DEHYDRATION -Dehydration means your body does not have as much water and fluids as it should.

-Dehydration can be mild, moderate, or severe based on how much of the body's fluid is lost or not replenished. When it is severe, dehydration is a life-threatening emergency. -defined as the excessive loss of body fluid, [1] with an accompanying disruption of metabolic processes. It is literally the removal of water (Ancient Greek: hdr) from an object; however, in physiological terms, it entails a deficiency of fluid within an organism -There are three types of dehydration: hypotonic or hyponatremic (primarily a loss of electrolytes, sodium in particular), hypertonic or hypernatremic (primarily a loss of water), and isotonic or isonatremic (equal loss of water and electrolytes).[2] In humans, the most commonly seen type of dehydration by far is isotonic (isonatraemic) dehydration which effectively equates with hypovolemia, but the distinction of isotonic from hypotonic or hypertonic dehydration may be important when treating people who become dehydrated. Physiologically, dehydration, despite the name, does not simply mean loss of water, as water and solutes (mainly sodium) are usually lost in roughly equal quantities to how they exist in blood plasma. In hypotonic dehydration, intravascular water shifts to the extravascular space, exaggerating intravascular volume depletion for a given amount of total body water loss. Neurological complications can occur in hypotonic and hypertonic states. The former can lead to seizures, while the latter can lead to osmotic cerebral edema upon rapid rehydration.[3] Although dehydration can happen to anyone, some people are at a greater risk. Those highest at risk include: People in higher altitudes Athletes, especially those in endurance events such as marathons, triathlons, and cycling tournaments. Dehydration can undermine performance in sports, as this article explains. People with chronic illnesses such as diabetes, kidney disease, cystic fibrosis, alcoholism, and adrenal gland disorders Older adults, infants, and children. Dehydration in elderly people can be explained by brain malfunction, a study revealed. An article explains how drinking more water improved the health of elderly people.

ETIOLOGY Dehydration can be caused by losing too much fluid, not drinking enough water or fluids, or both. Your body may lose too much fluids from: -Excessive sweating (for example, from exercise) -Excessive urine output, such as with uncontrolled diabetes or diuretic use -Fever -Vomiting or diarrhea You might not drink enough fluids because of: -Loss of appetite due to illness -Nausea -Sore throat or mouth sores **Dehydration in sick children is often a combination of refusing to eat or drink anything and losing fluid from vomiting, diarrhea, or fever. Infants and children are more likely to become dehydrated than adults because they weigh less and their bodies turn over water andelectrolytes more quickly. Diarrhea - the most common cause of dehydration and related deaths. The large intestine absorbs water from food matter, and diarrhea prevents this function, leading to dehydration. Vomiting - leads to a loss of fluids and makes it difficult to replace water by drinking it. Sweating - the body's cooling mechanism releases a significant amount of water. Hot and humid weather and vigorous physical activity can further increase fluid loss from sweating. Diabetes - high blood sugar levels cause increased urination and fluid loss. Tips for handling summer heat for people with diabetes. Frequent urination - usually caused by uncontrolled diabetes, but also can be due to alcohol and medications such as diuretics, antihistamines, blood pressure medications, and anti-psychotics. Burns - water seeps into damaged skin and the body loses fluids. SIGNS AND SYMPTOMS -Dry or sticky mouth -Lethargy or coma (with severe dehydration) -Low or no urine output; urine looks dark yellow -No tears -Sunken eyes -Sunken fontanelles (the soft spot on the top of the head) in an infant

**You may also have vomiting, diarrhea, or the feeling that you "can't keep anything down In humans, dehydration can be caused by a wide range of diseases and states that impair water homeostasis in the body. These include: External or stress-related causes Prolonged physical activity with sweating without consuming adequate water, especially in a hot and/or dry environment Prolonged exposure to dry air, e.g., in highflying airplanes (5%12% relative humidity) Blood loss or hypotension due to physical trauma Diarrhea Hyperthermia Shock (hypovolemic) Vomiting Burns Lacrimation Use of methamphetamine, amphetamine and other stimulants Excessive consumption of alcoholic beverages Infectious diseases Cholera Gastroenteritis Shigellosis Yellow fever Malnutrition Electrolyte disturbance Hypernatremia (also caused by dehydration) Hyponatremia, especially from restricted salt diets Fasting Recent rapid weight loss may reflect progressive depletion of fluid volume (the loss of 1 L of fluid results in a weight loss of 1 kg (2.2 lb)).[11] Patient refusal of nutrition and hydration Inability to swallow (obstruction of the oesophagus) Other causes of obligate water loss Severe hyperglycemia, especially in diabetes mellitus Glycosuria Uremia Diabetes insipidus Acute emergency dehydration event Foodborne illness PATHOPYSIO The negative fluid balance that causes dehydration results from decreased intake, increased output (renal, GI, or insensible losses), or fluid shift (ascites, effusions, and capillary leak states such as burns and sepsis). The

decrease in total body water causes reductions in both the intracellular and extracellular fluid volumes. Clinical manifestations of dehydration are most closely related to intravascular volume depletion. As dehydration progresses, hypovolemic shock ultimately ensues, resulting in end organ failure and death. Young children are more susceptible to dehydration due to larger body water content, renal immaturity, and inability to meet their own needs independently. Older children show signs of dehydration sooner than infants due to lower levels of extracellular fluid (ECF). Dehydration can be categorized according to osmolarity and severity. Serum sodium is a good surrogate marker of osmolarity assuming the patient has a normal serum glucose. Dehydration may be isonatremic (130-150 mEq/L), hyponatremic (< 130 mEq/L), or hypernatremic (>150 mEq/L). Isonatremic dehydration is the most common (80%). Hypernatremic and hyponatremic dehydration each comprise 5-10% of cases. Variations in serum sodium reflect the composition of the fluids lost and have different pathophysiologic effects. Isonatremic (isotonic) dehydration occurs when the lost fluid is similar in sodium concentration to the blood. Sodium and water losses are of the same relative magnitude in both the intravascular and extravascular fluid compartments. Hyponatremic (hypotonic) dehydration occurs when the lost fluid contains more sodium than the blood (loss of hypertonic fluid). Relatively more sodium than water is lost. Because the serum sodium is low, intravascular water shifts to the extravascular space, exaggerating intravascular volume depletion for a given amount of total body water loss.[1, 2] Hypernatremic (hypertonic) dehydration occurs when the lost fluid contains less sodium than the blood (loss of hypotonic fluid). Relatively less sodium than water is lost. Because the serum sodium is high, extravascular water shifts to the intravascular space, minimizing intravascular volume depletion for a given amount of total body water loss.[3, 4, 2] Neurologic complications can occur in hyponatremic and hypernatremic states. Severe hyponatremia may lead to intractable seizures, whereas rapid correction of chronic hyponatremia (>2 mEq/L/h) has been associated with central pontine myelinolysis. During hypernatremic dehydration, water is osmotically pulled from cells into the extracellular space. To compensate, cells can generate osmotically active particles (idiogenic osmoles) that pull

water back into the cell and maintain cellular fluid volume. During rapid rehydration of hypernatremia, the increased osmotic activity of these cells can result in a large influx of water, causing cellular swelling and rupture; cerebral edema is the most devastating consequence. Slow rehydration over 48 hours generally minimizes this risk. The symptoms of dehydration depend in part on the cause and in part on whether there is associated salt deprivation as well. When loss of water is disproportionately greater than loss of electrolytes(salt), the osmotic pressure of the extracellular fluids becomes higher than in the cells. Since water passes from a region of lower to a region of higher osmotic pressure, water flows out of the cells into the extracellular fluid, tending to lower its osmotic pressure and increase its volume toward normal. As a result of the flow of water out of the cells, they become dehydrated. This results in the thirstthat always accompanies pure water depletion. In those diseases in which there is loss of salt in excess of water loss, the decreased concentration of sodium in the extracellular fluid and in the blood serum results in decreased osmotic pressure, and water therefore enters the cells to equalize the osmotic pressure. Thus there is extracellular dehydration and intercellular hydrationand no thirst. Water deprivation produces distinctive symptoms in humans. Weight loss, amounting to two to three pounds per day, occurs. Thirst is the most prominent symptom, with the dryness of mouth, decreased production of saliva, and impaired swallowing that accompany it. It is probable that thirst is the result of this subsequent intracellular dehydration and increased intracellular osmotic pressure. Experimentally, thirst can be produced when the cells have lost about 1 percent of their intracellular water. As dehydration progresses, the tissues tend to shrink, the skin becomes dry and wrinkled, and the eyes become sunken and the eyeballs soft. Fever develops, possibly from mild to marked, as dehydration progresses. Dehydration itself probably affects the temperature regulatory centres in the brain. As dehydration and salt loss progress, however, the plasma volume and heart output decrease, with a consequent decrease in blood supply to the skin. Sweating decreases and may stop completely, and the main avenue for heat loss is closed. The body temperature may then rise precipitously.

There are marked changes in the volume of the extracellular and intracellular fluids, but the blood plasma volume changes the last and the least. The plasma volume is maintained more or less constant at the expense of the tissue fluids. If, however, the plasma volume does fall, the output of the heart also falls, and the pulse rate climbs, all of which indicates a dangerous physical state. The renal (kidney) changes that occur in humans during prolonged water depletion similarly tend to maintain a normal balance. If water deprivation continues and the plasma volume falls, however, the output of urine will be drastically reduced. As long as urine output of more than 30 millilitres (1 ounce) per hour is maintained, the kidney can excrete nitrogenous and nonnitrogenous solids with maximum efficiency. Once the urine flow is decreased below this level, the kidney is unable to function efficiently, the substances are retained in the body, and their concentration in the blood rises. The final result of prolonged dehydration is now apparent. The normal distribution of salt and water in the body is destroyed, the plasma volume decreases, and the blood viscosity increases. As a result of these changes renal function is impaired, the urinary output falls, and waste products accumulate. Far more lifethreatening, however, is decreased loss of moisture from the skin, with the subsequent rise in temperature, and the fall in cardiac output with the attendant irreversible shock. Once renal failure occurs, about 8 percent of the total body water has been lost (4 litres [about 4.25 quarts]). When 5 to 10 litres (about 5.25 to 10.5 quarts) of body water have been lost, a person is acutely and severely ill, with contracted plasma volume, increased concentration and viscosity of the blood, renal failure and excessive urea in the blood, and falling blood pressure. In a previously healthy adult, death follows the loss of 12 to 15 litres (about 12.5 to 15.8 quarts) of body water. In the very young, the very old, or the debilitated, death occurs at a lower level of dehydration. ***On extra hot days like we are experiencing at the moment I would advise cutting down on beer and coffee replacing it with water currently I am getting through several litres of water a day without even noticing I am consuming it as well as 3 4 showers a day. TREATMENT

Increased fluid intake and replacement of lost electrolytes are usually sufficient to restore fluid balance in patients who are mildly or moderately dehydrated. For individuals who are mildly dehydrated, just drinking plain water may be all the treatment that is needed. Adults may replace lost electrolytes by drinking sports beverages, such as Gatorade or Recharge. Parents should follow label instructions when giving children Pedialyte or other commercial products recommended for the treatment of dehydration in children. Children who are dehydrated should be given only clear fluids for the first 24 hours. A child who is vomiting should sip one or two teaspoons of liquid every 10 minutes. A child who is less than a year old and who is not vomiting should be given one tablespoon of liquid every 20 minutes. A child who is more than one year old and who is not vomiting should take two tablespoons of liquid every 30 minutes. A baby who is being breast-fed should be given clear liquids for two consecutive feedings before breastfeeding is resumed. A bottle-fed baby should be given formula diluted with water to half the formula strength for the first 24 hours after symptoms of dehydration are identified. To calculate fluid loss accurately, weight changes should be charted every day and a record kept of how many times a patient vomits or has diarrhea. A record of fluid output (including sputum or vomit) and of fluid intake or replacement should be kept for at least 24 to 48 hours to see if balance is being accomplished. Parents should note how many times a baby's diaper must be changed. If dehydration continues, emergency department treatment or hospitalization to receive intravenous fluids and electrolytes may be necessary. Children and adults can gradually return to their normal diet after they have stopped vomiting and no longer have diarrhea. Gelatin is often a welcomed substitute for additional water and does count as fluid replacement. Bland foods should be reintroduced first, with other foods added as the digestive system is able to tolerate them. Milk, ice cream, cheese, and butter should not be eaten until 72 hours after symptoms have disappeared. When treating dehydration, the underlying cause must be addressed. For example, if dehydration is caused by vomiting or diarrhea, medications should be prescribed to resolve these symptoms. Patients who are dehydrated due to diabetes, kidney disease, or adrenal gland disorders must receive treatment for these conditions as well as

for the resulting dehydration. If dehydration is being caused by diuretics. a dose adjustment made by the physician or a change to a different diuretic may be necessary. Drinking fluids is usually enough for mild dehydration. It is better to drink small amounts of fluid often (using a teaspoon or syringe for an infant or child), instead of trying to force large amounts of fluid at one time. Drinking too much fluid at once can bring on more vomiting. Electrolyte solutions or freezer pops are very effective. These are available at pharmacies. Sports drinks contain a lot of sugar and can cause or worsen diarrhea. In infants and children, avoid using water as the primary replacement fluid. Intravenous fluids and a hospital stay may be needed for moderate to severe dehydration. The health care provider will try to identify and then treat the cause of the dehydration. NSG. MGT. MED MGT. PHARMACOLOGIC MGT Prevention Patients who are vomiting or who have diarrhea can prevent dehydration by drinking enough fluid to keep their urine the color of pale straw. Infants and young children with diarrhea and vomiting can be given electrolyte solutions such as Pedialyte to help prevent dehydration, as well as suppository medication to stop the vomiting. People who are not ill can maintain proper fluid balance by drinking several glasses of water before going outside on a hot day. It is also a good idea to avoid coffee and tea, which increase body temperature and water loss. Patients should ask a pharmacist whether or not any medications they are taking may cause dehydration and what to do to prevent it other than adequate fluid intake. Prompt medical attention should be sought to correct any underlying condition that increases the risk of dehydration. Prognosis Mild dehydration rarely results in complications. If the cause is eliminated and lost fluid is replaced, mild dehydration can usually be resolved in 24 to 48 hours. Vomiting and diarrhea that continue for several days without adequate fluid replacement can be fatal since more is lost than water and sodium. Severe potassium loss may lead to cardiac arrhythmias,

respiratory distress or arrest, or convulsions (seizures). The risk of life-threatening complications is greater for young children and the elderly. However, dehydration that is rapidly recognized and treated has a good outcome. Exams and Tests A physical examination may also show signs of: Blood pressure that drops when you go from lying down to standing Delayed capillary refill Low blood pressure Poor skin turgor -- the skin may not be as elastic as normal and sag back into position slowly when the health care provider pinches it up into a fold (normally, skin springs right back into place) Rapid heart rate Shock Tests include: Blood chemistries (to check electrolytes, especially sodium, potassium, and bicarbonate levels) Blood urea nitrogen (BUN) Complete blood count (CBC) Creatinine Urine specific gravity ***The reason many people develop illnesses here are down to swapping water with beer and often just not consuming enough water. This often develops kidney problems and I know of 4 people in the last year which are currently going through various medical procedures. PNEUMONIA What is pneumonia? Pneumonia is a lung infection that can make you very sick. You may cough, run a fever, and have a hard time breathing. For most people,pneumonia can be treated at home. It often clears up in 2 to 3 weeks. But older adults, babies, and people with other diseases can become very ill. They may need to be in the hospital. You can get pneumonia in your daily life, such as at school or work. This is called communityassociated pneumonia. You can also get it when you are in a hospital or nursing home. This is called healthcare-associated pneumonia. It may be more severe because you already are ill. This topic focuses on pneumonia you get in your daily life. What causes pneumonia? Germs called bacteria or viruses usually cause pneumonia. Pneumonia usually starts when you breathe the germs into your lungs. You may be more likely

to get the disease after having a cold or the flu. These illnesses make it hard for your lungs to fight infection, so it is easier to get pneumonia. Having a long-term, or chronic, disease like asthma, heart disease, cancer, or diabetes also makes you more likely to get pneumonia. What are the symptoms? Symptoms of pneumonia caused by bacteria usually come on quickly. They may include: Cough. You will likely cough up mucus (sputum) from your lungs. Mucus may be rusty or green or tinged with blood. Fever. Fast breathing and feeling short of breath. Shaking and "teeth-chattering" chills. You may have this only one time or many times. Chest pain that often feels worse when you cough or breathe in. Fast heartbeat. Feeling very tired or feeling very weak. Nausea and vomiting. Diarrhea. When you have mild symptoms, your doctor may call this "walking pneumonia." Older adults may have different, fewer, or milder symptoms. They may not have a fever. Or they may have a cough but not bring up mucus. The main sign of pneumonia in older adults may be a change in how well they think. Confusion ordelirium is common. Or, if they already have a lung disease, that disease may get worse. Symptoms caused by viruses are the same as those caused by bacteria. But they may come on slowly and often are not as obvious or as bad. How is pneumonia diagnosed? Your doctor will ask you about your symptoms and do a physical exam. He or she may order a chest X-ray and a blood test. This is usually enough for your doctor to know if you have pneumonia. You may need more tests if you have bad symptoms, are an older adult, or have other health problems. In general, the sicker you are, the more tests you will have. Bacterial Streptococcus pneumoniae is the most common cause of bacterial pneumonia. People who suffer from chronic obstructive pulmonary disease (COPD) or alcoholism most often get pneumonia from Klebsiella pneumoniae and Hemophilus influenzae. Atypical pneumonia, a type of pneumonia that typically occurs during the summer and fall months, is caused by the bacteria Mycoplasma pneumoniae. People who have Legionnaire's disease caused by the

bacterium Legionella pneumoniae (often found in contaminated water supplies and air conditioners) may also develop pneumonia as part of the overall infection. Another type of bacteria responsible for pneumonia is called Chlamydia pneumoniae. Pneumocystis cariniipneumonia is a form of pneumonia that usually affects both lungs and is found in patients with weakened or compromised immune systems from such conditions as cancer and HIV/AIDS and those treated with TNF (tumor necrosis factor) for rheumatoid arthritis. Viral Viral pneumonias are pneumonias that do not typically respond to antibiotic treatment (in contrast to bacterial pneumonias). Adenoviruses, rhinovirus, influenza virus (flu), respiratory syncytial virus (RSV), and parainfluenza virus are all potential causes of viral pneumonia. Ads by Google Acare Vaccum Regulator - Suction Regulator in Medical use ISO13485 certified w/good quality - www.acaretech.com How to Get Pregnant Fast - I Stopped these common mistakes and got Pregnant in just 2 months! - www.MaximumFertility.com Global Handwashing Day - Let's say goodbye to diseases & Infection.Make a healthy lives Now! - Donatetounicef.org/killthegerms Fungal Histoplasmosis, coccidiomycosis, blastomycosis, aspergillosis, and cryptococcosis are fungal infections that can lead to fungal pneumonia. These types of pneumonias are relatively infrequent in the United States. Nosocomial and others Organisms that have been exposed to strong antibiotics and have developed resistance are called nosocomial organisms. If they enter the lungs, a person may develop nosocomial pneumonia. Resistant bacteria are often found in nursing homes and hospitals. An example isMRSA, or methicillin-resistant Staph aureus, which can cause skin infections as well as pneumonia. Similarly, outbreaks of the H5N1 influenza (bird flu) virus and severe acute respiratory syndrome (SARS) have resulted in serious pneumonia infections. Anthrax, plague,

and tularemia also may cause pneumonia, but their occurrences are rare. Who gets pneumonia? Some people are more likely than others to develop pneumonia. Individuals at higher risk include those who: Smoke. Abuse alcohol. Have other medical conditions, such as chronic obstructive pulmonary disease (COPD),emphysema, asthma, or HIV/AIDS. Are younger than 1 year of age or older than 65. Have a weakened or impaired immune system. Take medicines for gastroesophageal reflux disease (GERD). Have recently recovered from a cold or influenza infection. Are malnourished. Have been recently hospitalized in an intensive care unit. Have been exposed to certain chemicals or pollutants. Are Native Alaskan or certain Native American ethnicity. Have any increased risk of breathing mucus or saliva from the nose or mouth, liquids, or food from the stomach into the lungs. What are the symptoms of pneumonia? Symptoms of pneumonia caused by bacteria usually come on more quickly than pneumonia caused by virus. Elderly persons and small children may actually have fewer or more mild symptoms than expected for such high risk groups. Most people with pneumonia begin with cold and flu symptoms and then develop a high fever, chills, and cough with sputum. Although symptoms may vary greatly depending on other underlying conditions, common symptoms include: Cough Rusty or green mucus (sputum) coughed up from lungs Fever Fast breathing and shortness of breath Shaking chills Chest pain that usually worsens when taking a deep breath (pleuritic pain) Fast heartbeat Fatigue and feeling very weak Nausea and vomiting Diarrhea Sweating Headache Muscle pain Confusion or delirium

Dusky or purplish skin color (cyanosis) from poorly oxygenated blood How is pneumonia diagnosed? A pneumonia diagnosis usually begins with a physical exam and a discussion about your symptoms and medical history. A doctor may suspect pneumonia if they hear coarse breathing, wheezing, crackling sounds, or rumblings when listening to the chest through a stethoscope. Chest x-rays and blood tests may be ordered to confirm a pneumonia diagnosis. A chest x-ray can confirm pneumonia and determine its location and extent in the lungs. Blood tests measure white blood cell count to determine the severity of pneumonia and can be used to determine whether the infection is bacterial, viral, fungal, etc. An analysis of sputum also can be used to determine the organism that is causing the pneumonia. A more invasive diagnostic tool is the bronchoscopy - a procedure whereby the patient is under anesthesia and a thin, flexible, and lighted tube is inserted into the nose or mouth to directly examine the infected parts of the lung. How is pneumonia treated? Pneumonia treatments depend on the type of pneumonia and the severity of symptoms. Bacterial pneumonias are usually treated with antibiotics, whereas viral pneumonias are treated with rest and plenty of fluids. Fungal pneumonias are usually treated with antifungal medications. Over-the-counter medications are also commonly prescribed to better manage pneumonia symptoms. These include treatments for reducing fever, reducing aches and pains, and suppressing coughs. In addition, it is important to get plenty of rest and sleep and drink lots of fluids. Hospitalization for pneumonia may be required if symptoms are especially bad or a patient has a weakened immune system or other serious illness. At the hospital, patients generally are treated with intravenous antibiotics and possibly put on oxygen. How can pneumonia be prevented? There are several ways to prevent pneumonia. There are two vaccines that are available to prevent pneumococcal disease (the bacterial infection that is the most common cause of pneumonia): pneumococcal conjugate vaccine (Prevnar) and pneumococcal polysaccharide

vaccine (Pneumovax). Prevnar is generally administered as part of the normal infant immunization procedure and is recommended for children less than 2 years of age or between two and four years with certain medical conditions. Pneumovax is provided for adults who are at increased risk of developing pneumococcal pneumonia, such as the elderly, diabetics, those with chronic heart, lung, or kidney disease, alcoholics, smokers, and those without a spleen. The pneumonia vaccine may not completely prevent older adults from getting pneumonia, but it can reduce the severity of a future pneumonia. In addition to vaccinations, physicians recommend that people wash hands, refrain from smoking, eat healthfully, exercise, and stay away from sputum or cough particles from others with pneumonia. Pneumonia is the leading cause of death in children worldwide. Pneumonia kills an estimated 1.4 million children under the age of five years every year more than AIDS, malaria and tuberculosis combined. Pneumonia can be caused by viruses, bacteria or fungi. Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors. Pneumonia can be treated with antibiotics, but around 30% of children with pneumonia receive the antibiotics they need. Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake. Pneumonia is the single largest cause of death in children worldwide. Every year, it kills an estimated 1.4 million children under the age of five years, accounting for 18% of all deaths of children under five years old worldwide. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be preventedwith simple interventions, and treated with low-cost, low-tech medication and care. Causes

Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are: Streptococcus pneumoniae the most common cause of bacterial pneumonia in children; Haemophilus influenzae type b (Hib) the second most common cause of bacterial pneumonia; respiratory syncytial virus is the most common viral cause of pneumonia; in infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants. Transmission Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this has critical importance for treatment and prevention. Symptoms The symptoms of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. The symptoms of pneumonia include: rapid or difficult breathing cough fever chills loss of appetite wheezing (more common in viral infections). When pneumonia becomes severe, children may experience lower chest wall indrawing, where their chests move in or retract during inhalation (in a healthy person, the chest expands during inhalation). Very severely ill infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions. Risk factors While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed. Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.

The following environmental factors also increase a child's susceptibility to pneumonia: indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung) living in crowded homes parental smoking. Treatment Pneumonia 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. Hospitalization is recommended in infants aged two months and younger, and also in very severe cases. Prevention 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 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.