Sie sind auf Seite 1von 8

TORRES, Alyssa Denise & TORRES, Jade Ashley 3G-PH

Air-borne diseases: PNEUMONIA

History of the Disease Commented [H1]: https://www.passporthealthusa.com/2015/


08/pneumonia-history-and-prevention-of-the-winter-fever/
The Winter Fever, as pneumonia was once known, has been traced back through history. Symptoms https://www.preceden.com/timelines/270455-history-of-
of pneumonia were first described by the Greek physician Hippocrates around 460 BC. pneumonia

https://books.google.com.ph/books?id=bXtaX468LRYC&pg=PA76&l
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.”

Epidemiology of the Disease Commented [H2]: http://www.doh.gov.ph/mortality

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%).

NOTIFIABLE DISEASES BY REGION Number and Rate/100,000


Population Philippines, 2012 In 2012, it was reported that the
Area Acute LRTI and Pneumonia regions of Eastern Visayas,
Number Rate Davao, and Western Visayas,
Philippines 526,638 547.5
NCR 50,552 410.5 respectively, were the regions
CAR 13,450 802.2 most affected by Acute LRTI and
Ilocos 15,782 323.8
Pneumonia.
Cagayan Valley 25,274 759.9
Central Luzon 23,234 219.0
Calabarzon 16,611 123.4
Mimaropa 4,300 150.8
Bicol 18,989 339.6
Western Visayas 69,665 953.1
Central Visayas 17,917 253.7
Eastern Visayas 136,345 3235.0
Zamboanga Peninsula 16,505 465.5
Northern Mindanao 25,706 558.5
Davao 83,873 1799.8
SOCCSKSARGEN 1,401 32.4
CARAGA 2,745 109.5
ARMM 4,919 146.3
Factors that cause the disease

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

Effectiveness of Vaccine and Drug Therapy https://www.cdc.gov/vaccines/vpd/pneumo/public/index.html

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.

In a study including approximately 85,000 adults 65 years or older in the Netherlands,


(Polysaccharide conjugate vaccine against pneumococcal pneumonia in adults) PCV13 protected 75
out of 100 of those vaccinated against invasive pneumococcal disease and 45 out of 100 vaccinated
against pneumococcal pneumonia caused by the serotypes included in the vaccine.
According to the U.S. FDA in 2011, PPSV23 protects between 50 to 85 out of every 100 adults with
healthy immune systems against invasive disease caused by the 23 serotypes covered by the
vaccine.

 DRUG THERAPY Commented [H5]: http://www.clevelandclinicmeded.com/med


icalpubs/diseasemanagement/infectious-disease/community-
acquired-pneumonia/
Antibiotic therapy is the mainstay of treatment for community-acquired pneumonia. Streptococcus
pneumoniae is an encapsulated Gram-positive coccus (penicillin-sensitive/resistant strains). https://emedicine.medscape.com/article/300157-medication

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.

For outpatient treatment, treatments are dictated by age:

< 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.

≥ 5 yr: Amoxicillin or amoxicillin plus a macrolide. Amoxicillin/clavulanate is an alternative. If the


cause appears to be an atypical pathogen, a macrolide alone can be used.

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

No comorbidities/previously healthy; no risk factors for drug-resistant S pneumoniae:


 Azithromycin 500 mg PO one dose, then 250 mg PO daily for 4 d or extended-release 2 g PO
as a single dose or
 Clarithromycin 500 mg PO bid or extended-release 1000 mg PO q24h or
 Doxycycline 100 mg PO bid

Duration of therapy: minimum of 5 days, should be afebrile for 48-72 hours, or until afebrile for 3
days

Inpatient, non-ICU

 Levofloxacin 750 mg IV or PO q24h or


 Moxifloxacin 400 mg IV or PO q24h or
 Combination of a beta-lactam (ceftriaxone 1 g IV q24h or cefotaxime 1 g IV q8h or
ertapenem 1 g IV daily or ceftaroline 600 mg IV q12h) plus azithromycin 500 mg IV q24h

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%

Microorganisms responsible for pneumonia and the therapeutic agent of choice


Pathogen Drug(s) of choice
Streptococcus pneumoniae Penicillin
Staphylococcus aureus (MSSA) Flucloxacillin ± fusidic acid
Staphylococcus aureus (MRSA) Vancomycin or linezolid
Haemophilus influenza Cefotaxime or ciprofloxacin
Klebsiella pneumoniae Cefotaxime ± gentamicin
Pseudomonas aeruginosa Ceftazidime ± gentamicin or piperacillin-tazobactam ±
gentamicin
Mycoplasma pneumoniae Erythromycin or tetracycline
Legionella pneumophilia Erythromycin ± rifampicin
Chlamydia psittaci Tetracycline
Mycobacterium tuberculosis Rifampicin + isoniazid + ethambutol + pyrazinamide
Herpes simplex, varicella/zoster Aciclovir
Candida spp. Fluconazole or echinocandins
Aspergillus spp. Amphotericin B or broad-spectrum triazoles
Anaerobic bacteria Penicillin or metronidazole
Viral pneumonia usually improves in 1 to 3 weeks.

Treatment and Prevention of Common Causes of Viral Pneumonia


Virus Treatment
Influenza virus Oseltamivir, Peramivir, Zanamivir
Respiratory syncytial virus Ribavirin
Parainfluenza virus Ribavirin
Herpes simplex virus Acyclovir
Varicella-zoster virus Acyclovir
Adenovirus Ribavirin
Measles virus Ribavirin
Cytomegalovirus Ganciclovir, Foscarnet

Clinical Diagnosis of the Disease


Symptoms also can vary, depending on whether your pneumonia is bacterial or viral:

 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:

 Multilobar infiltrates suggest S. pneumoniae or Legionella pneumophila infection.


 Interstitial pneumonia (on chest x-ray, appearing as increased interstitial markings,
subpleural reticular opacities that increase from the apex to the bases of the lungs, and
peripheral honeycombing) suggests viral or mycoplasmal etiology.
 Cavitating pneumonia suggests S. aureus or a fungal or mycobacterial etiology.

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.

Health needs of the Community

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.

Effectiveness of the Healthcare Programs of the Government Commented [H6]: http://www.officialgazette.gov.ph/2013/07/


17/doh-vaccine-vs-pneumonia-in-children-now-part-of-
government-immunization-program/
 DOH launches pneumonia immunization program for seniors
In 2011, DOH issued Administrative Order 2011-0018, setting out the implementing http://www.sunstar.com.ph/davao/local-news/2016/05/18/doh-
launches-expanded-pneumonia-vaccination-474394
guidelines on influenza or pneumococcal immunization for indigent senior citizens . Under
the program, the DOH procured pneumococcal vaccines and administered a single dose to http://www.philstar.com/nation/2013/07/18/981461/pneumonia-
now-included-expanded-immunization-program
all idigent senior citizens. Since 2011, 1,409,957 senior citizens have received the
pneumococcal vaccine. http://www.pchrd.dost.gov.ph/index.php/news/library-health-
news/5480-doh-launches-pneumonia-immunization-program-for-
 The Department of Health (DOH) expanded its immunization program by including seniors
pneumococcal conjugate vaccines (PCV) against pneumonia in 2013
By including PCV in the DOH’s Expanded Program on Immunization (EPI), the patients will
be protected not only against pneumonia but also against other pneumococcal infections
like meningitis and otitis media or hearing infection.
 DOH launches expanded pneumonia vaccination in 2016
The DOH seeks to prevent the risk of the viral pneumonia by giving senior citizens with free
pneumococcal vaccinations. She added that at least 95 percent of senior citizens in Davao
will be immunized. There is no death reported due to vaccine. The pneumonia vaccine
would in fact ensure the health of the senior citizens and reduce the risk of viral pneumonia.

REFERENCES:

Bhatia, S. (2010). Biomaterials for Clinical Applications. New York: Springer-Verlag.

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.

Schmitt, S. (2010). Community-Acquired Pneumonia. Retrieved from


www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/infectious-disease/community-acquired-
pneumonia/

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/

World Health Organization. (2016). Pneumonia. Retrieved from www.who.int/mediacentre/factsheets/fs331/en/

Das könnte Ihnen auch gefallen