Pneumonia

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Pneumonia
Other namesPneumonitis
Frequency450 million (7%) per year[12][13]
DeathsFour million per year[12][13]

Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli.[3][14] Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing.[15] The severity of the condition is variable.[15]

Pneumonia is usually caused by infection with viruses or bacteria, and less commonly by other

Chest X-rays, blood tests, and culture of the sputum may help confirm the diagnosis.[8] The disease may be classified by where it was acquired, such as community- or hospital-acquired or healthcare-associated pneumonia.[18]

Risk factors for pneumonia include cystic fibrosis, chronic obstructive pulmonary disease (COPD), sickle cell disease, asthma, diabetes, heart failure, a history of smoking, a poor ability to cough (such as following a stroke), and a weak immune system.[5][7]

Vaccines to prevent certain types of pneumonia (such as those caused by Streptococcus pneumoniae bacteria, linked to influenza, or linked to COVID-19) are available.[10] Other methods of prevention include hand washing to prevent infection, and not smoking.[10]

Treatment depends on the underlying cause.[19] Pneumonia believed to be due to bacteria is treated with antibiotics.[11] If the pneumonia is severe, the affected person is generally hospitalized.[19] Oxygen therapy may be used if oxygen levels are low.[11]

Each year, pneumonia affects about 450 million people globally (7% of the population) and results in about 4 million deaths.

chronically ill.[12][20] Pneumonia often shortens the period of suffering among those already close to death and has thus been called "the old man's friend".[21]

Video summary (script)

Signs and symptoms

Symptoms frequency[22]
Symptom Frequency
Cough 79–91%
Fatigue 90%
Fever 71–75%
Shortness of breath 67–75%
Sputum 60–65%
Chest pain 39–49%
A diagram of the human body outlining the key symptoms of pneumonia
Main symptoms of infectious pneumonia

People with infectious pneumonia often have a

shaking chills, shortness of breath, sharp or stabbing chest pain during deep breaths, and an increased rate of breathing.[9] In elderly people, confusion may be the most prominent sign.[9]

The typical signs and symptoms in children under five are fever, cough, and fast or difficult breathing.

Bacterial and viral cases of pneumonia usually result in similar symptoms.

wheezing than bacterial pneumonia.[25] Pneumonia was historically divided into "typical" and "atypical" based on the belief that the presentation predicted the underlying cause.[28] However, evidence has not supported this distinction, therefore it is no longer emphasized.[28]

Cause

Three lone round objects in a black background
The bacterium Streptococcus pneumoniae, a common cause of pneumonia, imaged by an electron microscope

Pneumonia is due to infections caused primarily by bacteria or viruses and less commonly by fungi and

human rhinovirus (in 9% of patients), influenza virus (in 6%), and Streptococcus pneumoniae (in 5%)."[29]

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.[16][17]

Factors that predispose to pneumonia include smoking,

TLR6 variants, the risk of getting Legionnaires' disease is increased.[40]

Bacteria

Cavitating pneumonia due to MRSA as seen on a CT scan

Bacteria are the most common cause of

Chlamydophila pneumoniae in 13%, and Mycoplasma pneumoniae in 3% of cases;[41] Staphylococcus aureus; Moraxella catarrhalis; and Legionella pneumophila.[21] A number of drug-resistant versions of the above infections are becoming more common, including drug-resistant Streptococcus pneumoniae (DRSP) and methicillin-resistant Staphylococcus aureus (MRSA).[24]

The spreading of organisms is facilitated by certain risk factors.

Coxiella burnetti; aspiration of stomach contents with anaerobic organisms; and cystic fibrosis with Pseudomonas aeruginosa and Staphylococcus aureus.[21] Streptococcus pneumoniae is more common in the winter,[21] and it should be suspected in persons aspirating a large number of anaerobic organisms.[24]

Viruses

SARS

In adults, viruses account for about one third of pneumonia cases,

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can also result in pneumonia.[46]

Fungi

Fungal pneumonia is uncommon, but occurs more commonly in individuals with weakened immune systems due to AIDS,

Pneumocystis jiroveci (pneumocystis pneumonia, or PCP), and Coccidioides immitis. Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis is most common in the Southwestern United States.[21] The number of cases of fungal pneumonia has been increasing in the latter half of the 20th century due to increasing travel and rates of immunosuppression in the population.[47] For people infected with HIV/AIDS, PCP is a common opportunistic infection.[48]

Parasites

A variety of

developed world, these infections are most common in people returning from travel or in immigrants.[49] Around the world, parasitic pneumonia is most common in the immunodeficient.[50]

Noninfectious

Idiopathic interstitial pneumonia or noninfectious pneumonia

lipids entering the lung.[53] These lipids can either be inhaled or spread to the lungs from elsewhere in the body.[53]

Mechanisms

A schematic diagram of the human lungs with an empty circle on the left representing a normal alveolus and one on the right showing an alveolus full of fluid as in pneumonia
Pneumonia fills the lung's alveoli with fluid, hindering oxygenation. The alveolus on the left is normal, whereas the one on the right is full of fluid from pneumonia.

Pneumonia frequently starts as an

immunoglobulins are important for protection. Microaspiration of contaminated secretions can infect the lower airways and cause pneumonia. The progress of pneumonia is determined by the virulence of the organism; the amount of organism required to start an infection; and the body's immune response against the infection.[40]

Bacterial

Most bacteria enter the lungs via small aspirations of organisms residing in the throat or nose.

potentially infectious ones reside there only at certain times and under certain conditions.[28] A minority of types of bacteria such as Mycobacterium tuberculosis and Legionella pneumophila reach the lungs via contaminated airborne droplets.[24] Bacteria can also spread via the blood.[25] Once in the lungs, bacteria may invade the spaces between cells and between alveoli, where the macrophages and neutrophils (defensive white blood cells) attempt to inactivate the bacteria.[56] The neutrophils also release cytokines, causing a general activation of the immune system.[57] This leads to the fever, chills, and fatigue common in bacterial pneumonia.[57] The neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli, resulting in the consolidation seen on chest X-ray.[58]

Viral

Viruses may reach the lung by a number of different routes. Respiratory syncytial virus is typically contracted when people touch contaminated objects and then touch their eyes or nose.

organs and thus disrupt other body functions. Viruses also make the body more susceptible to bacterial infections; in this way, bacterial pneumonia can occur at the same time as viral pneumonia.[44]

Diagnosis

Pneumonia is typically diagnosed based on a combination of physical signs and often a

chest X-ray.[60] In adults with normal vital signs and a normal lung examination, the diagnosis is unlikely.[61] However, the underlying cause can be difficult to confirm, as there is no definitive test able to distinguish between bacterial and non-bacterial cause.[12][60] The overall impression of a physician appears to be at least as good as decision rules for making or excluding the diagnosis.[62]

Diagnosis in children

The World Health Organization has defined pneumonia in children clinically based on either a cough or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness.[63] A rapid respiratory rate is defined as greater than 60 breaths per minute in children under 2 months old, greater than 50 breaths per minute in children 2 months to 1 year old, or greater than 40 breaths per minute in children 1 to 5 years old.[63]

In children, low oxygen levels and lower chest indrawing are more sensitive than hearing chest crackles with a stethoscope or increased respiratory rate.[64] Grunting and nasal flaring may be other useful signs in children less than five years old.[65]

Lack of wheezing is an indicator of Mycoplasma pneumoniae in children with pneumonia, but as an indicator it is not accurate enough to decide whether or not macrolide treatment should be used.[66] The presence of chest pain in children with pneumonia doubles the probability of Mycoplasma pneumoniae.[66]

Diagnosis in adults

In general, in adults, investigations are not needed in mild cases.

auscultation are normal.[68] C-reactive protein (CRP) may help support the diagnosis.[69] For those with CRP less than 20 mg/L without convincing evidence of pneumonia, antibiotics are not recommended.[40]

serum electrolytes, C-reactive protein level, and possibly liver function tests – are recommended.[67]

The diagnosis of influenza-like illness can be made based on the signs and symptoms; however, confirmation of an influenza infection requires testing.[71] Thus, treatment is frequently based on the presence of influenza in the community or a rapid influenza test.[71]

Adults 65 years old or older, as well as cigarette smokers and people with ongoing medical conditions are at increased risk for pneumonia.[72]

Physical exam

oxygen saturation.[24] The respiratory rate may be faster than normal, and this may occur a day or two before other signs.[24][28] Examination of the chest may be normal, but it may show decreased expansion on the affected side. Harsh breath sounds from the larger airways that are transmitted through the inflamed lung are termed bronchial breathing and are heard on auscultation with a stethoscope.[24] Crackles (rales) may be heard over the affected area during inspiration.[24] Percussion may be dulled over the affected lung, and increased, rather than decreased, vocal resonance distinguishes pneumonia from a pleural effusion.[9]

Imaging

A chest X-ray showing a very prominent wedge-shaped area of airspace consolidation in the right lung characteristic of acute bacterial lobar pneumonia
A black-and-white image shows the internal organs in cross-section as generated by CT. Where one would expect black on the left, one sees a whiter area with black sticks through it.
CT of the chest demonstrating right-sided pneumonia (left side of the image)

A chest radiograph is frequently used in diagnosis.[23] In people with mild disease, imaging is needed only in those with potential complications, those not having improved with treatment, or those in which the cause is uncertain.[23][67] If a person is sufficiently sick to require hospitalization, a chest radiograph is recommended.[67] Findings do not always match the severity of disease and do not reliably separate between bacterial and viral infection.[23]

X-ray presentations of pneumonia may be classified as

lung consolidation of one lung segmental lobe, which is known as lobar pneumonia.[41] However, findings may vary, and other patterns are common in other types of pneumonia.[41] Aspiration pneumonia may present with bilateral opacities primarily in the bases of the lungs and on the right side.[41] Radiographs of viral pneumonia may appear normal, appear hyper-inflated, have bilateral patchy areas, or present similar to bacterial pneumonia with lobar consolidation.[41] Radiologic findings may not be present in the early stages of the disease, especially in the presence of dehydration, or may be difficult to interpret in the obese or those with a history of lung disease.[24] Complications such as pleural effusion may also be found on chest radiographs. Laterolateral chest radiographs can increase the diagnostic accuracy of lung consolidation and pleural effusion.[40]

A CT scan can give additional information in indeterminate cases[41] and provide more details in those with an unclear chest radiograph (for example occult pneumonia in chronic obstructive pulmonary disease). They can be used to exclude pulmonary embolism and fungal pneumonia, and detect lung abscesses in those who are not responding to treatments.[40] However, CT scans are more expensive, have a higher dose of radiation, and cannot be done at bedside.[40]

Lung ultrasound may also be useful in helping to make the diagnosis.[74] Ultrasound is radiation free and can be done at bedside. However, ultrasound requires specific skills to operate the machine and interpret the findings.[40] It may be more accurate than chest X-ray.[75]

Microbiology

In people managed in the community, determining the causative agent is not cost-effective and typically does not alter management.

blood cultures are recommended,[67] as well as testing the urine for antigens to Legionella and Streptococcus.[78] Viral infections, can be confirmed via detection of either the virus or its antigens with culture or polymerase chain reaction (PCR), among other techniques.[12] Mycoplasma, Legionella, Streptococcus, and Chlamydia can also be detected using PCR techniques on bronchoalveolar lavage and nasopharyngeal swab.[40] The causative agent is determined in only 15% of cases with routine microbiological tests.[9]

Classification

Pneumonitis refers to lung inflammation; pneumonia refers to pneumonitis, usually due to infection but sometimes non-infectious, that has the additional feature of

acute interstitial pneumonia;[41] or by the causative organism.[80] Pneumonia in children may additionally be classified based on signs and symptoms as non-severe, severe, or very severe.[81]

The setting in which pneumonia develops is important to treatment,[82][83] as it correlates to which pathogens are likely suspects,[82] which mechanisms are likely, which antibiotics are likely to work or fail,[82] and which complications can be expected based on the person's health status.

Community

Community-acquired pneumonia (CAP) is acquired in the community,[82][83] outside of health care facilities. Compared with healthcare-associated pneumonia, it is less likely to involve multidrug-resistant bacteria. Although the latter are no longer rare in CAP,[82] they are still less likely. Prior stays in healthcare-related environments such as hospitals, nursing homes, or hemodialysis centers or a history of receiving domiciliary care can increase patients' risk for CAP caused by multidrug-resistant bacteria.[84]

Healthcare

Health care–associated pneumonia (HCAP) is an infection associated with recent exposure to the health care system,[82] including hospitals, outpatient clinics, nursing homes, dialysis centers, chemotherapy treatment, or home care.[83] HCAP is sometimes called MCAP (medical care–associated pneumonia).

People may become infected with pneumonia in a hospital; this is defined as pneumonia not present at the time of admission (symptoms must start at least 48 hours after admission).

multidrug-resistant
pathogens. People in a hospital often have other medical conditions, which may make them more susceptible to pathogens in the hospital.

Ventilator-associated pneumonia occurs in people breathing with the help of mechanical ventilation.

endotracheal intubation.[83]

Differential diagnosis

Several diseases can present with similar signs and symptoms to pneumonia, such as: chronic obstructive pulmonary disease, asthma,

acute heart failure. Pulmonary infiltrates that resolved after giving mechanical ventilation should point to heart failure and atelectasis rather than pneumonia. For recurrent pneumonia, underlying lung cancer, metastasis, tuberculosis, a foreign bodies, immunosuppression, and hypersensitivity should be suspected.[40]

Prevention

Prevention includes vaccination, environmental measures, and appropriate treatment of other health problems.[23] It is believed that, if appropriate preventive measures were instituted globally, mortality among children could be reduced by 400,000; and, if proper treatment were universally available, childhood deaths could be decreased by another 600,000.[25]

Vaccination

Vaccination prevents against certain bacterial and viral pneumonias both in children and adults. Influenza vaccines are modestly effective at preventing symptoms of influenza,[12][85] The Centers for Disease Control and Prevention (CDC) recommends yearly influenza vaccination for every person 6 months and older.[86] Immunizing health care workers decreases the risk of viral pneumonia among their patients.[78]

Vaccinations against Haemophilus influenzae and Streptococcus pneumoniae have good evidence to support their use.

invasive pneumococcal disease by 74%, but there is insufficient evidence to suggest using the pneumococcal vaccine to prevent pneumonia or death in the general adult population.[90] The CDC recommends that young children and adults over the age of 65 receive the pneumococcal vaccine, as well as older children or younger adults who have an increased risk of getting pneumococcal disease.[89] The pneumococcal vaccine has been shown to reduce the risk of community acquired pneumonia in people with chronic obstructive pulmonary disease, but does not reduce mortality or the risk of hospitalization for people with this condition.[91] People with COPD are recommended by a number of guidelines to have a pneumococcal vaccination.[91] Other vaccines for which there is support for a protective effect against pneumonia include pertussis, varicella, and measles.[92]

Medications

When influenza outbreaks occur, medications such as amantadine or rimantadine may help prevent the condition, but they are associated with side effects.[93] Zanamivir or oseltamivir decrease the chance that people who are exposed to the virus will develop symptoms; however, it is recommended that potential side effects are taken into account.[94]

Other

surgical masks by the sick may also prevent illness.[78]

Appropriately treating underlying illnesses (such as HIV/AIDS,

diabetes mellitus, and malnutrition) can decrease the risk of pneumonia.[25][92][95] In children less than 6 months of age, exclusive breast feeding reduces both the risk and severity of disease.[25] In people with HIV/AIDS and a CD4 count of less than 200 cells/uL the antibiotic trimethoprim/sulfamethoxazole decreases the risk of Pneumocystis pneumonia[96] and is also useful for prevention in those that are immunocompromised but do not have HIV.[97]

Testing pregnant women for

Zinc supplementation in children 2 months to five years old appears to reduce rates of pneumonia.[104]

For people with low levels of vitamin C in their diet or blood, taking vitamin C supplements may be suggested to decrease the risk of pneumonia, although there is no strong evidence of benefit.[105] There is insufficient evidence to recommend that the general population take vitamin C to prevent or treat pneumonia.[105]

For adults and children in the hospital who require a respirator, there is no strong evidence indicating a difference between heat and moisture exchangers and heated humidifiers for preventing pneumonia.[106] There is tentative evidence that laying flat on the back compared to semi-raised increases pneumonia risks in people who are intubated.[107]

Management

CURB-65
Symptom Points
Confusion 1
Urea>7 mmol/L 1
Respiratory rate>30 1
SBP<90mmHg, DBP<60mmHg 1
Age>=65 1

mucolytics.[111] There is no strong evidence to recommend that children who have non-measles related pneumonia take vitamin A supplements.[113] Vitamin D, as of 2023 is of unclear benefit in children.[114] Vitamin C administration in pneumonia needs further research, although it can be given to patient of low plasma vitamin C because it is not expensive and low risk.[105]

Pneumonia can cause severe illness in a number of ways, and pneumonia with evidence of organ dysfunction may require

crystalloid infused intravenously.[40] In situations where fluids alone are ineffective, vasopressor medication may be required.[115]

For adults with moderate or severe acute respiratory distress syndrome (ARDS) undergoing mechanical ventilation, there is a reduction in mortality when people lie on their front for at least 12 hours a day. However, this increases the risk of endotracheal tube obstruction and pressure sores.[117]

Bacterial

Antibiotics improve outcomes in those with bacterial pneumonia.

fluoroquinolones in uncomplicated cases is discouraged due to concerns about side-effects and generating resistance in light of there being no greater benefit.[42][122]

For those who require hospitalization and caught their pneumonia in the community the use of a β-lactam such as

fluoroquinolone may replace azithromycin but is less preferred.[77] Antibiotics by mouth and by injection appear to be similarly effective in children with severe pneumonia.[124]

The duration of treatment has traditionally been seven to ten days, but increasing evidence suggests that shorter courses (3–5 days) may be effective for certain types of pneumonia and may reduce the risk of antibiotic resistance.

Methicillin resistant Staphylococcus aureus (MRSA) or Legionella infections, prolonged antibiotics may be beneficial.[40]

The addition of corticosteroids to standard antibiotic treatment appears to improve outcomes, reducing death and morbidity for adults with severe community acquired pneumonia, and reducing death for adults and children with non-severe community acquired pneumonia.[131][132] A 2017 review therefore recommended them in adults with severe community acquired pneumonia.[131] A 2019 guideline however recommended against their general use, unless refractory shock was present.[77] Side effects associated with the use of corticosteroids include high blood sugar.[131] There is some evidence that adding corticosteroids to the standard PCP pneumonia treatment may be beneficial for people who are infected with HIV.[48]

The use of granulocyte colony stimulating factor (G-CSF) along with antibiotics does not appear to reduce mortality and routine use for treating pneumonia is not supported by evidence.[133]

Viral

H5N1 influenza A, also known as avian influenza or "bird flu", have shown resistance to rimantadine and amantadine.[12] The use of antibiotics in viral pneumonia is recommended by some experts, as it is impossible to rule out a complicating bacterial infection.[12] The British Thoracic Society recommends that antibiotics be withheld in those with mild disease.[12] The use of corticosteroids is controversial.[12]

Aspiration

In general,

beta-lactam antibiotic and metronidazole, or an aminoglycoside.[135]
Corticosteroids are sometimes used in aspiration pneumonia, but there is limited evidence to support their effectiveness.[134]

Follow-up

The British Thoracic Society recommends that a follow-up chest radiograph be taken in people with persistent symptoms, smokers, and people older than 50.[67] American guidelines vary, from generally recommending a follow-up chest radiograph[136] to not mentioning any follow-up.[78]

Prognosis

With treatment, most types of bacterial pneumonia will stabilize in 3–6 days.

hospital-acquired infection that causes death.[28] Before the advent of antibiotics, mortality was typically 30% in those that were hospitalized.[21] However, for those whose lung condition deteriorates within 72 hours, the problem is usually due to sepsis.[40] If pneumonia deteriorates after 72 hours, it could be due to nosocomial infection or excerbation of other underlying comorbidities.[40] About 10% of those discharged from hospital are readmitted due to underlying co-morbidities such as heart, lung, or neurological disorders, or due to new onset of pneumonia.[40]

Complications may occur in particular in the elderly and those with underlying health problems.[137] This may include, among others: empyema, lung abscess, bronchiolitis obliterans, acute respiratory distress syndrome, sepsis, and worsening of underlying health problems.[137]

Clinical prediction rules

Clinical prediction rules have been developed to more objectively predict outcomes of pneumonia.[28] These rules are often used to decide whether to hospitalize the person.[28]

Pleural effusion, empyema, and abscess

An X-ray showing a chest lying horizontally. The lower black area, which is the right lung, is smaller with a whiter area below it of a pulmonary effusion. Red arrows indicate size.
A pleural effusion: as seen on chest X-ray. The A arrow indicates fluid layering in the right chest. The B arrow indicates the width of the right lung. The volume of the lung is reduced because of the collection of fluid around the lung.

In pneumonia, a collection of fluid may form in the space that surrounds the lung.[139] Occasionally, microorganisms will infect this fluid, causing an empyema.[139] To distinguish an empyema from the more common simple parapneumonic effusion, the fluid may be collected with a needle (thoracentesis), and examined.[139] If this shows evidence of empyema, complete drainage of the fluid is necessary, often requiring a drainage catheter.[139] In severe cases of empyema, surgery may be needed.[139] If the infected fluid is not drained, the infection may persist, because antibiotics do not penetrate well into the pleural cavity. If the fluid is sterile, it must be drained only if it is causing symptoms or remains unresolved.[139]

In rare circumstances, bacteria in the lung will form a pocket of infected fluid called a lung abscess.[139] Lung abscesses can usually be seen with a chest X-ray but frequently require a chest CT scan to confirm the diagnosis.[139] Abscesses typically occur in aspiration pneumonia, and often contain several types of bacteria. Long-term antibiotics are usually adequate to treat a lung abscess, but sometimes the abscess must be drained by a surgeon or radiologist.[139]

Respiratory and circulatory failure

Pneumonia can cause respiratory failure by triggering acute respiratory distress syndrome (ARDS), which results from a combination of infection and inflammatory response. The lungs quickly fill with fluid and become stiff. This stiffness, combined with severe difficulties extracting oxygen due to the alveolar fluid, may require long periods of mechanical ventilation for survival.[43] Other causes of circulatory failure are hypoxemia, inflammation, and increased coagulability.[40]

Sepsis is a potential complication of pneumonia but usually occurs in people with poor immunity or

hyposplenism. The organisms most commonly involved are Streptococcus pneumoniae, Haemophilus influenzae, and Klebsiella pneumoniae. Other causes of the symptoms should be considered such as a myocardial infarction or a pulmonary embolism.[140]

Epidemiology

Deaths from lower respiratory infections per million persons in 2012
  24–120
  121–151
  152–200
  201–241
  242–345
  346–436
  437–673
  674–864
  865–1,209
  1,210–2,085
Disability-adjusted life year for lower respiratory infections per 100,000 inhabitants in 2004[141]
  no data
  less than 100
  100–700
  700–1,400
  1,400–2,100
  2,100–2,800
  2,800–3,500
  3,500–4,200
  4,200–4,900
  4,900–5,600
  5,600–6,300
  6,300–7,000
  more than 7,000

Pneumonia is a common illness affecting approximately 450 million people a year and occurring in all parts of the world.

developing world than in the developed world.[12] Viral pneumonia accounts for about 200 million cases.[12] In the United States, as of 2009, pneumonia is the 8th leading cause of death.[24]

Children

In 2008, pneumonia occurred in approximately 156 million children (151 million in the developing world and 5 million in the developed world).

newborn period. The World Health Organization estimates that one in three newborn infant deaths is due to pneumonia.[144] Approximately half of these deaths can be prevented, as they are caused by the bacteria for which an effective vaccine is available.[145] The IDSA has recommended that children and infants with symptoms of CAP should be hospitalized so they have access to pediatric nursing care.[146] In 2011, pneumonia was the most common reason for admission to the hospital after an emergency department visit in the U.S. for infants and children.[147]

History

A poster with a shark in the middle of it, which reads "Pneumonia Strikes Like a Man-Eating Shark Led by its Pilot Fish the Common Cold"
WPA poster, 1936/1937

Pneumonia has been a common disease throughout human history.

pleuritic pain in the side, short rapid breaths, serrated pulse and cough."[151] This clinical description is quite similar to those found in modern textbooks, and it reflected the extent of medical knowledge through the Middle Ages
into the 19th century.

Christian Gram's paper describing the procedure in 1884 helped to differentiate the two bacteria, and showed that pneumonia could be caused by more than one microorganism.[155] In 1887, Jaccond demonstrated pneumonia may be caused by opportunistic bacteria always present in the lung.[156]

Sir William Osler, known as "the father of modern medicine", appreciated the death and disability caused by pneumonia, describing it as the "captain of the men of death" in 1918, as it had overtaken tuberculosis as one of the leading causes of death at the time. This phrase was originally coined by John Bunyan in reference to "consumption" (tuberculosis).[157][158] Osler also described pneumonia as "the old man's friend" as death was often quick and painless when there were much slower and more painful ways to die.[21]

Viral pneumonia was first described by Hobart Reimann in 1938. Reimann, Chairman of the Department of Medicine at Jefferson Medical College, had established the practice of routinely typing the pneumococcal organism in cases where pneumonia presented. Out of this work, the distinction between viral and bacterial strains was noticed.[159]

Several developments in the 1900s improved the outcome for those with pneumonia. With the advent of penicillin and other antibiotics, modern surgical techniques, and intensive care in the 20th century, mortality from pneumonia, which had approached 30%, dropped precipitously in the developed world. Vaccination of infants against Haemophilus influenzae type B began in 1988 and led to a dramatic decline in cases shortly thereafter.[160] Vaccination against Streptococcus pneumoniae in adults began in 1977, and in children in 2000, resulting in a similar decline.[161]

Society and culture

Awareness

Due to the relatively low awareness of the disease, 12 November was declared in 2009 as the annual World Pneumonia Day, a day for concerned citizens and policy makers to take action against the disease.[162][163]

Costs

The global economic cost of community-acquired pneumonia has been estimated at $17 billion annually.

Centers for Medicare and Medicaid Services, average 2012 hospital charges for inpatient treatment of uncomplicated pneumonia in the U.S. were $24,549 and ranged as high as $124,000. The average cost of an emergency room consult for pneumonia was $943 and the average cost for medication was $66.[166] Aggregate annual costs of treating pneumonia in Europe have been estimated at €10 billion.[167]

References

Footnotes

  1. medications),[3][4] although this inflammation is more accurately referred to as pneumonitis.[16][17]

Citations

  1. ^ "Pneumonia – Symptoms | NHLBI, NIH". nhlbi.nih.gov. 24 March 2022. Retrieved 1 October 2022.
  2. ^ ]
  3. ^ .
  4. ^ .
  5. ^ a b "Pneumonia – Causes and Risk Factors | NHLBI, NIH". nhlbi.nih.gov. 24 March 2022. Retrieved 1 October 2022.
  6. PMID 22786934
    . Susceptibility is higher among elderly people (≥65 years)
  7. ^ a b c "Complications and Treatments of Sickle Cell Disease | CDC". Centers for Disease Control and Prevention. 12 June 2019. Retrieved 6 May 2020.
  8. ^ a b c "How Is Pneumonia Diagnosed?". NHLBI. 1 March 2011. Archived from the original on 7 March 2016. Retrieved 3 March 2016.
  9. ^
    PMID 16675815
    .
  10. ^ a b c "How Can Pneumonia Be Prevented?". NHLBI. 1 March 2011. Archived from the original on 7 March 2016. Retrieved 3 March 2016.
  11. ^ a b c "How Is Pneumonia Treated?". NHLBI. 1 March 2011. Archived from the original on 6 March 2016. Retrieved 3 March 2016.
  12. ^
    PMID 21435708
    .
  13. ^ .
  14. .
  15. ^ . Retrieved 21 April 2011.
  16. ^ .
  17. ^ .
  18. ^ "Types of Pneumonia". NHLBI. 1 March 2011. Archived from the original on 5 February 2016. Retrieved 2 March 2016.
  19. ^ a b "What Is Pneumonia?". NHLBI. 1 March 2011. Archived from the original on 29 February 2016. Retrieved 2 March 2016.
  20. .
  21. ^ a b c d e f g h i j Eddy O (December 2005). "Community-Acquired Pneumonia: From Common Pathogens To Emerging Resistance". Emergency Medicine Practice. 7 (12).
  22. ^ .
  23. ^ .
  24. ^ .
  25. ^ a b c d e f g "Pneumonia (Fact sheet N°331)". World Health Organization. August 2012. Archived from the original on 30 August 2012.
  26. PMID 19002299
    .
  27. .
  28. ^ a b c d e f g h i j Murray and Nadel (2010). Chapter 32.
  29. ^
    PMID 26172429
    .
  30. .
  31. .
  32. .
  33. ^ .
  34. .
  35. ^ "Interprofessional Task force Uses a collaborative approach for internal feeding tube management". News and Views. 5 March 2013. p. 10. Retrieved 16 January 2023.
  36. ^ "ASPEN Safe Practices for Enteral Nutrition Therapy" (PDF). Journal of Parenteral and Enteral Nutrition. XX (X). 17 November 2016. Archived from the original (PDF) on 16 January 2023. Retrieved 16 January 2023.
  37. ^ "Urgent: Field Correction Cortrak* 2 Enteral Access System (EAS)" (PDF). Avanos: 1–2. 21 March 2022.
  38. ^ Park A (16 May 2022). "Avanos Medical faces Class I recall for feeding tube system linked to 23 deaths since 2015". Fierce Biotech. Retrieved 16 January 2023.
  39. ^ Health Cf (16 May 2022). "Avanos Medical Recalls Cortrak*2 Enteral Access System for Risk of Misplaced Enteral Tubes Could Cause Patient Harm". FDA.
  40. ^
    PMID 26277247
    .
  41. ^ .
  42. ^ .
  43. ^ a b c d e f g h i j Murray and Nadel (2010). Chapter 31.
  44. ^
    PMID 19820817
    .
  45. ^ ]
  46. .
  47. ^ .
  48. ^ .
  49. ^ a b c d e f Murray and Nadel (2010). Chapter 37.
  50. S2CID 2631717
    .
  51. .
  52. .
  53. ^ .
  54. ^ .
  55. .
  56. .
  57. ^ .
  58. .
  59. ^ .
  60. ^ .
  61. .
  62. .
  63. ^ .
  64. .
  65. .
  66. ^ .
  67. ^ .
  68. .
  69. .
  70. .
  71. ^ .
  72. ^ "Risk Factors for Pneumonia". CDC. 30 September 2022. Retrieved 16 January 2023.
  73. .
  74. .
  75. .
  76. ^ a b c "UOTW No. 34 – Ultrasound of the Week". Ultrasound of the Week. 20 January 2015. Archived from the original on 9 May 2017. Retrieved 27 May 2017.
  77. ^
    PMID 31573350
    .
  78. ^ .
  79. .
  80. .
  81. .
  82. ^ .
  83. ^ .
  84. .
  85. .
  86. ^ "Seasonal Influenza (Flu)". Centers for Disease Control and Prevention. Archived from the original on 29 June 2011. Retrieved 29 June 2011.
  87. PMID 19821336
    .
  88. ^ "WHO | Pneumococcal conjugate vaccines". who.int. Archived from the original on 28 April 2008. Retrieved 16 January 2018.
  89. ^ a b "Pneumococcal Disease | Vaccines – PCV13 and PPSV23 | CDC". cdc.gov. 18 September 2017. Retrieved 16 January 2018.
  90. PMID 23440780
    .
  91. ^ .
  92. ^ a b c "Pneumonia Can Be Prevented – Vaccines Can Help". Centers for Disease Control and Prevention. Archived from the original on 23 October 2012. Retrieved 22 October 2012.
  93. PMID 16625539
    .
  94. .
  95. .
  96. .
  97. .
  98. .
  99. .
  100. ^ Global Action Plan for Prevention and Control of Pneumonia (GAPP) (PDF). World Health Organization. 2009. Archived (PDF) from the original on 17 October 2013.
  101. ^
    PMID 19497156
    .
  102. .
  103. .
  104. .
  105. ^ .
  106. .
  107. .
  108. ^ .
  109. .
  110. .
  111. ^ .
  112. .
  113. .
  114. .
  115. ^ .
  116. .
  117. .
  118. ^ .
  119. (PDF) from the original on 9 April 2012.
  120. ^ "Pneumonia Fact Sheet". World Health Organization. September 2016. Retrieved 14 January 2018.
  121. PMID 23733365
    .
  122. .
  123. .
  124. .
  125. .
  126. .
  127. ^ .
  128. .
  129. . Retrieved 8 June 2022.
  130. .
  131. ^ .
  132. .
  133. .
  134. ^ .
  135. ^ O'Connor S (2003). "Aspiration pneumonia and pneumonitis". Australian Prescriber. 26 (1): 14–17. .
  136. .
  137. ^ a b c Cunha (2010). pp. 6–18.
  138. PMID 19105795
    .
  139. ^ .
  140. ^ Cunha (2010). pp. 250–51.
  141. ^ "Mortality and Burden of Disease Estimates for WHO Member States in 2002" (xls). World Health Organization. 2002. Archived from the original on 16 January 2013.
  142. S2CID 43866899
    .
  143. .
  144. .
  145. .
  146. ^ "Community-Acquired Pneumonia in Infants and Children". www.idsociety.org. Retrieved 16 January 2023.
  147. from the original on 3 August 2014.
  148. ^ .
  149. .
  150. ^ Hippocrates. On acute diseases.
  151. ^ Maimonides, Fusul Musa ("Pirkei Moshe").
  152. ^ Klebs E (10 December 1875). "Beiträge zur Kenntniss der pathogenen Schistomyceten. VII Die Monadinen" [Signs for Recognition of the Pathogen Schistomyceten]. Arch. Exp. Pathol. Pharmakol. 4 (5/6): 40–88.
  153. S2CID 28324193
    .
  154. ^ Fraenkel A (21 April 1884). "Über die genuine Pneumonie, Verhandlungen des Congress für innere Medicin". Dritter Congress. 3: 17–31.
  155. ^ Gram C (15 March 1884). "Über die isolierte Färbung der Schizomyceten in Schnitt- und Trocken-präparaten". Fortschr. Med. 2 (6): 185–89.
  156. ^ Scientific American. Munn & Company. 24 September 1887. p. 196.
  157. .
  158. ^ Osler W, McCrae T (1920). The principles and practice of medicine: designed for the use of practitioners and students of medicine (9th ed.). D. Appleton. p. 78. One of the most widespread and fatal of all acute diseases, pneumonia has become the "Captain of the Men of Death", to use the phrase applied by John Bunyan to consumption.]
  159. ^ Hodges JH (1989). Wagner FB (ed.). "Thomas Jefferson University: Tradition and Heritage". Jefferson Digital Commons. Part III, Chapter 9: Department of Medicine. p. 253.
  160. PMID 8417239
    .
  161. .
  162. ^ "World Pneumonia Day Official Website". Fiinex. Archived from the original on 2 September 2011. Retrieved 13 August 2011.
  163. PMID 23092708
    .
  164. ^ "Household Component Summary Data Tables". Archived from the original on 20 February 2017.
  165. ^ "Household Component Summary Data Tables". Archived from the original on 20 February 2017.
  166. ^ "One hospital charges $8,000 – another, $38,000". The Washington Post.
  167. PMID 20729232
    .

Bibliography

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