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(See also Infections in Neonates: Neonatal Pneumonia.)
Pneumonia
is acute inflammation of the lungs caused by infection. Initial
diagnosis is usually based on chest x-ray. Causes, symptoms, treatment,
preventive measures, and prognosis differ depending on whether the
infection is bacterial, viral, fungal, or parasitic; whether it is
acquired in the community, hospital, or nursing home; and whether
it develops in a patient who is immunocompetent or immunocompromised.
An estimated 2 to 3 million people in the US develop pneumonia each year, of whom about 45,000 die. Pneumonia is the most common fatal hospital-acquired infection and the most common overall cause of death in developing countries.
Bacteria are the most common cause of pneumonia in adults > 30 yr, Streptococcus pneumoniae infection being the most common pathogen across all age groups, settings, and geographic regions. However, pathogens of every sort, from viruses to parasites, cause pneumonia.
The airways and lungs are constantly exposed to pathogens in the external environment; the upper airways and oropharynx in particular are colonized with so-called normal flora rendered harmless by host defenses. Infection develops when pathogens that are inhaled or aspirated or reach the lungs via the bloodstream or contiguous spread overcome multiple host defenses.
Upper airway defenses include salivary IgA, proteases, and lysozymes; growth inhibitors produced by normal flora; and fibronectin, which coats the mucosa and inhibits adherence. Nonspecific lower airway defenses include cough, mucociliary clearance, and airway angulation preventing infection in airspaces. Specific lower airway defenses include various pathogen-specific immune mechanisms, including IgA and IgG opsonization, anti-inflammatory effects of surfactant, phagocytosis by alveolar macrophages, and T-cell–mediated immune responses. These mechanisms protect most people against infection. But numerous conditions alter normal flora (eg, systemic illness, undernutrition, hospital or nursing home exposure, antibiotic exposure) or impair these defenses (eg, cigarette smoking, nasogastric or endotracheal intubation). Pathogens that then reach airspaces can multiply and cause pneumonia.
Specific pathogens causing pneumonia cannot be found in < 50% of patients, even with extensive diagnostic investigation. But because pathogens and outcomes tend to be similar by setting and host risk factors, pneumonias can be categorized as
These categorizations allow treatment to be selected empirically.
The term interstitial pneumonia refers to various unrelated conditions of varied and sometimes unknown causes characterized by inflammation and fibrosis of the pulmonary interstitium (see Interstitial Lung Diseases: Idiopathic Interstitial Pneumonias).
Last full review/revision May 2008 by John G. Bartlett, MD
Content last modified May 2008
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