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What is Pneumonia?

According to the Oxford dictionary pneumonia is a lung inflammation caused by

bacterial or viral infection, in which the air sacs fill with pus and become solid, if the
inflammation occurs in both lungs its called double pneumonia but if its occurring in
only one then it is called single pneumonia.

Brief history of pneumonia

Throughout the 20th century scientists have found evidence of the disease in various
Egyptian mummies from 1250-1000 B.C. who were proof of the existence back then of
pneumonia and other diseases of the lungs. In one case of mummy pneumonia, the
mummy was found to have a bacillus similar to the plague.
Pleurisy was defined by the Ancient Greeks as inflammation of the pleural cavity, and
they recognized symptoms of pleurisy and pneumonia as a sharp pain in the side.
Hippocratic writers simply grouped these two conditions together under the phrase
peripneumonia. The condition may also have been confused with other maladies such
as asthma or heart failure, which were generally grouped under the umbrella term
During the ancient ancient world, there were essentially only three diseases that affected
breathing, and they were tuberculosis, asthma, and pneumonia. Pretty much everything
else that caused breathing trouble was grouped under the umbrella term asthma, which
was pretty much a generic term for shortness of breath. Pneumonia was not asthma
because even the ancients could see that parts of the lung was full of inflammation,
secretions, and pus.
Plutarch (46-120 A.D.) recognized that while pleurisy often accompanied pneumonia
and may have been responsible for the pleuritic chest pain and fever, it sometimes
occurred on its own. He decided that the term peripneumonia was superfluous, and
therefore referred to inflammation of the lungs as pneumnonia, and inflammation of the
pleural sac as pleurisy.
Hippocrates noted that death from pneumonia usually occurs on the seventh
day. Areteaus of Cappadocia, about 140 A.D., concurred with Hippocrates that death
usually ensues on the sevenths day. He wrote about the usefulness of the lungs, and
explained that certain maladies can cause havoc.

Later on, Claudius Galen of Pergamum was an ancient Greek physician (120-210 A.D.)
who became one of the most prolific writers of medicine after Hippocrates. He wrote
one of the most famous medical journals that was worshiped by physicians for 1500
years after his death. He is believed to be the first to differentiate between pneumonia
and pleurisy, although he continued to refer to them as peripneumonia.
Maimonides (1138-1204 AD), whose medical writings were well respected for many
years, described: "The basic symptoms which occur in pneumonia and which are never
lacking are as follows: acute fever, sticking (pleuritic) pain in the side, short rapid
breaths, serrated pulse and cough." This was the first recorded description of the same
signs of pneumonia as we define it in modern times.
Even Scottish physician and asthmatic William Cullen (1710-1790) explained
pneumonia as either inflammation of the "viscera of the thorax or the membrane lining
that cavity." In 1792 Dr. Jean P. Frank mentioned that pneumonia "must be studied
under the common name pleuro-pneumonia.
Throughout 18th century phlebotomy or bleeding continued to be a common treatment
as it was during the time of Hippocrates. Many examples of pneumonia or pneumonialike symptoms were described in medical writings and autopsies.
In 1875 Edwin Klebs became the first to associate pneumonia with bacteria. A few
years later Karl Friedlander and Hans Christian Gram started working together in the
morgue of a hospital in Berlin and added to Klebs work by identifying the specific types
of bacteria associated with pneumonia.
In 1882 Friedlander isolated streptococcus Pneunomiae in the sputum of a patient
inflicted with pneumonia, and in 1884 Gram isolated Klebsiella Pneumoniae in the
sputum of a patient inflicted with pneumonia.
By 1918 pneumonia became the leading cause of death, overtaking tuberculosis.
In 1928 Sir Alexander Fleming observed that colonies of the Bacterium
Staphylococcus that he was growing in a colony were dissolving. He later discovered
the plates had been infested by a blue-green mold, and he determined it was this molt
that was responsible for the bacteria dissolving. He later grew the mold in its pure form
and discovered that it killed many different kinds of bacteria.
The mold he used was Peiciillium notatum. The importance of this discovery was not
known until 1939 when Howard Florey and Ernst Chain isolated the active ingredient
and developed a powdered form of it.Several European and American scientists worked
together on a therapeutic medicine that could be used to treat bacterial infections.
By 1941 they had succeeded, and penicillin studies were performed.In 1944 antibiotics
were made available to treat allied soldiers wounded on the battlefield.
Incidence of pneumonia started to decline in 1937 due to improved medicine. So
oxygen therapy, coupled with penicillin and helped decrease the rate of pneumonia
deaths. Yet cases of pneumonia continued to be prevalent.

For example, operations weren't commonly performed in hospitals until the 1950s when
effective anaesthetics and breathing machines were available. In the 1960s and 1970s
physicians noted the high incidence of pneumonia after operations (particularly
abdominal surgeries) despite the use of antibiotics. Similar observations were noted
among patients taking sedatives or pain relievers such as morphine.
Further study helped researchers determine the reason was because due to pain, or due
to the sedatives, these patients weren't taking deep enough breaths, and weren't
adequately coughing. This helped to create a breeding ground in the lungs for certain
bacteria. Post operative pneumonia was learned to complicate treatment, prolong
hospital stays, and even cause of death.
To treat this, the incentive spirometer was invented. The goal of this device was to
encourage post operative patients to take deep breaths followed by a breath hold and a
good cough.
So the incidence of pneumonia took a sharp decline, and deaths likewise declined.
When a pneumonia vaccine hit the market in 1977 pneumonia rates declined a little
more. By 2000 a pneumonia vaccine became available for children, and this helped
decline pneumonia deaths to its current level as the sixth leading cause of death.
What is Atypical Pneumonia?
"Atypical pneumonia" is a term loosely applied to lower respiratory tract infections that
are not characterized by signs and symptoms of lobar consolidation. This description
can apply to disease caused by a variety of bacterial, viral and even protozoan
organisms. In reality, differentiation as to etiology of pneumonia cannot be
distinguished on the basis of clinical presentation.
Atypical pneumonia can be caused by one of three types of bacteria:
Legionella Pneumophila causes the Legionella Pneumonia that is also known as
legionnaires disease. This can be contracted when you breath water vapors infested
with this bacteria.
Mycoplasma Pneumoniae causes Mycoplasma Pneumonia and it tends to affect people
under the age of 40.
It mostly occurs in people that works or lives in heavily populated areas. However,
many people are diagnosed without any specific factors to be recalled.
Chlamydophilia Pneumoniae produces Chlamydophilia Pneumonia, this type of
pneumonia occurs throughout the year and it presents mild symptoms and rarely causes
serious cases.
Diagnose of Atypical Pneumonia
The first step is to evaluate the pneumonia patient with detailed history and physical
examination. The diagnosis may be made clinically in the appropriate setting, although
complete blood counts, blood biochemistry, and CXR are usually performed as well.

In more severe illness, especially when admission is needed and in order to identify a
possible typical bacterial pathogen, cultures of blood and sputum may be required, as
well as specific cultures and urine antigen tests for Legionella and Streptococcus
pneumoniae. Some authors even advocate the use of specific tests for the identification
of atypical bacterial and viral pathogens in such settings to guide specific targeted
therapy. In some cases (up to 25%) mixed infections can be identified. If available,
virological diagnostics should be performed to guide possible treatment for influenza.
Pneumonia due to mycoplasma and chlamydophila bacteria is usually mild.
Pneumonia due to Legionella pneumophila gets worse during the first 4 to 6
days, and then improves over 4 to 5 days.
Even though symptoms will improve, it may take a while for them to go away
The most common symptoms of pneumonia are:
Cough (with Legionella pneumonia, you may cough up bloody mucus)
Fever, which may be mild or high
Shortness of breath (may only occur when you exert yourself)
Other symptoms include:
Chest pain that gets worse when you breathe deeply or cough
Confusion, especially in older people or those with Legionella pneumonia
Loss of appetite, low energy, and fatigue
Muscle aches and joint stiffness
Sweating and clammy skin
Less common symptoms include:
Diarrhea (especially with Legionella pneumonia)
Ear pain (with mycoplasma pneumonia)
Eye pain or soreness (with mycoplasma pneumonia)
Neck lump (with mycoplasma pneumonia)
Rash (with mycoplasma pneumonia)

Sore throat (with mycoplasma pneumonia)

Treatment approach for atypical pneumonia
Initial treatment for any patient with pneumonia is guided by the severity of the
disease and presence of co-morbidities, prior hospitalisations, and resistant
bacteria in the community.
Patients should be assessed for hydration status, adequacy of gas exchange, and
haemodynamic stability. Oxygen and ventilation should be started immediately
if needed.
Atypical bacterial pneumonia pathogens generally do not respond to beta-lactam
antibiotics and require treatment with a macrolide, tetracycline or
Use of a macrolide or doxycycline for uncomplicated community-acquired
pneumonia to ensure coverage of atypical organisms
Tetracyclines and fluoroquinolones are generally not recommended in children
or pregnant women; however, their use may be considered in these patients
when the benefits of using these drugs outweigh the risks, and there are no other
suitable treatment options available.
When a specific aetiology for the pneumonia is found using a reliable method,
antimicrobial therapy should be directed at that pathogen.
Scoring the severity of illness can help to determine whether the patient can be
treated as an outpatient or requires hospitalisation or intensive care. It is most
commonly determined using the Pneumonia Severity Index (PSI).

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