Pneumonia is a condition of pulmonary inflammation that primarily affects small air sacs known as alveoli. Usually the symptoms include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. Severity varies.
Pneumonia is usually caused by viral or bacterial infections and less frequently by other microorganisms, drugs and certain conditions such as autoimmune diseases. Risk factors include other lung diseases such as cystic fibrosis, COPD, and asthma, diabetes, heart failure, smoking history, poor coughing ability such as following a stroke, or a weakened immune system. Diagnosis is often based on symptoms and physical examination. Chest x-rays, blood tests, and sputum cultures can help confirm the diagnosis. The disease can be classified by being acquired with community, hospital, or health care related to pneumonia.
Vaccines to prevent certain types of pneumonia are available. Other prevention methods include hand washing and not smoking. Treatment depends on the underlying cause. Pneumonia is believed to be caused by bacteria treated with antibiotics. If the pneumonia is severe, the affected person is usually hospitalized. Oxygen therapy can be used if oxygen levels are low.
Pneumonia affects about 450 million people globally (7% of the population) and generates about 4 million deaths per year. Pneumonia was considered by William Osler in the 19th century as the "captain of the dead". With the introduction of antibiotics and vaccines in the 20th century, survival increased. However, in developing countries, and among very old, very young, and chronically ill, pneumonia remains the leading cause of death. Pneumonia often shortens the suffering between those who are close to death and thus are called "parent friends".
Video Pneumonia
Signs and symptoms
Pneumonia sufferers often have a productive cough, fever accompanied by chills, shortness of breath, piercing or piercing chest pain while breathing deeply, and an increased rate of breathing. In the elderly, confusion can be the most prominent sign.
The signs and symptoms that are typical in children under five are fever, cough, and rapid breathing or difficult. Fever is not very specific, as is the case with many other common diseases, probably not in those with severe illness, malnutrition or in the elderly. In addition, cough is often absent in children less than 2 months. More severe signs and symptoms in children may include blue-tinged skin, aversion to drinking, seizures, ongoing vomiting, extreme temperatures, or a decreased level of consciousness.
Cases of bacterial and viral pneumonia usually present with similar symptoms. Some causes are related to classical clinical characteristics, but are not specific. Pneumonia caused by Legionella may occur with abdominal pain, diarrhea, or confusion. Pneumonia caused by Streptococcus pneumoniae is associated with rusty colored sputum. Pneumonia caused by Klebsiella may have bloody sputum which is often described as "currant jelly". Sputum-bleed (known as hemoptysis) can also occur with tuberculosis, Gram-negative pneumonia, pulmonary abscess and acute bronchitis are more common. Pneumonia caused by Mycoplasma pneumoniae may occur related to swollen lymph nodes in the neck, joint pain, or middle ear infections. Viral pneumonia is more common with wheezing than bacterial pneumonia. Pneumonia has historically been divided into "typical" and "atypical" based on the belief that presentation predicts an underlying cause. However, the evidence does not support this distinction, therefore it is no longer emphasized.
Maps Pneumonia
Cause
Pneumonia is caused by an infection that is primarily caused by bacteria or viruses and less often by fungi and parasites. Although there are more than 100 strains of infectious agents identified, few are responsible for most cases. Mixed infection with viruses and bacteria can occur in about 45% of infections in children and 15% of infections in adults. The causative agent can not be isolated in roughly half of cases despite careful testing.
The term "pneumonia" is sometimes more widely applied to any condition that results in inflammation of the lung (caused by, for example, autoimmune diseases, chemical burns or drug reactions); However, this inflammation is more accurately referred to as pneumonitis.
Conditions and risk factors that predispose to pneumonia include smoking, immunodeficiency, alcoholism, chronic obstructive pulmonary disease, asthma, chronic kidney disease, liver disease, and old age. The use of acid-suppressing drugs - such as proton pump inhibitors or H2 inhibitors - is associated with an increased risk of pneumonia. About 10% of people in need of mechanical ventilation develop ventilator-related pneumonia, and people with gastric feeding tubes have an increased risk of developing aspiration pneumonia. For people with a specific variant of the FER gene, the risk of death is reduced in sepsis caused by pneumonia. However, for those with the TLR6 variant, the risk of developing Legionnaires disease increases.
Bacteria
Bacteria are the most common cause of community acquired pneumonia (CAP), with Streptococcus pneumoniae isolated in nearly 50% of cases. Other commonly isolated bacteria include Haemophilus influenzae <20%, Chlamydophila pneumoniae in 13%, and Mycoplasma pneumoniae in 3% of cases; Staphylococcus aureus ; Moraxella catarrhalis ; Legionella pneumophila ; and Gram-negative bacilli. A number of drug-resistant versions of the above infection are becoming more common, including those with drug resistance (Streptococcus pneumoniae) (DRSP) and methicillin-resistant Staphylococcus aureus (MRSA).
The spread of organisms is facilitated when there are risk factors. Alcoholism is associated with Streptococcus pneumoniae , anaerobic organisms, and Mycobacterium tuberculosis ; smoking facilitates the effects of Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and Legionella pneumophila. Exposure to birds is associated with Chlamydia psittaci ; farm animals with Coxiella burnetti ; aspiration of the stomach contents with anaerobic organisms; and cystic fibrosis with Pseudomonas aeruginosa and Staphylococcus aureus . Streptococcus pneumoniae is more common in winter, and should be suspected in people who inhale large numbers of anaerobic organisms.
Virus
In adults, the virus accounts for about a third and in children about 15% of cases of pneumonia. Commonly involved agents include rhinovirus, coronaviruses, influenza virus, syncytial respiratory virus (RSV), adenovirus, and parainfluenza. Herpes simplex virus rarely causes pneumonia, except in groups such as: newborns, people with cancer, transplant recipients, and people with significant burns. People who follow organ transplants or those who are immunocompromised show high rates of cytomegalovirus pneumonia. Those with viral infections can be infected secondary to the bacteria Streptococcus pneumoniae, Staphylococcus aureus, or Haemophilus influenzae, especially when other health problems are present. Different viruses predominate at different periods throughout the year; during the influenza season, for example, influenza can cause more than half of all cases of the virus. Outbreaks of other viruses also occasionally occur, including hantaviruses and coronavirus .
Mushroom
Fungal pneumonia is rare, but occurs more often in individuals with weak immune systems due to AIDS, immunosuppressive drugs, or other medical problems. This is most often caused by Histoplasma capsulatum , blastomyces, Cryptococcus neoformans , Pneumocystis jiroveci (pneumocystis pneumonia, or PCP), and Coccidioides immitis . Histoplasmosis is most common in the Mississippi River valley, and coccidioidomycosis is most common in the Southwest United States. The number of cases has increased in the second half of the 20th century due to increased travel and immunosuppressed levels in the population. For people infected with HIV/AIDS, PCP is a common opportunistic infection.
Parasites
Various parasites can affect the lungs, including Toxoplasma gondii , Strongyloides stercoralis , Ascaris lumbricoides , and Plasmodium malariae . These organisms usually enter the body through direct contact with skin, swallowing, or through insect vectors. Except for Paragonimus westermani , most parasites do not specifically affect the lungs but involve the lungs secondary to other sites. Some parasites, especially those that belong to the genus ascaris and Strongyloides , stimulate a strong eosinophilic reaction, which can cause eosinophilic pneumonia. In other infections, such as malaria, lung involvement is primarily caused by systemic inflammation induced by cytokines. In developed countries, this infection is most common in people returning from travel or immigrants. Worldwide, these infections are most common in immunodeficiency patients.
Not contagious
Interstitial idiopathic pneumonia or non-communicable pneumonia is a class of diffuse lung disease. They include diffuse alveolar damage, organizing pneumonia, nonspecific interstitial pneumonia, interstitial lymphocytic pneumonia, interstitial desquamative pneumonia, interstitial lung disease, respiratory bronchiolitis, and interstitial pneumonia.
Mechanism
Pneumonia often begins as an upper respiratory tract infection that moves into the lower respiratory tract. This is a type of pneumonitis (pneumonia). The normal flora of the upper airway provides protection by competing with pathogens for nutrition. In the lower airways, glottic reflexes, complementary protein actions and immunoglobulins are important for protection. Microassociation of contaminated secretions can infect the lower airways and cause pneumonia. The virulence of the organism, the number of organisms to initiate infection and the immune response to the infection all determine the development of pneumonia.
Viral
The virus can reach the lungs with a number of different routes. Syncytial respiratory viruses are usually contracted when people touch contaminated objects and then they touch their eyes or nose. Other viral infections occur when contaminated air droplets are inhaled through the mouth or nose. Once in the upper airway, the virus can enter the lungs, where they attack cells lining the airways, alveoli, or pulmonary parenchyma. Some viruses such as measles and herpes simplex can reach the lungs through the blood. Lung invasion can cause different levels of cell death. When the immune system responds to an infection, even lung damage can occur. Especially white blood cells, especially mononuclear cells, produce inflammation. As well as damaging the lungs, many viruses simultaneously affect other organs and thus interfere with other body functions. Viruses also make the body more susceptible to bacterial infections; in this way, bacterial pneumonia can occur simultaneously with viral pneumonia.
Bacteria
Most bacteria enter the lungs through small aspirations of organisms that are in the throat or nose. Half of normal people have small aspirations during sleep. While the throat always contains a potentially contagious, bacteria that lies there only at certain times and under certain conditions. A small proportion of bacteria such as Mycobacterium tuberculosis and Legionella pneumophila reach the lungs through contaminated air droplets. Bacteria can spread also through the blood. Once in the lungs, bacteria can invade the space between the cells and between the alveoli, where macrophages and neutrophils (defensive white blood cells) try to deactivate bacteria. Neutrophils also release cytokines, leading to a general activation of the immune system. It causes fever, chills, and general fatigue in bacterial pneumonia. Neutrophils, bacteria, and fluids from surrounding blood vessels fill the alveoli, resulting in a consolidation seen on chest x-rays.
Diagnosis
Pneumonia is usually diagnosed on the basis of a combination of physical signs and chest X-rays. However, the underlying cause can be difficult to confirm, as there is no definitive test that can distinguish between bacterial and non-bacterial origin.
The World Health Organization has defined pneumonia in children clinically by cough or difficulty breathing and rapid breathing rate, chest indrawing, or decreased level of consciousness. Rapid breathing rates are defined as greater than 60 breaths per minute in children under 2 months, greater than 50 breaths per minute in children 2 months to 1 year, or more than 40 breaths per minute in children aged 1 to 5 years. In children, low oxygen levels and lower chest indrawing are more sensitive than hearing a chest crack with a stethoscope or an increase in respiratory rate. Boiling and nasal bubbles may be other useful signs in children younger than five years.
In general, in adults, investigation is not necessary in mild cases. The risk of pneumonia is very low if all vital signs and auscultation are normal. In people who require hospitalization, pulse oximeter, chest radiography and blood tests - including full blood count, serum electrolytes, C-reactive protein levels, and possibly liver function tests - are recommended. Procalcitonin can help determine the cause and support that antibiotics should receive. Antibiotics are recommended if procalcitonin levels reach 0.25 Âμg/L, strongly recommended if it reaches 0.5 Âμg/L, and strongly discouraged if levels are below 0.10 Âμg/L. For those with CRP less than 20 mg/L without Convincing evidence of pneumonia, antlikosis is not recommended.
Diagnosis of diseases such as influenza can be made based on signs and symptoms; however, confirmation of influenza infection requires testing. Thus, treatment is often based on the presence of influenza in the community or rapid influenza tests.
Physical exam
Physical examination can sometimes reveal low blood pressure, high heart rate, or low oxygen saturation. The respiratory rate may be faster than normal, and this can happen a day or two before any other signs. A chest examination may be normal, but may indicate a decrease in chest expansion on the affected side. The loud breathing of the larger airways transmitted through the inflamed lungs is called bronchial breathing and is heard in auscultation with a stethoscope. Crackles (rales) can be heard in the affected area during inspiration. Percussion can thin out over the affected lung, and increase, not decrease, vocal resonance distinguish pneumonia from pleural effusion.
Imaging
Chest radiography is often used in diagnosis. In people with mild disease, imaging is needed only in those with potential complications, those who do not improve with treatment, or those with uncertain causes. If a person is sick enough to require hospitalization, chest x-rays are recommended. The findings do not always match the severity of the disease and do not reliably separate between bacterial infections and viral infections.
Presentation X-ray pneumonia can be classified as lobar pneumonia, bronchopneumonia (also known as lobular pneumonia), and interstitial pneumonia. Bacteria, community-acquired pneumonia classically shows lung consolidation from one segmental lobe of the lung, known as lobar pneumonia. However, the findings may vary, and other patterns are common in other types of pneumonia. Aspiration pneumonia may present with bilateral opacities especially at the base of the lungs and on the right side. Viral pneumonia radiography may appear normal, appear hyper-inflated, have bilateral patchwork areas, or present similar to bacterial pneumonia with lobe consolidation. Radiological findings may not be present in the early stages of the disease, especially in the presence of dehydration, or it may be difficult to interpret in obese patients or those with a history of lung disease. Complications such as pleural effusions can also be found on chest radiography. Laterolateral chest radiography may improve pulmonary consolidation diagnostic accuracy and pleural effusion. CT scans may provide additional information in indeterminate cases. CT scans can also provide further details on those with unclear chest radiographs (eg occult pneumonia in chronic obstructive pulmonary disease (COPD)) and are able to exclude pulmonary embolism and fungal pneumonia and detect lung abscess in those who do not respond to treatment. However, CT scans are more expensive, have higher radiation doses, and can not be done by the bed. Lung ultrasound may also be useful in helping make the diagnosis. Ultrasound is radiation free and can be done beside the bed. However, ultrasound requires special skills to operate the machine and interpret the findings.
Microbiology
In community-managed patients, determining which agents are not cost-effective and usually does not change management. For people not responding to treatment, sputum culture should be considered, and culture for Mycobacterium tuberculosis should be performed in people with chronic productive cough. Microbiological evaluation is also shown in severe pneumonia, alcoholism, asplenia, immunosuppression, HIV infection, and alcohol abuse. Although a positive blood culture and pleural fluid culture definitively confirm the type of microorganism involved, a positive sputum culture should be interpreted with caution for possible colonization of the respiratory tract. Tests for other specific organisms may be recommended during outbreaks, for public health reasons. In those hospitalized for severe disease, both sputum and blood cultures are recommended, as well as testing urine for the antigen into Legionella and Streptococcus . Viral infections can be confirmed by either detection of either a virus or antigen with a culture or polymerase chain reaction (PCR), among other techniques. Mycoplasma , Legionella , Streptococcus , and Chlamydia can also be detected using PCR techniques in bronchoalveolar lavage and nasopharyngeal swabs. Causal agents are defined in only 15% of cases with routine microbiological tests.
Classification
Pneumonitis refers to pulmonary inflammation; Pneumonia refers to pneumonitis, usually due to infection but is sometimes not contagious, which has additional features of pulmonary consolidation. Pneumonia is most often classified according to where or how it is obtained: community acquired pneumonia, aspiration, health care, hospital-acquired, and ventilator-related pneumonia. It may also be classified by the affected lung region: lobar pneumonia, bronchial pneumonia and acute interstitial pneumonia; or by the causative organism. Pneumonia in children can also be classified based on signs and symptoms as not severe, severe, or very severe.
The setting in which pneumonia develops is important for treatment, as it relates to the possible suspect pathogens, which mechanisms are possible, which antibiotics may work or fail, and what complications can be expected based on a person's health status.
Community
Community-acquired pneumonia (CAP) is obtained in the community, outside of health care facilities. Compared with pneumonia associated with health care, it is less likely to involve drug-resistant bacteria. Although the latter is no longer rare in the CAP, they are still less likely.
Healthcare
Health care-associated pneumonia (HCAP) is an infection associated with recent exposure to the health care system, including hospitals, outpatient clinics, nursing homes, dialysis centers, chemotherapy treatments, or home care. HCAP is sometimes called MCAP (medical-related pneumonia).
Hospital
Hospital-acquired pneumonia is acquired in the hospital, in particular, pneumonia occurring 48 hours or more after admission, which does not incubate at admission. This may involve hospital-acquired infections, with a higher risk of many drug-resistant pathogens. Also, since hospital patients are often sick (which is why they are present in the hospital), the disruption that accompanies it is a problem.
Ventilator
Ventilator-related pneumonia occurs in people who breathe with the help of mechanical ventilation. Ventilator-related pneumonia is specifically defined as pneumonia that occurs more than 48 to 72 hours after endotracheal intubation.
Differential diagnosis
Some diseases may present with signs and symptoms similar to pneumonia, such as chronic obstructive pulmonary disease (COPD), asthma, pulmonary edema, bronchiectasis, lung cancer, and pulmonary embolism. Unlike pneumonia, asthma and COPD usually present with wheezing, pulmonary edema present with abnormal electrocardiogram, cancer and bronchiectasis present with longer duration of cough, and pulmonary embolism is present with acute onset chest pain and shortness of breath. Mild pneumonia should be distinguished from upper respiratory tract infection (URTI). Severe pneumonia should be distinguished from acute heart failure. Pulmonary infiltrates lost after mechanical ventilation should show heart failure and atelectasis rather than pneumonia. For recurrent pneumonia, the underlying lung cancer, metastasis, tuberculosis, foreign body, immunosuppression, and hypersensitivity should be sought.
Prevention
Prevention includes vaccinations, environmental measures and appropriate treatment for other health problems. It is believed that, if appropriate precautions are instituted globally, deaths among children can be reduced to 400,000; and, if appropriate treatment is universally available, child mortality may be reduced to 600,000.
Vaccinations
Vaccination prevents against certain bacterial and viral pneumonia in both children and adults. Influenza vaccine is effective enough to prevent influenza symptoms, the Centers for Disease Control and Prevention (CDC) recommend annual influenza vaccinations for everyone aged 6 months or older. Immunization health care workers lower the risk of viral pneumonia among their patients.
Vaccination against Haemophilus influenzae and Streptococcus pneumoniae has good evidence to support its use. There is strong evidence to vaccinate children under 2 years of age against Streptococcus pneumoniae (pneumococcal conjugate vaccine). Children's vaccination against Streptococcus pneumoniae has caused a decrease in infection rates in adults, as many adults get infections from children. The vaccine Drugs
When an influenza outbreak occurs, drugs such as amantadine or rimantadine may help prevent the condition; but is associated with side effects. Zanamivir or oseltamivir reduces the likelihood that those exposed will experience symptoms; however, it is recommended that potential side effects be taken into account.
More
Smoking cessation and reducing indoor air pollution, such as from home cooking with wood or dirt, are both recommended. Smoking appears to be the biggest risk factor for pneumococcal pneumonia in healthy adults. Hand hygiene and coughing in a person's arm can also be an effective preventive measure. Wearing a surgical mask by a sick person can also prevent illness.
Treating underlying diseases (such as HIV/AIDS, diabetes mellitus, and malnutrition) may reduce the risk of pneumonia. In children less than 6 months of age, exclusive breastfeeding reduces the risk and severity of the disease. In those with HIV/AIDS and a CD4 cell count of less than 200 cells/uL trimethoprim/sulfamethoxazole antibiotics decreases the risk of Pneumocystis pneumonia and is also useful for prevention in those who are immunocomprised but do not have HIV.
Testing pregnant women for Group B Streptococcus and Chlamydia trachomatis , and administration of antibiotic treatment, if necessary, reduces pneumonia levels in infants; preventive measures for mother-to-child transmission of HIV can also be efficient. Sucking the mouth and throat of infants with amniotic fluid mixed with meconium has not been found to reduce aspiration levels of pneumonia and can cause potential hazards, so this practice is not recommended in most situations. In poor oral health care a good elderly can reduce the risk of aspiration pneumonia. Zinc supplements in children ages 2 months to five years seem to reduce the level of pneumonia.
For people with low levels of vitamin C in their diet or blood, taking vitamin C supplements may be recommended to reduce the risk of pneumonia, although there is no strong evidence that is beneficial. There is not enough evidence to recommend that the general population take vitamin C to prevent pneumonia.
For adults and children in hospitals requiring respirators, there is no strong evidence that shows the difference between heat exchangers and humidifiers and hot humidifiers to prevent pneumonia.
Management
Oral antibiotics, rest, simple analgesics, and fluids are usually sufficient for complete resolution. However, those with other medical conditions, older people, or those with significant breathing difficulties may require more sophisticated treatment. If symptoms worsen, pneumonia does not improve with home care, or complications occur, hospitalization may be necessary. Worldwide, about 7-13% of cases in children result in hospitalization, while in developed countries between 22 and 42% of adults with community-acquired pneumonia are recognized. The CURB-65 score is useful for determining the need for entry in adults. If the score is 0 or 1, people can usually be managed at home; if it is 2, short hospital stay or close follow-up is required; if 3-5, hospitalization is recommended. In children with respiratory disorders or oxygen saturation less than 90% should be hospitalized. The utility of chest physiotherapy in pneumonia has not been determined. Non-invasive ventilation may be beneficial to those treated in intensive care units. Over-the-counter cough medicine has not been found to be effective or has zinc use in children. There is not enough evidence for mukolitik. There is no strong evidence to recommend that children with non-measles pneumonia take vitamin A supplements. For those with sepsis, 30 ml/kg of crystalloid should be infused to correct hypotension.
Bacteria
Antibiotics increase the yield in those with bacterial pneumonia. The first dose of antibiotics should be given as soon as possible. Increased use of antibiotics, however, may lead to the development of antimicrobial resistant bacterial strains. The choice of antibiotics initially depends on the characteristics of the affected person, such as age, underlying health, and location of acquired infection. Use of antibiotics is also associated with side effects such as nausea, diarrhea, dizziness, taste distortion, or headache. In the UK, pre-cultured treatment with amoxicillin is recommended as a first line for community acquired pneumonia, with doxycycline or clarithromycin as an alternative. In North America, where the "atypical" forms of community acquired pneumonia are more common, macrolides (such as azithromycin or erythromycin), and doxycycline have replaced amoxicillin as the first-line outpatient treatment in adults. In children with mild or moderate symptoms, the amoxicillin taken is still in the first line. The use of fluoroquinolones in uncomplicated cases is not recommended because of concerns about side effects and produces resistance because there is no greater clinical benefit.
For those who require hospitalization and catching their pneumonia in a community of lactam-use such as cephazolin plus macrolide such as azithromycin or fluoroquinolones is recommended.
The duration of treatment is traditionally seven to ten days, but more evidence suggests that shorter programs (3-5 days) may be effective for certain types of pneumonia and may reduce the risk of antibiotic resistance. For ventilator-related pneumonia caused by Gram-negative non-fermented bacilli (NF-GNB), shorter antibiotics increase the risk of returning pneumonia. Recommendations for hospital-acquired pneumonia include third and fourth generation cephalosporins, carbapenems, fluoroquinolone, aminoglycosides, and vancomycin. These antibiotics are often given intravenously and used in combination. In those treated in the hospital, more than 90% improved with early antibiotics. For people with acquired ventilator pneumonia, the choice of antibiotic therapy will depend on a person's risk of being infected with a drug-resistant strain of various drugs. Once clinically stable, intravenous antibiotics should be swept into oral antibiotics. For those with Methicillin-resistant Staphylococcus aureus (MRSA) or Legionella , prolonged antibiotics may be helpful.
The addition of corticosteroids to standard antibiotic treatment appears to improve yield, reduce mortality and morbidity for adults with severe community pneumonia, and reduce morbidity for adults and children with community-acquired pneumonia. There are adverse effects associated with the use of corticosteroids such as high blood sugar and superinfection. There is some evidence that adding corticosteroids to the treatment of standard PCP pneumonia may be of benefit for people infected with HIV.
The use of granulocyte colonic stimulation factor (G-CSF) along with antibiotics does not seem to reduce mortality and routine use to treat pneumonia is not supported by evidence.
Viral
Neuraminidase inhibitors can be used to treat viral pneumonia caused by influenza virus (influenza A and influenza B). No specific antiviral drugs are recommended for other types of communities affected by viral pneumonia including coronavirus SARS virus, adenovirus, hantavirus, and parainfluenza. Influenza A can be treated with rimantadine or amantadine, while influenza A or B can be treated with oseltamivir, zanamivir or peramivir. This is particularly useful if it starts within 48 hours of onset of symptoms. Many strains of H5N1 influenza A, also known as bird flu or "bird flu", have shown resistance to rimantadine and amantadine. The use of antibiotics in viral pneumonia is recommended by some experts, as it is impossible to rule out complicated bacterial infections. The British Thoracic Society recommends that antibiotics be kept secret in those with mild disease. The use of controversial corticosteroids.
Aspiration
In general, aspiration pneumonitis is treated conservatively with antibiotics indicated only for aspiration pneumonia. The choice of antibiotics will depend on several factors, including suspected cause organisms and whether pneumonia is acquired in the community or developed in the hospital. Common options include clindamycin, a combination of beta-lactam antibiotics and metronidazole, or aminoglycosides. Corticosteroids are sometimes used in aspiration pneumonia, but there is limited evidence to support their effectiveness.
Prognosis
With treatment, most types of bacterial pneumonia will stabilize within 3-6 days. It often takes several weeks before most of the symptoms disappear. The X-ray findings are usually clear within four weeks and the mortality rate is low (less than 1%). In the elderly or people with other lung problems, recovery may take more than 12 weeks. In people who require hospitalization, deaths can be as high as 10%, and in those who require intensive care can reach 30-50%. Pneumonia is the most common hospital-acquired infection that causes death. Before the advent of antibiotics, deaths were usually 30% in those admitted to the hospital. However, for those whose lung condition worsens within 72 hours, the problem is usually due to sepsis. If pneumonia worsens after 72 hours, it can be caused by a nosocomial or excretory infection of other underlying comorbidities. Approximately 10% of those discharged from hospital are re-admitted because of comorbidities such as heart, lung, or neurological disorders, or due to the onset of new pneumonia.
Complications can occur especially in the elderly and those with health problems. These may include, among others: empyema, lung abscess, bronchiolitis obliterans, acute respiratory distress syndrome, sepsis, and worsening health problems.
Clinical prediction rule
Clinical prediction rules have been developed to predict the more objective outcome of pneumonia. These rules are often used in deciding whether or not to hospitalize the person.
- Pneumonia severity index (or PSI score )
- The CURB-65 score, which takes into account the severity of the symptoms, the underlying disease, and the age
Pleural effusion, empyema, and abscess
In pneumonia, fluid collections can form in the space surrounding the lungs. Sometimes, microorganisms will infect this fluid, causing empyema. To distinguish the empyema from the more common simple parapneumonic effusion, the fluid can be collected with a needle (thoracentesis), and examined. If this shows evidence of empyema, complete drainage of fluid is required, often requiring a drainage catheter. In cases of severe empyema, surgery may be necessary. If the infected fluid is not drained, the infection may persist, because antibiotics do not penetrate well into the pleural cavity. If the liquid is sterile, it should be dried only if it causes symptoms or remains unresolved.
In rare circumstances, bacteria in the lungs will form a bag of infected fluid called a lung abscess. Lung abscesses can usually be seen with chest x-ray but often require a chest CT scan to confirm the diagnosis. Abscesses usually occur in aspiration pneumonia, and often contain several types of bacteria. Long-term antibiotics are usually sufficient to treat lung abscess, but sometimes the abscess should be dried by a surgeon or radiologist.
Respiratory and circulatory failure
Pneumonia can cause respiratory failure by triggering acute respiratory distress syndrome (ARDS), which results from a combination of infections and inflammatory responses. The lungs are quickly filled with fluid and become stiff. This stiffness, combined with the severe difficulty of extracting oxygen due to alveolar fluid, may require periods of long mechanical ventilation to survive. Other causes of circulatory failure are hypoxemia, inflammation, and increased coagulability.
Sepsis is a potential complication of pneumonia but usually occurs in people with poor immunity or hyposplenism. The most commonly involved organisms are Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella pneumoniae . Other causes of symptoms should be considered such as myocardial infarction or pulmonary embolism.
Epidemiology
Pneumonia is a common disease affecting about 450 million people per year and occurs in all parts of the world. This is the leading cause of death among all age groups resulting in 4 million deaths (7% of total world deaths) each year. The highest rate in children is less than five, and adults older than 75 years. That happens about five times more often in developing countries than in developed countries. Viral pneumonia accounts for about 200 million cases. In the United States, in 2009, pneumonia was the cause of death to-8.
Children
In 2008, pneumonia occurred in about 156 million children (151 million in developing countries and 5 million in developed countries). In 2010, it resulted in 1.3 million deaths, or 18% of all deaths in those under five years, of which 95% occurred in developing countries. Countries with the greatest burden of diseases include India (43 million), China (21 million) and Pakistan (10 million). This is the leading cause of death among children in low-income countries. Many of these deaths occur in the newborn period. The World Health Organization estimates that one in three newborns deaths are caused by pneumonia. About half of these deaths can be prevented, because they are caused by the bacteria that are effective vaccines available. In 2011, pneumonia was the most common reason for admission to hospital after emergency department visits in the US for infants and children.
History
Pneumonia has become a common disease throughout human history. The word comes from the Greek word ??????? (pnea ºm? n) meaning "lung". Symptoms are described by Hippocrates (about 460 BC - 370 BC): "Peripneumonia, and pleural affection, should be observed: If fever is acute, and if there is pain on both sides, or both, and if expiration is if cough is present, widened to a blond or pale color, or also thin, foaming, and reddish, or have a different character than that common... When pneumonia reaches its peak, the case is beyond the drug if it is not cleaned, and it is bad if it has dyspnoea , and the urine is thin and sharp, and if the sweat comes out about the neck and head, because such sweat is bad, as proceeding from the suffocation, rales, and the violence of the disease that get the upper hand. "However, Hippocrates is called pneumonia as a disease" named by the ancients ". He also reported the results of empyemas surgical drainage. Maimonides (1135-1204 AD) observed: "The basic symptoms that occur in pneumonia and which are never less are as follows: acute fever, pleuritic pain attached to the side, short short breath, jagged pulse and cough." This clinical picture is very similar to that found in modern textbooks, and it reflects the level of medical knowledge through the Middle Ages into the 19th century.
Edwin Klebs was the first to observe bacteria in the airways of people who died of pneumonia in 1875. Initial work identified two common causes of bacteria, Streptococcus pneumoniae and Klebsiella pneumoniae, performed by Carl FriedlÃÆ'¤nder and Albert Fraenkel in 1882 and 1884, respectively. Friedlönmer's initial work introduces Gram staining, a fundamental laboratory test still in use today to identify and categorize bacteria. The Christian Gram paper describing the procedure in 1884 helped distinguish the two bacteria, and showed that pneumonia can be caused by more than one microorganism.
Sir William Osler, known as the "father of modern medicine," appreciated the death and disability caused by pneumonia, describing him as the "captain of the dead" in 1918, for having taken over tuberculosis as one of the leading causes of death when this. This phrase was originally created by John Bunyan in reference to "consumption" (tuberculosis). Osler also describes pneumonia as an "old man's friend" because death is often quick and painless when there is a much slower and more painful way to die.
Some developments in the 1900s increased the yield for those with pneumonia. With the advent of penicillin and other antibiotics, modern surgical techniques, and intensive care in the 20th century, the mortality rate of pneumonia, which has been close to 30%, has fallen dramatically in developed countries. The infant vaccination against type B haemophilus influenzae started in 1988 and caused a dramatic decline in cases shortly thereafter. The vaccination against Streptococcus pneumoniae in adults started in 1977, and in children in 2000, produced a similar decrease.
Society and culture
Awareness
Due to the relatively low awareness of the disease, November 12 is declared a World Day of Pneumonia annual, a day for caring citizens and policymakers to take action against the disease, in 2009.
Cost
The global economic cost of community-acquired pneumonia is estimated at $ 17 billion per year. The other estimates are much higher. By 2012, the estimated aggregate cost of treating pneumonia in the United States is $ 20 billion; the average cost of one inpatient related to pneumonia is over $ 15,000. According to data released by Centers for Medicare and Medicaid Services, the average cost of 2012 hospitals for uncomplicated hospitalization of pneumonia in the United States is $ 24,549 and ranges as high as $ 124,000. The average cost of emergency room consulted for pneumonia is $ 943 and the median cost for treatment is $ 66. The aggregate annual cost of treating pneumonia in Europe has been estimated at EUR10 billion.
Research
In 2016 there has been one large trial that studied the use of vitamin D to prevent pneumonia in children, who found no effect.
References
Bibliography
External links
- Pneumonia in Curlie (based on DMOZ)
Source of the article : Wikipedia
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