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  Pneumonia

Pneumonia is a disease of the lungs in which the alveoli become irritated, inflamed and fill with fluid. There are many causes of pneumonia: fungi, bacteria, virus and parasites. Pneumonia can also be the result of lung cancer and alcohol abuse.

Pneumonia Lung diseases
Pneumonia


Symptoms:

Infectious pneumonia produces the following symptoms:

• High fever
• Shaking chills
• Shortness of breath
• Cough with greenish yellow sputum or blood
• Shortness of breath

Pneumonia patients may also have headaches, loose their appetite, fatigue, nausea, vomiting, blue or pale skin, joint and muscle pain.

Pneumonia that is caused by the bacteria Legionella has the symptoms of stomach pain and diarrhea. Pneumonia that is from TB may only have the symptoms of weight loss and night sweats. The elderly may not have many of the above symptoms and just appear, confused or unsteady. Infants who have pneumonia may have some of the above symptoms, but often they are sleepier and not eating as much as they typically do.

Diagnosis:

Diagnosis of pneumonia is made from a complete physical examination, which may also include a chest X-ray, blood tests and sputum cultures. Chest X-ray is usually used by hospitals, especially in the case of aspiration pneumonia. Pneumonia in a doctor’s office is usually based on symptoms and physical exam. Other illnesses can make diagnosing pneumonia difficult. A chest CT scan or other imaging procedures may be used to determine if pneumonia is present.

A physical exam can include detection of fever or low body temperature, low blood pressure, fast heart rate, increased respiration rate, and low oxygen saturation levels in the blood. Listening to the lungs with a stethoscope can reveal the following symptoms: abnormal breath sounds, crackling sounds (known as rales) and areas of fluid that are called consolidation. The exam can also include palpation of the chest to localize consolidation or fluid build-up.

Chest X-rays can be misleading due to lung scaring and congestive heart failure. A CT scan can reveal pneumonia that is not detected on the X-ray. Initial stages of pneumonia may not be detectable in an X-ray.

If antibiotics are not curing the pneumonia, a culture of an individual’s sputum will be performed. The culture requires up to two days to determine the results. They are used to determine which antibiotics will work the most effectively against the pneumonia causing agents. A blood sample may also be cultured to determine if a blood infection is present. A complete blood count, CBC will determine the white blood cell count, which is typically elevated when infection is present. Blood tests can determine bacteria (such as Mycopklasma, Legionella and Chlamydophila. Sputum can be tested for viruses that cause pneumonia, such as, adenovirus, influenza and respiratory syncytial virus.

Causes:

Infectious pneumonia is caused by invasive agents and the response of the immune system to the infection. The most common causes of pneumonia are bacteria and viruses; less common are fungi and parasites.

Viruses that cause pneumonia are the influenza virus, respiratory syncytial virus, adenovirus, metapneumovirus, herpes simplex virus (seen more in newborns) and cytomegalovirus (most commonly in AIDS patients, or patients with impaired immune systems).

Bacteria pneumonia caused by streptococcus pneumoniae, Gram-negative bacteria, and athypical baceria. Complications from bacteria pneumonia are low blood pressure and damage to multiple organs due to septic shock and a complication known as empyema. The most common Gram-positive bacteria, that causes pneumonia is staphylococcus aureus. Other gram-negative bacteria that can cause pneumonia are pseudomonas aeruginosa, E. coli, Klebsiella pneumoniae, haemophilous influenzae and Moraxella catarrhalis. Atypical bacteria that can cause pneumonia are Chlamydophila pneumoniae, Legionella pneumophila, and mycoplasma pneumoniae.

Fungal pneumonia is not common, but does occur in patients with immune system impairment caused by AIDS, immunosuppressive drugs and other conditions. The most common causes of fungi pneumonia are Cryptococcus neoformans, pneumocytis jiroveci, coccidiodes immitis, histoplasmosis, coccidiodomycosis and Histoplasma capsulatum.

Certain parasites can cause pneumonia. The most common pneumonia causing parasites are strongyloides stercoralis, ascariasis, and toxoplasma gondii. A complication of pneumonia is called eosinophilic pneumonia. A type of white blood cell, the eosinophil will build up in the lungs, in order to fight the parasite infection.

Classifications:

Pneumonia is sometimes classified by anatomic changes found in the lungs when an autopsy is performed. Microbiologic classification is another type of classification, based on the infection. Clinical classification combines a varity of factors, including age, risk factors for organisms, underlying lung disease, recent hospitalization and any systemic conditions or diseases.

Early classifications based on pathologic appearance of the lung are lobar pneumoniak, multi lobar pneumonia and interstitial pneumonia. Lobar pneumonia involves infection of only one lobe or section of the lung. Multi lobar pneumonia involves more than one lobe of a lung and is more severe than lobar pneumonia. Interstitial pneumonia involves the spaces between alveoli and is usually caused by viruses or atypical bacteria.

Clinical classification of pneumonia are chronic, or lasting longer than three weeks and acute lasting less than three weeks. Chronic pneumonias are either non-infectious, mixed bacterial infections or mycobacterial or fungal. Acute pneumonias are divided into bacterial broncho-pneumonias, atypical pneumonias and aspiration pneumonia.

Two broader categories are community acquired and hospital acquired pneumonia. Community acquired pneumonia appears in a person who has not recently been hospitalized. It is the most common type of pneumonia. Streptococcus pneumoniae is the most common cause of community acquired pneumonia worldwide. Hospital-acquired pneumonia is acquired during a hospital stay or after a recent hospital stay. Five percent of patients admitted to a hospital for other conditions develop pneumonia. Risk factors for these patients are already present, such as heart and lung disease, ventilator users, malnutrition, reduced stomach acid and immune system impairments. Hospital acquired pneumonia tends to be more deadly than community acquired pneumonia, because of the exposure of certain antibiotic resistant bacteria, such as Pseudomonas, enterobacter, serratia and MRSA.

Other types of pneumonia are Severe Acute Respiratory Syndrome (SARS), bronchiolitis obliterans organizing pneumonia, eosinophilic pneumonia, chemical pneumonia (due to inhaling pesticides or other toxins), and aspiration pneumonia.

Treatment

Treatment depends on the type of pneumonia, the cause, age, overall health of the patient and any underlying illnesses or conditions. Common treatments are usually administered at home without hospitalization. Oral antibiotics, rest and extra fluids are the usual therapy. People who have trouble breathing, or other medical conditions and older patients may need to be hospitalized. Antibiotics are used to treat bacterial pneumonia. Viral pneumonia cannot be treated with antibiotics, though antibiotics are used to prevent viral pneumonia from becoming bacterial pneumonia and any underlying infection.

A specific cause for pneumonia is only identified in about fifty percent of all patients. Treatment should not be delayed when pneumonia is diagnosed, so an empiric treatment is begun before all lab results are acquired. Empiric treatment usually involves a combination of antibiotics, depending on the patient’s tolerance and allergies.

Hospital acquired pneumonia involves a combination of antibiotics that are not typically prescribed by pharmacists. People who also experience difficulty breathing will need extra oxygen, and possibly intubation and artificial ventilation.

Pneumonia caused by influenza can be treated with anti-viral medication that must be begun within 48 hours of the flu symptoms. Avian influenza or bird flu are resistant to rimantadine and amantadine. There are no effective treatments for hantavirus, parainfluenza virusn, SARS coronavirus and adenovirus.

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