Prevention includes vaccination, environmental measures and appropriate treatment of other health problems. It is believed that, if appropriate preventive measures were instituted globally, mortality among children could be reduced by 400,000; and, if proper treatment were universally available, childhood deaths could be decreased by another 600,000.
Prevention
Pneumonia
Pneumonia | Prevention
It includes vaccination, environmental measures and appropriate treatment of other health problems. Prevention includes vaccination, environmental measures and appropriate treatment of other health problems. Through vaccination, environmental measures and appropriate treatment of other health problems. Prevention includes vaccination, environmental measures and appropriate treatment of other health problems
who does the voice over for bart simpson
user
Nancy Jean Cartwright
assistant
when did she start her career?
user
She moved to Hollywood in 1978 and trained alongside voice actor Daws Butler.
assistant
who is this other voice actor?
user
He worked mostly for the Hanna-Barbera animation production company where he originated the voices of many familiar characters, including Loopy De Loop.
assistant
how did he die?
user
He had suffered a stroke and been battling pneumonia in the last few months before he died.
assistant
the disease that he battled with, what are its symptoms?
user
Some combination of productive or dry cough, chest pain, fever and difficulty breathing.
assistant
how can it be diagnosed?
user
It is typically diagnosed based on a combination of physical signs and a chest X-ray.
assistant
how can it be prevented?
user
CAP is diagnosed by assessing symptoms, performing a physical examination, by x-ray or by sputum examination. Patients with CAP sometimes require hospitalization, and it is treated primarily with antibiotics, antipyretics and cough medicine. Some forms of CAP can be prevented by vaccination and by abstaining from tobacco products.
Community-acquired pneumonia | Introduction
Pneumonia is typically diagnosed based on a combination of physical signs and a chest X-ray. In adults with normal vital signs and a normal lung examination the diagnosis is unlikely. However, the underlying cause can be difficult to confirm, as there is no definitive test able to distinguish between bacterial and non-bacterial origin. The overall impression of a physician appears to be at least as good as decision rules for making or excluding the diagnosis. The World Health Organization has defined pneumonia in children clinically based on either a cough or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness.
Pneumonia | Diagnosis
Smoking cessation and reducing indoor air pollution, such as that from cooking indoors with wood, crop residues or dung, are both recommended. Smoking appears to be the single biggest risk factor for pneumococcal pneumonia in otherwise-healthy adults. Hand hygiene and coughing into one's sleeve may also be effective preventative measures. Wearing surgical masks by the sick may also prevent illness. Appropriately treating underlying illnesses (such as HIV/AIDS, diabetes mellitus, and malnutrition) can decrease the risk of pneumonia. In children less than 6 months of age, exclusive breast feeding reduces both the risk and severity of disease. In people with HIV/AIDS and a CD4 count of less than 200 cells/uL the antibiotic trimethoprim/sulfamethoxazole decreases the risk of "Pneumocystis pneumonia" and is also useful for prevention in those that are immunocompromised but do not have HIV.
Pneumonia | Other
In hospitalised patients who develop respiratory symptoms and fever, one should consider the diagnosis. The likelihood increases when upon investigation symptoms are found of respiratory insufficiency, purulent secretions, newly developed infiltrate on the chest X-Ray, and increasing leucocyte count. If pneumonia is suspected material from sputum or tracheal aspirates are sent to the microbiology department for cultures. In case of pleural effusion, thoracentesis is performed for examination of pleural fluid. In suspected ventilator-associated pneumonia it has been suggested that bronchoscopy(BAL) is necessary because of the known risks surrounding clinical diagnoses.
Hospital-acquired pneumonia | Diagnosis
In immunocompromised patients, prophylaxis with co-trimoxazole (trimethoprim/sulfamethoxazole), atovaquone, or regular pentamidine inhalations may help prevent PCP.
Pneumocystis pneumonia | Prevention
In people requiring hospitalization, pulse oximetry, chest radiography and blood tests – including a complete blood count, serum electrolytes, C-reactive protein level, and possibly liver function tests – are recommended.
Pneumonia | Diagnosis
Prevention includes vaccination, environmental measures and appropriate treatment of other health problems. It is believed that, if appropriate preventive measures were instituted globally, mortality among children could be reduced by 400,000; and, if proper treatment were universally available, childhood deaths could be decreased by another 600,000.
Pneumonia | Prevention
For recurrent pneumonia, underlying lung cancer, metastasis, tuberculosis, a foreign bodies, immunosuppression, and hypersensitivity should be suspected.
Pneumonia | Differential diagnosis
UIP may be diagnosed by a radiologist using computed tomography (CT) scan of the chest, or by a pathologist using tissue obtained by a lung biopsy.
Usual interstitial pneumonia | Diagnosis
Sometimes the coughing can produce rusty or blood-streaked sputum. In 25% of cases, a parapneumonic effusion may occur. Chest X-rays will typically show lobar consolidation or patchy infiltrates. In most cases, once pneumococcal pneumonia has been identified, doctors will prescribe antibiotics. These antibiotic usually help alleviate and eliminate symptoms between 12 and 36 hours after being taken. Despite most antibiotics' effectiveness in treating the disease, sometimes the bacteria can resist the antibiotics, causing symptoms to worsen. Additionally, age and health of the infected patient can contribute to the effectiveness of the antibiotics. A vaccine has also been developed for the prevention of pneumococcal pneumonia, recommended to children under age five as well as adults over the age of 65.
Pneumococcal pneumonia | Introduction
Risk factors for pneumonia include cystic fibrosis, chronic obstructive pulmonary disease (COPD), sickle cell disease, asthma, diabetes, heart failure, a history of smoking, a poor ability to cough (such as following a stroke), and a weak immune system. Vaccines to prevent certain types of pneumonia (such as those caused by "Streptococcus pneumoniae" bacteria or that linked to influenza) are available. Other methods of prevention include hand washing to prevent infection, and not smoking.
Pneumonia | Introduction
Prevention of bacterial pneumonia is by vaccination against "Streptococcus pneumoniae" (pneumococcal polysaccharide vaccine for adults and pneumococcal conjugate vaccine for children), "Haemophilus influenzae" type B, meningococcus, "Bordetella pertussis", "Bacillus anthracis", and "Yersinia pestis".
Bacterial pneumonia | Prevention
Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever and difficulty breathing. The severity of the condition is variable. Pneumonia is usually caused by infection with viruses or bacteria, and less commonly by other microorganisms. Identifying the responsible pathogen can be difficult. Diagnosis is often based on symptoms and physical examination. Chest X-rays, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired, such as community- or hospital-acquired or healthcare-associated pneumonia.
Pneumonia | Introduction
Approximately half of these deaths can be prevented, as they are caused by the bacteria for which an effective vaccine is available. 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.
Pneumonia | Children
CAP may be prevented by treating underlying illnesses that increasing its risk, by smoking cessation, and by vaccination. Vaccination against "haemophilus influenzae" and "streptococcus pneumoniae" in the first year of life has been protective against childhood CAP. A vaccine against "streptococcus pneumoniae", available for adults, is recommended for healthy individuals over 65 and all adults with COPD, heart failure, diabetes mellitus, cirrhosis, alcoholism, cerebrospinal fluid leaks or who have had a splenectomy. Re-vaccination may be required after five or ten years. Patients who have been vaccinated against "streptococcus pneumoniae", health professionals, nursing-home residents and pregnant women should be vaccinated annually against influenza.
Community-acquired pneumonia | Prevention
The diagnosis can be confirmed by the characteristic appearance of the chest X-ray and an arterial oxygen level (PaO) that is strikingly lower than would be expected from symptoms. Gallium 67 scans are also useful in the diagnosis. They are abnormal in about 90% of cases and are often positive before the chest X-ray becomes abnormal. Chest X-ray typically shows widespread pulmonary infiltrates. CT scan may show pulmonary cysts (not to be confused with the cyst-forms of the pathogen). The diagnosis can be definitively confirmed by histological identification of the causative organism in sputum or bronchoalveolar lavage (lung rinse). Staining with toluidine blue, silver stain, periodic acid-Schiff stain, or an immunofluorescence assay shows the characteristic cysts.
Pneumocystis pneumonia | Diagnosis
The presence of chest pain in children with pneumonia doubles the probability of "Mycoplasma pneumoniae". In general, in adults, investigations are not needed in mild cases. There is a very low risk of pneumonia if all vital signs and auscultation are normal. C-reactive protein (CRP) may help support the diagnosis. For those with CRP less than 20 mg/L without convincing evidence of pneumonia, antibiotics are not recommended. Procalcitonin may help determine the cause and support defcisions about who should receive antibiotics. 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.
Pneumonia | Diagnosis
Additional tests include X-ray computed tomography, bronchoscopy or lung biopsy.
Community-acquired pneumonia | Prognosis
The best prevention against viral pneumonia is vaccination against influenza, adenovirus, chickenpox, herpes zoster, measles, and rubella.
Viral pneumonia | Prevention
A chest radiograph is frequently used in diagnosis. In people with mild disease, imaging is needed only in those with potential complications, those not having improved with treatment, or those in which the cause is uncertain. If a person is sufficiently sick to require hospitalization, a chest radiograph is recommended. Findings do not always match the severity of disease and do not reliably separate between bacterial and viral infection. X-ray presentations of pneumonia may be classified as lobar pneumonia, bronchopneumonia, lobular pneumonia, and interstitial pneumonia. Bacterial, community-acquired pneumonia classically show lung consolidation of one lung segmental lobe, which is known as lobar pneumonia.
Pneumonia | Imaging
Fungal pneumonia can be diagnosed in a number of ways. The simplest and cheapest method is to culture the fungus from a patient's respiratory fluids. However, such tests are not only insensitive but take time to develop which is a major drawback because studies have shown that slow diagnosis of fungal pneumonia is linked to high mortality. Microscopy is another method but is also slow and imprecise. Supplementing these classical methods is the detection of antigens. This technique is significantly faster but can be less sensitive and specific than the classical methods. A molecular test based on quantitative PCR is also available from Myconostica.
Fungal pneumonia | Diagnosis
Prevention of VAP involves limiting exposure to resistant bacteria, discontinuing mechanical ventilation as soon as possible, and a variety of strategies to limit infection while intubated. Resistant bacteria are spread in much the same ways as any communicable disease. Proper hand washing, sterile technique for invasive procedures, and isolation of individuals with known resistant organisms are all mandatory for effective infection control. A variety of aggressive weaning protocols to limit the amount of time a person spends intubated have been proposed. One important aspect is limiting the amount of sedation that a ventilated person receives. Weak evidence suggests that raising the head of the bed to at least 30 degrees may help prevent VAP, however further research is required to understand the risks associated with this.
Ventilator-associated pneumonia | Prevention
The symptoms of pneumonia are fever, productive cough, shortness of breath, and pleuritic chest pain. Inspiratory crackles may be heard on exam. A chest x-ray can be useful to differentiate pneumonia from congestive heart failure. As the cause is usually a bacterial infection, antibiotics are typically used for treatment.
Shortness of breath | Pneumonia
The diagnosis is typically made by clinical examination. Chest X-ray is sometimes useful to exclude bacterial pneumonia, but not indicated in routine cases. Chest x-ray may also be useful in people with impending respiratory failure. Additional testing such as blood cultures, complete blood count, and electrolyte analyses are not recommended for routine use although may be useful in children with multiple comorbidities or signs of sepsis or pneumonia. Testing for the specific viral cause can be done but has little effect on management and thus is not routinely recommended. RSV testing by direct immunofluorescence testing on nasopharyngeal aspirate had a sensitivity of 61% and specificity of 89%.
Bronchiolitis | Diagnosis
In some cases, chest CT can reveal pneumonia not seen on x-rays. However, congestive heart failure or other types of lung damage can mimic CAP on x-ray.
Community-acquired pneumonia | Diagnosis
Pneumonia can be classified in several ways, most commonly by where it was acquired (hospital versus community), but may also by the area of lung affected or by the causative organism. There is also a combined clinical classification, which combines factors such as age, risk factors for certain microorganisms, the presence of underlying lung disease or systemic disease and whether the person has recently been hospitalized.
Classification of pneumonia | Introduction
Patients with symptoms of CAP require evaluation. Diagnosis of pneumonia is made clinically, rather than on the basis of a particular test. Evaluation begins with a physical examination by a health provider, which may reveal fever, an increased respiratory rate (tachypnea), low blood pressure (hypotension), a fast heart rate (tachycardia) and changes in the amount of oxygen in the blood. Palpating the chest as it expands and tapping the chest wall to identify dull, non-resonant areas can identify stiffness and fluid, signs of CAP. Listening to the lungs with a stethoscope (auscultation) can also reveal signs associated with CAP. A lack of normal breath sounds or the presence of crackles can indicate fluid consolidation.
Community-acquired pneumonia | Diagnosis
Antibiotics by mouth, rest, simple analgesics, and fluids usually suffice for complete resolution. However, those with other medical conditions, the elderly, or those with significant trouble breathing may require more advanced care. If the symptoms worsen, the pneumonia does not improve with home treatment, or complications occur, hospitalization may be required. Worldwide, approximately 7–13% of cases in children result in hospitalization, whereas in the developed world between 22 and 42% of adults with community-acquired pneumonia are admitted. The CURB-65 score is useful for determining the need for admission in adults. If the score is 0 or 1, people can typically be managed at home; if it is 2, a short hospital stay or close follow-up is needed; if it is 3–5, hospitalization is recommended.
Pneumonia | Management
Approximately half of these cases and deaths are theoretically preventable, being caused by the bacteria for which an effective vaccine is available.
Epidemiology of pneumonia | Children
There have been several practices associated with decreased incidence and decreased severity of aspiration pneumonia as detailed below.
Aspiration pneumonia | Prevention
Initial descriptions of pneumonia focused on the anatomic or pathologic appearance of the lung, either by direct inspection at autopsy or by its appearance under a microscope. The discovery of x-rays made it possible to determine the anatomic type of pneumonia without direct examination of the lungs at autopsy and led to the development of a radiological classification. Early investigators distinguished between typical lobar pneumonia and atypical (e.g. Chlamydophila) or viral pneumonia using the location, distribution, and appearance of the opacities they saw on chest x-rays. Certain x-ray findings can be used to help predict the course of illness, although it is not possible to clearly determine the microbiologic cause of a pneumonia with x-rays alone.
Classification of pneumonia | By area of lung affected
Stop Pneumonia is an initiative launched with the purpose to assist communities who suffer from the consequences of pneumonia and who lack access to lifesaving interventions. The initiative highlights the importance of water, sanitation and hygiene, also promoting other ways to help prevent pneumonia.
Stop Pneumonia initiative | Introduction
For optimal management of a pneumonia patient, the following must be assessed: pneumonia severity (including treatment location, e.g., home, hospital or intensive care), identification of causative organism, analgesia of chest pain, the need for supplemental oxygen, physiotherapy, hydration, bronchodilators and possible complications of emphysema or lung abscess.
Lower respiratory tract infection | Pneumonia
During an outbreak, drugs such as amantadine, rimantadine, zanamivir and oseltamivir have been demonstrated to prevent influenza.
Community-acquired pneumonia | Prevention
Several diseases can present with similar signs and symptoms to pneumonia, such as: chronic obstructive pulmonary disease, asthma, pulmonary edema, bronchiectasis, lung cancer, and pulmonary emboli. Unlike pneumonia, asthma and COPD typically present with wheezing, pulmonary edema presents with an abnormal electrocardiogram, cancer and bronchiectasis present with a cough of longer duration, and pulmonary emboli present with acute onset sharp chest pain and shortness of breath. Mild pneumonia should be differentiated from upper respiratory tract infection (URTI). Severe pneumonia should be differentiated from acute heart failure. Pulmonary infiltrates that resolved after giving mechanical ventilation should point to heart failure and atelectasis rather than pneumonia.
Pneumonia | Differential diagnosis
Increased vibration of the chest when speaking, known as tactile fremitus, and increased volume of whispered speech during auscultation can also indicate the presence of fluid. Several tests can identify the cause of CAP. Blood cultures can isolate bacteria or fungi in the bloodstream. Sputum Gram staining and culture can also reveal the causative microorganism. In severe cases, bronchoscopy can collect fluid for culture. Special tests, such as urinalysis, can be performed if an uncommon microorganism is suspected. Chest X-rays and X-ray computed tomography (CT) can reveal areas of opacity (seen as white), indicating consolidation. CAP does not always appear on x-rays, sometimes because the disease is in its initial stages or involves a part of the lung not clearly visible on x-ray.
Community-acquired pneumonia | Diagnosis
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 is most commonly classified by where or how it was acquired: community-acquired, aspiration, healthcare-associated, hospital-acquired, and ventilator-associated pneumonia. It may also be classified by the area of the 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 as non-severe, severe, or very severe. The setting in which pneumonia develops is important to treatment, as it correlates to which pathogens are likely suspects, which mechanisms are likely, which antibiotics are likely to work or fail, and which complications can be expected based on the person's health status.
Pneumonia | Classification
Arterial blood gases may reveal hypoxemia when tested in a lab. Respiratory alkalosis may also be present. Peripheral lymphocytosis can be observed. A lung biopsy may also be indicated.
Lymphocytic interstitial pneumonia | Diagnosis
Chest radiographs (X-ray photographs) often show a pulmonary infection before physical signs of atypical pneumonia are observable at all. This is occult pneumonia. In general, occult pneumonia is rather often present in patients with pneumonia and can also be caused by "Streptococcus pneumoniae", as the decrease of occult pneumonia after vaccination of children with a pneumococcal vaccine suggests. Infiltration commonly begins in the perihilar region (where the bronchus begins) and spreads in a wedge- or fan-shaped fashion toward the periphery of the lung field. The process most often involves the lower lobe, but may affect any lobe or combination of lobes.
Atypical pneumonia | Diagnosis
The lungs are normally protected against aspiration by a series of "protective reflexes" such as coughing and swallowing. Significant aspiration can only occur if the protective reflexes are absent or severely diminished (in neurological disease, coma, drug overdose, sedation or general anesthesia). In intensive care, sitting patients up reduces the risk of pulmonary aspiration and ventilator-associated pneumonia. Measures to prevent aspiration depend on the situation and the patient. In patients at imminent risk of aspiration, tracheal intubation by a trained health professional provides the best protection. A simpler intervention that can be implemented is to lay the patient on their side in the recovery position (as taught in first aid and CPR classes), so that any vomitus produced by the patient will drain out their mouth instead of back down their pharynx.
Pulmonary aspiration | Prevention
The chest x-ray is distinctive with features that appear similar to an extensive pneumonia, with both lungs showing widespread white patches. The white patches may seem to migrate from one area of the lung to another as the disease persists or progresses. Computed tomography (CT) may be used to confirm the diagnosis. Often the findings are typical enough to allow the doctor to make a diagnosis without ordering additional tests. To confirm the diagnosis, a doctor may perform a lung biopsy using a bronchoscope. Many times, a larger specimen is needed and must be removed surgically. Plain chest radiography shows normal lung volumes, with characteristic patchy unilateral or bilateral consolidation.
Cryptogenic organizing pneumonia | Imaging
Pneumonia has historically been characterized as either typical or atypical depending on the presenting symptoms and thus the presumed underlying organism. Attempting to make this distinction based on symptoms however has not been found to be accurate and The American Thoracic Society does not recommend its use.
Classification of pneumonia | By cause
Classification can be complex, and the combined efforts of clinicians, radiologists, and pathologists can help in the generation of a more specific diagnosis. Idiopathic interstitial pneumonia can be subclassified based on histologic appearance into the following patterns: Usual interstitial pneumonia is the most common type.
Idiopathic interstitial pneumonia | Diagnosis
pneumoniae" lipoproteins. Introduction of peptides that block adhesion receptors on the surface of the host cell may also be able to prevent attachment of "M. pneumoniae".
Mycoplasma pneumoniae | Treatment and prevention
Usually initial therapy is empirical. If sufficient reason to suspect influenza, one might consider oseltamivir. In case of legionellosis, erythromycin or fluoroquinolone. A third generation cephalosporin (ceftazidime) + carbapenems (imipenem) + beta lactam & beta lactamase inhibitors (piperacillin/tazobactam)
Hospital-acquired pneumonia | Treatment
Risk factors include exposure to tobacco smoke, dust, and other air pollution. A small number of cases are due to high levels of air pollution or bacteria such as "Mycoplasma pneumoniae" or "Bordetella pertussis". Diagnosis is typically based on a person's signs and symptom. The color of the sputum does not indicate if the infection is viral or bacterial. Determining the underlying organism is typically not needed. Other causes of similar symptoms include asthma, pneumonia, bronchiolitis, bronchiectasis, and COPD. A chest X-ray may be useful to detect pneumonia. Prevention is by not smoking and avoiding other lung irritants. Frequent hand washing and flu vaccination may also be protective.
Acute bronchitis | Introduction
Hospital-acquired pneumonia, also called nosocomial pneumonia, is pneumonia acquired during or after hospitalization for another illness or procedure with onset at least 72 hrs after admission. The causes, microbiology, treatment and prognosis are different from those of community-acquired pneumonia. Up to 5% of patients admitted to a hospital for other causes subsequently develop pneumonia. Hospitalized patients may have many risk factors for pneumonia, including mechanical ventilation, prolonged malnutrition, underlying heart and lung diseases, decreased amounts of stomach acid, and immune disturbances. Additionally, the microorganisms a person is exposed to in a hospital are often different from those at home. Hospital-acquired microorganisms may include resistant bacteria such as MRSA, "Pseudomonas", "Enterobacter", and "Serratia".
Classification of pneumonia | Hospital-acquired
Physical examination may sometimes reveal low blood pressure, high heart rate, or low oxygen saturation. The respiratory rate may be faster than normal, and this may occur a day or two before other signs. Examination of the chest may be normal, but it may show decreased expansion on the affected side. Harsh breath sounds from the larger airways that are transmitted through the inflamed lung are termed bronchial breathing and are heard on auscultation with a stethoscope. Crackles (rales) may be heard over the affected area during inspiration. Percussion may be dulled over the affected lung, and increased, rather than decreased, vocal resonance distinguishes pneumonia from a pleural effusion.
Pneumonia | Physical exam
Pneumonia is an illness which can result from a variety of causes, including infection with bacteria, viruses, fungi, or parasites. Pneumonia can occur in any animal with lungs, including mammals, birds, and reptiles. Symptoms associated with pneumonia include fever, fast or difficult breathing, nasal discharge, and decreased activity. Different animal species have distinct lung anatomy and physiology and are thus affected by pneumonia differently. Differences in anatomy, immune systems, diet, and behavior also affects the particular microorganisms commonly causing pneumonia. Diagnostic tools include physical examination, testing of the sputum, and x-ray investigation. Treatment depends on the cause of pneumonia; bacterial pneumonia is treated with antibiotics.
Pneumonia (non-human) | Introduction
Eosinophilic pneumonia is diagnosed in one of three circumstances: when a complete blood count reveals increased eosinophils and a chest X-ray or computed tomography identifies abnormalities in the lungs, when a biopsy identifies increased eosinophils in lung tissue, or when increased eosinophils are found in fluid obtained by a bronchoscopy (bronchoalveolar lavage fluid). Association with medication or cancer is usually apparent after review of a person's medical history. Specific parasitic infections are diagnosed after examining a person's exposure to common parasites and performing laboratory tests to look for likely causes. If no underlying cause is found, a diagnosis of acute or chronic eosinophilic pneumonia is made based upon the following criteria.
Eosinophilic pneumonia | Diagnosis
Healthcare-associated pneumonia can be defined as pneumonia in a patient with at least one of the following risk factors:
Hospital-acquired pneumonia | Definition
In hospitalized individuals or those with immune deficiencies, local guidelines determine the selection of antibiotics.
Bacterial pneumonia | Treatment
In rare circumstances, bacteria in the lung will form a pocket of infected fluid called a lung abscess. Lung abscesses can usually be seen with a chest X-ray but frequently require a chest CT scan to confirm the diagnosis. Abscesses typically occur in aspiration pneumonia, and often contain several types of bacteria. Long-term antibiotics are usually adequate to treat a lung abscess, but sometimes the abscess must be drained by a surgeon or radiologist.
Pneumonia | Pleural effusion, empyema, and abscess
The 2003 SARS-CoV virus was prevented from causing a pandemic. Rapid action by national and international health authorities such as the World Health Organization helped to slow transmission and eventually broke the chain of transmission, which ended the localized epidemics before they could become a pandemic. However, the disease has not been eradicated and could re-emerge. This warrants monitoring and reporting of suspicious cases of atypical pneumonia. Effective isolation of patients was enough to control spread because infected individuals usually not transmitting the virus until several days after symptoms began and were most infectious only after developing severe symptoms.
Pandemic prevention | History
With treatment, most types of bacterial pneumonia will stabilize in 3–6 days. It often takes a few weeks before most symptoms resolve. X-ray findings typically clear within four weeks and mortality is low (less than 1%). In the elderly or people with other lung problems, recovery may take more than 12 weeks. In persons requiring hospitalization, mortality may be as high as 10%, and in those requiring intensive care it may reach 30–50%. Pneumonia is the most common hospital-acquired infection that causes death. Before the advent of antibiotics, mortality was typically 30% in those that were hospitalized. However, for those whose lung condition deteriorates within 72 hours, the problem is usually due to sepsis.
Pneumonia | Prognosis
pneumoniae" infections.
Mycoplasma pneumoniae | Diagnosis
In terms of the diagnosis of "Klebsiella" pneumonia the following can be done to determine if the individual has this infection, including "susceptibility testing" for (ESBL) "Extended Spectrum β-Lactamase", as well as:
Klebsiella pneumoniae | Diagnosis
New or progressive infiltrate on the chest X-ray with one of the following: In an elderly person, the first sign of hospital-acquired pneumonia may be mental changes or confusion. Other symptoms may include:
Hospital-acquired pneumonia | Signs and symptoms
A chest X-ray or CT is necessary to differentiate between pneumonitis and pneumonia of an infectious etiology. Some degree of pulmonary fibrosis may be evident in a CT which is indicative of chronic pulmonary inflammatory processes. Diagnosis of Pneumonitis is often difficult as it depends on a high degree of clinical suspicion when evaluating a patient with a recent onset of a possible interstitial lung disease. In addition, interpreting pathologic and radiographic test results remains a challenge to clinicians. Pneumonitis is often difficult to recognize and discern from other interstitial lung diseases. Diagnostic procedures currently available include: Exposure to causative agents of pneumonitis in a specific environment can be confirmed through aero/microbiologic analysis to verify its presence.
Pneumonitis | Diagnosis
Occult pneumonia is a pneumonia that is not observable directly by the eye, but can only be shown indirectly, especially by radiography. Occult pneumonia can be made visible by chest X-rays. The general symptoms "cough for more than 10 days" and "fever for more than 3 days" can indicate the presence of occult pneumonia, just as a temperature of 39 °C or higher and a high white blood cell count. Administration of a pneumococcal vaccine decreases the incidence of occult pneumonia, which suggests that "Streptococcus pneumoniae" is a cause of occult pneumonia. Occult pneumonia, however, can also be the result of atypical pneumonia.
Occult pneumonia | Introduction
Pneumonia is the second leading cause of death among children under five. Early diagnosis and treatment with simple antibiotics can prevent a large proportion of these deaths. A severe form of acute respiratory infection, pneumonia can be treated effectively using Five & Alive's pre-packaged therapy kits that contain cotrimoxazole and are easy to administer. Combined with comprehensive communications, this treatment is currently provided through private sector clinics to treat pneumonia in children under five.
Five &amp; Alive | Pneumonia treatment
Due to the importance of disease caused by "S. pneumoniae" several vaccines have been developed to protect against invasive infection. The World Health Organization recommend routine childhood pneumococcal vaccination; it is incorporated into the childhood immunization schedule in a number of countries including the United Kingdom, United States, and South Africa.
Pneumococcal infection | Prevention
pneumoniae".
Streptococcus pneumoniae | Diagnosis
Diagnosis of "Mycoplasma pneumoniae" infections is complicated by the delayed onset of symptoms and the similarity of symptoms to other pulmonary conditions. Often, "M. pneumoniae" infections are diagnosed as other conditions and, occasionally, non-pathogenic mycoplasmas present in the respiratory tract are mistaken for "M. pneumoniae". Historically, diagnosis of "M. pneumoniae" infections was made based on the presence of cold agglutinins and the ability of the infected material to reduce tetrazolium. Causative diagnosis is dependent upon laboratory testing, however these methods are more practical in epidemiological studies than in patient diagnosis. Culture tests are rarely used as diagnostic tools; rather immunoblotting, immunofluorescent staining, hemadsorption tests, tetrazolium reduction, metabolic inhibition tests, serological assays, and polymerase chain reaction (PCR) are used for diagnosis and characterization of bacterial pneumonic infections.
Mycoplasma pneumoniae | Diagnosis
In pneumonia, a collection of fluid may form in the space that surrounds the lung. Occasionally, microorganisms will infect this fluid, causing an empyema. To distinguish an empyema from the more common simple parapneumonic effusion, the fluid may be collected with a needle (thoracentesis), and examined. If this shows evidence of empyema, complete drainage of the fluid is necessary, often requiring a drainage catheter. In severe cases of empyema, surgery may be needed. If the infected fluid is not drained, the infection may persist, because antibiotics do not penetrate well into the pleural cavity. If the fluid is sterile, it must be drained only if it is causing symptoms or remains unresolved.
Pneumonia | Pleural effusion, empyema, and abscess
To prevent spreading" Klebsiella" infections between patients, healthcare personnel must follow specific infection-control precautions, which may include strict adherence to hand hygiene (preferably using an alcohol based hand rub (60-90%) or soap and water if hands are visibly soiled. Alcohol based hand rubs are effective against these Gram-negative bacilli) and wearing gowns and gloves when they enter rooms where patients with "Klebsiella"–related illnesses are housed. Healthcare facilities also must follow strict cleaning procedures to prevent the spread of "Klebsiella". To prevent the spread of infections, patients also should clean their hands very often, including:
Klebsiella pneumoniae | Prevent from spreading
The CURB-65 is used as a means of deciding the action that is needed to be taken for that patient.
CURB-65 | Pneumonia
Pneumonia is due to infections caused primarily by bacteria or viruses and less commonly by fungi and parasites. Although more than 100 strains of infectious agents have been identified, only a few are responsible for the majority of cases. Mixed infections with both viruses and bacteria may occur in roughly 45% of infections in children and in 15% of infections in adults. A causative agent may not be isolated in about half of cases despite careful testing. 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.
Pneumonia | Cause
Tuberculosis should be suspected when a pneumonia-like illness has persisted longer than three weeks, or when a respiratory illness in an otherwise healthy individual does not respond to regular antibiotics.
Tuberculosis diagnosis | Medical history
Evaluation of aspiration is generally performed with a video fluoroscopic swallowing study involving radiologic evaluation of the swallowing mechanism via challenges with liquid and solid food consistencies. These studies allow for evaluation of penetration to the vocal folds and below but are not a sensitive and specific marker for aspiration. Additionally, it is difficult to distinguish between aspiration pneumonia and aspiration pneumonitis. Aspiration pneumonia is typically diagnosed by a combination of clinical circumstances (people with risk factors for aspiration) and radiologic findings (an infiltrate in the proper location). A chest x-ray is typically performed in cases where any pneumonia is suspected, including aspiration pneumonia.
Aspiration pneumonia | Diagnosis
With the advent of modern microbiology, classification based upon the causative microorganism became possible. Determining which microorganism is causing an individual's pneumonia is an important step in deciding treatment type and length. Sputum cultures, blood cultures, tests on respiratory secretions, and specific blood tests are used to determine the microbiologic classification. Because such laboratory testing typically takes several days, microbiologic classification is usually not possible at the time of initial diagnosis.
Classification of pneumonia | By area of lung affected
The combined clinical classification, now the most commonly used classification scheme, attempts to identify a person's risk factors when he or she first comes to medical attention. The advantage of this classification scheme over previous systems is that it can help guide the selection of appropriate initial treatments even before the microbiologic cause of the pneumonia is known. There are two broad categories of pneumonia in this scheme: community-acquired pneumonia and hospital-acquired pneumonia. A recently introduced type of healthcare-associated pneumonia (in patients living outside the hospital who have recently been in close contact with the health care system) lies between these two categories.
Classification of pneumonia | Clinical
The differential diagnosis includes other types of lung disease that cause similar symptoms and show similar abnormalities on chest radiographs. Some of these diseases cause fibrosis, scarring or honeycomb change. The most common considerations include:
Usual interstitial pneumonia | Differential diagnosis
Acute exacerbations can be partially prevented. Some infections can be prevented by vaccination against pathogens such as influenza and "Streptococcus pneumoniae". Regular medication use can prevent some COPD exacerbations; long acting beta-adrenoceptor agonists (LABAs), long-acting anticholinergics, inhaled corticosteroids and low-dose theophylline have all been shown to reduce the frequency of COPD exacerbations. Other methods of prevention include:
Acute exacerbation of chronic obstructive pulmonary disease | Prevention
Traditionally, clinicians have classified pneumonia by clinical characteristics, dividing them into "acute" (less than three weeks duration) and "chronic" pneumonias. This is useful because chronic pneumonias tend to be either non-infectious, or mycobacterial, fungal, or mixed bacterial infections caused by airway obstruction. Acute pneumonias are further divided into the classic bacterial bronchopneumonias (such as "Streptococcus pneumoniae"), the atypical pneumonias (such as the interstitial pneumonitis of "Mycoplasma pneumoniae" or "Chlamydia pneumoniae"), and the aspiration pneumonia syndromes. Chronic pneumonias, on the other hand, mainly include those of "Nocardia", "Actinomyces" and "Blastomyces dermatitidis", as well as the granulomatous pneumonias ("Mycobacterium tuberculosis" and atypical mycobacteria, "Histoplasma capsulatum" and "Coccidioides immitis").
Classification of pneumonia | Clinical
Pneumonia frequently starts as an upper respiratory tract infection that moves into the lower respiratory tract. It is a type of pneumonitis (lung inflammation). The normal flora of the upper airway give protection by competing with pathogens for nutrients. In the lower airways, reflexes of the glottis, actions of complement proteins and immunoglobulins are important for protection. Microaspiration of contaminated secretions can infect the lower airways and cause 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.
Pneumonia | Mechanisms
Testing 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 the urine for antigens to "Legionella" and "Streptococcus". Viral infections, can be confirmed via detection of either the virus or its antigens with culture or polymerase chain reaction (PCR), among other techniques. "Mycoplasma", "Legionella", "Streptococcus", and "Chlamydia" can also be detected using PCR techniques on bronchoalveolar lavage and nasopharyngeal swab. The causative agent is determined in only 15% of cases with routine microbiological tests.
Pneumonia | Microbiology
Prevention is by not smoking and avoiding other lung irritants. Frequent hand washing may also be protective. Furthermore, an oral whole cell nontypeable Haemophilus influenzae vaccine given in the fall has demonstrated short term effectiveness in reducing the frequency and severity of the disease during the winter.
Acute bronchitis | Prevention
However, this increases the risk of endotracheal tube obstruction and pressure sores.
Pneumonia | Management
Clinical prediction rules have been developed to more objectively predict outcomes of pneumonia. These rules are often used to decide whether to hospitalize the person.
Pneumonia | Clinical prediction rules
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 treatment, or home care. HCAP is sometimes called MCAP (medical care–associated pneumonia). 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). It is likely to involve hospital-acquired infections, with higher risk of multidrug-resistant pathogens. People in a hospital often have other medical conditions, which may make them more susceptible to pathogens in the hospital.
Pneumonia | Healthcare
Another is more invasive and advocates a bronchoscopy plus bronchoalveolar lavage (BAL) for people with symptoms of VAP. Both strategies also require a new or enlarging infiltrate on chest x-ray as well as clinical signs/symptoms such as fever and shortness of breath. There is no strong evidence to suggest that an invasive method to collect cultures is more effective than a non-invasive method. In addition, a quantitative approach to assessing the culture (performing a bacterial count of the pathogen that is causing the pneumonia) does not appear to be superior to a qualitative approach (determining the presence of the pathogen).
Ventilator-associated pneumonia | Diagnosis
If pneumonia deteriorates after 72 hours, it could be due to nosocomial infection or excerbation of other underlying comorbidities. 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. Complications may occur in particular in the elderly and those with underlying health problems. This may include, among others: empyema, lung abscess, bronchiolitis obliterans, acute respiratory distress syndrome, sepsis, and worsening of underlying health problems.
Pneumonia | Prognosis
Healthcare-associated pneumonia seems to have fatality rates similar to hospital-acquired pneumonia, worse than community-acquired pneumonia but less severe than pneumonia in ventilated patients. Besides clinical markers like tachypnea (fast breathing) or a high white cell count (leukocytosis), the prognosis seems to be influenced by the underlying associated diseases (comorbidities) and functional capacities (for example, the ADL score). Many patients have a decreased health condition after the episode.
Hospital-acquired pneumonia | Prognosis
Some CAP patients require intensive care, with clinical prediction rules such as the pneumonia severity index and CURB-65 guiding the decision whether or not to hospitalize. Factors increasing the need for hospitalization include: Laboratory results indicating hospitalization include: X-ray findings indicating hospitalization include:
Community-acquired pneumonia | Hospitalization
The CAP outpatient mortality rate is less than one percent, with fever typically responding within the first two days of therapy, and other symptoms abating in the first week. However, X-rays may remain abnormal for at least a month. Hospitalized patients have an average mortality rate of 12 percent, with the rate rising to 40 percent for patients with bloodstream infections or those who require intensive care. Factors increasing mortality are identical to those indicating hospitalization. When CAP does not respond to treatment, this may indicate a previously unknown health problem, a treatment complication, inappropriate antibiotics for the causative organism, a previously unsuspected microorganism (such as tuberculosis) or a condition mimicking CAP (such as granuloma with polyangiitis).
Community-acquired pneumonia | Prognosis
The pragmatic challenge is to distinguish from aspiration pneumonia with an infectious component because the former does not require antibiotics while the later does. While some issues, such as a recent history of exposure to substantive toxins, can foretell the diagnosis, for a patient with dyphagia the diagnosis may be less obvious, as the dyshagic patient may have caustic gastric contents damaging the lungs which may or may not have progressed to bacterial infection. The following tests help determine how severely the lungs are affected:
Chemical pneumonitis | Diagnosis
In clinical situations the antibiotic sensitivity can be obtained through disk diffusion assays of E-strip test. Treatment of clinical cases, such as the outbreak at the Hospital Joan March, were treated case by case, based on the antibiogram obtained from each patient's sputum sample. More broadly, prevention of initial infection, particularly in a hospital setting, is a key element of treatment. Sterilising all surfaces, and prostheses, as well as constant replacement and maintenance of prosthesis, is an integral element of stopping disease establishment.
Corynebacterium striatum | Treatment
On clinical examination, crackles are common, and more rarely, patients may have clubbing (<5% of cases). Laboratory findings are nonspecific. Almost 75% of people have symptoms for less than two months before seeking medical attention. A flu-like illness, with a cough, fever, a feeling of illness (malaise), fatigue, and weight loss heralds the onset in about 40% of patients. Doctors do not find any specific abnormalities on routine laboratory tests or on a physical examination, except for the frequent presence of crackling sounds (called rales) upon auscultation with a stethoscope by the care provider. Pulmonary function tests usually show that the amount of air the lungs can hold is below normal.
Cryptogenic organizing pneumonia | Diagnosis
Tiamulin, chlortetracycline or tilmicosin may be used to treat and prevent the spread of the disease. Vaccination is a very effective method of control, and also has an effect on pig productivity. Eradication of the disease is possible but the organism commonly reinfects herds.
Porcine enzootic pneumonia | Treatment and control
Clinical features may include initial symptoms of an upper respiratory tract infection mimicking a viral infection, usually associated with fevers, often low-grade. This may progress to the lower respiratory tract in a few days, with features often resembling those of a wheezy bronchitis. Sputum may be difficult to expectorate and is often grey or creamy in color. The cough may persist for weeks without appropriate treatment. Many cases are diagnosed after presenting chest infections that do not respond to penicillins or first-generation cephalosporins. A chest X-ray can identify alveolar consolidation. Clinical diagnosis of "H. influenzae" is typically performed by bacterial culture or latex particle agglutinations.
Haemophilus influenzae | Diagnosis
Controlling nosocomial infection is to implement QA/QC measures to the health care sectors, and evidence-based management can be a feasible approach. For those with ventilator-associated or hospital-acquired pneumonia, controlling and monitoring hospital indoor air quality needs to be on agenda in management, whereas for nosocomial rotavirus infection, a hand hygiene protocol has to be enforced. To reduce HAIs, the state of Maryland implemented the Maryland Hospital-Acquired Conditions Program that provides financial rewards and penalties for individual hospitals based on their ability to avoid HAIs. An adaptation of the Centers for Medicare & Medicaid Services payment policy causes poor-performing hospitals to lose up to 3% of their inpatient revenues, whereas hospitals that are able to avoid HAIs can earn up to 3% in rewards.
Hospital-acquired infection | Prevention
Knoll's research interests include the epidemiology of vaccine-preventable infectious diseases and the methodologic issues pertaining to the design, conduct and analysis of epidemiologic studies and clinical trials. Current projects include the PERCH study to determine the causes of pneumonia in settings representative of developing countries to guide the development of new pneumonia vaccines and treatment algorithms for 2015 onwards, estimating the burden and serotype distribution of pneumococcal and meningococcal disease among children and adults, measuring the impact on disease burden of pneumococcal conjugate vaccine use in Kenya and The Gambia, and evaluating the value of antigen-based diagnostic tests in blood to improve sensitivity of pneumococcal detection in pneumonia patients.
Maria Deloria Knoll | Research
Among the factors contributing to contracting HAP are mechanical ventilation (ventilator-associated pneumonia), old age, decreased filtration of inspired air, intrinsic respiratory, neurologic, or other disease states that result in respiratory tract obstruction, trauma, (abdominal) surgery, medications, diminished lung volumes, or decreased clearance of secretions may diminish the defenses of the lung. Also, poor hand-washing and inadequate disinfection of respiratory devices cause cross-infection and are important factors.
Hospital-acquired pneumonia | Risk factors
Pneumonia that starts in the hospital tends to be more serious than other lung infections because: people in the hospital are often very sick and cannot fight off germs. The types of germs present in a hospital are often more dangerous and more resistant to treatment than those outside in the community. Pneumonia occurs more often in people who are using a respirator. This machine helps them breathe. Hospital-acquired pneumonia can also be spread by health care workers, who can pass germs from their hands or clothes from one person to another. This is why hand-washing, wearing grows, and using other safety measures is so important in the hospital.
Hospital-acquired pneumonia | Causes
CAP is treated with an antibiotic that kills the infecting microorganism; treatment also aims at managing complications. If the causative microorganism is unidentified, which is often the case, the laboratory identifies the most effective antibiotic; this may take several days. Health professionals consider a person's risk factors for various organisms when choosing an initial antibiotic. Additional consideration is given to the treatment setting; most patients are cured by oral medication, while others must be hospitalized for intravenous therapy or intensive care. Current treatment guidelines recommend a beta lactam, like amoxicillin and a macrolide, like azithromycin or clarithromycin, or a quinolone, such as levofloxacin.
Community-acquired pneumonia | Treatment
PCR is the most rapid and effective way to determine the presence of "M. pneumoniae", however the procedure does not indicate the activity or viability of the cells present. Enzyme immunoassay (EIA) serological assays are the most common method of "M. pneumoniae" detection used in patient diagnosis due to the low cost and relatively short testing time. One drawback of serology is that viable organisms are required, which may overstate the severity of infection. Neither of these methods, along with others, has been available to medical professionals in a rapid, efficient and inexpensive enough form to be used in routine diagnosis, leading to decreased ability of physicians to diagnose "M.
Mycoplasma pneumoniae | Diagnosis
Pneumonia is an inflammatory condition of the lung in humans. This may also refer to:
Pneumonia (disambiguation) | Introduction
Pneumonia has been a common disease throughout human history. The word is from Greek πνεύμων (pneúmōn) meaning "lung". The symptoms were described by Hippocrates (c. 460–370 BC): "Peripneumonia, and pleuritic affections, are to be thus observed: If the fever be acute, and if there be pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated be of a blond or livid color, or likewise thin, frothy, and florid, or having any other character different from the common... When pneumonia is at its height, the case is beyond remedy if he is not purged, and it is bad if he has dyspnoea, and urine that is thin and acrid, and if sweats come out about the neck and head, for such sweats are bad, as proceeding from the suffocation, rales, and the violence of the disease which is obtaining the upper hand." However, Hippocrates referred to pneumonia as a disease "named by the ancients".
Pneumonia | History
The amount of oxygen in the blood is often low at rest and is even lower with exercise.
Cryptogenic organizing pneumonia | Diagnosis