What is Pneumonia?

What is Pneumonia?

Community-acquired pneumonia (CAP) is the world’s most frequently reported infectious disease and therefore of great socio-medical and economic importance. About 90% are of bacterial origin. In the U.S. alone are diagnosed each year 2-3 million cases, leading to 10 million physician contacts, and about 500,000 hospitalizations. For Germany, comparable data are lacking, especially as many are AEP cases treated exclusively as outpatients. The incidence (number of new cases) in the general population is estimated at 1 to 11 cases per 1000 population per year in nursing home residents, even to 68 114 cases per 1000 people. This corresponds to about 800,000 cases per year in Germany. About 30% of patients being treated at the hospital, including 10% in the ICU (ie about 3% of all patients with community-acquired pneumonia). Thus, the community-acquired pneumonia led to more frequent hospitalization than myocardial infarction (132,000) or cerebrovascular accident (stroke =, 162,000). About 20,000 people die annually from pneumonia in Germany. The disease caused by the costs would amount to more than 500 million € per year. Among the pathogens are pneumococci , with around 25 to 45% of AEP’s leader, followed by Haemophilus influenzae (10 to 20%). Mycoplasma pneumoniae (10 to 12%), especially in younger people has a meaning. However, these figures are derived mainly from studies in hospitalized patients recorded so that they are probably due to the selected patient population does not reflect the distribution in the outpatient setting. In 10 to 25% of the cases are viruses detected, usually with a concomitant bacterial superinfection . Above all, influenza viruses are common, which often caused by pneumococcal infection is increased. What is pneumonia?

Typical and atypical pneumonia
Traditionally, between the typical, by bacteria such as pneumococci, staphylococci, or caused the atypical and differed by viruses, fungi and obligate intracellular bacteria caused pneumonia. This distinction is associated with each characteristic distribution of the radiographic findings:
•    The typical lobar pneumonia acute onset is, on one or more lobes of the lungs restricted, goes with fever , chills , cough , purulent mucus production, reduced performance status and typical Auskultationszeichen associated. In blood, there are signs of infection : increased erythrocyte sedimentation rate , leukocytosis , elevated acute-phase proteins . pleural effusions are common and pronounced. Most pneumococcal pathogens (are Streptococcus pneumoniae ), but also staphylococci and Klebsiella , Pseudomonas and Proteus . In older patients, the inflammatory signs (fever, typical blood tests) are absent in a lobar pneumonia. The typical stages of lobar pneumonia, a correlation between histological changes in structure and pathophysiology produce are: congestion> Red hepatization > Grey hepatization> yellow hepatization> lysis.

•    Or atypical interstitial pneumonia often begin a lesser extent, are associated with only moderate fever and are usually of the head and body aches accompanied. With this type of pneumonia, the pathogen (usually virus, also chlamydia, rickettsia, mycoplasma , legionella , pneumocystis jirovecii , Coxiella burnetii ) absorbed by alveolar macrophages and thus pass into the interstitium (tissue between the alveoli), which distinguishes them from the alveolar pneumonia . The inflammatory process is therefore in the “framework” rather than the lungs. A nonproductive cough (not pus) and the interstitium nachzeichnende structures on the radiograph are characteristic signs.

•    Falls between these two is bronchopneumonia, which is a secondary pneumonia from a descending bronchitis and developed by a focal, bronchi near the lung tissue distribution notice.
Be said must be acknowledged that the radiographic findings does not allow reliable conclusions about the excitation spectrum in question.
The introduction of antibiotics , chemotherapeutic agents and immunosuppressive drugs , but also by the general increase in life expectancy, the spectrum of pneumonia in the last 70 years has changed significantly. Were used predominantly pneumococcal pneumonia is responsible for, today, viruses are obligate intracellular bacteria and become more frequent.

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