Beruflich Dokumente
Kultur Dokumente
Peijun Zhao
ISM Period B6
November 4, 2018
PNEUMONIA 2
Abstract
The aim of the study is to understand the different ways pneumonia spreads throughout
the immune system as well as the type of penicillin-based antibiotics used to fight against this
disease. Pneumonia has affected millions of civilians for hundreds of years and adding to the
continuous research conducted to fight against this disease will benefit the community’s
awareness. This study involves intensive research concerning recent articles, scientific
references, and magazines on the causes, symptoms, vaccination, and treatments for pneumonia.
I will then type this information for a conclusive and thorough research paper with clear
citations. Eventually, I will condense this information into a pamphlet for usage at the doctor’s
office which benefits daily patients concerned about pneumonia. If the resulting pamphlet is not
suited for the doctor’s office, then I will provide them to students at Clear Horizons as an
informative tool. By completing this project, I will both form a solid understanding of this illness
for future references during my studies for medical school while informing the community about
Introduction
This literature review covers the history and overview of pneumonia as well as its current
antibiotics used for treatment. Additionally, there will be information provided about the
Pneumonia, at its basis, is the infection of the lungs with over 30 different causes and acts
as the leading cause of death in children under the age of five. It is a very common infection that
often occurs in the young, the elderly, and those comprised by a weak immune system. Despite
the large death rate, the bacteria Streptococcus pneumonia was not discovered until the late
1800s, which allowed for researchers to identify it and associate the bacteria with the lung
infection. Research grew, allowing scientists to procure antibiotics in the late 1900s to treat
pneumonia. However, the battle is still ongoing as pneumonia is still prominent across the world,
breath. These symptoms may slightly differ between patients with viral or bacterial pneumonia.
Once these symptoms are ongoing, the physician may suggest an X-ray to determine the extent
and treatment options of pneumonia. The patient may then be prescribed antibiotics to lessen the
inflammation. If the infection was caused due to a virus, then the physician may treat the
symptoms and allow the body to naturally fight against the virus (Dallas, 2018).
Despite the resourcefulness of the antibiotics, there are still millions of cases of
pneumonia that affect individuals across the world, especially in 3rd world countries. Pneumonia
strains continue to develop resistances against our current antibiotic treatment, and due to both
the costs of continually conducting research and the amount of time necessary to develop these
medicines, the fight against pneumonia is still ongoing, similar to the flu (Reynolds, 2014)
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Literature Review
This review establishes three main parts of pneumonia: the history, the overview, and
current prospects over using antibiotics to treat the disease. This information will provide the
reader with a general but thorough understanding over the different aspects over the disease.
Background
Starting History. Pneumonia has plagued the country for centuries, causing millions of
children to contract coughing, wheezing, and fevers with the potential of death. Even since the
early 300BC, the disease was described as the Winter Fever, as this was the time where most
immune systems were compromised, allowing the disease to spread rapidly. This disease
remained widely unknown until 1875 when the first researcher, Edwin Klebs identified the
bacteria. However, this recorded disease was never truly understood until two microbiologists,
George Sternberg and Louis Pasteur, discovered the bacteria form, Streptococcus pneumonia.
This allowed for researchers to diagnose who had pneumonia and understand different properties
of the disease. Further research in the early 1900s identified the interaction of the bacteria with
the immune system, its structure, and how the body’s immune system could fight against the
infection. In 1913, there was an antiserum used to treat patients with evident decreased mortality.
The antiserum was composed of antibodies that could be injected into the patient, but the venture
was costly and inefficient at assisting most patients. Pneumonia remained the leading cause of
First Major Change. One of the biggest proponents of a new treatment for pneumonia
was Alexander Fleming’s discover of penicillin in which the researcher noticed that penicillin
could be harvested as a liquid from mold. The penicillin could be used to kill off certain bacteria
in a test tray, depending on the strain. Based on this discovery, Fleming published his discovery
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and allowed other research groups to take the helm. There were three other main notable
individuals that contributed to the rise of penicillin-based antibiotics. The next individual,
Howard Florey, conducted research on the purification of the drug and promoted the drug
production across the United States. Florey, with backing from the Rockefeller Foundation,
could conduct additional research and form a synthesized product that could be used to treat
patients. He tested the antibiotics, which showed stunning results of treating patients on their
death beds. As these results became clearer, more companies started to invest in penicillin
antibiotics and assisted in concocting ways to manufacture the drug efficiently. Over time, the
drug became widespread, curing millions of citizens. The final individual was Ernst Chain who
established the chemical structure of penicillin, allowing for other antibiotics to base its chemical
compound off this drug such of that of amoxicillin. Thus, with the push of these three main
Continuing History. Yet, despite the prevalence of this new drug, the pneumonia
many strong antibiotics now still treat bacterial pneumonia, viral and fungal infections of
pneumonia are often different and require additional resources to cure. In 1977, a vaccine called
pneumococcal polysaccharide vaccine (PPV) was developed against certain strains of pneumonia
(Chow, 2018). Pneumococcal represented the type of bacteria while polysaccharide represented
the type of structure. The second vaccine pneumococcal conjugate vaccine (PCV13) was formed
in 2013 against additional strains, but even with this vaccine, the overall prevalence of
pneumonia remained. Currently, pneumonia remains as the leading cause of death for children
under the age of five, especially in developing countries. Cases of pneumonia still affect our
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system each year, and until we develop a common vaccine against multiple types of pneumonia,
more strains will develop, and people will contract the disease.
Overview
Pneumonia is the infection of the lungs, causing inflammation, and if left untreated, will
Causes. Pneumonia can be caused by a variety of different things. In fact, there are
multiple types of pneumonia which can range from bacteria, viral, fungi, or chemicals found in
the surrounding environment. However, the causes tend to differ between countries. In
developed countries, the most common cause of pneumonia comes from viral infections,
typically the common flu, while in developed countries, the cause comes from bacterial
infections (UNICEF, 2018). The primary reason behind this pattern derives from the level of
sanitation and health resources within the country. In the United States, there is a higher level of
healthcare and sanitation where everyone has relatively close access to clean water and living
conditions. However, due to close living quarters high population density, there is a higher
chance of contracting the flu. In developing countries such as Africa, sanitation standards are low
where impure water and living circumstances are dire. As a result, people are more likely to
contract a pneumonia infection from bacteria. Generally, when a virus or bacteria infects the
lungs, white blood cells, neutrophils, and plasma proteins, called opsonins, attempt to kill the
bacteria or virus causing the infection. During this process, products created by these combat
cells are damaging to both the enemy cells and the lungs, causing inflammation and fluid-
buildup called pulmonary edema (Boston University, 2012). Over time, this may cause an excess
amount of fluid to fill the lungs, preventing oxygen distribution throughout the entire body. If
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left untreated, this infection can cause death. This process may have minor differences between
each type of pneumonia, but the general inflammation process and fluid-buildup is the same.
Symptoms and Risk Factors. Children under the age of five along with those over the
age of 65 are more likely to contract pneumonia due to a weakened immune system. Yet,
everyone can contract pneumonia if their immune system is compromised or if they have been
untreated for various illnesses such as bronchitis or the common flu. With pneumonia, there are a
few primary symptoms such as cough, fever (a sign of infection), chills, shortness of breath,
mucus, and chest pain when breathing or coughing. Typically, these symptoms are similar to that
of the common flu, and it is possible for the flu to develop into pneumonia once the flu infection
reaches the lungs (American Lung Association, 2018). However, pneumonia lasts longer than the
common flu, and if the illness continues, then there is a higher chance of the illness being
pneumonia. Risks are also increased if a person smokes or has damaged lungs. This is due to the
weakened lungs unable to produce the same level of combat against foreign bodies in the lungs.
Finally, those who obtain vaccinations such as the PCV and the annual flu shot are less likely to
Diagnosis. There are several different signs that a doctor may use to diagnose
pneumonia. The first sign comes from a patient with fever, congestion, coughs, and difficulty
breathing. A fever is a typical sign of an infection and difficulty breathing usually results from
the lungs. Afterwards, the doctor may listen to the patient’s lungs and prescribe some medication
to help with the infection, especially those to ease the symptoms. Usually with a stethoscope, the
doctor may hear a slight scratching or crunching such as hair bristling against each other or feet
crunching on snow. This is usually the first indicator that the doctor would have. However, it is
difficult for a doctor to automatically assume if a patient has pneumonia unless the patient
obtains a chest x-ray which will determine if there is fluid buildup in the lungs. Above is an
example image of pneumonia in which you can compare it directly to a clear chest x-ray. The
chest x-ray with pneumonia has a slightly whitish layer which represents liquid deposits.
Although it may be difficult to see, radiologists can often identify these small differences and
will issue a small report. Afterwards, the report will then be provided to the doctor to issue their
treatment of choice.
Treatment. There are two main types of treatment options: outpatient and inpatient
treatment. Most cases, roughly 80% of the time, doctors can treat patients without admitting
them to the hospital. An outpatient saves the patient a large amount of time and energy from
going to the hospital, waiting overnight, and paying the hospital thousands of dollars for
medicinal treatment. Through this process the doctor first observes the patient through a checkup
and once they detect specific symptoms, they may prescribe either Tamiflu or other steroids to
reduce inflammation of the lung (American Lung Association, 2018). Viral pneumonia can’t be
treated by antibiotics, so doctor treat the symptoms to allow the patient’s immune system to
develop and fight the virus safely. Additionally, the doctor will prescribe the patient several days
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of rest with plenty of fluid and medication for fever. For bacterial pneumonia, the doctor will
the cell wall of bacteria cells or preventing the bacteria from reproducing. This process usually
takes between a few days and a week for the patient to start recovering from pneumonia. If the
patient does not recover during this process, the doctor will then admit the patient into the
hospital for monitoring where the patient will receive stronger medication and machinery in the
ICU (intensive care unit) if patient has difficulty breathing (Vernadakis, 2018). Additionally,
patients that are under the age of five, over the age of 65, or have a weakened immune system
are also admitted to the hospital for possibility of emergent cases. If the patient recovers, then the
doctor will recommend the patient to finish their medication and another x-ray to verify the
success of the treatment. Once pneumonia is no longer detected and the patient has recovered
from their symptoms, the patient is released from treatment. There are always other treatment
options for different types of pneumonia. For example, in fungal pneumonia, require antifungal
medication, and the provider may request a culture sample to identify the exact type of fungal
infection. This may take more time, and if the fungal treatment is detected late, the patient may
Prevention. One of the best preventative measures for pneumonia are through
vaccinations and sanitary living conditions. Vaccinations such as PCV will provide resistances
towards certain pneumonia strains, but patients should also invest in the flu shot each year for
further protection against newer strains. In fact, roughly a “third of all pneumonia cases in this
country are caused by respiratory viruses, most commonly influenza” which severity can be
reduced through immunization shots (Gupta, 2016). Flu shots are synthesized RNA or
recombinant DNA that replicate a virus’s structure, and when the structure is introduced into the
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immune system, the body develops a resistance towards the flu. By obtaining this early
smoke develop higher chances of pneumonia in the future. When someone smokes, they
introduce chemicals that clog the lung’s breathing capacities. The lung’s mechanisms are then
paralyzed or unable to fully defend the lung when an infection arrives. For bacterial pneumonia,
sanitation is vital to keeping a healthy lifestyle. If an individual drinks dirty water, work in a coal
factory, or breathes in a poorly ventilated environment. Each of these incidents have the capacity
to lower the efficiency of the lungs or introduce bacterial strains into the system. Thus, there are
Antibiotics Prospect
Penicillin-based antibiotics are one of the main treatment options for those infected by
bacterial pneumonia. However, resistances have developed to the point where some of these
antibiotics no longer hold the same value. Thus, there is reason in looking into why resistances
have developed and how society can limit the chances of resistant bacteria spreading.
Antibiotic Resistances. Despite the possible treatments for pneumonia, many issues still
arise with the continuation of antibiotic resistant bacteria. When a patient doesn’t consume
enough antibiotics, some of the bacteria may survive. As some bacteria reproduces, one of these
bacteria stains may mutate to produce DNA to code for a specific resistance. When that occurs,
the antibiotic no longer works on that specific bacteria, allowing the bacteria to multiply. When
this bacteria spreads, the antibiotic’s effectiveness lessens through the infected population. As a
result, bacterial pneumonia becomes more difficult to treat. For example, although penicillin was
a breakthrough in the 1940s against different bacterial strains including pneumonia, resistance
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against the antibiotic started in 1965, rendering the basic form of penicillin virtually useless
(Ventola, 2015).
Figure 3 and 4. Chemical Structure for Penicillin and Amoxicillin (Ventola, 2015)
To counter the resistance, other antibiotics based on the same penicillin structure have
been created as seen in the figures above. However, despite these similarities, bacterial
resistances have grown significantly over the last few years, and there are a few measures to
counter this growth. The first being the introduction of trustworthy prescriptions. In countries
such as Vietnam or Mexico, prescriptions are often unregulated, and it is possible to gain greater
access to antibiotics without the word of a doctor. This practice is highly dangerous as patients
may abuse these substances, causing resistant strains to be more prominent. The next step into
preventing antibiotic resistance derives from the patient’s responsibility to finish prescriptions
from the doctor. Often, whenever a patient recovers considerably from an illness, they may stop
feeling certain symptoms and stop taking the medication afterwards. However, unless the
prescription informs the patient to “take as needed,” the patient must finish the prescription.
Remaining living bacteria could regenerate and mutate. Over time, the bacteria could form a
resistance, causing the medication to have less impact on the strain. In addition, farmers and
livestock owners tend to overuse antibiotics, which often adds to the growing issue of antibiotic
resistance. Around “80% of antibiotics sold in the U.S. are used in animals, primarily to promote
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growth and prevent infection,” which leads to a heavy cause of the resistant bacteria (Ventola,
2015). Antibiotic-resistant bacteria may survive through the continuous usage of these
antibiotics, and when humans consume meat products infected with this bacterium, humans may
contract several illnesses without many antibiotic options. Finally, the last step involves safely
throwing away old medication and restraining from sharing antibiotics with other individuals. In
one case, if a patient acquires similar symptoms as a previous illness, and uses that same
prescription medication from before, the medication may not be strong enough. As time passes,
concentration of medication increases since the vitality of a bacteria also changes. In fact, an
adult male may be given twice the amount of amoxicillin than they would be given a decade ago.
This same policy follows in which the prescription of antibiotics may have changed, and the
patient should check with their doctor of what type of medication to use before they start on a
certain medication.
Current Research. The importance of documenting and raising awareness of this type of
antibiotic resistance derives from the fact that most individuals in developing countries are
affected by bacterial pneumonia. When these resistances become rampant, researchers find it
difficult to fund and identify new alternatives for pneumonia medication. According to a 2014
BMC central article, antibiotic resistance pneumonia treatment costs roughly $233 million
dollars for the American public each year with Streptococcus pneumoniae representing one of
the most common strains of bacteria to form continuous resistances (Reynolds, 2014). This trend
continues to grow as researchers must spend more money to keep up with the evolution of
bacterial strains. Over time, this may cost the United States millions of dollars in patients paying
for hospital nights, purchasing expensive medication, and funding for additional research in
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medication. Thus, with this type of information in mind, patients should abide by doctor
Conclusion
Pneumonia remains prominent in our current society, representing most reasons for
hospitalizations and causes of death for children under the age of five. With symptoms similar to
the common flu and a multitude of treatment options, providers may have difficulties providing
patients with the proper level of care, especially with patients in developing countries. Antibiotic
bacterial resistances only represent a fraction of the issue with most viral pneumonia untreatable
by antibiotics and doctors only treating the symptoms. Perhaps there are further options of
research to test how often proper antibiotic prescriptions are provided improperly. However,
unless our current society stays informed about the prominence of pneumonia, vaccinations, and
antibiotic treatment, the medical field will continue to see the resurgence of pneumonia-related
cases. Thus, there is no other option but to stay educated about such matters.
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References
https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/flemingpenicill
20, 2018.
Dallas ME. Pneumonia 101: What You Need to Know | Everyday Health. Stroke Center -
Gupta S. Q: Can the flu turn into pneumonia? Stroke Center - EverydayHealth.com.
https://www.everydayhealth.com/columns/paging-dr-gupta/can-flu-turn-into-pneumonia/.
https://www.lung.org/lung-health-and-diseases/lung-disease-
Times Now Digital. Antibiotic Resistance: 5 Simple Tips to Help Prevent or Reduce the Spread
https://www.timesnownews.com/health/article/antibiotic-resistance-5-simple-tips-to-
help-prevent-or-reduce-the-spread-of-drug-resistant-infections/316714. Published
Ventola C. The Antibiotic Resistance Crisis: Part 1: Causes and Threats. P T. 40(4):277-83.