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Hippocrates wrote: “Peripneumonia are to be thus observed: If the fever be acute, and if there be pg=PA76&dq=edwin+klebs+pneumonia&source=bl&ots=kDgeYoGN
pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated 8V&sig=ocYFu_Qh6swnRSLxURcchu9LTjA&hl=en&sa=X&ved=0ahUK
EwjpzaTP8rrXAhUEpJQKHZjMCGoQ6AEIUDAG#v=onepage&q=edwi
be of a blond or livid color, or likewise thin, frothy, and florid, or having any other character n%20klebs%20pneumonia&f=false
different from the common.”
Although it was often identified as a sickness, it wasn’t until the 19th century (1800) that scholars
were able to identify pneumonia as its own infection, and not just a symptom of other diseases.
In 1875, German pathologist Edwin Klebs observed pneumonia bacteria under a microscope for the
first time. He observed bacteria in the airways of individuals who died from pneumonia. In 1880,
Louis Pasteur discovered the Streptococcus pneumoniae bacterium. Soon after, Carl Friedlander
identified S. pneumoniae as the most causative agent for pneumonia.
Albert Frankel, in 1884, identified Klebsiella pneumoniae as another causative agent for pneumonia.
At the end of the 19th century, physicians understood pneumonia to be a pathological disease
process in which “the spongy pulmonary tissue is rapidly converted into a solid mass.”
http://www.wpro.who.int/philippines/typhoon_haiyan/media/Pne
Pneumonia is an acute respiratory infection affecting the lungs that can be caused by viruses, umonia.pdf
bacteria, or fungi. It is the inflammation in the air sacs in your lungs (alveoli) as it is filled with fluid
http://www.doh.gov.ph/sites/default/files/publications/PHS2012.p
or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing df
Pneumonia is the single largest infectious cause of death in children worldwide. Pneumonia killed
920 136 children under the age of 5 in 2015, accounting for 16% of all deaths of children under five
years old.
The Philippines is one of the 15 countries that together account for 75% of childhood pneumonia
cases worldwide.
In 2013, Pneumonia (53,101 out of 514,745 deaths registered; 10.0%) was the 4th leading cause of
mortality in the Philippines. It was also the leading cause of infant mortality (3,146 out of 21,992
registered infant deaths; 14.3%).
Pneumonia is classified by its causes. It can be caused by viruses, bacteria, or fungi. Bacterial
pneumonia is transmitted by breathing in infected air droplets from someone who has pneumonia.
In some cases, the bacteria can be generated by improperly cleaned air conditioners. The bacteria
(S. pneumoniae, H. influenza, C. Pneumoniae, and P. aeruginosa) can live in the throat, waiting for a
chance to grow and spread.
Fungal pneumonia is caused by the inhalation of the fungi from bird and bat droppings in the soil,
caves, chicken cops and construction sites (Histoplasma, Cryptococcus, Coccidioides).
Pneumonia can also be contracted through the use of ventilator tubes or other tubes that open a
patient’s throat provide a direct point of access for airborne bacteria and viruses to enter the lungs
(not cleaning and replacing equipment in between patients) (Ventilator-associated pneumonia).
It can also result from food, saliva, liquids, or vomit is breathed into the lungs or airways leading to
the lungs, instead of being swallowed into the esophagus and stomach (Aspiration pneumonia).
Prevention of the Occurrence and Spread of the Disease Commented [H3]: http://www.who.int/mediacentre/factsheet
s/fs331/en/
1. Get a flu vaccine (shot) once every year to avoid viral pneumonia. Immunization against https://my.clevelandclinic.org/health/articles/pneumonia
Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to
prevent pneumonia.
2. Don't smoke, and avoid secondhand smoke as a prevention for both bacterial and viral
pneumonia.
3. Wash your hands before eating, before handling food, when using the restroom, and after
being outside to prevent spread of bacteria.
4. Avoid being around people who are sick.
5. Tell your doctor if you have trouble swallowing.
6. Addressing environmental factors such as indoor air pollution (by providing affordable
clean indoor stoves or cleaning air conditioners)
7. If infected with HIV, the antibiotic cotrimoxazole is given daily to decrease the risk of
contracting pneumonia that can be caused by Pneumocystis jirovecii (fungal pneumonia).
Commented [H4]: https://www.blf.org.uk/support-for-
you/pneumonia/prevention
https://www.emedicinehealth.com/bacterial_pneumonia/page7_e
m.htm
https://www.medicinenet.com/pneumococcal_vaccination/article.
VACCINES htm
https://www.emedicinehealth.com/bacterial_pneumonia/page7_e
m.htm
Vaccines are available that prevent certain types of pneumonia. However, since there are many
bacteria that cause pneumonia, a person may contract pneumonia despite receiving the vaccine.
There are more than 80 different types of pneumococcus bacteria -- 23 of them covered by the
vaccine. Pneumococcal vaccination does not protect against pneumonia caused by microbes other
than pneumococcus bacteria.
There are two types of vaccine available for pneumonia. They protect against the most common
cause of pneumonia, the bacterium Streptococcus pneumoniae. They aim to protect people who are
at a higher risk from pneumonia, including older people and babies.
The pneumococcal polysaccharide vaccine (PPV23) is for people over 65 and anyone over the age of
two who’s in a high-risk group*. Most adults will only need to have this vaccination once in their
life.
*people > 2 years of age with serious long-term health problems such as heart failure, liver failure (cirrhosis of
the liver), diabetes, or lung disease (other than asthma),
*people > 2 years of age with lowered immunity due to cancer, chemotherapy, removal or diseases of the spleen,
chronic kidney problems, or have had an organ or bone marrow transplant
PPV23 is given as a single dose to people who are recommended to receive it. One or two booster
doses are recommended for some people. This vaccine is indicated for active immunization for the
prevention of pneumococcal disease caused by the 23 serotypes contained in the vaccine (1, 2, 3, 4,
5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19F, 19A, 20, 22F, 23F, and 33F).
The pneumococcal conjugate vaccine (PCV13) is given to infants. Babies get their first dose when
they’re two months old. It can also help prevent some ear infections. S. pneumoniae is a versatile
pathogen which can cause sinusitis or otitis media (infections of the sinuses or middle ear).
PCV13 is given in a three-dose primary series starting at 2 months of age plus one booster dose at
12 through 15 months of age. Children who begin vaccination after 6 months of age will receive
fewer doses. Adults who are recommended to receive it only need a single dose.
The vaccine helps protect against the 13 types of pneumococcal bacteria that are the most common
causes of serious infections in children and adults. It is indicated for active immunization for the
prevention of pneumonia and invasive disease caused by S. pneumoniae serotypes 1, 3, 4, 5, 6A, 6B,
7F, 9V, 14, 18C, 19A, 19F and 23F.
Pneumococcal vaccines should not be taken at the same time. Persons who have never received a
pneumococcal vaccine should receive the PCV13 first and then within six months to a one year
receive the PPSV23.
https://emedicine.medscape.com/article/2011819-overview
Appropriate treatment involves starting empiric antibiotics as soon as possible, preferably ≤8 h
after presentation. Outpatients are typically treated with oral antibiotics. For the most part, https://emedicine.medscape.com/article/300455-treatment
parenteral medications are given to patients admitted to the hospital. A rational approach may be
to administer an oral extended-spectrum macrolide or amoxicillin and clavulanate to those with
mild, outpatient disease.
< 5 yr: Amoxicillin or amoxicillin/clavulanate is usually the drug of choice. If epidemiology suggests
an atypical pathogen as the cause and clinical findings are compatible, a macrolide (eg,
azithromycin or clarithromycin) can be used instead. Some experts suggest not using antibiotics if
clinical features strongly suggest viral pneumonia.
Resistance among Strep. pneumoniae to penicillin has increased worldwide; vancomycin may be
indicated. Alternative agents include meropenem.
Oral fluoroquinolone may be substituted if a comorbid illness or allergy to the first-line agents is
present or for good dosing compliance. Admitted patients should receive IV therapy, a third-
generation cephalosporin alone or with a macrolide. An alternative regimen would be IV
fluoroquinolones alone. Levofloxacin is rapidly becoming a popular choice in pneumonia; this agent
is a fluoroquinolone used to treat CAP caused by S aureus, S pneumoniae (including penicillin-
resistant strains), H influenzae, H parainfluenzae, Klebsiella pneumoniae, M catarrhalis, C
pneumoniae, Legionella pneumophila, or M pneumoniae. Along with Levofloxacin, Moxifloxacin is
also a “respiratory quinolone.”
Third-generation quinolone possess the attributes of their predecessors but exhibit greater activity
against Strep. Pneumoniae. All the quinolones are bactericidal, and orally active. Penicillin G
remains the mainstay of therapy for the treatment of penicillin-susceptible pneumococcal
pneumonia. Penicillin-resistant pneumococcal pneumonia can be safely treated with adequate beta-
lactams at the right dosage. The new fluoroquinolones are very active and effective in
pneumococcal pneumonia.
Outpatient
Duration of therapy: minimum of 5 days, should be afebrile for 48-72 hours, or until afebrile for 3
days
Inpatient, non-ICU
Duration of therapy: minimum of 5 days, should be afebrile for 48-72 hours, stable blood pressure,
adequate oral intake, and room air oxygen saturation of greater than 90%
In bacterial pneumonia, your temperature may rise as high as 105 degrees F. This
pneumonia can cause profuse sweating, and rapidly increased breathing and pulse rate.
Lips and nailbeds may have a bluish color due to lack of oxygen in the blood. A patient's
mental state may be confused or delirious.
The initial symptoms of viral pneumonia are the same as influenza symptoms: fever, a dry
cough, headache, muscle pain, and weakness. Within 12 to 36 hours, there is increasing
breathlessness; the cough becomes worse and produces a small amount of mucus. There
may be a high fever and there may be blueness of the lips.
Identification of the pathogen can be useful to direct therapy and verify bacterial susceptibilities to
antibiotics.
Chest x-ray determines the extent and location of the infection. Findings generally cannot
distinguish one type of infection from another, although the following findings are suggestive:
Pulse oximetry measures the oxygen level in your blood. Pneumonia can prevent your lungs from
moving enough oxygen into your bloodstream.
Sputum test is the collection of a sample of sputum (spit) or phlegm (slimy substance from deep in
your lungs) that was produced from one of your deep coughs, and the sample is sent to the lab for
testing. This may help find out if bacteria are causing your pneumonia. For mucus tests, tests
include a gram stain and a sputum culture.
In pleural fluid culture, a fluid sample is taken from the pleural space (a thin space between two
layers of tissue that line the lungs and chest cavity). Doctors use thoracentesis to collect the fluid
sample. The fluid is studied for bacteria that may cause pneumonia.
Blood cultures, which are often obtained in patients hospitalized for pneumonia, can identify
causative bacterial pathogens if bacteremia is present.
Common vaccines that can prevent common diseases that sometimes lead to pneumonia (eg:
chickenpox vaccine, flu vaccine) should be administered. More government programs should be
implemented and should not be limited to free vaccinations; rather, education and awareness
regarding pneumonia should be a primary focus. Healthcare professionals should practice frequent
cleaning of the patient’s mouth, and thorough cleaning or replacing of equipment in between
patients to eliminate the risk of pneumonia.
REFERENCES:
Crisostomo, S. (2013). Pneumonia now included in expanded immunization program. Retrived from
www.philstar.com/nation/2013/07/18/981461/pneumonia-now-included-expanded-immunization-program
Department of Health, Philippines. (2013). Philippine Health Statistics 2013. Retrieved from www.doh.gov.ph/mortality
Denyer, S., Hodges, N., Gorman, S., Gilmore, B. (2011). Hugo and-Russell's Pharmaceutical Microbiology, 8th Edition.
Oxford, UK: Blackwell Publishing Ltd.
Sowards, W. (2015). Pneumonia: History and Prevention of the ‘Winter Fever’. Retrieved from
www.passporthealthusa.com/2015/08/pneumonia-history-and-prevention-of-the-winter-fever/