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Pneumonia is the inflammation of the lung parenchyma caused by infection.

Theinflammation is triggered by many infectious organisms and irritating agent. Due toinflammation process, fluid accumulates in the lungs hindering gaseous exchange. Community-acquired pneumonia refers to pneumonia acquired outside of hospitals or extended-care facilities. Community-acquired pneumonia (CAP) is one of the most common infectious diseases addressed by clinicians. CAP is an important cause of mortality and morbidity worldwide. A number of pathogens can give rise to CAP. Typical bacterial pathogens that cause the condition include Streptococcus pneumoniae (penicillin-sensitive and -resistant strains), Haemophilus influenzae (ampicillin-sensitive and -resistant strains), and Moraxella catarrhalis (all strains penicillin-resistant). These 3 pathogens account for approximately 85% of CAP cases. CAP is usually acquired via inhalation or aspiration of pulmonary pathogenic organisms into a lung segment or lobe. Less commonly, CAP results from secondary bacteremia from a distant source, such as Escherichia coli urinary tract infection and/or bacteremia. Aspiration pneumonia is the only form of CAP caused by multiple pathogens (eg, aerobic/anaerobic oral organisms). CAP morbidity and mortality are highest in elderly patients and in immunocompromised hosts. Other factors that predict an increased risk of mortality in patients with CAP include the presence of significant comorbidities, an increased respiratory rate, hypotension, fever, multilobar involvement, anemia, and hypoxia. Typical CAP pathogens As previously mentioned, typical bacterial pathogens that cause community-acquired pneumonia (CAP) include S pneumoniae (penicillin-sensitive and -resistant strains), H influenzae (ampicillin-sensitive and -resistant strains), and M catarrhalis (all strains penicillinresistant). These 3 pathogens account for approximately 85% of CAP cases. Gram stains of S pneumoniae, H influenzae, and M catarrhalis are seen below. Importantly, Staphylococcus aureus, K pneumoniae, and Pseudomonas aeruginosa are not typical causes of CAP in otherwise healthy hosts. S aureusmay cause CAP in individuals with influenza (eg, human seasonal influenza and H1N1 [swine] influenza).[7] K pneumoniae CAP occurs primarily in individuals with chronic alcoholism. P aeruginosa is a cause of CAP in patients withbronchiectasis or cystic fibrosis. In certain patients admitted to the ICU, the microbial etiology of the pneumonia may be complex. In a study by Cilloniz et al, polymicrobial infection was present in 11% of cases. The most frequently identified pathogens in polymicrobial infections were S pneumoniae, respiratory viruses, and P aeruginosa. Chronic respiratory disease and acute respiratory distress syndrome criteria were independent predictors of a polymicrobic infection.[8]

Other gram-negative pathogens (eg, Enterobacter species, Serratia species,Stenotrophomonas maltophilia, Burkholderia cepacia) rarely cause CAP. Excluding aspiration CAP, which can be caused by multiple pathogens, virtually all cases of CAP are due to a single pathogen. Studies that report multiple pathogens in CAP are flawed and demonstrate 1 organism microbiologically, with serologic evidence of prior exposure to the other pathogen. Atypical CAP pathogens Atypical pneumonias can be divided into those caused by either zoonotic or nonzoonotic atypical pathogens. Zoonotic atypical CAP pathogens include Chlamydophila (Chlamydia) psittaci(psittacosis), Francisella tularensis (tularemia), and Coxiella burnetii (Q fever). Nonzoonotic atypical CAP pathogens include Legionella species, M pneumoniae,and Chlamydophila (Chlamydia) pneumoniae. These organisms account for approximately 15% of all CAP cases. The clinical diagnosis of typical and atypical CAP is diagrammed below.

Patients who require hospital treatment for CAP are typically elderly persons; persons with underlying chronic obstructive pulmonary disease (COPD), such aschronic bronchitis (not emphysema); and individuals with severe CAP related to underlying cardiopulmonary function, immune status, or pathogen virulence. The Philippines ranks among the top 10 countries with the most recorded pneumoniacases. About 9,000 Filipino children die from the disease every year. In 2007, there were605,471 reported pneumonia cases. Children and babies who develop pneumonia often do nothave any specific signs of a chest infection but develop a fever, appear quite ill, and can becomelethargic. Elderly people may also have few symptoms with pneumonia

Globally, every year, it kills an estimated 1.4 million children under the age of five years,accounting for 18% of all deaths of children under five years old and elderly worldwide.Pneumonia affects children and families everywhere, but is most prevalent in South Asia andsub-Saharan Africa. Ignatavicius and Workmann stated that in the United States 2 to 5 million cases of pneumonia occur each year and its the seventh leading cause of death. The highest incidence among adult occur in older adult, nursing homes resident, hospitalized patent and thosebeing mechanically ventilated (p659). The Centers for Diseases Control and Prevention (CDC)estimate that pneumococcus is the most common community-acquired pneumonia.

ACCODING TO SETTING OF ACQUISITION a. Community-acquired pneumonia Community-acquired pneumonia (CAP) occurs either in the community setting or withinfirst 48 hour of hospitalization or institutionalization. Hospitalization of this condition dependson the severity of pneumonia. Most people get CAP by breathing in germs (especially whilesleeping) that live in the mouth, nose, or throat. CAP is the most common type of pneumonia.Most cases occur during the winter. (Bare B. & Smeltzer S.2008). b. Hospital-Acquired Pneumonia This is a type of pneumonia is acquired during hospital stay for another illness. Its also known as nosocomial pneumonia. Patients are at higher risk of getting HAP if they're on aventilator (a machine that helps you breathe). The onset of this pneumonia symptoms starts morethan 48 hours of hospitalization. HAP tends to be more severe compared to CAP because of existing infections. Also, hospitals tend to have more germs that are resistant to antibiotics(medicines used to treat pneumonia). (Bare B. & Smeltzer S.2008). c. Ventilator-associated pneumonia This type affect patients are intubated and mechanically ventilated. The endotracheal tubekeeps the glottis open, so secretion can be aspired into the lungs. (Williams and hopper 2007) B. ACCORDING TO CAUSATIVE AGENT a. Aspiration Pneumonia This refers to the consequences resulting from entry of endogenous or exogenoussubstances gaining access to the lower airways. The most common cause is infection fromaspirated bacteria that normally resides at upper respiratory airways.(Williams & Wilkins, 2010).

4It can occur in community or hospital. The most common bacteria are Streptococcus pneumonia,hemophilia influenza, and staphylococcus aureus . Other causes may include, gastric content,chemical or irritating gases inhale food, drink, vomit, or saliva from your mouth into your lungs.This may happen if something disturbs your normal gag reflex, such as a brain injury,swallowing problem, or excessive use of alcohol or drugs. (Joyce M. Black 2009) b. Bacterial pneumonia : This type of pneumonia is caused by different types of bacteria. The most pneumoniainducing bacterium is Streptococcus pneumoniae. This pneumonia types generally affects peoplewho have weakened immune system for reasons like old age, illness, malnutrition etc. (Lewis, etal 2008) c. Viral pneumonia : This Type of pneumonia can be caused by different types of viruses. The most commonforms of viruses causing viral pneumonia are flu virus, parainfluenza virus, herpes simplex virus,rhinovirus, adenovirus, Hantavirus, cytomegalovirus and respiratory syncytial virus.(lemone&burke 2007) d. Fungal pneumonia : This is rare types of pneumonia. The fungus causing this type of pneumonia is Pneumocystis carinii. Its common among people with weak immune system or immunosuppressed. Often pneumocystis carinii pneumonia is described as a complicationexperienced by patients with diseases that weaken the immune system such as AIDS, Cancer etc.(Leone &burke 2008) . e. Hypostatic pneumonia 5This type is related to patients who hypoventilate because of bed rest, immobility orshallow respiration. Secretions pools in dependent areas of the lungs and can lead toinflammation and infection (Williams and hopper 2007) f. Chemical pneumonia Inhalation of toxic chemicals can cause inflammation and tissue damage, which will leadto chemical pneumonia. (Williams and hopper 2007) g. Atypical Pneumonia (Walking Pneumonia) This refers to pneumonia that is mild enough so that you are not bedridden. Thecondition can be treated without hospitalization. It is caused by mycoplasma pneumonia Legionella pneumophila, mycoplasma pneumonia, and

Chlamydophila pneumoniae. It is knownas atypical because its presentation and its course significantly differ from other bacterialpneumonia . ACCORDING TO THE PART IT AFFECT Lobar pneumonia As the name suggest, this types affect one or more lobes of the lungs. It can be anywherein the lobe and may include both lobes. Bronchopneumonia or lobular pneumonia This type affects the epithelial cells of distal airways and alveoli part of the lungs causingconsolidations thereby decreasing gaseous exchange. Interstitial pneumonia This type is characterized by progressive scarring of both lungs.

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