c
 


 
 

c
  is an inflammatory condition of the lung, especially inflammation of

the alveoli (microscopic air sacs in the lungs) or when the lungs fill with fluid
(called Ô
 
and 

).

There are many causes of pneumonia. Infection is the most common cause, and may
involve bacteria, viruses, fungi, or parasites. Chemical burns or physical injury to the lungs can
also produce pneumonia.

Typical symptoms associated with pneumonia include cough, chest pain, fever, and difficulty in
breathing. Diagnostic tools include x-rays and examination of the sputum. Treatment depends
on the cause of pneumonia; bacterial pneumonia is treated with antibiotics.

Pneumonia is a common disease that occurs in all age groups. It is a leading cause of death
among the young, the old, and the chronically ill. Vaccinesto prevent certain types of
pneumonia are available. The prognosis depends on the type of pneumonia, the treatment, any
complications, and the person's underlying health.

x
 

Pneumonia can be due to microorganisms, irritants or an unknown cause. When

pneumonias are grouped this way, infectious causes are the most common.

The symptoms of infectious pneumonia are caused by the invasion of the lungs
by microorganisms and by the immune system's response to the infection. Although more than
one hundred strains of microorganism can cause pneumonia, only a few are responsible for
most cases. The most common causes of pneumonia are viruses and bacteria. Less common
causes of infectious pneumonia are fungi and parasites.

Viruses

Viruses have been found to account for between 18Ͷ28% of pneumonia in a few limited
studies. Viruses invade cells in order to reproduce. Typically, a virus reaches the lungs when
airborne droplets are inhaled through the mouth and nose. Once in the lungs, the virus invades
the cells lining the airways and alveoli. This invasion often leads to cell death, either when the
virus directly kills the cells, or through a type of cell controlled self-destruction calledapoptosis.
When the immune system responds to the viral infection, even more lung damage
occurs. 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.

Viral pneumonia is commonly caused by viruses such as influenza virus, respiratory syncytial
virus (RSV), adenovirus, and parainfluenza. Herpes simplex virus is a rare cause of pneumonia
except in newborns. People with weakened immune systems are also at risk of pneumonia
caused by cytomegalovirus(CMV).

Bacteria

The bacterium Streptococcus pneumoniae, a common cause of pneumonia, imaged by

an electron microscop. Bacteria are the most common cause of community acquired
pneumonia with Streptococcus pneumoniae the most commonly isolated bacteria.[8] Another
important Gram-positive cause of pneumonia is Staphylococcus aureus, with Streptococcus
agalactiae being an important cause of pneumonia in newborn babies. Gram-negative bacteria
cause pneumonia less frequently than gram-positive bacteria. Some of the gram-negative
bacteria that cause pneumonia include Haemophilus influenzae, Klebsiella
pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Moraxella catarrhalis. These
bacteria often live in the stomach or intestines and may enter the lungs if vomit is
inhaled. "Atypical" bacteria which cause pneumonia include Chlamydophila
pneumoniae,Mycoplasma pneumoniae, and Legionella pneumophila.

Bacteria typically 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 the body. Many bacteria
live in parts of the upper respiratory tract, such as the nose, mouth and sinuses, and can easily
be inhaled into the alveoli. Once inside, bacteria may invade the spaces between cells and
between alveoli through connecting pores. This invasion triggers the immune systemto
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.

Fungi
Fungal pneumonia is uncommon, but it may occur in individuals with immune system
problems due to AIDS, immunosuppresive drugs, or other medical problems. The
pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia. Fungal
pneumonia is most often caused by Histoplasma capsulatum, blastomyces, Cryptococcus
neoformans, Pneumocystis jiroveci, andCoccidioides immitis. Histoplasmosis is most common in
the Mississippi River basin, and coccidioidomycosis in the southwestern United States.

Parasites

A variety of parasites can affect the lungs. These parasites typically enter the body through the
skin or by being swallowed. Once inside, they 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. One type of white blood cell,
the eosinophil, responds vigorously to parasite infection. Eosinophils in the lungs can lead
to eosinophilic pneumonia, thus complicating the underlying parasitic pneumonia. The most
common parasites causing pneumonia areToxoplasma gondii, Strongyloides stercoralis,
and Ascariasis.

Idiopathic

Idiopathic interstitial pneumonias (IIP) are a class of diffuse lung diseases. While this group is
called idiopathic, which means that the cause is unknown, in some types of pneumonia
classified as IIPs the cause is known and the name of group is misleading. For
example, desquamative interstitial pneumonia is classified as an IIP, but it is caused by smoking.
Many types of IIP, such as usual interstitial pneumonia do not have a known cause.

À 
 


The incubation period ranges from to one to three days with sudden onset of shaking
chills, rapidly rising fever and stabbing chest pains aggravated by coughing and respiration.


 
  

1.? The disease is transmitted through droplet infection. Droplets from the mouth
and nose of an infected person via the nasopharynx carry the infectious
disease and the disease is transmitted through intimate contact with carriers.
2.? The disease can also be transmitted through indirect contact. Contaminated
objects may possibly carry the infectious disease. Systemic infection is possible
through inhalation of caustic or toxic chemicals, aspiration of food, fluid or
vomitus.


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People with infectious pneumonia often have a cough producing greenish or

yellow sputum, or phlegm and a high fever that may be accompanied by shaking
chills. Shortness of breath is also common, as is pleuritic chest pain, a sharp or stabbing pain,
either experienced during deep breaths or coughs or worsened by them. People with
pneumonia may cough up blood, experience headaches, or develop sweaty and clammy skin.
Other possible symptoms are loss of appetite, fatigue, blueness of the skin, nausea, vomiting,
mood swings, and joint pains or muscle aches. Less common forms of pneumonia can cause
other symptoms; for instance, pneumonia caused by Ô
 may cause abdominal pain
and diarrhea, while pneumonia caused by tuberculosis or 

Ômay cause only weight
loss and night sweats. In elderly people, manifestations of pneumonia are seldom typical. They
may develop a new or worsening confusion (delirium) or may experience unsteadiness, leading
to falls. Infants with pneumonia may have many of the symptoms above, but in many cases
they are simply sleepy or have a decreased appetite.

Symptoms of pneumonia need immediate medical evaluation. Physical examination by a health

care provider may reveal fever or sometimes low body temperature, an increased respiratory
rate, low blood pressure, a high heart rate, or a low oxygen saturation, which is the amount of
oxygen in the blood as indicated by either pulse oximetry or blood gas analysis. People who are
struggling to breathe, who are confused, or who have cyanosis (blue-tinged skin) require
immediate attention. Findings from physical examination of the lungs may be normal, but often
show decreased expansion of the chest on the affected side, bronchial breathing on
auscultation with a stethoscope (harsher sounds from the larger airways transmitted through
the inflamed and consolidated lung), and rales (or crackles) heard over the affected area during
inspiration. Percussion may be dulled over the affected lung, but increased rather than
decreased vocal resonance (which distinguishes it from a pleural effusion). While these signs
are relevant, they are insufficient to diagnose or rule out a pneumonia; moreover, in studies it
has been shown that two doctors can arrive at different findings on the same patient.

 

 The physician diagnoses the type of the pneumonia suffered by the patient. But usually
the diagnosis depends upon the history of the patient, the course, and the physical findings.

1.? Physical findings for patient with Ô 



a.? The patient has malar paleness, flushed face, and dilated pupils, with high
fever, fast respiration and relatively low pulse.
b.? The patient͛s sputum is rusty with the hacking paroxysmal cough.
c.? The chest movement on affected side is diminished with dull percussion.
2.? Chest x-ray is necessary to confirm the diagnostic examination.
3.? Sputum analysis, sputum smear, and culture is important.
 ü.? The patient may be subjected to blood/serologic exam.

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In the United States more than 80% of cases of community acquired pneumonia are
treated without hospitalization. Typically, oral antibiotics, rest, fluids, and home care are
sufficient for complete resolution. However, people who are having trouble breathing, with
other medical problems, and the elderly may need greater care. If the symptoms get worse, the
pneumonia does not improve with home treatment, or complications occur, then
hospitalization may be recommended. Over the counter cough medicine has not been found to
be helpful in pneumonia.

Bacterial

Antibiotics improve outcomes in those with bacterial pneumonia. Initially antibiotic choice
depends on the characteristics of the person affected such as age, underlying health, and
location the infection was acquired.

In the UK empiric treatment is usually with amoxicillin, erythromycin, or azithromycin for

community-acquired pneumonia. In North America, where the "atypical" forms of community-
acquired pneumonia are becoming more common, macrolides (such as azithromycin),
and doxycycline have displaced amoxicillin as first-line outpatient treatment for community-
acquired pneumonia. The use of fluoroquinolones in uncomplicated cases is discouraged due to
concerns of side effects and resistance. The duration of treatment has traditionally been seven
to ten days, but there is increasing evidence that short courses (three to five days) are
equivalent. Antibiotics recommended for hospital-acquired pneumonia include third- and
fourth-generation cephalosporins,carbapenems, fluoroquinolones, aminoglycosides,
and vancomycin. These antibiotics are often given intravenously and may be used in
combination.

Viral

No specific treatments exist for most types of viral pneumonia including SARS
coronavirus, adenovirus, hantavirus, and parainfluenza virus with the exception of influenza
A and influenza B. Influenza A may be treated with rimantadine or amantadine while influenza
A or B may be treated with oseltamivir or zanamivir. These are beneficial only if they are started
within ü8 hours of the onset of symptoms. Many strains of H5N1 influenza A, also known
as avian influenza or "bird flu," have shown resistance to rimantadine and amantadine.
Aspiration

There is no evidence to support the use of antibiotics in chemical pneumonitis without bacterial
superinfection. If infection is present in aspiration pneumonia, the choice of antibiotic will
depend on several factors, including the suspected causative organism and whether pneumonia
was acquired in the community or developed in a hospital setting. Common options
include clindamycin, a combination of a beta-lactam antibiotic and metronidazole, or
an aminoglycoside. Corticosteroids are commonly used in aspiration pneumonia, but there is no
evidence to support their use either.

A  


1.? Maintain the patients͛ airway and adequate oxygenation.

2.? Teach the patient how to cough and perform deep breathing exercise to clear
secretions and advise him to do this often.
3.? Obtain sputum specimen as needed and teach the correct collection of specimen.
ü.? Maintain adequate nutrition to offset high-calorie utilization.
5.? Provide a calm environment as the patient needs rest.
6.? Control the spread of infection by disposing secretions properly
7.? Control the temperature by doing cooling measures.
8.? Monitor vital signs closely and watch for danger signs like:
a.? Marked dyspnea
b.? Thread, small irregular pulse,
c.? Delirium with extreme restlessness
d.? Cold moist skin
e.? Cyanosis and exhaustion.