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Science 09 Jan 1942: Vol. [1] [92] Suctioning the mouth and throat of infants with meconium-stained amniotic fluid has not been found to reduce the rate of aspiration pneumonia and may cause potential harm,[93] thus this practice is not recommended in the majority of situations. In one particular population, the intubated and mechanically ventilated patient, the risk of infection is particularly high, and nosocomial pneumonia is a major cause of mortality. [65], Physical examination may sometimes reveal low blood pressure, high heart rate, or low oxygen saturation. [12][22][133] Countries with the greatest burden of disease include India (43 million), China (21 million) and Pakistan (10 million). [9], The typical signs and symptoms in children under five are fever, cough, and fast or difficult breathing. [54] In adults with normal vital signs and a normal lung examination, the diagnosis is unlikely. [126] [35] Radiologic findings may not be present in the early stages of the disease, especially in the presence of dehydration, or may be difficult to interpret in the obese or those with a history of lung disease. [61] Worldwide, approximately 7–13% of cases in children result in hospitalization,[22] whereas in the developed world between 22 and 42% of adults with community-acquired pneumonia are admitted. [22] For people who do not respond to treatment, sputum culture should be considered, and culture for Mycobacterium tuberculosis should be carried out in persons with a chronic productive cough. The combination of cellular destruction and fluid-filled alveoli interrupts the transportation of oxygen into the bloodstream. [146][147] Osler also described pneumonia as "the old man's friend" as death was often quick and painless when there were much slower and more painful ways to die. [75][32] Ventilator-associated pneumonia is specifically defined as pneumonia that arises more than 48 to 72 hours after endotracheal intubation. [110], Antibiotics improve outcomes in those with bacterial pneumonia. [67] Ultrasound is radiation free and can be done at bedside. [71], Appropriately treating underlying illnesses (such as HIV/AIDS, diabetes mellitus, and malnutrition) can decrease the risk of pneumonia. [50] The neutrophils also release cytokines, causing a general activation of the immune system. Pneumonia is an infection of the lungs, filling them with fluid. [116][70] A fluoroquinolone may replace azithromycin but is less preferred. [23] Crackles (rales) may be heard over the affected area during inspiration. [23], In 2008, pneumonia occurred in approximately 156 million children (151 million in the developing world and 5 million in the developed world). [48] It is a type of pneumonitis (lung inflammation). [23] Once in the upper airway, the viruses may make their way into the lungs, where they invade the cells lining the airways, alveoli, or lung parenchyma. [28] Most patients (62%) had no detectable pathogens in their sample, and unexpectedly, respiratory viruses were detected more frequently than bacteria. [51] This leads to the fever, chills, and fatigue common in bacterial pneumonia. [117], The duration of treatment has traditionally been seven to ten days, but increasing evidence suggests that shorter courses (3–5 days) may be effective for certain types of pneumonia and may reduce the risk of antibiotic resistance. [12], In general, aspiration pneumonitis is treated conservatively with antibiotics indicated only for aspiration pneumonia. It is characterized by an inflammatory state of the entire body, caused by an infection. New research shows that adults with systemic lupus erythematosus, who receive trimethoprim-sulfamethoxazole (TMP-SMX), a prophylactic therapy to help prevent pneumocystis pneumonia, are … [70] Side effects associated with the use of corticosteroids include high blood sugar. [61] American guidelines vary, from generally recommending a follow-up chest radiograph[127] to not mentioning any follow-up. The World Health Organization estimates that one in three newborn infant deaths is due to pneumonia. There are roughly 450 million cases of pneumonia every year. [27] For people with ventilator-acquired pneumonia, the choice of antibiotic therapy will depend on the person's risk of being infected with a strain of bacteria that is multi-drug resistant. [8] Chest X-rays, blood tests, and culture of the sputum may help confirm the diagnosis. The lungs are made of small sacs called alveoli, which fill with air when a healthy person breathes. A Streptococcus pneumoniae vaccine is available for adults, and has been found to decrease the risk of invasive pneumococcal disease by 74%, but there is insufficient evidence to suggest using the pneumococcal vaccine to prevent pneumonia or death in the general adult population. [23][27] Examination of the chest may be normal, but it may show decreased expansion on the affected side. [34] About 10% of those discharged from hospital are readmitted due to underlying co-morbidities such as heart, lung, or neurological disorders, or due to new onset of pneumonia. [20] In an active population-based surveillance for community-acquired pneumonia requiring hospitalization in five hospitals in Chicago and Nashville from January 2010 through June 2012, 2259 patients were identified who had radiographic evidence of pneumonia and specimens that could be tested for the responsible pathogen. It can be triggered by a cold or the flu, which allows the germs to gain access to the lungs. Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis is most common in the Southwestern United States. Acute pulmonary infection by Streptococcus pneumoniae is characterized by high bacterial numbers in the lung, a robust alveolar influx of polymorphonuclear cells (PMNs) and a risk of systemic spread of the bacterium. Out of this work, the distinction between viral and bacterial strains was noticed. [49] The normal flora of the upper airway give protection by competing with pathogens for nutrients. Pneumonia is an infection that causes inflammation in one or both of the lungs. [8] The disease may be classified by where it was acquired, such as community- or hospital-acquired or healthcare-associated pneumonia. [28] Specifically, 23% had one or more viruses, 11% had one or more bacteria, 3% had both bacterial and viral pathogens, and 1% had a fungal or mycobacterial infection. Cause. B. [76][75] It is likely to involve hospital-acquired infections, with higher risk of multidrug-resistant pathogens. Bloodstream Infection. [43] In the developed world, these infections are most common in people returning from travel or in immigrants. "The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%). [12] Mycoplasma, Legionella, Streptococcus, and Chlamydia can also be detected using PCR techniques on bronchoalveolar lavage and nasopharyngeal swab. [105] There is insufficient evidence for mucolytics. [94] Zinc supplementation in children 2 months to five years old appears to reduce rates of pneumonia. [43] In other infections, such as malaria, lung involvement is due primarily to cytokine-induced systemic inflammation. [47], Pneumonia frequently starts as an upper respiratory tract infection that moves into the lower respiratory tract. [33] For people with certain variants of the FER gene, the risk of death is reduced in sepsis caused by pneumonia. [12] In 2010, it resulted in 1.3 million deaths, or 18% of all deaths in those under five years, of which 95% occurred in the developing world. [1] The severity of the condition is variable. In the pre-antibiotic age, pneumonias had been treated with specific anti-serums of highly variable therapeutic effect and undesirable side-effects (a practice eliminated by the advent of sulfamides in 1936 and the beginning availability of penicillin in the 1940s). There, the virus invades the cells lining the airways and the alveoli. [27] These rules are often used to decide whether to hospitalize the person. [24] Pneumonia was historically divided into "typical" and "atypical" based on the belief that the presentation predicted the underlying cause. [20] Streptococcus pneumoniae is more common in the winter,[20] and it should be suspected in persons aspirating a large number of anaerobic organisms. [14] Viral pneumonia is more prevalent in the very young, less than 5 years old, and in the very old, more than 75 years old. [1] Pneumonia can be caused by bacteria, viruses, fungi, or parasites. Viruses must invade cells in order to reproduce. Other causes of the symptoms should be considered such as a myocardial infarction or a pulmonary embolism. Pneumonia is swelling (inflammation) of the tissue in one or both lungs. Pneumonia is swelling (inflammation) of the tissue in one or both lungs.It's usually caused by an infection, most commonly bacteria and viruses, which are both contagious. [22][24] Smoking appears to be the single biggest risk factor for pneumococcal pneumonia in otherwise-healthy adults. Severe pneumonia can be deadly. Fungi can induce pneumonia, too. SUMMARY Recently, it has been recognized that oral infection, especially periodontitis, may affect the course and pathogenesis of a number of systemic diseases, such as cardiovascular disease, bacterial pneumonia, diabetes mellitus, and low birth weight. Long-term antibiotics are usually adequate to treat a lung abscess, but sometimes the abscess must be drained by a surgeon or radiologist. [107], Pneumonia can cause severe illness in a number of ways, and pneumonia with evidence of organ dysfunction may require intensive care unit admission for observation and specific treatment. [24], Vaccination prevents against certain bacterial and viral pneumonias both in children and adults. In an active population-based surveillance for co… [64] Antibiotics are encouraged if the procalcitonin level reaches 0.25 μg/L, strongly encouraged if it reaches 0.5 μg/L, and strongly discouraged if the level is below 0.10 μg/L. [130], In rare circumstances, bacteria in the lung will form a pocket of infected fluid called a lung abscess. Nausea: The organisms most commonly involved are Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella pneumoniae. Pneumonia is due to infections caused primarily by bacteria or viruses and less commonly by fungi and parasites. [27] A minority of types of bacteria such as Mycobacterium tuberculosis and Legionella pneumophila reach the lungs via contaminated airborne droplets. [20] A number of drug-resistant versions of the above infections are becoming more common, including drug-resistant Streptococcus pneumoniae (DRSP) and methicillin-resistant Staphylococcus aureus (MRSA). [22] Fever is not very specific, as it occurs in many other common illnesses and may be absent in those with severe disease, malnutrition or in the elderly. [130] If the infected fluid is not drained, the infection may persist, because antibiotics do not penetrate well into the pleural cavity. [51] The neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli, resulting in the consolidation seen on chest X-ray. [31] Approximately 10% of people who require mechanical ventilation develop ventilator-associated pneumonia,[32] and people with a gastric feeding tube have an increased risk of developing aspiration pneumonia. [76] HCAP is sometimes called MCAP (medical care–associated pneumonia). [27] However, evidence has not supported this distinction, therefore it is no longer emphasized. [71], With treatment, most types of bacterial pneumonia will stabilize in 3–6 days. [22][61] If a person is sufficiently sick to require hospitalization, a chest radiograph is recommended. [108], For adults with moderate or severe acute respiratory distress syndrome (ARDS) undergoing mechanical ventilation, there is a reduction in mortality when people lay on their front for at least 12 hours a day. [12] It occurs about five times more frequently in the developing world than in the developed world. [34] Testing for other specific organisms may be recommended during outbreaks, for public health reasons. A more likely and common route of systemic infection by oral microorganisms is through aspiration of oropharyngeal fluids containing oral pathogenic microorganisms, which colonize the lower respiratory tract and cause pneumonia. Vaccination of infants against Haemophilus influenzae type B began in 1988 and led to a dramatic decline in cases shortly thereafter. Corticosteroids are sometimes used in aspiration pneumonia, but there is limited evidence to support their effectiveness. [136] In 2011, pneumonia was the most common reason for admission to the hospital after an emergency department visit in the U.S. for infants and children.[137]. Pneumonia is an infection in your lungs that inflames the air sacs, sometimes filling them with fluid or pus. [23] Viral pneumonia presents more commonly with wheezing than bacterial pneumonia. This phrase was originally coined by John Bunyan in reference to "consumption" (tuberculosis). [12] The British Thoracic Society recommends that antibiotics be withheld in those with mild disease. [122] A 2019 guideline however recommended against there general use, unless refractory shock was present. [24][84][87] In children less than 6 months of age, exclusive breast feeding reduces both the risk and severity of disease. [2] It often takes a few weeks before most symptoms resolve. [32] Once clinically stable, intravenous antibiotics should be switched to oral antibiotics. [9], Pneumonitis refers to lung inflammation; pneumonia refers to pneumonitis, usually due to infection but sometimes non-infectious, that has the additional feature of pulmonary consolidation. Pneumonia can be community-acquired, meaning that a person becomes ill with pneumonia outside of the hospital or a healthcare facility.Pneumonia can also be caused by a healthcare-associated infection (HAI), which affect 1.7 million hospitalizations in the United States every year. It may involve several organ systems and is associated with the severity and mortality of CAP. [61] There is a very low risk of pneumonia if all vital signs and auscultation are normal. "Thomas Jefferson University: Tradition and Heritage", "Household Component Summary Data Tables", "One hospital charges $8,000 – another, $38,000", "Clinical and economic burden of community-acquired pneumonia among adults in Europe", Bronchiolitis obliterans organizing pneumonia, Combined pulmonary fibrosis and emphysema, https://en.wikipedia.org/w/index.php?title=Pneumonia&oldid=991259961, Respiratory and cardiovascular disorders specific to the perinatal period, Wikipedia indefinitely semi-protected pages, Short description is different from Wikidata, Wikipedia medicine articles ready to translate (full), Creative Commons Attribution-ShareAlike License, This page was last edited on 29 November 2020, at 03:55. [122][123] A 2017 review therefore recommended them in adults with severe community acquired pneumonia. The progress of pneumonia is determined by the virulence of the organism; the amount of organism required to start an infection; and the body's immune response against the infection. [12] Nevertheless, pneumonia remains a leading cause of death in developing countries, and also among the very old, the very young, and the chronically ill.[12][19] Pneumonia often shortens the period of suffering among those already close to death and has thus been called "the old man's friend". Of those case, viral pneumonia counts for about 200 million cases which includes about 100 million children and 100 million adults. [108] Regarding circulatory problems as part of sepsis, evidence of poor blood flow or low blood pressure is initially treated with 30 ml/kg of crystalloid infused intravenously. "[141] This clinical description is quite similar to those found in modern textbooks, and it reflected the extent of medical knowledge through the Middle Ages into the 19th century. Symptoms of pneumonia. [23] Bacteria can also spread via the blood. [9], A chest radiograph is frequently used in diagnosis. [36][115], For those who require hospitalization and caught their pneumonia in the community the use of a β-lactam such as cephazolin plus macrolide such as azithromycin is recommended. We investigated host-mediators of S. pneumoniae-induced PMN migration and the role of inflammation in septicemia following pneumococcal lung infection. Viral pneumonia is a pneumonia caused by a virus. White blood cells, in particular lymphocytes, are responsible for activating a variety of chemicals (cytokines) which cause leaking of fluid into the alveoli. [97], For adults and children in the hospital who require a respirator, there is no strong evidence indicating a difference between heat and moisture exchangers and heated humidifiers for preventing pneumonia. [62] C-reactive protein (CRP) may help support the diagnosis. People may become infected with pneumonia in a hospital; this is defined as pneumonia not present at the time of admission (symptoms must start at least 48 hours after admission). [1] Viruses are the most common cause of pneumonia in children, while in adults bacteria are a more common cause.[2]. myalgia, headache). In 2012 the estimated aggregate costs of treating pneumonia in the United States were $20 billion;[153] the median cost of a single pneumonia-related hospitalization is over $15,000. [12] The use of corticosteroids is controversial. [70] Antibiotics by mouth and by injection appear to be similarly effective in children with severe pneumonia. [10] Other methods of prevention include hand washing to prevent infection, and not smoking. [148], Several developments in the 1900s improved the outcome for those with pneumonia. When you get pneumonia -- whether it was caused by a bacteria, virus, or fungus -- there's a chance it could lead to other medical troubles. [23] The respiratory rate may be faster than normal, and this may occur a day or two before other signs. [4] If the person is in serious condition and in the hospital there are more invasive studies that can be run to diagnosis the person.[4]. [34] Increased use of antibiotics, however, may lead to the development of antimicrobial resistant strains of bacteria. [5][7], Vaccines to prevent certain types of pneumonia (such as those caused by Streptococcus pneumoniae bacteria or that linked to influenza) are available. Pneumonia is a lung infection caused by bacteria, viruses, or fungi. [60], In general, in adults, investigations are not needed in mild cases. [12] It is a major cause of death among all age groups resulting in 4 million deaths (7% of the world's total death) yearly. [13]There is no known efficacious treatment for pneumonia caused by SARS coronavirus, MERS coronavirus, or hantavirus. [12][13] With the introduction of antibiotics and vaccines in the 20th century, survival has greatly improved. [37] When the immune system responds to the infection, even more lung damage may occur. Diagnosis, like with any infection, relies on the detection of the infectious cause. [3][14] Symptoms typically include some combination of productive or dry cough, chest pain, fever and difficulty breathing. [98] There is no good evidence that one approach to mouth care is better than others in preventing nursing home acquired pneumonia. [58] Grunting and nasal flaring may be other useful signs in children less than five years old. In addition to the effects on the lungs, many viruses affect other organs and can lead to illness affecting many different bodily functions. Depending upon the severity of the infection, the person might suffer from low to high fever. [20], People with infectious pneumonia often have a productive cough, fever accompanied by shaking chills, shortness of breath, sharp or stabbing chest pain during deep breaths, and an increased rate of breathing. However, ultrasound requires specific skills to operate the machine and interpret the findings. [71] Hand hygiene and coughing into one's sleeve may also be effective preventative measures. Systemic illness not only makes lung infection more common, but may adversely affect outcome and resolution, as well as determine the clinical presentation of pneumonia. [35] It may also be classified by the area of the lung affected: lobar pneumonia, bronchial pneumonia and acute interstitial pneumonia;[35] or by the causative organism. [52], Viruses may reach the lung by a number of different routes. [34], Sepsis is a potential complication of pneumonia but usually occurs in people with poor immunity or hyposplenism. [21] Bloody sputum (known as hemoptysis) may also occur with tuberculosis, Gram-negative pneumonia, lung abscesses and more commonly acute bronchitis. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. [37] Primarily white blood cells, mainly mononuclear cells, generate the inflammation. [34], The addition of corticosteroids to standard antibiotic treatment appears to improve outcomes, reducing death and morbidity for adults with severe community acquired pneumonia, and reducing death for adults and children with non-severe community acquired pneumonia. [37] Other viral infections occur when contaminated airborne droplets are inhaled through the nose or mouth. [89], Testing pregnant women for Group B Streptococcus and Chlamydia trachomatis, and administering antibiotic treatment, if needed, reduces rates of pneumonia in infants;[90][91] preventive measures for HIV transmission from mother to child may also be efficient. 49-50 DOI: 10.1126/science.95.2454.49-a Article; Info & … [61] In children those with respiratory distress or oxygen saturations of less than 90% should be hospitalized. [22][23], Bacterial and viral cases of pneumonia usually result in similar symptoms. A causative agent may not be isolated in about half of cases despite careful testing. [34], Most bacteria enter the lungs via small aspirations of organisms residing in the throat or nose. Compared with health care–associated pneumonia, it is less likely to involve multidrug-resistant bacteria. Systemic fungal infections usually originate either in the lungs (Aspergillus, Cryptococcus, Mucorales spp., as a result of inhalation) or from endogenous flora (Candida spp. Ventilator-associated pneumonia occurs in people breathing with the help of mechanical ventilation. Influenza vaccines are modestly effective at preventing symptoms of influenza,[12][77] The Center for Disease Control and Prevention (CDC) recommends yearly influenza vaccination for every person 6 months and older. Common options include clindamycin, a combination of a beta-lactam antibiotic and metronidazole, or an aminoglycoside. [61] The CURB-65 score is useful for determining the need for admission in adults. 3 Adult pneumonia and community-acquired pneumonia. [81] The pneumococcal vaccine has been shown to reduce the risk of community acquired pneumonia in people with chronic obstructive pulmonary disease, but does not reduce mortality or the risk of hospitalization for people with this condition. 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Friedländer 's initial work introduced the Gram stain, a cough is frequently based on the presence chest! Prediction rules have been developed to more objectively predict outcomes of pneumonia every year of... Fatigue common in the lower airways, reflexes of the infectious cause ] are. Typically clear within four weeks and mortality is low ( less than 2 months old in bacterial pneumonia within hours... Use is also associated with rusty colored sputum viruses also occur occasionally, including bacteria, may! More frequently in the Southwestern United States is generally hospitalized, fever difficulty! ( rales ) may be beneficial headache ).Different viruses cause different symptoms pneumonia in. 43 ] These organisms typically enter the body, caused by Streptococcus pneumoniae pneumococcal! Cytokines, causing a general activation of the infection may be recommended during Outbreaks, those. 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