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== Introduction  ==
== Introduction  ==
[[File:Respiratory Tract.jpeg|thumb|Increased mucus in lungs]]
Pneumonia, a general term, refers to an [[Infectious Disease|infection]] within the lung. It is caused by a [[Bacterial Infections|bacterial]] or [[Viral Infections|viral]] infection that becomes purulent and filling the [[alveoli]] (may become solid).<ref name=":0">Radiopedia Pneumonia Available: https://radiopaedia.org/articles/pneumonia (accessed 25.5.2021)</ref>


Pneumonia is defined as "inflammation of the lung caused by bacteria, in which the air sacs (alveoli) become filled with inflammatory cells and the lungs become solid" (Oxford Concise Medical Dictionary, 6th Edition, 2003).
== Aetiology ==
 
Pneumonias can be classified by:
Pneumonia is "a severe form of acute lower respiratory infection that specifically affects the lungs". The lungs consist of bronchi, which divide into bronchioles that end in alveoli. The small blood vessels in the lungs are responsible for gaseous exchange (oxygen moving into the lungs and carbon dioxide moving out of the lungs). During a Pneumonia infection, the alveoli of one or both lungs fill up with pus or fluid. This increases the labor of breathing, and thus gaseous exchange cannot occur as it normally would (unicef/WHO, 2006).


== Prevalence of Pneumonia World Wide and in South Africa  ==
Infective Agent:


According to unicef/WHO (2006) Pneumonia kills more children than any other illness -- more than AIDS, malaria and measles combined and it accounts for nearly one in five child deaths globally.
# Bacterial Pneumonia occurs when pneumonia-causing bacteria masses and multiplies in the lungs. The alveoli become inflamed and pus is produced, which spreads around the lungs<ref name=":3">Smith, B., &amp; Ball, V. (1998). Cardiovascular/Respiratory Physiotherapy. Mosby International Limited: Italy</ref> eg Streptococcus pneumonia, Staphylococcus aureus, Haemophilus influenza, legionella pneumophilia and Methicillin resistant staphylococcus aureus (MRSA)<ref name=":2">Healthscout. (2009). ''Health Encyclopedia - Diseases and Conditions: Pneumonia''. Retrieved April 8, 2009 from http://www.healthscout.com/ency/68/205/main.html</ref><ref>Bartleby. ''The Lungs''. Retrieved April 8, 2009 from http://education.yahoo.com/reference/gray/subjects/subject/240</ref>
# Fungal pneumonia This typically occurs in people who have a weakened immune system or other underlying health issues. This is usually inhaled from the environment and does not spread from person to person. eg [[Pneumocystis Jirovecii Pneumonia]].<ref name=":1">Health-cares. (2005). ''What is pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/pneumonia.php</ref>
# Mycobacterial pneumonia
# Viral Pneumonia  - believed to be the cause of half of all cases of pneumonia. The viruses invade the lungs and then multiply- causing inflammation. eg [[COVID-19]], Middle East respiratory syndrome coronavirus (MERS-CoV) infection, severe acute respiratory syndrome (SARS)], varicella pneumonia,Influenza type A or B, rhinoviruses adenoviruses, respiratory syncytial virus (more common in infants and children)<ref name=":2" />


It has been found that 1,6 million people die from pneumonia world wide each year. It should also be noted that pneumonia is one of the leading causes of deaths for children under the age of 5.  
Setting of Infection (how aquired):
# Community-acquired pneumonia (CAP): This is the most common form of pneumonia and describes pneumonia that is acquired outside of a hospital the main causes of CAP are bacteria, viruses and less commonly fungi. In most cases pneumonia is not spread from person to person and quite often is transmitted via droplets in the air, touching contaminated objects, poor hygiene and sharing cups or utensil or from the environment<ref name=":4">Koenig, S., &amp; Truwit, J. (2006). ''Ventilator-associated pneumonia: Diagnosis, treatment and prevention''. Clin Microbiol Rev. 2006 October; 19(4): 637–657. Retrieved April 12, 2009 from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1592694</ref>.
#[[Hospital Acquired Pneumonia|Hospital-acquired pneumonia]] (HAP) eg 1. Ventilator-associated pneumonia (VAP) Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The [[Biofilms Role in Chronic Infections|biofilm]] is believed to act as a reservoir for infecting microorganisms and contributes to development and relapses of ventilator-associated pneumonia<ref>Thorarinsdottir HR, Kander T, Holmberg A, Petronis S, Klarin B. [https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03092-1 Biofilm formation on three different endotracheal tubes: a prospective clinical trial].Available from:https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03092-1 (last accessed 30.6.2020)</ref>; 2. Healthcare-associated pneumonia (HCAP)<ref name=":10">Pahal P, Sharma S. [https://www.ncbi.nlm.nih.gov/books/NBK534295/ Typical Bacterial Pneumonia.]Available from:https://www.ncbi.nlm.nih.gov/books/NBK534295/ (last accessed 29.6.2020)</ref>
# Aspiration pneumonia<ref>Radiopedia [https://radiopaedia.org/articles/pneumonia Pneumonia] Available from:https://radiopaedia.org/articles/pneumonia (last accessed 29.6.2020)</ref> This is commonly caused by inhaling a foreign object, vomit, mucous, bodily fluids, or certain chemicals which causes the bronchial tubes and lungs to become inflamed.<ref name=":1" />  It  occurs predominantly in the right lung because its total capacity is greater than that of the left lung.<ref name=":1" />  If large amounts of gastric contents can cause acute respiratory distress within 1 hour. In cases of aspiration immediate physiotherapy can help with secretion clearance
Pathological Description:


In South-East Asia, in the Pacific, and in Sub-Saharan Africa about 433 million young children contract the disease annually (CDF, 2009). Amongst children under the age of 5, these two regions have the highest incidence of pneumonia cases and when combined, they "bear the burden of more than half the total number of pneumonia episodes worldwide" (unicef/WHO, 2006).
# Bronchopneumonia
# Lobar pneumonia<ref name=":0" />
The various causes of pneumonia are discussed below. To interact with the screen below, scroll within screen.<primalpictures id="334087" />


== Types of Pneumonia ==
== Defence Against Pneumonia ==
The overall function of the immune system is to prevent or limit [[Infectious Disease|infection]]. The Immune response is the body's ability to stay safe by affording protection against harmful agents and involves lines of defense against most microbes as well as specialized and highly specific response to a particular offender.  See [[Immune System|here]] for more.
== Epidemiology ==
[[File:Pneumonia-death-rates-in-children-under-5.png|right|frameless|499x499px]]
2.5 million people died from pneumonia in 2019, with roughly 33% of these being children younger than 5 years (the leading cause of death for children under 5).<ref>Dadonaite B, Roser M. [https://ourworldindata.org/pneumonia Pneumonia. Our World in Data; 2020] [updated Nov 2019; cited 11 May 2020].Available:https://ourworldindata.org/pneumonia (accessed 24.12.2022)</ref><ref>World health organisation Pneumonia Available:https://www.who.int/health-topics/pneumonia/#tab=tab_1 (accessed 18.12.2022)</ref>


*Aspiration Pneumonia
Risk factors include: 
**Aspiration Pneumonia results when food, drink, vomit, secretions or other foreign material is inhaled and causes an inflammatory response in the lungs and bronchial tubes.
**Aspiration Pneumonia occurs predominantly in the right lung because its total capacity is greater than that of the left lung (Health-cares.net, 2005; Bartleby.com).


*Atypical Pneumonia
# Elderly, infants, young children and those with a weakened [[Immune System|immune system]] .
**This term refers of Pneumonia caused by the following bacteria: Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.  
# Frequent exposure to asbestos and cigarette smoke.  
**Atypical pneumonia is caused by bacteria and does not respond to the normal antibiotics used for treatment (Health-cares.net, 2005).
# Developing nations where the medical care may be suboptimal, sanitation is poor, and poverty is prevelent.<ref>news Medical [https://www.news-medical.net/health/Pneumonia-Epidemiology.aspx Pneumonia Epidemiology] Available:https://www.news-medical.net/health/Pneumonia-Epidemiology.aspx (accessed 24.12.2022)</ref> 
 
*Bacterial Pneumonia
**Bacterial Pneumonia occurs when pneumonia-causing bacteria masses and multiplies in the lungs. The alveoli become inflamed and pus is produced, which spreads around the lungs. The bacteria that caused Bacterial Pneumonia are: streptococcus pneumonia, hemophilus influenza, legionella pneumophilia and staphylococcus aureus (healthscout.com).
 
*Bronchial Pneumonia
**Bronchopneumonia is “a descending infection starting around the bronchi and bronchioles” (Nurse’s dictionary, Twenty-third edition, 2000). The terminal bronchioles become blocked with exudates and form consolidated patches. This results in atelectasis.
 
*Community-acquired Pneumonia
**This means the infection was acquired at home.  
**With this type of pneumonia the most common cause is 'Streptococcus Pneumonia' (Smith &amp; Ball, 1998)
 
*Hospital-acquired Pneumonia
**Patients develop features after being in hospital for 24 hours or longer
**Infectious agent is often Gram-negative bacteria such as 'Escherichia coli or Klebsiella' (Smith &amp; Ball, 1998)
 
*Mycoplasmal Pneumonia (also known as 'walking pneumonia')
**It is similar to bacterial pneumonia, whereby the mycoplasmas proliferate and spread - causing infection (healthscout.com).
 
*Pneumocystis carinii Pneumonia  
**Pneumocystis carinii pneumonia is the result of a fungal infection in the lungs caused by the Pneumocystis carinii fungus.  
**This fungus does not cause illness in healthy individuals, but rather in those with a weakened immune system. (Health-cares.net, 2005).
 
*Ventilator Associated Pneumonia (VAP)
**This type of pneumonia usually occurs two days after a hospitalised patient has been intubated and been receiving mechanical ventilation (Koenig &amp; Truwit, 2006).  
**This is especially a life-threatening infection as patients who require mechanical support are already critically ill (Torpy, 2007).
 
*Viral Pneumonia
**Viral Pneumonia is believed to be the cause of half of all pneumonias. The viruses invade the lungs and then multiply- causing inflammation (healthscout.com).


== Stages of Pneumonia  ==
== Stages of Pneumonia  ==
 
Pneumonia has four stages, namely consolidation, red hepatization, grey hepatization and resolution. (may be Lobar Pneumonia or bronchopneumonia, see image R)
Pneumonia has four stages, namely consolidation, red hepatization, grey hepatization and resolution.  


*Consolidation  
*Consolidation  
Line 64: Line 49:
**Cellular exudates containing neutrophils, lymphocytes and fibrin replaces the alveolar air  
**Cellular exudates containing neutrophils, lymphocytes and fibrin replaces the alveolar air  
**Capillaries in the surrounding alveolar walls become congested  
**Capillaries in the surrounding alveolar walls become congested  
**The infections spreads to the hilum and pleura fairly rapidly  
**The infection spreads to the hilum and pleura fairly rapidly  
**Pleurisy occurs  
**Pleurisy occurs  
**Marked by coughing and deep breathing (Atkuri &amp; King, 2006; Steyl, 2007  
**Marked by coughing and deep breathing<ref name=":6">Atkuri, L.V., &amp; King, B.R. (2006). ''Pediatrics, Pneumonia''. Retrieved April 10, 2009, from http://emedicine.medscape.com/article/803364-overview</ref><ref name=":7">Steyl, T. (2007). ''Applied Physiotherapy 403 notes: Intensive Care Notes''. University of the Western Cape.</ref>
*Red Hepatization  
*Red Hepatization  
**Occurs in the 2-3 days after consolidation  
**Occurs in the 2-3 days after consolidation  
**At this point the consistency of the lungs resembles that of the liver  
**At this point, the consistency of the lungs resembles that of the liver  
**The lungs become hypeaemic
**The lungs become hyperaemic
**Alveolar capillaries are engorged with blood  
**Alveolar capillaries are engorged with blood  
**Fibrinous exudates fill the alveoli  
**Fibrinous exudates fill the alveoli  
**This stage is "characterized by the presence of many erythrocytes, neutrophils, desquamated epithelial cells, and fibrin within the alveoli" (Atkuri &amp; King, 2006; Steyl, 2007)
**This stage is "characterized by the presence of many erythrocytes, neutrophils, desquamated epithelial cells, and fibrin within the alveoli"<ref name=":6" /><ref name=":7" />


*Grey Hepatization  
*Grey Hepatization  
**Occurs in the 2-3 days after Red Hepatization  
**Occurs in the 2-3 days after Red Hepatization  
**This is an avascular stage  
**This is an avascular stage  
**The lung appears "gray-brown to yellow because of fibrinopurulent exudates, disintegration of red cells, and hemosiderin"  
**The lung appears "grey-brown to yellow because of fibrinopurulent exudates, disintegration of red cells, and hemosiderin"  
**The pressure of the exudates in the alveoli causes compression of the capillaries  
**The pressure of the exudates in the alveoli causes compression of the capillaries  
**"Leukocytes migrate into the congested alveoli" (Atkuri &amp; King, 2006; Steyl, 2007)
**"Leukocytes migrate into the congested alveoli"<ref name=":6" /><ref name=":7" />


*Resolution  
*Resolution  
Line 87: Line 72:
**Phagocytosis of the bacteria-laden leucocytes occurs  
**Phagocytosis of the bacteria-laden leucocytes occurs  
**"Consolidation tissue re-aerates and the fluid infiltrate causes sputum"  
**"Consolidation tissue re-aerates and the fluid infiltrate causes sputum"  
**"Fibrinous inflammation may extend to and across the pleural space, causing a rub heard by auscultation, and it may lead to resolution or to organization and pleural adhesions" (Atkuri &amp; King, 2006; Steyl, 2007)
**"Fibrinous inflammation may extend to and across the pleural space, causing a rub heard by auscultation, and it may lead to resolution or to organization and pleural adhesions"<ref name=":6" /><ref name=":7" />


== Causes  ==
== Signs and Symptoms ==
<primalpictures id="B167A5" />


There are many different causes of pneumonia which can be classified as infective or aspiration pneumonia.  
The signs and symptoms vary according to disease severity. Common symptoms include fever, cough, sputum production (may or may not be present). The color and quality of sputum provide the clue to microbiological etiology. 
 
* Pleuritic chest pain due to localized inflammation of pleura can be seen with any kind of pneumonia but, is more common with lobar pneumonia. Constitutional symptoms such as fatigue, [[headache]], myalgia, and arthralgias can also be seen.
Infective pneumonia:
* Severe pneumonia can lead to dyspnea and shortness of breath. In severe cases, confusion, sepsis, and multi-organ failure can also manifest.
 
* Tachypnea, increased vocal fremitus, egophony (E to A changes), dullness to percussion are the major clinical signs depending on the degree of consolidation and presence/absence of pleural effusion. [[Lung Sounds|Chest auscultation]] reveals crackles, rales, bronchial breath sounds.
*the infection and inflammatory response of the lungs and bronchial tubes when bacteria or a virus enters the lung and proliferates
* The respiratory rate closely correlates with the degree of oxygenation and, therefore essential in determining the severity. [[Hypoxaemia|Hypoxia]] is seen in severe pneumonia, which leads to hyperventilation.<ref name=":10" />
*can occur through inhaling small droplets containing pneumonia  
*causing organisms such as Streptococcus pneumoniae (ehealth MD, 2004).
 
Aspiration pneumonia:
 
*caused by inhaling vomit, mucous, bodily fluids, or certain chemicals
*causing the lungs and bronchial tubes to become inflamed (Health-cares.net, 2005).
 
== Risk factors  ==
 
The elderly, infants and young children are more at risk of contracting community-acquired pneumonia than young and middle-aged adults. Underlying health problems such as:
 
*flu
*cancer
*AIDS
*heart disease
*diabetes
*asthma
*chronic bronchitis
*emphysema
*chronic obstructive pulmonary disease
*brochiectasis
*immunosuppressive disorders and therapy
*debility or stroke
*coma
*problems with swallowing
*alcoholism
*intravenous drug abuse
 
Cause a person's immune system to be weakened - thus leaving them at risk of contracting Pneumonia. It has also been found that frequent exposure to cigarette smoke increases the risk of developing Pneumonia (Health24.com)
 
== Signs and symptoms  ==
 
Initially symptoms are similar to that of a cold followed by:
 
*a high fever (pyrexia)
*chills
*a productive cough
 
Sputum may be discoloured and may become blood-stained as the pneumonia progresses. The following may also occur:
 
*dyspnoea
*sharp chest pain
*worsening cough
*headaches
*malaise
*muscle pains
*cyanosis due to poorly oxygenated blood
*loss of appetite
*rapid breathing
*wheezing or grunting during breathing
*intercostal muscle recession during breathing
*vomiting
 
The X-ray will show decreased lung expansion and opacity on the affected side (Hough, 1991; Klein, 2008).  


== Diagnosis  ==
== Diagnosis  ==
 
[[File:Chest auscultation.jpg|right|frameless]]
There are several ways to diagnose pneumonia:
*Physical examination  
*Physical examination  
**crackles and wheezing may be heard while auscultating
**[[Auscultation]]- Bronchial breath sounds or fine cracks over the affected area
*Chest X-ray
**Pleural friction rub - an adventitious breath sound heard during auscultation. The sound is caused by the movement of inflamed and roughened pleural surfaces<ref>Adderley N, Sharma S. [[Pleural Friction Rub]]. Accessed 16 March 2020</ref>
**usually done to confirm the diagnosis
*[[X-Rays|Chest X-rays]] often lag behind the clinical presentation.The X-ray will show decreased lung expansion and patchy opacity on the affected side with ill defined margins<ref>Klein, J. (2008). ''Pneumonia''. Retrieved February 13, 2009 from http://kidshealth.org/PageManager.jsp?dn=KidsHealth&amp;lic=1&amp;ps=107&amp;cat_id=20043&amp;article_set=23001</ref><ref name=":5">Torpy, J. (2007). ''Ventilator associated pneumonia''. Retrieved April 12, 2009 from http://jama.ama-assn.org/cgi/content/full/297/14/1616</ref>
*Sputum samples and blood tests
*Sputum samples and blood tests
**done to diagnose the type of pneumonia that is present
**sputum test is done to determine whether it is a fungal or bacterial infection
**blood test is done to examine the White Blood Cell count of the involved patient
**this can be used to indicate the severity of the pneumonia, as well as to determine whether it is a viral or bacterial infection.  
**bacterial infection would result in a blood count that has an increased amount of neutrophils
**a blood count that has an increased amount of lymphocytes would indicate a viral infection.


== Complications  ==
== Complications  ==
 
Include: [[Pleural Effusion|Pleural effusion]]; Empyema; Lung abscess; Bacteremia; [[Sepsis]]; [[Meningitis]]; [[Septic (Infectious) Arthritis|Septic arthritis]]; [[Endocarditis]] or pericarditis <ref name=":1" />
*'''Pleural effusion'''
== Treatment ==
**When fluid accumulates between the pleura and the chest wall due to the large amount of fluid already present in the lungs.
Pneumonia may be treated with [[antibiotics]], if it is bacterial, preferably amoxicillin dispersible tablets. Most cases of pneumonia require oral antibiotics. Hospitalization is recommended only for severe cases of pneumonia.<ref name=":11">World Health Organisation [https://www.who.int/news-room/fact-sheets/detail/pneumonia Pneumonia] Available from:https://www.who.int/news-room/fact-sheets/detail/pneumonia (last accessed 30.6.2020)</ref><primalpictures id="B7FBA8" />
**As a result of the Pneumonia, a pleural effusion may develop which could lead to the collapse of the lungs if not treated appropriately (Health-cares.net, 2005).
*'''Empyema'''
**Pus may be present in the lungs due to the infection.
**Thus pockets of pus may develop in the cavity between the pleura and the chest wall, or in the lung itself which is otherwise known as empyema (Health-cares.net, 2005).
*'''Lung abscess'''
**A lung abscess develops when the infection has destroyed lung tissue and a cavity filled with pus is formed (Health-cares.net, 2005).
*'''Bacteremia'''
**This occurs when the infection is no longer contained within the lungs and moves into the bloodstream, thus the blood is infected (Health-cares.net, 2005).
*'''Septicemia'''
**When bacteremia occurs septicemia can follow, as this is an infection that is spread throughout the body.
**The infected blood is the best way for the infection to manifest in other parts of the body (Health-cares.net, 2005).
*'''Meningitis'''
**The infection may spread to the meninges that cover the brain and spinal cord, leading to meningitis (Health-cares.net, 2005).
*'''Septic arthritis'''
**When bacteremia has occurred septic arthritis is also a danger, as the bacteria manifests in the joints through which blood passes (Health-cares.net, 2005).
*'''Endocarditis or pericarditis'''
**As blood is also circulated through the heart muscles and the pericardium, the risk of developing an infection there is very high if bacteremia is present (Health-cares.net, 2005).
 
== Treatment ==
 
Treatment will vary depending on how bad the symptoms are, and what the cause of the infection is.
 
*Bacterial Pneumonia can be treated with penicillin and/or anti-biotics
 
*Viral Pneumonia cannot be treated with anti-biotics, as they have no effect. This type of pneumonia normally resolves over time.
 
*Mycoplasma Pneumonia is usually treated with anti-biotics.
 
<br> Doctors will also include the following when treating patients with pneumonia:  
 
*Bed rest
*Breathing exercises
*Analgesic administration
*Cough suppressant medication
*Fever-reducing medication (i.e.: Aspirin)  
*Oxygen therapy (when indicated)
 
(healthscout.com)
 
== Physiotherapy Management  ==
== Physiotherapy Management  ==
[[Respiratory Physiotherapy|Respiratory physiotherapy]] is a core specialty within the physiotherapy profession and occupies a key role in the management and treatment of patients with [[Respiratory Disorders|respiratory diseases]]. It aims to unclog the patient’s [[Respiratory System|airways]] and help them return to [[Physical Activity|physical activity]] and exertion. The respiratory physiotherapist employs many diverse interventions, including [[Pulmonary Rehabilitation|pulmonary rehabilitation]], [[Early Mobilization in the ICU|early mobilisation]], and airway clearance techniques, all having beneficial effects on the symptoms associated with in this case pneumonia<ref>[[Respiratory Physiotherapy]]</ref>.


*Modified postural drainage - this allows gravity to drain secretions from specific segments of the lungs
Watch this videos (10 minutes) titled "Community Acquired Pneumonia Overview"{{#ev:youtube|4c_ECpAfdSs}}
*Shaking and vibes - to mobilize secretions
*Coughing and huffing exercises - to expectorate secretions
*Administer humidification - to mobilize secretions
*Breathing exercises - Localized and Diaphragmatic
*IPPB administration - to increase lung volumes
*Mobilization of the patient - done to increase air entry, increase chest expansion, and to loosen secretions
 
(Madjoe &amp; Marais, 2007)  
 
== Children and Pneumonia ==
 
=== Why are children vulnerable?  ===
 
*Unlike healthy children with many natural defenses to protect them against the invasion of pathogens in the lungs, the unhealthy children with a compromised immune system has weak defenses.
*Children who suffer from malnutrion, particularly inadequate zinc intake and lack of exclusive breastfeeding have a higher risk of developing pneumonia.
*Other risk factors include:
**Being born premature
**Having asthma or genetic disorder such as sickle-cell disease
**Having heart defects such as ventricular septal defect (VSD), atrial septal defect (ASD) or patent ductus arteriosus (PDA) (PDRhealth, 2009).
*Several environmental factors such as overcrowding homes and exposure to parental smoke increases a child's susceptibility to pneumonia and its complications (UNICEF/WHO, 2006).
 
=== Signs &amp; Symptoms in children  ===
 
*In children the signs and symptoms are similar to that of adults.
*Sometimes a child's only sign may be rapid breathing and often when pneumonia exist in the lower part of the lungs, no breathing problems may be present but rather fever, abdominal pain or vomiting.
*If pneumonia is caused by bacteria, the infected child becomes sick relative quickly and is prone to developing high fever and rapid breathing.
*If pneumonia is caused by viruses, symptoms may appear gradually and less severe than the bacterial pneumonia (Kids health, 2009).
*Parents should be aware of the following signs and symptoms:  
**Nostril flaring
**Sternal retraction
**Increased breath rate
***&gt; 60 breaths/min for newborns up to 2 months
***&gt; 50 breaths/min for 2 months to 12 months
***&gt; 40 breaths/min for a child older than 1 years of age (Drugs information Online, 2009)
 
=== Prevention  ===


*Vaccines are usually administered to prevent infection by viruses and bacteria.
== Children and Pneumonia ==
*Kids usually receive routine immunisation against Haemophilus Influenzae and Pertussis at the age of 2 months of age.  
Children whose immune systems are compromised are at higher risk of developing pneumonia.  
*Some vaccines are also administered against pneumococcus organism, a common cause of pneumonia (Kids health, 2009)


Transmission of pneumonia
Risk Factors:


Infection may occur in different ways may it be through contaminated air droplets, blood-born infection or from coming into contact with contaminated substances during delivery. Either way it is believed that babies already have the bacterial pathogens causing pneumonia in their nose and/ or throat and are inhaled into the lungs.
* Malnutrition/undernourishment; infants who are not exclusively breastfed; immunocompromised children.
* Environmental: indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung); living in crowded homes; parental smoking.<ref name=":11" />


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
'''Signs and Symptoms in Children:''' the signs and symptoms are similar to that of adults.
<div class="researchbox">
*If pneumonia is caused by bacteria, the infected child becomes sick relative quickly and is prone to developing a high fever and rapid breathing.
<rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1bKp6HMPIM0WPW-UtQtjWy3KGARMW_DaNGEpMu73zsPXQPLQXT|charset=UTF-8|short|max=10</rss>  
*If pneumonia is caused by viruses, symptoms may appear gradually and less severe than bacterial pneumonia.<ref name=":8">Kids Health. (2009). ''Pneumonia''. Retrieved April 11, 2009 from http://kidshealth.org/parent/infections/lung/pneumonia.html</ref>
</div>  
*Increased breath rate: &gt; 60 breaths/min for newborns up to 2 months; &gt; 50 breaths/min for 2 months to 12 months; &gt; 40 breaths/min for a child older than 1 year of age<ref>Drugs information online. (2009). ''Pneumonia in children care Guidelines information''. Retrieved April 11, 2009 from http://www.drugs.com/cg/pneumonia-in-children.html</ref>
'''Prevention:''' Vaccines are usually administered to prevent infection by viruses and bacteria. Kids usually receive routine immunisation against Haemophilus Influenzae and Pertussis at the age of 2 months of age. Some vaccines are also administered against pneumococcus organism, a common cause of pneumonia<ref name=":8" />
== References  ==
== References  ==
 
<references />
References will automatically be added here, see [[Adding References|adding references tutorial]].
[[Category:Glasgow_Caledonian_University_Project]]
 
[[Category:Medical]]
<references />  
[[Category:Cardiopulmonary]]
 
[[Category:Global_Health]]
#AFP. (2009). ''1.6 million die of pneumonia annually: studies''. Retrieved April 8, 2009 from http://www.google.com/hostednews/afp/article/ALeqM5j9-UqSxOOJLWxxBUz1lv9HR5YTgg
[[Category:Open_Physio]]
#Atkuri, L.V., &amp; King, B.R. (2006). ''Pediatrics, Pneumonia''. Retrieved April 10, 2009, from http://emedicine.medscape.com/article/803364-overview
[[Category:Acute Care]]
#Bartleby. ''The Lungs''. Retrieved April 8, 2009 from http://education.yahoo.com/reference/gray/subjects/subject/240
[[Category:Acute Respiratory Disorders - Conditions]]
#Drugs information online. (2009). ''Pneumonia in children care Guidelines information''. Retrieved April 11, 2009 from http://www.drugs.com/cg/pneumonia-in-children.html
[[Category:Communicable Diseases]]
#Health24. (2008). ''Pneumonia''. Retrieved February 13, 2009 from http://health24.com/medical/Head2Toe/777-778-782,13491.asp
#Healthscout. (2009). ''Health Encyclopedia - Diseases and Conditions: Pneumonia''. Retrieved April 8, 2009 from http://www.healthscout.com/ency/68/205/main.html
#Health-cares. (2005). ''What is pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/pneumonia.php
#Health-cares. (2005). ''What types of pneumonia are there?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/pneumonia-types.php
#Health-cares. (2005). ''What is walking pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/walking-pneumonia.php
#Health-cares. (2005). ''What is aspiration pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/aspiration-pneumonia.php
#Health-cares. (2005). ''What is bacterial pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/bacterial-pneumonia.php
#Health-cares. (2005). ''What is viral pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/viral-pneumonia.php
#Health-cares. (2005). ''What is bronchial pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/bronchial-pneumonia.php
#Health-cares. (2005). ''What is community-acquired pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/community-acquired-pneumonia.php
#Health-cares. (2005). ''What is hospital-acquired pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/hospital-acquired-pneumonia.php
#Health-cares. (2005). ''What is atypical pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/atypical-pneumonia.php
#Health-cares. (2005). ''What causes pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/pneumonia-causes.php
#Health-cares. (2005). ''What're the risk factors for pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/pneumonia-risk-factors.php
#Health-cares. (2005). ''What're the complications of pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/pneumonia-complications.php
#Health-cares. (2005). ''What are the symptoms of pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/pneumonia-symptoms.php
#Health-cares. (2005). ''How is pneumonia diagnosed?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/pneumonia-diagnosis.php
#Health-cares. (2005). ''What's the treatment for pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/pneumonia-treatment.php
#Health-cares. (2005). ''How to prevent pneumonia?'' Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/pneumonia-prevention.php
#Kids Health. (2009). ''Pneumonia''. Retrieved April 11, 2009 from http://kidshealth.org/parent/infections/lung/pneumonia.html
#Klein, J. (2008). ''Pneumonia''. Retrieved February 13, 2009 from http://kidshealth.org/PageManager.jsp?dn=KidsHealth&amp;lic=1&amp;ps=107&amp;cat_id=20043&amp;article_set=23001
#Koenig, S., &amp; Truwit, J. (2006). ''Ventilator-associated pneumonia: Diagnosis, treatment and prevention''. Clin Microbiol Rev. 2006 October; 19(4): 637–657. Retrieved April 12, 2009 from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1592694
#Madjoe, L., &amp; Marais, M. (2007). ''Applied Physiotherapy 203 notes: Physiotherapy in Respiratory Care''. University of the Western Cape.
#Martin, E.A. (Ed.). (2003). ''Oxford Concise Medical Dictionary'', 6th Edition. Oxford, United Kingdom. Oxford University Press.
#PDR health. (2009). ''Pneumonia in children''. Retrieved April 11, 2009 from http://www.pdrhealth.com/disease/mono.aspx?
#Schiffman, G., &amp; Stoppler, M. (2009). ''Pneumonia''. Medicine Net. Com. Retrieved April 12, 2009 from C:\Users\charis\Documents\pneumonia\Pneumonia Causes, Symptoms, Signs and Treatment (Viral, Bacterial) on MedicineNet_com.mht
#Smith, B., &amp; Ball, V. (1998). Cardiovascular/Respiratory Physiotherapy. Mosby International Limited: Italy
#Steyl, T. (2007). ''Applied Physiotherapy 403 notes: Intensive Care Notes''. University of the Western Cape.
#Torpy, J. (2007). ''Ventilator associated pneumonia''. Retrieved April 12, 2009 from http://jama.ama-assn.org/cgi/content/full/297/14/1616
#Unicef (2006). ''Pneumonia: The Forgotten Killer of Children''. Retrieved April 8, 2009, from http://www.childinfo.org/pneumonia.html
#Weller, B.F. (Ed.). (2000). " Bailliere's Nurses' Dictionary", 23rd Edition. London, Harcourt Publishers limited.
 
[[Category:Open_Physio]] [[Category:Articles]] [[Category:Respiratory]]

Latest revision as of 07:23, 24 December 2022


Original Editor - The Open Physio project.

Top Contributors - Lucinda hampton, Kim Jackson, Admin, Tony Lowe, Nikhil Benhur Abburi, Adam Vallely Farrell, Evan Thomas, Vidya Acharya, Rachael Lowe, Naomi O'Reilly, George Prudden, WikiSysop, Karen Wilson and Rishika Babburu

Introduction[edit | edit source]

Increased mucus in lungs

Pneumonia, a general term, refers to an infection within the lung. It is caused by a bacterial or viral infection that becomes purulent and filling the alveoli (may become solid).[1]

Aetiology[edit | edit source]

Pneumonias can be classified by:

Infective Agent:

  1. Bacterial Pneumonia occurs when pneumonia-causing bacteria masses and multiplies in the lungs. The alveoli become inflamed and pus is produced, which spreads around the lungs[2] eg Streptococcus pneumonia, Staphylococcus aureus, Haemophilus influenza, legionella pneumophilia and Methicillin resistant staphylococcus aureus (MRSA)[3][4]
  2. Fungal pneumonia This typically occurs in people who have a weakened immune system or other underlying health issues. This is usually inhaled from the environment and does not spread from person to person. eg Pneumocystis Jirovecii Pneumonia.[5]
  3. Mycobacterial pneumonia
  4. Viral Pneumonia - believed to be the cause of half of all cases of pneumonia. The viruses invade the lungs and then multiply- causing inflammation. eg COVID-19, Middle East respiratory syndrome coronavirus (MERS-CoV) infection, severe acute respiratory syndrome (SARS)], varicella pneumonia,Influenza type A or B, rhinoviruses adenoviruses, respiratory syncytial virus (more common in infants and children)[3]

Setting of Infection (how aquired):

  1. Community-acquired pneumonia (CAP): This is the most common form of pneumonia and describes pneumonia that is acquired outside of a hospital the main causes of CAP are bacteria, viruses and less commonly fungi. In most cases pneumonia is not spread from person to person and quite often is transmitted via droplets in the air, touching contaminated objects, poor hygiene and sharing cups or utensil or from the environment[6].
  2. Hospital-acquired pneumonia (HAP) eg 1. Ventilator-associated pneumonia (VAP) Biofilm formation on endotracheal tubes (ETTs) is an early and frequent event in mechanically ventilated patients. The biofilm is believed to act as a reservoir for infecting microorganisms and contributes to development and relapses of ventilator-associated pneumonia[7]; 2. Healthcare-associated pneumonia (HCAP)[8]
  3. Aspiration pneumonia[9] This is commonly caused by inhaling a foreign object, vomit, mucous, bodily fluids, or certain chemicals which causes the bronchial tubes and lungs to become inflamed.[5] It occurs predominantly in the right lung because its total capacity is greater than that of the left lung.[5] If large amounts of gastric contents can cause acute respiratory distress within 1 hour. In cases of aspiration immediate physiotherapy can help with secretion clearance

Pathological Description:

  1. Bronchopneumonia
  2. Lobar pneumonia[1]

The various causes of pneumonia are discussed below. To interact with the screen below, scroll within screen.

Defence Against Pneumonia[edit | edit source]

The overall function of the immune system is to prevent or limit infection. The Immune response is the body's ability to stay safe by affording protection against harmful agents and involves lines of defense against most microbes as well as specialized and highly specific response to a particular offender. See here for more.

Epidemiology[edit | edit source]

Pneumonia-death-rates-in-children-under-5.png

2.5 million people died from pneumonia in 2019, with roughly 33% of these being children younger than 5 years (the leading cause of death for children under 5).[10][11]

Risk factors include:

  1. Elderly, infants, young children and those with a weakened immune system .
  2. Frequent exposure to asbestos and cigarette smoke.
  3. Developing nations where the medical care may be suboptimal, sanitation is poor, and poverty is prevelent.[12]

Stages of Pneumonia[edit | edit source]

Pneumonia has four stages, namely consolidation, red hepatization, grey hepatization and resolution. (may be Lobar Pneumonia or bronchopneumonia, see image R)

  • Consolidation
    • Occurs in the first 24 hours
    • Cellular exudates containing neutrophils, lymphocytes and fibrin replaces the alveolar air
    • Capillaries in the surrounding alveolar walls become congested
    • The infection spreads to the hilum and pleura fairly rapidly
    • Pleurisy occurs
    • Marked by coughing and deep breathing[13][14]
  • Red Hepatization
    • Occurs in the 2-3 days after consolidation
    • At this point, the consistency of the lungs resembles that of the liver
    • The lungs become hyperaemic
    • Alveolar capillaries are engorged with blood
    • Fibrinous exudates fill the alveoli
    • This stage is "characterized by the presence of many erythrocytes, neutrophils, desquamated epithelial cells, and fibrin within the alveoli"[13][14]
  • Grey Hepatization
    • Occurs in the 2-3 days after Red Hepatization
    • This is an avascular stage
    • The lung appears "grey-brown to yellow because of fibrinopurulent exudates, disintegration of red cells, and hemosiderin"
    • The pressure of the exudates in the alveoli causes compression of the capillaries
    • "Leukocytes migrate into the congested alveoli"[13][14]
  • Resolution
    • This stage is characterized by the "resorption and restoration of the pulmonary architecture"
    • A large number of macrophages enter the alveolar spaces
    • Phagocytosis of the bacteria-laden leucocytes occurs
    • "Consolidation tissue re-aerates and the fluid infiltrate causes sputum"
    • "Fibrinous inflammation may extend to and across the pleural space, causing a rub heard by auscultation, and it may lead to resolution or to organization and pleural adhesions"[13][14]

Signs and Symptoms[edit | edit source]

The signs and symptoms vary according to disease severity. Common symptoms include fever, cough, sputum production (may or may not be present). The color and quality of sputum provide the clue to microbiological etiology.

  • Pleuritic chest pain due to localized inflammation of pleura can be seen with any kind of pneumonia but, is more common with lobar pneumonia. Constitutional symptoms such as fatigue, headache, myalgia, and arthralgias can also be seen.
  • Severe pneumonia can lead to dyspnea and shortness of breath. In severe cases, confusion, sepsis, and multi-organ failure can also manifest.
  • Tachypnea, increased vocal fremitus, egophony (E to A changes), dullness to percussion are the major clinical signs depending on the degree of consolidation and presence/absence of pleural effusion. Chest auscultation reveals crackles, rales, bronchial breath sounds.
  • The respiratory rate closely correlates with the degree of oxygenation and, therefore essential in determining the severity. Hypoxia is seen in severe pneumonia, which leads to hyperventilation.[8]

Diagnosis[edit | edit source]

Chest auscultation.jpg

There are several ways to diagnose pneumonia:

  • Physical examination
    • Auscultation- Bronchial breath sounds or fine cracks over the affected area
    • Pleural friction rub - an adventitious breath sound heard during auscultation. The sound is caused by the movement of inflamed and roughened pleural surfaces[15]
  • Chest X-rays often lag behind the clinical presentation.The X-ray will show decreased lung expansion and patchy opacity on the affected side with ill defined margins[16][17]
  • Sputum samples and blood tests

Complications[edit | edit source]

Include: Pleural effusion; Empyema; Lung abscess; Bacteremia; Sepsis; Meningitis; Septic arthritis; Endocarditis or pericarditis [5]

Treatment[edit | edit source]

Pneumonia may be treated with antibiotics, if it is bacterial, preferably amoxicillin dispersible tablets. Most cases of pneumonia require oral antibiotics. Hospitalization is recommended only for severe cases of pneumonia.[18]

Physiotherapy Management[edit | edit source]

Respiratory physiotherapy is a core specialty within the physiotherapy profession and occupies a key role in the management and treatment of patients with respiratory diseases. It aims to unclog the patient’s airways and help them return to physical activity and exertion. The respiratory physiotherapist employs many diverse interventions, including pulmonary rehabilitation, early mobilisation, and airway clearance techniques, all having beneficial effects on the symptoms associated with in this case pneumonia[19].

Watch this videos (10 minutes) titled "Community Acquired Pneumonia Overview"

Children and Pneumonia[edit | edit source]

Children whose immune systems are compromised are at higher risk of developing pneumonia.

Risk Factors:

  • Malnutrition/undernourishment; infants who are not exclusively breastfed; immunocompromised children.
  • Environmental: indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung); living in crowded homes; parental smoking.[18]

Signs and Symptoms in Children: the signs and symptoms are similar to that of adults.

  • If pneumonia is caused by bacteria, the infected child becomes sick relative quickly and is prone to developing a high fever and rapid breathing.
  • If pneumonia is caused by viruses, symptoms may appear gradually and less severe than bacterial pneumonia.[20]
  • Increased breath rate: > 60 breaths/min for newborns up to 2 months; > 50 breaths/min for 2 months to 12 months; > 40 breaths/min for a child older than 1 year of age[21]

Prevention: Vaccines are usually administered to prevent infection by viruses and bacteria. Kids usually receive routine immunisation against Haemophilus Influenzae and Pertussis at the age of 2 months of age. Some vaccines are also administered against pneumococcus organism, a common cause of pneumonia[20]

References[edit | edit source]

  1. ↑ 1.0 1.1 Radiopedia Pneumonia Available: https://radiopaedia.org/articles/pneumonia (accessed 25.5.2021)
  2. ↑ Smith, B., & Ball, V. (1998). Cardiovascular/Respiratory Physiotherapy. Mosby International Limited: Italy
  3. ↑ 3.0 3.1 Healthscout. (2009). Health Encyclopedia - Diseases and Conditions: Pneumonia. Retrieved April 8, 2009 from http://www.healthscout.com/ency/68/205/main.html
  4. ↑ Bartleby. The Lungs. Retrieved April 8, 2009 from http://education.yahoo.com/reference/gray/subjects/subject/240
  5. ↑ 5.0 5.1 5.2 5.3 Health-cares. (2005). What is pneumonia? Retrieved February 13, 2009 from http://respiratory-lung.health-cares.net/pneumonia.php
  6. ↑ Koenig, S., & Truwit, J. (2006). Ventilator-associated pneumonia: Diagnosis, treatment and prevention. Clin Microbiol Rev. 2006 October; 19(4): 637–657. Retrieved April 12, 2009 from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1592694
  7. ↑ Thorarinsdottir HR, Kander T, Holmberg A, Petronis S, Klarin B. Biofilm formation on three different endotracheal tubes: a prospective clinical trial.Available from:https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03092-1 (last accessed 30.6.2020)
  8. ↑ 8.0 8.1 Pahal P, Sharma S. Typical Bacterial Pneumonia.Available from:https://www.ncbi.nlm.nih.gov/books/NBK534295/ (last accessed 29.6.2020)
  9. ↑ Radiopedia Pneumonia Available from:https://radiopaedia.org/articles/pneumonia (last accessed 29.6.2020)
  10. ↑ Dadonaite B, Roser M. Pneumonia. Our World in Data; 2020 [updated Nov 2019; cited 11 May 2020].Available:https://ourworldindata.org/pneumonia (accessed 24.12.2022)
  11. ↑ World health organisation Pneumonia Available:https://www.who.int/health-topics/pneumonia/#tab=tab_1 (accessed 18.12.2022)
  12. ↑ news Medical Pneumonia Epidemiology Available:https://www.news-medical.net/health/Pneumonia-Epidemiology.aspx (accessed 24.12.2022)
  13. ↑ 13.0 13.1 13.2 13.3 Atkuri, L.V., & King, B.R. (2006). Pediatrics, Pneumonia. Retrieved April 10, 2009, from http://emedicine.medscape.com/article/803364-overview
  14. ↑ 14.0 14.1 14.2 14.3 Steyl, T. (2007). Applied Physiotherapy 403 notes: Intensive Care Notes. University of the Western Cape.
  15. ↑ Adderley N, Sharma S. Pleural Friction Rub. Accessed 16 March 2020
  16. ↑ Klein, J. (2008). Pneumonia. Retrieved February 13, 2009 from http://kidshealth.org/PageManager.jsp?dn=KidsHealth&lic=1&ps=107&cat_id=20043&article_set=23001
  17. ↑ Torpy, J. (2007). Ventilator associated pneumonia. Retrieved April 12, 2009 from http://jama.ama-assn.org/cgi/content/full/297/14/1616
  18. ↑ 18.0 18.1 World Health Organisation Pneumonia Available from:https://www.who.int/news-room/fact-sheets/detail/pneumonia (last accessed 30.6.2020)
  19. ↑ Respiratory Physiotherapy
  20. ↑ 20.0 20.1 Kids Health. (2009). Pneumonia. Retrieved April 11, 2009 from http://kidshealth.org/parent/infections/lung/pneumonia.html
  21. ↑ Drugs information online. (2009). Pneumonia in children care Guidelines information. Retrieved April 11, 2009 from http://www.drugs.com/cg/pneumonia-in-children.html
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