Pneumonia in African Adults

By Michelle Buama Abebrese, MD. DLHA Volunteer and Freelance Health Writer, Medically reviewed by: A. Odutola, MB.BS., PhD.

An African couple standing side by side, with the female wearing a brown T-shirt and coughing into her right fist and the male wearing a navy blue T-shirt holding his chest in apparent pain. AI generated image by ChatGPT.

 

Highlights

• Pneumonia is a serious lung infection that is especially concerning for African adults because of HIV, TB, indoor air pollution, and limited healthcare access.

• The illness is caused by different germs, like bacteria, viruses, and fungi, with risks worsened by poor nutrition, smoking, and smoke from cooking fuels.

• Common symptoms include cough, fever, chest pain, breathing difficulties, tiredness, and in older adults, confusion or loss of appetite.

• Diagnosis often relies on physical examination, chest X-rays, and lab tests, but in many African hospitals doctors must depend mainly on symptoms and physical findings as diagnostic investigative resources may not always be available..

• Treatment involves the use of anti-infective medication tailored to the causative germ, along with rest, fluids, oxygen, pain medications and hospital care in severe cases.

• Prevention is possible through vaccination, stopping smoking, better nutrition, cleaner cooking fuels, good hygiene, and effective management of HIV and TB.

 

Introduction

Pneumonia is an infection of the lungs ( a part of the lower respiratory system) caused by different types of germs. As the tiny air sacs in your lungs (called alveoli) get inflamed, they are filled with fluid or pus. This makes it hard for you to breathe and reduces the oxygen that your body can take in.

In Africa, pneumonia is a major cause of sickness and death, not only in adults but also in children too. Because of factors like HIV, Tuberculosis (TB), air pollution, and limited healthcare access, pneumonia in adults in Africa can be more dangerous than in other parts of the world.

This article aims to blend medical insight with clear, practical advice to inform you on the challenges of pneumonia in Africa, outlining its types, common causes, symptoms, and risk factors, while also offering you guidance on treatment and prevention.

 

Types of Pneumonia 

Types of pneumonia. Click on image to enlarge

 

Pneumonia types can be grouped in various ways:

1. By causative germs

1. Bacterial Pneumonia
2. Viral Pneumonia
3. Fungal Pneumonia
4. Atypical Pneumonia
   1. Mycoplasma
   2. Chlamydia

2. By Location (i.e. where acquired)

1. Community Acquired Pneumonia
2. Hospital Acquired Pneumonia 
3. Other Health Facility Acquired Pneumonia
4. Ventilator Acquired Pneumonia

3. By Pattern of Infection

1. Lobar Pneumonia (i.e., whole lobe of lung affected)
2. Bronchopneumonia (i.e., limited part of lung tissue and associated air passage) -bronchus, is affected)
3.  Interstitial Pneumonia

4. Others

1. Aspiration Pneumonia
2. Opportunistic Pneumonia 

          

What Causes Pneumonia?

Image showing some of the common organisms (germs) causing pneumonia in Africans, Click on image to enlarge.

 

Pneumonia is caused by germs that are acquired from the community, hospital, intensive care or nursing homes. Pneumonia can also be caused by aspirating food or vomit into the lungs 

Causes of Community Acquired Pneumonia (CAP)

This is the term used to describe the pneumonia that you get outside the hospital. The common germs that cause CAP include:

• Bacteria – The most common ones in Africa include Mycobacterium tuberculosis, which causes Tuberculosis (TB), Klebsiella pneumoniae, Pseudomonas aeruginosa, and sometimes Streptococcus pneumoniae.
• Viruses – Influenza (flu virus) is a major culprit, but others like coronaviruses or RSV can also cause pneumonia.
• Fungi and other germs – From Aspergillus or Histoplasma species especially in people with weak immune systems, such as those living with HIV.

Causes of Hospital Acquired Pneumonia (HAP) 

If you are admitted to a hospital for treatment or a procedure, you may catch pneumonia that is often caused by bacterial germs that are resistant to many antibiotics (e.g. Methicillin resistant staphylococcus aureus. MRSA). For this reason, HAP is difficult to treat and can make you sicker.

Causes of Intensive Care and Nursing Home Acquired Pneumonia 

If you are treated in an Intensive care unit of a hospital or are in a nursing home, you may catch pneumonia too. This pneumonia is similar to HAP in the sense that it is often caused by antibiotic resistant bacteria.

Causes of Ventilator Acquired Pneumonia (VAP) 

If you are hospitalised and need breathing support through a machine or ventilator, you may also catch pneumonia. The germs that cause VAP are the same as the ones that cause CAP or HAP.

Causes of Aspiration Pneumonia

Aspiration pneumonia occurs when fluid, food, spit or vomit enters your lung through the windpipe. When you’re unable to cough out the foreign item, your lung gets infected with the same germs as in CAP and HAP and pneumonia results. 

 

Risk Factors for Pneumonia

Info-poster showing some pneumonia risk factors in Africans. Click on image to enlarge.
 

The risk factors for pneumonia include:

• Age -  the very young and very old are at higher risk because of weakened immunity
• HIV and TB – very common in Africa and make pneumonia more severe.
• Infections
• Chronic medical conditions - e.g. diabetes, heart disease, chronic kidney disease, etc.
• Indoor air pollution – cooking or heating with firewood, charcoal, or kerosene in poorly ventilated homes increases the risk.
• Smoking and Exposure to second hand smoking
• Alcohol abuse
• Surgery & Trauma
• Poor nutrition – weakens the lungs and the body's ability to fight infections.
• Cancer and Cancer treatment - both weaken the body's ability to fight infections
• Other causes of weakened Immunity - e.g. Corticosteroid use

 

What Are the Symptoms?

An image showing an African man exhibiting chest pain due to pneumonia. AI generated image by ChatGPT.

 

Typical symptoms and signs of pneumonia in adults include:

• Cough (sometimes with phlegm or blood)
• Fever and chills
• Difficulty breathing or shortness of breath
• Chest pain (especially when coughing or breathing deeply)
• Tiredness and weakness
• Loss of appetite
• Confusion

Always talk with your healthcare provider early if you have any of these symptoms. 

 

How Is Pneumonia Diagnosed?

Your healthcare provider will:

1. Take a detailed history - Asking details about your complaints and your past medical conditions, family and social life, previous illnesses, occupation, medications, etc.
2. Conduct a physical examination – checking your body for any abnormality. This includes listening to your chest with a stethoscope for any abnormal breathing related sounds.
3. Order imaging tests – like a chest x-ray or CT scan to look for lung abnormalities. This may not always be available in rural health facilities in Africa.
4. Order laboratory tests – like sputum tests, TB tests, or blood tests when considered necessary. These can help to identify the specific germ causing your illness and the most effective drug to use in treating it

In some African hospitals, doctors may rely mainly on history and physical examination to make a probable or working diagnosis of pneumonia because advanced diagnostic test resources may not always be available.

 

How Is Pneumonia Treated?

• Antibiotics – such as amoxicillin or penicillin, are usually the first-line treatment for bacterial pneumonia.
• TB treatment – if pneumonia is caused by tuberculosis, standard anti-TB treatment must be implemented.
• Antiviral or antifungal medicines – Viral pneumonia usually resolves on its own with supportive care and often does not need specific medications. You will however need anti-fungal medications if a fungus is suspected or confirmed as the cause of your pneumonia. 
• Supportive care – rest, fluids, oxygen (if available), and healthy diet/nutrition.

Although mild to moderate pneumonia can be treated while you still live at home, severe cases may require hospital care, especially if you have HIV, TB, or other co-existing health problems.

 

How You Can Prevent Catching Pneumonia

Some preventive measures against pneumonia. Click on image to enlarge. AI generated image by ChatGPT.

 

 Prevention is possible and very important. Here’re how:

1. Vaccination –
   • The pneumococcal vaccine and flu vaccine can protect against common causes of pneumonia.
   • In South Africa, childhood vaccination with Pneumococcal Conjugae Vaccine (PCV) was found to have reduced pneumonia-related deaths in children <19  years. 
2. Healthy living –
   • Stop smoking.
   • Eat a balanced diet to keep the immune system strong.
   • Wash hands regularly to prevent infections.
3. Reduce indoor air pollution –
   • Use cleaner cooking fuels (gas or electricity when possible).
   • Improve ventilation by opening windows.
4. Manage other illnesses –
   • Early treatment of HIV and TB lowers the risk of pneumonia.

 

Complications of Pneumonia

Complications of pneumonia are common in those with high risk factors such as, weakened immunity, the very young and old, those with diabetes and heart disease, etc. They include:

1. Lung related:

• Pleural effusion (fluid buildup in the chest cavity)
• Hydrothorax (water in the lungs)
• Bronchial obstruction (blockage of the airways)
• Pulmonary hypertension (high blood pressure in the lungs)

2. Systemic:

• Sepsis (bloodstream infection) 
• Multiple organ failure (e.g., kidney, heart, liver)
• Shock with the possibility of death
• Brain infection 

 

When to See a Doctor

Prompt diagnosis and treatment is very important for the prevention of pneumonia complications. Seek immediate medical attention, if you have any of the common symptoms of pneumonia such as fever, headache, chills, cough, difficulty breathing and chest pain, 

 

Takeaway

Pneumonia is a serious lung infection that can be fatal if untreated. The common causes include germs like bacteria (especially TB), viruses, and fungi. The common symptoms of mild to severe pneumonia include, cough, fever, chest pain, difficulty breathing, tiredness, weakness, confusion.

Treatment of pneumonia includes the use of specific anti-infective medications tailored to the causative germs as well as supportive care. Prevention is advisable and methods include getting vaccinated, reducing exposure to environmental pollutants and indoor smoke, eating healthy, stopping smoking, reducing alcohol consumption, and preventing or managing any underlying HIV/TB infection.

Be informed. It is in your power to protect yourself and your loved ones from getting pneumonia. 

 

Resources: 

1. World Health Organization [Internet, n.d.]. [Cited September 15, 2025]. Available from here.

2. Ziko LM, Hoffman TW, Fwoloshi S, Chanda D, Nampungwe YM, Patel D. et al. Aetiology and prognosis of community-acquired pneumonia at the Adult University  Teaching Hospital in Zambia. PLOS One. [Internet] Published 2022 Jul 15. [Cited September 15, 2025]. Available from here.

3. Bondo G, Naidoo M. The management of community-acquired pneumonia in adults at a rural regional hospital in KwaZulu Natal. BMC Infect Dis 2024 September 2; 24, 896. doi: 10.1186/s12879-024-09705-2. Available from here. 

 

Related:

Chest pain in African adults: Causes, symptoms and when to seek help

Chest Pain in African Adults: Diagnosis, Treatment, and Home Remedies

What Africans need to know about cough

How to investigate the causes of chronic cough in adult Africans

A guide to the treatment of chronic cough In African adults

 

 

Published:  September 27, 2025.

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