PNEUMONIA

The bacterium Streptococcus pneumoniae, a common cause of pneumonia, imaged by an electron microscope

Pneumonia is an inflammatory condition of the lung—affecting primarily the microscopic air

sacs known as alveoli. It is usually caused by infection with viruses or bacteria and less
commonly other microorganisms, certain drugs and other conditions such as autoimmune
diseases.
Typical symptoms include a cough, chest pain, fever, and difficulty breathing. Diagnostic tools
include x-rays and culture of the sputum. Vaccinesto prevent certain types of pneumonia are
available. Treatment depends on the underlying cause. Presumed bacterial pneumonia is treated
with antibiotics. If the pneumonia is severe, the affected person is generally admitted to hospital.
Annually, pneumonia affects approximately 450 million people, seven percent of the world's
total, and results in about 4 million deaths. Although pneumonia was regarded by William
Osler in the 19th century as "the captain of the men of death", the advent of antibiotic therapy and
vaccines in the 20th century has seen improvements in survival. Nevertheless, in developing
countries, and among the very old, the very young and the chronically ill, pneumonia remains a
leading cause of death. Pneumonia kills an estimated 1.2 million children under the age of five
years every year – more than AIDS, malaria and tuberculosis combined.
Pneumonia is primarily due to infections caused by bacteria or viruses and less commonly
by fungi and parasites. Although there are more than 100 strains of infectious agents identified,
only a few are responsible for the majority of the cases. Mixed infections with both viruses and
bacteria may occur in up to 45% of infections in children and 15% of infections in adults. A
causative agent may not be isolated in approximately half of cases despite careful testing.
The term pneumonia is sometimes more broadly applied to any condition resulting
in inflammation of the lungs (caused for example by autoimmune diseases, chemical burns or
drug reactions); however, this inflammation is more accurately referred to as pneumonitis.
Infective agents were historically divided into "typical" and "atypical" based on their presumed
presentations, but the evidence has not supported this distinction, thus it is no longer emphasized.
Conditions and risk factors that predispose to pneumonia include: smoking, immunodeficiency,
alcoholism, chronic obstructive pulmonary disease,chronic kidney disease, and liver disease. The
use of acid-suppressing medications -such as proton-pump inhibitors or H2 blockers- is
associated with an increased risk of pneumonia. Old age also predisposes pneumonia.
Pneumonia caused by bacteria can be treated with antibiotics. These are usually prescribed at a
health centre or hospital, but the vast majority of cases of childhood pneumonia can be
administered managed effectively within the home with inexpensive oral antibiotics.
Hospitalization is recommended in infants aged two months and younger, and also in very severe
cases.
Preventing pneumonia in children is an essential component of a strategy to reduce child
mortality. Immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is
the most effective way to prevent pneumonia.
Adequate nutrition is the key to improving children's natural defences, starting with exclusive
breastfeeding for the first six months of life. In addition to being effective in preventing
pneumonia, it also helps to reduce the length of the illness if a child does become ill.
Addressing environmental factors such as indoor air pollution (by providing affordable clean
indoor stoves, for example) and encouraging good hygiene in crowded homes also reduces the
number of children who fall ill with pneumonia. In children infected with HIV, the antibiotic
cotrimoxazole is given daily to decrease the risk of contracting pneumonia.