PNEUMONIA

PNEUMONIA: 

PNEUMONIA Mary Jeannie Wu Hearty Yao

Pneumonia: 

Pneumonia infection of the lungs, especially the alveoli, which can be caused by a variety of microorganisms (viruses , bacteria, fungi , parasites) respiratory disease characterized by inflammation of the lung parenchyma (excluding the bronchi) with congestion caused by viruses or bacteria or irritants 3 rd leading cause of mortality and morbidity in the philippines (2001)

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caused by the inhalation of infected microorganisms (tiny, single-celled living organisms, such as bacteria, viruses, fungi or protozoa) spread through contact with an infected person. The microorganisms enter the body through the mouth, nose and eyes. If the body's resistance is down, the natural process of fighting off diseases is weakened and the microorganisms are free to spread into the lungs and the lungs' air sacs. The air sacs become filled with fluid and pus from the infectious agent, making it more difficult for the body to get the oxygen it needs, and the person may become sick. Potential complications of pneumonia include pleural effusion (fluid around the lung), empyema (pus in the pleural cavity), hyponatremia (low blood sodium) and rarely, an abscess in the lung.

Synonyms of pneumonia: 

Synonyms of pneumonia Anaerobic pneumonia Aspiration of vomitus Aspiration pneumonia Bacterial pneumonia Classic pneumococcal pneumonia Lobar pneumonia Necrotizing pneumonia Pyogenic pneumonia Walking pneumonia - atypical pneumonia

Causative agent: 

Causative agent viruses and bacteria (most common infectious causes ) fungi and parasites (less common)

History!: 

History! Pneumonia is an infection of one or both lungs which is usually caused by bacteria, viruses, or fungi. Prior to the discovery of antibiotics, one-third of all people who developed pneumonia subsequently died from the infection. Currently, over 3 million people develop pneumonia each year in the United States. Over a half a million of these people are admitted to a hospital for treatment. Although most of these people recover, approximately 5% will die from pneumonia. Pneumonia is the sixth leading cause of death in the United States.

Viruses (Viral pneumonia): 

Viruses (Viral pneumonia) In adults viruses account for approximately a third of pneumonia cases Half of all pneumonias are believed to be caused by viruses, such as influenza (flu), adenovirus, coxsackievirus , chickenpox, measles , cytomegalovirus and respiratory syncytial virus . These viruses invade the lungs and multiply. rhinoviruses , coronaviruses , influenza virus respiratory syncytial virus (RSV ) adenovirus P arainfluenza Herpes simplex virus - rare cause of pneumonia except in newborns cytomegalovirus (CMV )- People with weakened immune systems

Bacteria (Bacterial pneumonia): 

Bacteria (Bacterial pneumonia) most common cause of community acquired pneumonia Pneumonia-causing bacteria is present in many throats, but when the body's defenses are weakened (for example, by illness, old age, malnutrition or impaired immunity) the bacteria can multiply, working its way into the lungs, inflaming the air sacs and filling the lungs with liquid and pus. The bacteria that cause bacterial pneumonia are streptococcus pneumonia (resulting in lobar pneumonia), hemophilus influenza (resulting in bronchopneumonia), legionella pneumophilia (resulting in Legionnaires ' disease ) and staphylococcus aureus . Streptococcus pneumoniae 50% Haemophilus influenzae 20% Chlamydophila pneumoniae 13% Mycoplasma pneumoniae 3% Staphylococcus aureus , with Streptococcus agalactiae –new born babies

Gram - bacteria: 

Gram - bacteria Haemophilus influenzae , Klebsiella pneumoniae , Escherichia coli , Pseudomonas aeruginosa Moraxella catarrhalis live in the stomach or intestines and may enter the lungs if vomit is inhaled

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"Atypical" bacteria which cause pneumonia include Chlamydophila pneumoniae , Mycoplasma pneumoniae , Legionella pneumophila .

Fungi (Fungal Pneumonia): 

Fungi (Fungal Pneumonia) uncommon, but it may occur in individuals with immune system problems due to AIDS , immunosuppressive drugs Histoplasma capsulatum , blastomyces , Cryptococcus neoformans , Pneumocystis jiroveci , and Coccidioides immitis . Histoplasmosis is most common in the Mississippi River basin , and coccidioidomycosis in the southwestern United States .

Parasites (Parasitic pneumonia): 

Parasites (Parasitic pneumonia) enter the body through the skin or by being swallowed. travel to the lungs, usually through the blood. There, as in other cases of pneumonia, a combination of cellular destruction and immune response causes disruption of oxygen transportation . Eosinophils in the lungs can lead to eosinophilic pneumonia , thus complicating the underlying parasitic pneumonia. The most common parasites causing pneumonia are Toxoplasma gondii , Strongyloides stercoralis , and Ascariasis .

Idiopathic interstitial pneumonia: 

Idiopathic interstitial pneumonia Idiopathic interstitial pneumonia or noninfectious pneumonia [17] are a class of diffuse lung diseases . They include: diffuse alveolar damage , organizing pneumonia , nonspecific interstitial pneumonia , lymphocytic interstitial pneumonia , desquamative interstitial pneumonia , respiratory bronchiolitis interstitial lung disease , and usual interstitial pneumonia . [

Mycoplasmal pneumonia: 

Mycoplasmal pneumonia also called "walking pneumonia" Similar to bacterial pneumonia, the mycoplasmas multiply and spread, causing infection. Some of the other pneumonia-related disorders are aspiration pneumonia, chlamydial pneumonia, Loffler's syndrome, pneumocystis carinii pneumonia, pediatric pneumonia and necrotizing pneumonia.

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Risk factors include: 65 years of age or older People in nursing homes or other chronic care facilities Male Children under the age of two People with colds or other respiratory infections People with reduced immunity People with other lung diseases, such as asthma , cystic fibrosis and lung cancer People with AIDS or HIV Organ transplant recipients People who have had their spleen removed People receiving chemotherapy People who smoke Alcoholics People with chronic health problems, such as lung disease, heart disease , kidney disorders, sickle cell anemia or diabetes

Etiology: 

Etiology Typical S. Pneumoniae H. Influenza S. Aureus K. Pneumoniae P. aeruginosa At ypical M. Pneumoniae C. Pneumoniae Legionella spp. Respiratory viruses

Pathophysiology: 

Pathophysiology Viral Invade cells in order to reproduce reaches the lungs when airborne droplets are inhaled through the mouth and nose . invades the cells lining the airways and alveoli and often lead to cell death or apoptosis NOTE: When the immune system responds to the viral infection, even more lung damage occurs.

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White blood cells , mainly lymphocytes , activate certain chemical cytokines which allow fluid to leak into the alveoli. This combination of cell destruction and fluid-filled alveoli interrupts the normal transportation of oxygen into the bloodstream. As well as damaging the lungs, many viruses affect other organs and thus disrupt many body functions. Viruses can also make the body more susceptible to bacterial infections; for which reason bacterial pneumonia may complicate viral pneumonia.

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Bacterial enter the lung when airborne droplets are inhaled, but can also reach the lung through the bloodstream when there is an infection in another part of live in parts of the upper respiratory tract , such as the nose, mouth and sinuses, and can easily be inhaled into the alveoli the body . This invasion triggers the immune system to send neutrophils , a type of defensive white blood cell, to the lungs. The neutrophils engulf and kill the offending organisms, and also release cytokines , causing a general activation of the immune system. This leads to the fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils , bacteria, and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation.

Classification: 

Classification Where or how it is acquired community-acquired , aspiration , healthcare-associated , hospital-acquired , and ventilator-associated pneumonia ) but may also be classified by the area of lung affected ( lobar pneumonia , bronchial pneumonia and acute interstitial pneumonia ) or by the causative organism . Pneumonia in children may additionally be classified based on signs and symptoms into non severe, severe, and very severe.

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Community -Acquired Pneumonia (CAP) Typical Atypical Health Care-Associated P neumonia (HCAP) Hospital-Acquired pneumonia (HAP) Ventilator-Associated Pneumonia (VAP)

Signs and Symptoms : 

Signs and Symptoms fever chills cough nasal congestion unusually rapid breathing (in some cases, this is the only symptom) breathing with grunting or wheezing sounds labored breathing that makes the rib muscles retract (when muscles under the ribcage or between ribs draw inward with each breath) and causes nasal flaring vomiting chest pain abdominal pain decreased activity loss of appetite (in older kids) or poor feeding (in infants), which may lead to dehydration in extreme cases, bluish or gray color of the lips and fingernails

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Symptoms of Pneumonia Symptoms vary, depending on the type of pneumonia and the individual. With bacterial pneumonia , the person may experience: shaking chills chattering teeth severe chest pain cough that produces rust- colored or greenish mucus very high fever sweating rapid breathing rapid pulse rate With viral pneumonia , the person may experience: fever dry cough headache muscle pain and weakness These flu-like symptoms may be followed within one or two days by: increasing breathlessness dry cough becomes worse and produces a small amount of mucus higher fever bluish color to the lips With mycoplasma pneumonia , the person may experience: violent coughing attacks

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chills fever nausea vomiting slow heartbeat breathlessness bluish color to lips and nailbeds diarrhea rash muscle aches Regardless of the type of pneumonia, the person may also experience the following symptoms: a loss in appetite feeling ill clammy skin nasal flaring fatigue mental confusion joint and muscle stiffness anxiety , stress and tension abdominal pain

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Incubation The incubation period (the length of time between exposure and feeling sick) for pneumonia varies, depending on the type of virus or bacteria causing the infection. For instance, for RSV, this is 4 to 6 days; for influenza, 18 to 72 hours. Duration With treatment, most types of bacterial pneumonia can be cured within 1 to 2 weeks. Viral pneumonia may last longer. Mycoplasmal pneumonia may take 4 to 6 weeks to resolve completely

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Contagiousness The viruses and bacteria that cause pneumonia are contagious and usually found in fluid from the mouth or nose of someone who's infected. Illness can spread when an infected person coughs or sneezes on others, by sharing drinking glasses and eating utensils, and when someone touches the used tissues or handkerchiefs of an infected person.

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Diagnosis of Pneumonia To diagnose pneumonia , the doctor begins with a medical history and physical examination. By placing a stethoscope on the chest, the doctor may be able to hear crackling sounds, coarse breathing, wheezing and/or the breathing may be faint in a particular area of the chest. Additionally, the doctor may order a chest x-ray, a sputum gram stain and a blood test. The chest x-ray may show a blotchy-white area, where fluid and pus has accumulated in the lung's air sacs. The sputum grain stain and the blood test may determine the cause and severity of the condition. If these tests are inconclusive, the doctor may perform a procedure called a bronchoscopy . In this procedure, a flexible, thin and lit viewing tube is inserted into the nose or mouth after a local anesthetic is administered. The breathing passages can then be directly examined by the doctor and specimens from the infected part of the lung can be obtained

Things to do: 

Things to do See your doctor. Go to your local emergency room if your doctor is unavailable, if you have a high fever accompanied by a cough that brings up colored sputum, or if you have difficulty breathing. 2Receive anti-pneumonia medication, either oral or intravenous. 3Drink plenty of fluids. This aids the immune system and helps loosen lung congestion. 4Take analgesics for pain. Your chest muscles may become sore from coughing and the added effort of breathing, and your body will feel achy from fighting infection. Ask your doctor what analgesic is right for you. For severe pneumonia, your doctor may prescribe codeine, but take it as sparingly as possible. Codeine suppresses coughing, and coughing is beneficial to the lungs. 5Rest. If you have pneumonia, get at least eight hours of sleep each night, and take a midday catnap. 6Cough and breathe deeply. Expand your lungs and help them heal by taking deep breaths through your mouth, holding the air in for 5 to 10 seconds and exhaling forcefully. 7Take an expectorant, like guaifenesin , to bring up sputum. However, studies offer no conclusive proof that expectorants speed up recovery from pneumonia.

TIPS AND WARNINGS: 

TIPS AND WARNINGS Tips & Warnings Bacterial pneumonia drugs are usually antibiotics such as penicillin, cephalosporins and clarithromycin . Viral pneumonia associated with AIDS is treated with trimethoprim / sulfamethoxazole . Pneumonia is a serious illness. Each year, 40,000 to 70,000 Americans die from the disease. See your doctor for prolonged cough, soreness when breathing, rust- colored , brown, green or yellow sputum, or prolonged fever. If you have any questions or concerns about your health, contact a physician or other health care professional. This information is not intended as a substitute for professional medical advice or treatment.

Treatment (NATURAL): 

Treatment (NATURAL) There are several natural and herbal remedies available to treat pneumonia. A 3-month treatment program is recommended. Diet and Nutrition 1Remove excessive amounts of animal protein from your diet. During a bout with pneumonia, it is important to get as much protein from vegetable sources as possible. Excessive amounts of animal protein can be hard on your digestive system, especially if you are sick. When you are ill, it is important to keep yourself regular and allow whole foods to work quickly so your body can absorb their nutrients and fight the infection. A healthy amount of protein can be found in vegetables such as beets, artichokes, spinach, cauliflower, peas, eggplant and potatoes. 2Mince 4 to 6 garlic gloves and 1/2 onion. Add 8 to 10 oz. of water and 2 tsp. of honey. Blend well and drink 30 minutes before you eat your first meal. This mixture will help open your bronchial passages so you can stay comfortable during the day. Drink this mixture throughout the day if you feel unusually congested. 3Drink a 12 to 14 oz. glass of cranberry/apple juice with breakfast. This will add antioxidants to your system. Do not eat any solid foods for breakfast, except for a small bowl of yogurt or kefir . 4Drink a potassium broth with lunch. Making a potassium broth is simple. It can be done by juicing 2 large carrots, 2 stalks of celery, 4 cloves of garlic, 2 radishes and a few pinches of parsley. If you don't have a juicer, drink 10 to 12 oz. of low-sodium vegetable juice. V-8 Juice is among the top brands. It is important to get as much potassium as possible during a bout with pneumonia. Potassium helps repair damaged tissue in the lungs. Do not drink a potassium broth if you have heart disease; potassium helps to regulate your heart function and too much can be dangerous. Consult your health care provider before drinking a potassium broth. 5Drink a 12-ounce glass of carrot juice with dinner. Add 1 tbsp. of cayenne pepper. Carrot juice will help heal the lungs, and add antioxidants to your damaged tissue. Carrot juice, aside from being a wonderful source of vitamin A, is also rich in calcium, magnesium, potassium, phosphorus, iron and vitamin B complex. Cayenne will increase the effectiveness of the carrot juice. It also helps in repairing tissues in the lungs. 6Drink 1 or 2 cups of olive leaf extract tea before bed. Olive leaf extract acts as a natural antibiotic and will help your body fight your infection by attacking the pneumonia, while keeping the rest of your immune system healthy. Olive leaf extract is sold in tea form at health food stores. It is also available in capsules, powder and as a liquid elixir, if you wish to take it in a form other than tea.

Treatment(natural): 

Treatment(natural) Body Care 1Relax in an oxygen bath at least once a day. An oxygen bath consists of adding 2 cups of hydrogen peroxide, 1/4 cup of sea salt and 1/2 cup of baking soda to a hot bath. Sit for at least 15 to 30 minutes. An oxygen bath will help you breathe while it oxidizes the toxins and mucous built up in your lungs so they can be released through your pores, nose and urine. 2Apply a mustard plaster to your chest twice a week. A mustard plaster is made by mixing 2 tbsp. of mustard powder, 2 eggs, 6 tbsp. of wheat flower and a cup of water into paste. Apply liberally to your chest and let it sit for 20 minutes, or until you skin flushes to a light pink color . This mixture will held bring the toxins in your lungs to the surface so they can escape through your pores. Do not use the mustard plaster if you have any allegies to mustard, egg or wheat. 3Sit in a hot sauna or steam bath for 20 minutes at least once a week. If a sauna or steam room is not available, simply add 10 to 20 drops of eucalyptus oil to a hot bath. Breathe in the steam slowly and allow the oils to open your pores so toxins may be release through your skin. 4Perform a nasal/mucous treatment at least once a day or as needed: Bring a large pot of water to a boil. Add 5 to 10 drops of eucalyptus oil. Place a bath towel over your head and breath in the steam from the water. Do this until the water is room temperature or the steam subsides.

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Tips an warnings Take at least 3,000 mg of vitamin C per day. Drink at least 8 to 10 ounces of water per day. Use a topical herbal oxygen spray as needed. Oxygen spray will penetrate your pores and help ease the pain. There are many pain relieving sprays on the market. A highly effective oxygen spray is Oxy-Spray, made by Earth's Bounty. Take 4,000 mg of cornsilk extract per day; this extract fights infection and acts as a diuretic. Blow your nose and rid your throat of mucous as needed. Antibiotics are considered the best way to heal your body from pneumonia. Do not discontinue antibiotic use without the advice of your health care provider and do not substitute home remedies for needed medical intervention. Avoid smoking. Smoking robs the body of oxygen. Refer to an herb guide before mixing herbs with antibiotics. Do not take any herbal supplements without first consulting with your health care provider. Cover your mouth and nose with a scarf or simple respirator if you go outdoors in cold weather. Get plenty of sleep. Avoid strenuous activity. Avoid caffeine. This article, in no way, is to be considered medial advice. If you have questions about supplements, dietary or lifestyle changes, consult your doctor or other health care professional. If you have unusual side effects from any supplement, stop taking it and call your doctor. If you feel extremely ill at any time, dial 911.

Treatment: 

Treatment Treatment of Pneumonia Treatment depends on the severity of symptoms and the type of organism causing the infection. Bacterial pneumonia (caused by the streptococcus pneumonia bacteria) is often treated with penicillin, ampicillin-clavulanate ( Augmentin ) and erythromycin. Bacterial pneumonia (caused by the hemophilus influenza bacteria) is treated with antibiotics, such as cefuroxime ( Ceftin ), ampicillin-clavulanate ( Augmentin ), ofloxacin ( Floxin ), and trimethoprim-sulfanethoxazole ( Bactrim and Septra ). Bacterial pneumonia (caused by legionella pneumophilia and staphylococcus aureus bacteria) are treated with antibiotics, such as erythromycin. Viral pneumonia does not respond to antibiotic treatment. This type of pneumonia usually resolves over time. If the lungs become infected with a secondary bacterial infection, the doctor will prescribe an appropriate antibiotic to eliminate the bacterial infection. Mycoplasma pneumonia is often treated with antibiotics, such as erythromycin, clarithromycin ( Biaxin ), tetracycline or azithromycin ( Zithromax ). Hib Vaccine. Currently three Hib conjugate vaccines are available for use in infants and young children. The efficacy of Hib vaccine in preventing invasive disease (mainly meningitis, but also pneumonia) Pneumococcal Vaccines. Two kinds of vaccines are currentlyavailable against pneumococci : a 23-valent polysaccharide vaccine (23-PSV), which is more appropriate for adults than children, and a 7-valent protein-conjugated polysaccharide vaccine(7-PCV). A 9-valent vaccine (9-PCV) has undergone clinical trials in The Gambia and South Africa, and an 11-valent vaccine (11-PCV) is being tried in the Philippine

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In addition to the pharmaceutical intervention, the doctor will also recommend bedrest , plenty of fluids, therapeutic coughing, breathing exercises, proper diet, cough suppressants, pain relievers and fever reducers, such as aspirin (not for children) or acetaminophen. In severe cases, oxygen therapy and artificial ventilation may be required.

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The course of pneumonia varies. Recovery time depends upon the organism involved, the general health of the person and how promptly medical attention was obtained. A majority of sufferers recover completely within a few weeks, with residual coughing persisting between six and eight weeks after the infection has gone.

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n. Amoxicillin is concentrated in tissues and in macrophages, and drug levels are directly correlated with oral dosages. Therefore, higher doses than in the past—given twice a day—are now being used to successfully treat ear infections caused by penicillin-resistant S. pneumoniae . Amoxicillin is clearly better than penicillin for such infections. The situation with co- trimoxazole is less clear (Strauss and others 1998), and in the face of high rates of cotrimoxazole resistance, amoxicil

PREVENTION: 

PREVENTION

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Prevention of Pneumonia Practice good hygiene. Get an influenza shot each fall. Get a pneumonococcal vaccine. People who stand to benefit most from vaccination are those over the age 65; anyone with chronic health problems (such as diabetes, kidney disease, heart disease, etc.); anyone who has had their spleen removed; anyone living in a nursing home or chronic care facility; caregivers of the chronically ill (healthcare workers or family caregivers); children with chronic respiratory diseases (such as asthma), and anyone who has had pneumonia in the past (due to increased risk of reinfection ). The pneumonococcal vaccine is 90 percent effective against the bacteria and protects against infection for five to 10 years. Practice good preventive measures by eating a proper diet, getting regular exercise and plenty of sleep. Do not smoke. Questions To Ask Your Doctor About Pneumonia Are tests needed to diagnose or determine the cause of this pneumonia? What is the cause? How serious is the condition? What treatment do you recommend? How long until full recovery? Can pneumonia recur more frequently? Do you recommend a vaccination?

Government programs: 

Government programs World Pneumonia Day Advocacy Program 2010 Expanded Program for Immunization (EPI)

Statistics: 

Statistics Pneumonia remains the leading killer of children under fiveyears of age, with over 1.5 million young children dying from the disease annually limited access to prevention and treatment measures,account for 98% of all pneumonia deaths worldwide MANILA - Pneumonia has become the "No. 1 killer" for children 5 years old and below, health groups said on Tuesday. In connection with World Pneumonia Day on November 2, members of the government, private sector, media, and concerned health groups held a health forum early this week on raising awareness about pneumonia. According to resource persons at the forum, about 9,000 Filipino children die from the disease every year.

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East Asia and the Pacific and sub-Saharan Africa have the highest pneumonia mortality rates among children under five Percentage of deaths among children under five years of age attributed to pneumonia (neonatal deaths not included), 2008 Source: WHO/Child Health Epidemiology Reference Group (CHERG) estimates presented in The Lancet , June 2010.

Notifiable Diseases Reported Cases by Cause 2001 - 2008: 

Notifiable Diseases Reported Cases by Cause 2001 - 2008 Pneumonia 652,585 (2001) 734,581  (2002) 674,386  (2003) 776,562 (2004) 690,566 (2005) 670,231 (2006) 605,471 (2007) 780,199 (2008)

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