such as pneumonia.

Dr Mahesh noted a similar trend happening in Singapore, with more viral causes being detected here. The doctors said this could be due to the ability of advanced tests to detect viruses as the potential cause of pneumonia in recent years.

According to Dr Wiener, viruses such as influenza (or the flu) tend to be more contagious than most bacteria. A person with influenza also faces a higher risk of getting subsequent bacterial pneumonia, a complication that was associated with severe illness and deaths in young people during the 2009 H1N1 pandemic, he added.

PREVENTION BETTER THAN CURE

While pneumonia can be treated when detected promptly, doctors said prevention is better than cure.

“Most cases of bacterial and viral pneumonia are transmitted person-to-person, therefore it certainly can pass within families. The risk of acquiring the infection increases with the number of people around ... Thus being careful about coughing or sneezing in public and hand-washing are excellent preventive strategies,” said Dr Wiener.

Vaccination is another important line of defence against pneumonia.

“I believe that vaccination is important for improving public health. In the hospital, we not only have the influenza vaccination to protect ourselves but also our patients. Similarly, in a household that has at-risk groups living in close proximity, these individuals and the people living with them should do all they can to not bring influenza home,” added Dr Wiener.

Mdm Norlizam now urges parents to take their children’s vaccinations seriously. “I hope other children will never have to experience what my son went through last year,” she said.

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