Introduction

Pneumoniaisdefinedas"inflammationofthelungcausedbybacteria,inwhichthe
airsacs(alveoli)becomefilledwithinflammatorycellsandthelungsbecomesolid"
(OxfordConciseMedicalDictionary,6thEdition,2003).
Pneumoniais"asevereformofacutelowerrespiratoryinfectionthatspecifically
affectsthelungs".Thelungsconsistofbronchi,whichdivideintobronchiolesthat
endinalveoli.Thesmallbloodvesselsinthelungsareresponsibleforgaseous
exchange(oxygenmovingintothelungsandcarbondioxidemovingoutofthelungs).
DuringaPneumoniainfection,thealveoliofoneorbothlungsfillupwithpusor
fluid.Thisincreasesthelaborofbreathing,andthusgaseousexchangecannotoccur
asitnormallywould(unicef/WHO,2006).
PrevalenceofPneumonia
Accordingtounicef/WHO(2006)Pneumoniakillsmorechildrenthananyother
illnessmorethanAIDS,malariaandmeaslescombinedanditaccountsfornearly
oneinfivechilddeathsglobally.
Ithasbeenfoundthat1,6millionpeoplediefrompneumoniaworldwideeachyear.It
shouldalsobenotedthatpneumoniaisoneoftheleadingcausesofdeathsfor
childrenundertheageof5.
InSouthEastAsia,inthePacific,andinSubSaharanAfricaabout433millionyoung
childrencontractthediseaseannually(CDF,2009).Amongstchildrenundertheage
of5,thesetworegionshavethehighestincidenceofpneumoniacasesandwhen
combined,they"beartheburdenofmorethanhalfthetotalnumberofpneumonia
episodesworldwide"(unicef/WHO,2006).
TypesofPneumonia

AspirationPneumonia
o

AspirationPneumoniaresultswhenfood,drink,vomit,secretionsor
otherforeignmaterialisinhaledandcausesaninflammatoryresponse
inthelungsandbronchialtubes.

AspirationPneumoniaoccurspredominantlyintherightlungbecause
itstotalcapacityisgreaterthanthatoftheleftlung(Healthcares.net,
2005;Bartleby.com).

AtypicalPneumonia
o

ThistermrefersofPneumoniacausedbythefollowingbacteria:
Legionellapneumophila,Mycoplasmapneumoniae,and
Chlamydophilapneumoniae.

BacterialPneumonia
o

Bronchopneumoniaisadescendinginfectionstartingaroundthe
bronchiandbronchioles(Nursesdictionary,Twentythirdedition,
2000).Theterminalbronchiolesbecomeblockedwithexudatesand
formconsolidatedpatches.Thisresultsinatelectasis.

CommunityacquiredPneumonia
o

Thismeanstheinfectionwasacquiredathome.

Withthistypeofpneumoniathemostcommoncauseis'Streptococcus
Pneumonia'(Smith&Ball,1998)

HospitalacquiredPneumonia
o

Patientsdevelopfeaturesafterbeinginhospitalfor24hoursorlonger

InfectiousagentisoftenGramnegativebacteriasuchas'Escherichia
coliorKlebsiella'(Smith&Ball,1998)

MycoplasmalPneumonia(alsoknownas'walkingpneumonia')
o

BacterialPneumoniaoccurswhenpneumoniacausingbacteriamasses
andmultipliesinthelungs.Thealveolibecomeinflamedandpusis
produced,whichspreadsaroundthelungs.Thebacteriathatcaused
BacterialPneumoniaare:streptococcuspneumonia,hemophilus
influenza,legionellapneumophiliaandstaphylococcusaureus
(healthscout.com).

BronchialPneumonia
o

Atypicalpneumoniaiscausedbybacteriaanddoesnotrespondtothe
normalantibioticsusedfortreatment(Healthcares.net,2005).

Itissimilartobacterialpneumonia,wherebythemycoplasmas
proliferateandspreadcausinginfection(healthscout.com).

PneumocystiscariniiPneumonia
o

Pneumocystiscariniipneumoniaistheresultofafungalinfectionin
thelungscausedbythePneumocystiscariniifungus.

Thisfungusdoesnotcauseillnessinhealthyindividuals,butratherin
thosewithaweakenedimmunesystem.(Healthcares.net,2005).

VentilatorAssociatedPneumonia(VAP)

Thistypeofpneumoniausuallyoccurstwodaysafterahospitalised
patienthasbeenintubatedandbeenreceivingmechanicalventilation
(Koenig&Truwit,2006).

Thisisespeciallyalifethreateninginfectionaspatientswhorequire
mechanicalsupportarealreadycriticallyill(Torpy,2007).

ViralPneumonia
o

ViralPneumoniaisbelievedtobethecauseofhalfofallpneumonias.
Thevirusesinvadethelungsandthenmultiplycausinginflammation
(healthscout.com).

StagesofPneumonia
Pneumoniahasfourstages,namelyconsolidation,redhepatization,greyhepatization
andresolution.

Consolidation
o

Occursinthefirst24hours

Cellularexudatescontainingneutrophils,lymphocytesandfibrin
replacesthealveolarair

Capillariesinthesurroundingalveolarwallsbecomecongested

Theinfectionsspreadstothehilumandpleurafairlyrapidly

Pleurisyoccurs

Markedbycoughinganddeepbreathing(Atkuri&King,2006;Steyl,
2007

RedHepatization
o

Occursinthe23daysafterconsolidation

Atthispointtheconsistencyofthelungsresemblesthatoftheliver

Thelungsbecomehypeaemic

Alveolarcapillariesareengorgedwithblood

Fibrinousexudatesfillthealveoli

Thisstageis"characterizedbythepresenceofmanyerythrocytes,
neutrophils,desquamatedepithelialcells,andfibrinwithinthealveoli"
(Atkuri&King,2006;Steyl,2007)

GreyHepatization
o

Occursinthe23daysafterRedHepatization

Thisisanavascularstage

Thelungappears"graybrowntoyellowbecauseoffibrinopurulent
exudates,disintegrationofredcells,andhemosiderin"

Thepressureoftheexudatesinthealveolicausescompressionofthe
capillaries

"Leukocytesmigrateintothecongestedalveoli"(Atkuri&King,2006;
Steyl,2007)

Resolution
o

Thisstageischaracterizedbythe"resorptionandrestorationofthe
pulmonaryarchitecture"

Alargenumberofmacrophagesenterthealveolarspaces

Phagocytosisofthebacterialadenleucocytesoccurs

"Consolidationtissuereaeratesandthefluidinfiltratecausessputum"

"Fibrinousinflammationmayextendtoandacrossthepleuralspace,
causingarubheardbyauscultation,anditmayleadtoresolutionorto
organizationandpleuraladhesions"(Atkuri&King,2006;Steyl,
2007)

Causes
Therearemanydifferentcausesofpneumoniawhichcanbeclassifiedasinfectiveor
aspirationpneumonia.
Infectivepneumonia:

theinfectionandinflammatoryresponseofthelungsandbronchialtubes
whenbacteriaoravirusentersthelungandproliferates

canoccurthroughinhalingsmalldropletscontainingpneumonia

causingorganismssuchasStreptococcuspneumoniae(ehealthMD,2004).

Aspirationpneumonia:

causedbyinhalingvomit,mucous,bodilyfluids,orcertainchemicals

causingthelungsandbronchialtubestobecomeinflamed(Healthcares.net,
2005).

Riskfactors
Theelderly,infantsandyoungchildrenaremoreatriskofcontractingcommunity
acquiredpneumoniathanyoungandmiddleagedadults.Underlyinghealthproblems
suchas:

flu

cancer

AIDS

heartdisease

diabetes

asthma

chronicbronchitis

emphysema

chronicobstructivepulmonarydisease

brochiectasis

immunosuppressivedisordersandtherapy

debilityorstroke

coma

problemswithswallowing

alcoholism

intravenousdrugabuse

Causeaperson'simmunesystemtobeweakenedthusleavingthematriskof
contractingPneumonia.Ithasalsobeenfoundthatfrequentexposuretocigarette
smokeincreasestheriskofdevelopingPneumonia(Health24.com)

Signsandsymptoms
Initiallysymptomsaresimilartothatofacoldfollowedby:

ahighfever(pyrexia)

chills

aproductivecough

Sputummaybediscolouredandmaybecomebloodstainedasthepneumonia
progresses.Thefollowingmayalsooccur:

dyspnoea

sharpchestpain

worseningcough

headaches

malaise

musclepains

cyanosisduetopoorlyoxygenatedblood

lossofappetite

rapidbreathing

wheezingorgruntingduringbreathing

intercostalmusclerecessionduringbreathing

vomiting

TheXraywillshowdecreasedlungexpansionandopacityontheaffectedside
(Hough,1991;Klein,2008).
Diagnosis

Physicalexamination
o

cracklesandwheezingmaybeheardwhileauscultating

ChestXray

usuallydonetoconfirmthediagnosis

Sputumsamplesandbloodtests
o

donetodiagnosethetypeofpneumoniathatispresent

sputumtestisdonetodeterminewhetheritisafungalorbacterial
infection

bloodtestisdonetoexaminetheWhiteBloodCellcountofthe
involvedpatient

thiscanbeusedtoindicatetheseverityofthepneumonia,aswellasto
determinewhetheritisaviralorbacterialinfection.

bacterialinfectionwouldresultinabloodcountthathasanincreased
amountofneutrophils

abloodcountthathasanincreasedamountoflymphocyteswould
indicateaviralinfection.

Complications

Pleuraleffusion
o

Whenfluidaccumulatesbetweenthepleuraandthechestwalldueto
thelargeamountoffluidalreadypresentinthelungs.

AsaresultofthePneumonia,apleuraleffusionmaydevelopwhich
couldleadtothecollapseofthelungsifnottreatedappropriately
(Healthcares.net,2005).

Empyema
o

Pusmaybepresentinthelungsduetotheinfection.

Thuspocketsofpusmaydevelopinthecavitybetweenthepleuraand
thechestwall,orinthelungitselfwhichisotherwiseknownas
empyema(Healthcares.net,2005).

Lungabscess
o

Alungabscessdevelopswhentheinfectionhasdestroyedlungtissue
andacavityfilledwithpusisformed(Healthcares.net,2005).

Bacteremia

Septicemia
o

Whenbacteremiaoccurssepticemiacanfollow,asthisisaninfection
thatisspreadthroughoutthebody.

Theinfectedbloodisthebestwayfortheinfectiontomanifestinother
partsofthebody(Healthcares.net,2005).

Meningitis
o

Theinfectionmayspreadtothemeningesthatcoverthebrainand
spinalcord,leadingtomeningitis(Healthcares.net,2005).

Septicarthritis
o

Thisoccurswhentheinfectionisnolongercontainedwithinthelungs
andmovesintothebloodstream,thusthebloodisinfected(Health
cares.net,2005).

Whenbacteremiahasoccurredsepticarthritisisalsoadanger,asthe
bacteriamanifestsinthejointsthroughwhichbloodpasses(Health
cares.net,2005).

Endocarditisorpericarditis
o

Asbloodisalsocirculatedthroughtheheartmusclesandthe
pericardium,theriskofdevelopinganinfectionthereisveryhighif
bacteremiaispresent(Healthcares.net,2005).

Treatment
Treatmentwillvarydependingonhowbadthesymptomsare,andwhatthecauseof
theinfectionis.

BacterialPneumoniacanbetreatedwithpenicillinand/orantibiotics

ViralPneumoniacannotbetreatedwithantibiotics,astheyhavenoeffect.
Thistypeofpneumonianormallyresolvesovertime.

MycoplasmaPneumoniaisusuallytreatedwithantibiotics.

Doctorswillalsoincludethefollowingwhentreatingpatientswithpneumonia:

Bedrest

Breathingexercises

Analgesicadministration

Coughsuppressantmedication

Feverreducingmedication(i.e.:Aspirin)

Oxygentherapy(whenindicated)

(healthscout.com)
PhysiotherapyManagement

Modifiedposturaldrainagethisallowsgravitytodrainsecretionsfrom
specificsegmentsofthelungs

Shakingandvibestomobilizesecretions

Coughingandhuffingexercisestoexpectoratesecretions

Administerhumidificationtomobilizesecretions

BreathingexercisesLocalizedandDiaphragmatic

IPPBadministrationtoincreaselungvolumes

Mobilizationofthepatientdonetoincreaseairentry,increasechest
expansion,andtoloosensecretions

(Madjoe&Marais,2007)
ChildrenandPneumonia
Whyarechildrenvulnerable?

Unlikehealthychildrenwithmanynaturaldefensestoprotectthemagainstthe
invasionofpathogensinthelungs,theunhealthychildrenwithacompromised
immunesystemhasweakdefenses.

Childrenwhosufferfrommalnutrion,particularlyinadequatezincintakeand
lackofexclusivebreastfeedinghaveahigherriskofdevelopingpneumonia.

Otherriskfactorsinclude:
o

Beingbornpremature

Havingasthmaorgeneticdisordersuchassicklecelldisease

Havingheartdefectssuchasventricularseptaldefect(VSD),atrial
septaldefect(ASD)orpatentductusarteriosus(PDA)(PDRhealth,
2009).

Severalenvironmentalfactorssuchasovercrowdinghomesandexposureto
parentalsmokeincreasesachild'ssusceptibilitytopneumoniaandits
complications(UNICEF/WHO,2006).

Signs&Symptomsinchildren

Inchildrenthesignsandsymptomsaresimilartothatofadults.

Sometimesachild'sonlysignmayberapidbreathingandoftenwhen
pneumoniaexistinthelowerpartofthelungs,nobreathingproblemsmaybe
presentbutratherfever,abdominalpainorvomiting.

Ifpneumoniaiscausedbybacteria,theinfectedchildbecomessickrelative
quicklyandispronetodevelopinghighfeverandrapidbreathing.

Ifpneumoniaiscausedbyviruses,symptomsmayappeargraduallyandless
severethanthebacterialpneumonia(Kidshealth,2009).

Parentsshouldbeawareofthefollowingsignsandsymptoms:
o

Nostrilflaring

Sternalretraction

Increasedbreathrate

>60breaths/minfornewbornsupto2months

>50breaths/minfor2monthsto12months

>40breaths/minforachildolderthan1yearsofage(Drugs
informationOnline,2009)

Prevention

Vaccinesareusuallyadministeredtopreventinfectionbyvirusesandbacteria.

KidsusuallyreceiveroutineimmunisationagainstHaemophilusInfluenzae
andPertussisattheageof2monthsofage.

Somevaccinesarealsoadministeredagainstpneumococcusorganism,a
commoncauseofpneumonia(Kidshealth,2009)

Transmissionofpneumonia

Infectionmayoccurindifferentwaysmayitbethroughcontaminatedairdroplets,
bloodborninfectionorfromcomingintocontactwithcontaminatedsubstances
duringdelivery.Eitherwayitisbelievedthatbabiesalreadyhavethebacterial
pathogenscausingpneumoniaintheirnoseand/orthroatandareinhaledintothe
lungs.