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Pneumonia
Original Editor - The Open Physio (/Open_Physio) project.

Top Contributors - Rachael Lowe (/User:Rachael_Lowe), Evan Thomas (/User:Evan_Thomas) and Naomi O'Reilly (/User:Naomi_O%27Reilly)

Contents
1 Introduction
2 Prevalence of Pneumonia
3 Types of Pneumonia
4 Stages of Pneumonia
5 Causes
6 Risk factors
7 Signs and symptoms
8 Diagnosis
9 Complications
10 Treatment
11 Physiotherapy Management
12 Children and Pneumonia
12.1 Why are children vulnerable?
12.2 Signs & Symptoms in children
12.3 Prevention
13 Recent Related Research (from Pubmed)
14 References

Introduction
Pneumonia is defined as "inflammation of the lung caused by bacteria, in which the air sacs (alveoli) become filled with inflammatory cells and the lungs become solid"
(Oxford Concise Medical Dictionary, 6th Edition, 2003).

Pneumonia is "a severe form of acute lower respiratory infection that specifically affects the lungs". The lungs consist of bronchi, which divide into bronchioles that end in
alveoli. The small blood vessels in the lungs are responsible for gaseous exchange (oxygen moving into the lungs and carbon dioxide moving out of the lungs). During a
Pneumonia infection, the alveoli of one or both lungs fill up with pus or fluid. This increases the labor of breathing, and thus gaseous exchange cannot occur as it normally
would (unicef/WHO, 2006).

Prevalence of Pneumonia
According to unicef/WHO (2006) Pneumonia kills more children than any other illness -- more than AIDS, malaria and measles combined and it accounts for nearly one in
five child deaths globally.

It has been found that 1,6 million people die from pneumonia world wide each year. It should also be noted that pneumonia is one of the leading causes of deaths for
children under the age of 5.

In South-East Asia, in the Pacific, and in Sub-Saharan Africa about 433 million young children contract the disease annually (CDF, 2009). Amongst children under the age
of 5, these two regions have the highest incidence of pneumonia cases and when combined, they "bear the burden of more than half the total number of pneumonia
episodes worldwide" (unicef/WHO, 2006).

Types of Pneumonia
Aspiration Pneumonia
Aspiration Pneumonia results when food, drink, vomit, secretions or other foreign material is inhaled and causes an inflammatory response in the lungs and
bronchial tubes.
Aspiration Pneumonia occurs predominantly in the right lung because its total capacity is greater than that of the left lung (Health-cares.net, 2005; Bartleby.com).
Atypical Pneumonia
This term refers of Pneumonia caused by the following bacteria: Legionella pneumophila, Mycoplasma pneumoniae, and Chlamydophila pneumoniae.
Atypical pneumonia is caused by bacteria and does not respond to the normal antibiotics used for treatment (Health-cares.net, 2005).
Bacterial Pneumonia
Bacterial Pneumonia occurs when pneumonia-causing bacteria masses and multiplies in the lungs. The alveoli become inflamed and pus is produced, which
spreads around the lungs. The bacteria that caused Bacterial Pneumonia are: streptococcus pneumonia, hemophilus influenza, legionella pneumophilia and
staphylococcus aureus (healthscout.com).
Bronchial Pneumonia
Bronchopneumonia is a descending infection starting around the bronchi and bronchioles (Nurses dictionary, Twenty-third edition, 2000). The terminal
bronchioles become blocked with exudates and form consolidated patches. This results in atelectasis.
Community-acquired Pneumonia
This means the infection was acquired at home.
With this type of pneumonia the most common cause is 'Streptococcus Pneumonia' (Smith & Ball, 1998)
Hospital-acquired Pneumonia
Patients develop features after being in hospital for 24 hours or longer
Infectious agent is often Gram-negative bacteria such as 'Escherichia coli or Klebsiella' (Smith & Ball, 1998)
 Mycoplasmal Pneumonia (also known as 'walking pneumonia')
It is similar to bacterial pneumonia, whereby the mycoplasmas proliferate and spread - causing infection (healthscout.com).
Pneumocystis carinii Pneumonia
Pneumocystis carinii pneumonia is the result of a fungal infection in the lungs caused by the Pneumocystis carinii fungus.
This fungus does not cause illness in healthy individuals, but rather in those with a weakened immune system. (Health-cares.net, 2005).
Ventilator Associated Pneumonia (VAP)
This type of pneumonia usually occurs two days after a hospitalised patient has been intubated and been receiving mechanical ventilation (Koenig & Truwit,
2006).
This is especially a life-threatening infection as patients who require mechanical support are already critically ill (Torpy, 2007).
Viral Pneumonia
Viral Pneumonia is believed to be the cause of half of all pneumonias. The viruses invade the lungs and then multiply- causing inflammation (healthscout.com).

Stages of Pneumonia
Pneumonia has four stages, namely consolidation, red hepatization, grey hepatization and resolution.

Consolidation
Occurs in the first 24 hours
Cellular exudates containing neutrophils, lymphocytes and fibrin replaces the alveolar air
Capillaries in the surrounding alveolar walls become congested
The infections spreads to the hilum and pleura fairly rapidly
Pleurisy occurs
Marked by coughing and deep breathing (Atkuri & King, 2006; Steyl, 2007
Red Hepatization
Occurs in the 2-3 days after consolidation
At this point the consistency of the lungs resembles that of the liver
The lungs become hypeaemic
Alveolar capillaries are engorged with blood
Fibrinous exudates fill the alveoli
This stage is "characterized by the presence of many erythrocytes, neutrophils, desquamated epithelial cells, and fibrin within the alveoli" (Atkuri & King, 2006;
Steyl, 2007)
Grey Hepatization
Occurs in the 2-3 days after Red Hepatization
This is an avascular stage
The lung appears "gray-brown to yellow because of fibrinopurulent exudates, disintegration of red cells, and hemosiderin"
The pressure of the exudates in the alveoli causes compression of the capillaries
"Leukocytes migrate into the congested alveoli" (Atkuri & King, 2006; Steyl, 2007)
Resolution
This stage is characterized by the "resorption and restoration of the pulmonary architecture"
A large number of macrophages enter the alveolar spaces
Phagocytosis of the bacteria-laden leucocytes occurs
"Consolidation tissue re-aerates and the fluid infiltrate causes sputum"
"Fibrinous inflammation may extend to and across the pleural space, causing a rub heard by auscultation, and it may lead to resolution or to organization and
pleural adhesions" (Atkuri & King, 2006; Steyl, 2007)

Causes
There are many different causes of pneumonia which can be classified as infective or aspiration pneumonia.

Infective pneumonia:

the infection and inflammatory response of the lungs and bronchial tubes when bacteria or a virus enters the lung and proliferates
can occur through inhaling small droplets containing pneumonia
causing organisms such as Streptococcus pneumoniae (ehealth MD, 2004).
Aspiration pneumonia:

caused by inhaling vomit, mucous, bodily fluids, or certain chemicals

causing the lungs and bronchial tubes to become inflamed (Health-cares.net, 2005).

Risk factors
The elderly, infants and young children are more at risk of contracting community-acquired pneumonia than young and middle-aged adults. Underlying health problems
such as:

flu
cancer
AIDS
heart disease
diabetes
asthma
chronic bronchitis
emphysema
chronic obstructive pulmonary disease
brochiectasis
immunosuppressive disorders and therapy
 debility or stroke
coma
problems with swallowing
alcoholism
intravenous drug abuse
Cause a person's immune system to be weakened - thus leaving them at risk of contracting Pneumonia. It has also been found that frequent exposure to cigarette smoke
increases the risk of developing Pneumonia (Health24.com)

Signs and symptoms

Initially symptoms are similar to that of a cold followed by:

a high fever (pyrexia)

chills
a productive cough
Sputum may be discoloured and may become blood-stained as the pneumonia progresses. The following may also occur:

dyspnoea
sharp chest pain
worsening cough
headaches
malaise
muscle pains
cyanosis due to poorly oxygenated blood
loss of appetite
rapid breathing
wheezing or grunting during breathing
intercostal muscle recession during breathing
vomiting
The X-ray will show decreased lung expansion and opacity on the affected side (Hough, 1991; Klein, 2008).

Diagnosis
Physical examination
crackles and wheezing may be heard while auscultating
Chest X-ray
usually done to confirm the diagnosis
Sputum samples and blood tests
done to diagnose the type of pneumonia that is present
sputum test is done to determine whether it is a fungal or bacterial infection
blood test is done to examine the White Blood Cell count of the involved patient
this can be used to indicate the severity of the pneumonia, as well as to determine whether it is a viral or bacterial infection.
bacterial infection would result in a blood count that has an increased amount of neutrophils
a blood count that has an increased amount of lymphocytes would indicate a viral infection.

Complications
Pleural effusion
When fluid accumulates between the pleura and the chest wall due to the large amount of fluid already present in the lungs.
As a result of the Pneumonia, a pleural effusion may develop which could lead to the collapse of the lungs if not treated appropriately (Health-cares.net, 2005).
Empyema
Pus may be present in the lungs due to the infection.
Thus pockets of pus may develop in the cavity between the pleura and the chest wall, or in the lung itself which is otherwise known as empyema (Health-
cares.net, 2005).
Lung abscess
A lung abscess develops when the infection has destroyed lung tissue and a cavity filled with pus is formed (Health-cares.net, 2005).
Bacteremia
This occurs when the infection is no longer contained within the lungs and moves into the bloodstream, thus the blood is infected (Health-cares.net, 2005).
Septicemia
When bacteremia occurs septicemia can follow, as this is an infection that is spread throughout the body.
The infected blood is the best way for the infection to manifest in other parts of the body (Health-cares.net, 2005).
Meningitis
The infection may spread to the meninges that cover the brain and spinal cord, leading to meningitis (Health-cares.net, 2005).
Septic arthritis
When bacteremia has occurred septic arthritis is also a danger, as the bacteria manifests in the joints through which blood passes (Health-cares.net, 2005).
Endocarditis or pericarditis
As blood is also circulated through the heart muscles and the pericardium, the risk of developing an infection there is very high if bacteremia is present (Health-
cares.net, 2005).

Treatment
Treatment will vary depending on how bad the symptoms are, and what the cause of the infection is.

Bacterial Pneumonia can be treated with penicillin and/or anti-biotics

 Viral Pneumonia cannot be treated with anti-biotics, as they have no effect. This type of pneumonia normally resolves over time.
Mycoplasma Pneumonia is usually treated with anti-biotics.

Doctors will also include the following when treating patients with pneumonia:

Bed rest
Breathing exercises
Analgesic administration
Cough suppressant medication
Fever-reducing medication (i.e.: Aspirin)
Oxygen therapy (when indicated)
(healthscout.com)

Physiotherapy Management
Modified postural drainage - this allows gravity to drain secretions from specific segments of the lungs
Shaking and vibes - to mobilize secretions
Coughing and huffing exercises - to expectorate secretions
Administer humidification - to mobilize secretions
Breathing exercises - Localized and Diaphragmatic
IPPB administration - to increase lung volumes
Mobilization of the patient - done to increase air entry, increase chest expansion, and to loosen secretions
(Madjoe & Marais, 2007)

Children and Pneumonia

Why are children vulnerable?
Unlike healthy children with many natural defenses to protect them against the invasion of pathogens in the lungs, the unhealthy children with a compromised immune
system has weak defenses.
Children who suffer from malnutrion, particularly inadequate zinc intake and lack of exclusive breastfeeding have a higher risk of developing pneumonia.
Other risk factors include:
Being born premature
Having asthma or genetic disorder such as sickle-cell disease
Having heart defects such as ventricular septal defect (VSD), atrial septal defect (ASD) or patent ductus arteriosus (PDA) (PDRhealth, 2009).
Several environmental factors such as overcrowding homes and exposure to parental smoke increases a child's susceptibility to pneumonia and its complications
(UNICEF/WHO, 2006).

Signs & Symptoms in children

In children the signs and symptoms are similar to that of adults.
Sometimes a child's only sign may be rapid breathing and often when pneumonia exist in the lower part of the lungs, no breathing problems may be present but rather
fever, abdominal pain or vomiting.
If pneumonia is caused by bacteria, the infected child becomes sick relative quickly and is prone to developing high fever and rapid breathing.
If pneumonia is caused by viruses, symptoms may appear gradually and less severe than the bacterial pneumonia (Kids health, 2009).
Parents should be aware of the following signs and symptoms:
Nostril flaring
Sternal retraction
Increased breath rate
> 60 breaths/min for newborns up to 2 months
> 50 breaths/min for 2 months to 12 months
> 40 breaths/min for a child older than 1 years of age (Drugs information Online, 2009)

Prevention
Vaccines are usually administered to prevent infection by viruses and bacteria.
Kids usually receive routine immunisation against Haemophilus Influenzae and Pertussis at the age of 2 months of age.
Some vaccines are also administered against pneumococcus organism, a common cause of pneumonia (Kids health, 2009)
Transmission of pneumonia

Infection may occur in different ways may it be through contaminated air droplets, blood-born infection or from coming into contact with contaminated substances during
delivery. Either way it is believed that babies already have the bacterial pathogens causing pneumonia in their nose and/ or throat and are inhaled into the lungs.

Recent Related Research (from Pubmed

(https://www.ncbi.nlm.nih.gov/pubmed/))
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parsing XML for RSS

References
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2. Atkuri, L.V., & King, B.R. (2006). Pediatrics, Pneumonia. Retrieved April 10, 2009, from http://emedicine.medscape.com/article/803364-overview
(http://emedicine.medscape.com/article/803364-overview)
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(http://health24.com/medical/Head2Toe/777-778-782,13491.asp)
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(http://www.healthscout.com/ency/68/205/main.html)
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