Pneumonia in Spinal Cord Injury

As COVID-19 rages on, Dr Ed Baalbergen reminds people with spinal cord injuries about the risks associated to respiratory infections

I have chosen pneumonia in people with a spinal cord injury (SCI) as a topic for this issue as speaking about respiratory infections seemed like a good way to remind readers of the risks, especially with the current coronavirus pandemic.

Besides the myriad of reasons persons develop pneumonia, those with an SCI are at greater risk, especially if they have a high lesion that compromises the normal functioning of the respiratory system.

Normally, the respiratory system functions with intact intercostal muscles (the muscles between the ribs), accessory muscles of the neck, the diaphragm and the abdominal muscles. All these muscles assist the lungs in their function, effective aeration and effective coughing and expectoration. If any of these muscle groups are paralysed, aeration is compromised along with the effective clearing of secretions, which makes individuals more likely to develop pneumonia.

What is Pneumonia

Pneumonia is an opportunistic infection of the lower respiratory tract and any person may be prone to developing pneumonia at any stage. The common causes for pneumonia can be divided into two groups: bacterial pneumonias and viral pneumonias (and more rarely fungal pneumonias).

Pneumonias present with fever, cough, pain on breathing, shortness of breath and often many other symptoms such as sore throat and muscles aches. Generally, pneumonia affects the greatest number of people at the upper and lower ends of the age spectrums (the very young and the very old) and can be more prevalent in the winter months but does occur in other seasons.

However, there are many groups of persons within a normal population that would be more susceptible to developing pneumonia. This includes persons with multiple comorbidities, those that smoke, those with a compromised immune system, those with an SCI and, more so, those with an injury higher up on the spine, which affects the normal respiratory functioning.


Pneumonias are treated either at home or in hospital if severe. Bacterial pneumonias can normally be treated very effectively with antibiotics. Some people who contract bacterial pneumonia, in addition to requiring antibiotics, will need adjunctive management such as nebulisations, mucolytic or physiotherapy to help with expectoration, possibly oxygen and in-hospital supportive care.

β€œAny person may be prone to developing pneumonia at any stage.”

Viral pneumonias, however, tend to be more difficult to manage as they do not respond to antibiotics as is the case with the coronavirus for which there is also no suitable vaccine is available. Management is therefore supportive on the whole.


As we have learned with the coronavirus pandemic, germs are spread by human contact with surfaces carrying the germ or by droplets from infected persons. Basic handwashing (or sanitising), avoiding infected persons and, in extreme cases such as the one we are in now, masking is important in preventing the spread. This remains the most important way to prevent the spread.

Vaccines can be used to prevent both bacterial and viral pneumonias. The annual influenza strains are generally prevented with a suitable annual flu injection; however, due to the many stains of the influenza virus that circulate every year, a vaccine may not cover all strains.

Vaccines are available to prevent bacterial pneumonias – the best example of this is the vaccine Prevenar, which is used to prevent infection caused by pneumococcal bacteria. My recommendation to all individuals with an SCI is to have the annual flu jab and consider vaccinating against pneumococcal pneumonia.

Regarding coronavirus, until there is a suitable vaccine, continue to practice social distancing, good hand hygiene and mask up and stay safe.

Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association.


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