Pneumonia is a common acute respiratory infection that affects the alveoli and distal airways; it is a major health problem and associated with high morbidity and short-term and long-term mortality in all age groups worldwide. Pneumonia is broadly divided into community-acquired pneumonia or hospital-acquired pneumonia.
A large variety of microorganisms can cause pneumonia, including bacteria, respiratory viruses and fungi, and there are great geographical variations in their prevalence. Pneumonia occurs more commonly in susceptible individuals, including children of <5 years of age and older adults with prior chronic conditions. Development of the disease largely depends on the host immune response, with pathogen characteristics having a less prominent role. Individuals with pneumonia often present with respiratory and systemic symptoms, and diagnosis is based on both clinical presentation and radiological findings.
It is crucial to identify the causative pathogens, as delayed and inadequate antimicrobial therapy can lead to poor outcomes. New antibiotic and non-antibiotic therapies, in addition to rapid and accurate diagnostic tests that can detect pathogens and antibiotic resistance will improve the management of pneumonia.
Tuberculosis is an ancient killer, and is one of the few diseases that has been traced back to Ancient Egypt and beyond. TB has ravaged humanity for millennia, and was commonly called consumption due to its tendency to produce weight loss.
Once thought to be under control, TB has received a new lease on life with the emergence of AIDS. All countries except North America, western Europe, and Australia have a problem with tuberculosis, which kills more than 1 million people each year.
The tuberculosis germ is unusual in that It has a cell wall high in the lipid, mycolic acid. This protects the germ when it is engulfed by first responders such as macrophages. The infected cell Is surrounded by other macrophages, lymphocytes and Fibroblasts to form a granuloma. This creates a standoff, where the tuberculosis germ is still alive, but walled off, and becomes an inactive or “latent” case of tuberculosis, a small percentage of which become active each year.
Active tuberculosis produces the usual infectious symptoms of fever, chills, and cough, often productive with blood. The tuberculosis germ multipliesu much more slowly than most other bacteria and the symptoms are long and drawn out; a cough lasting for more than a month, especially if accompanied by weight loss, should raise the suspicion of TB.
TB can spread to infect bones, kidneys, liver, and brain, but prefers the lung.
A spot on the Lung, confirmed by a Tuberculin test, or a blood test called a T-spot, will confirm the diagnosis.
The slow multipication of the tuberculosis Germ requires much longer treatment, and the combination with AIDS has caused a rapid development of resistant organisms. Fortunately, there are several drugs available.
Only one immunization is currently available, namely BCG. This has been used a lot in Europe and other countries . BCG produces a weekly positive tuberculin test.
A large number of conditions which reduce immunity, such as cigarette smoking, drug use, and immunosuppressive treatments associated with organ transplants and cancer will predispose a person to catching tuberculosis. TV is transmitted in the tiny droplets from sneezing, coughing, or talking such as we were accustomed to thinking about during Covid. The same preventative measures, such as masks and avoiding close contact with infected individuals should be practiced to prevent spread from an infected person.
If you follow a healthy lifestyle and are careful when traveling, you will most likely have no trouble with this nasty infection. Please check with the following reference or more complete information.
Bacteria have long been classified according to how they are stained by the chemical dye called the Gram stain. Pseudomonas aeruginosa is Gram-negative, compared to the Staph aureus which is gram-positive.
Being Gram negative, Pseudomonas has an extra membrane, the outer membrane, and a shell of a nasty material called Lipo polysaccharide. These extra structures act as a barrier to entrance of antibiotics. In addition, the Pseudomonas has many more genes than the average bacterium and uses these genes for adaptation. For instance, it is good at forming a raft of mutually supporting cells called a biofilm, which enables it to become particularly entrenched. In a condition of the lung called cystic fibrosis, this biofilm contains specialized cells, one of which is called the Persister cell. When Pseudomonas senses that a critical number of bacteria is present, called quorum sensing, the persister cell multiplies to become around 10% of the bacterial population, and slows down their metabolism massively, becoming a sort of “zombie cell”. These cells are very hard to kill and persist through an antibiotic treatment that kills other Pseudomonas cells, only to rev up their metabolism and become active again once treatment is withdrawn.
In addition, Pseudomonas has all of the other resistant talents mentioned in the previous article on Staphylococcus aureus, such as plasmid acceptance, ability to destroy penicillin, efflux pumps, and rerouting of metabolism.
In trying to control Pseudomonas, techniques other than antibiotics are being tried out of desperation, including interference with a quorum sensing, use of bacteriophages and chemical elements such as Gallium which masquerades as the iron this bacterium requires.
Pseudomonas is not as actively pathogenic as Staphylococcus aureus, but it has made a great niche for itself in the respiratory tract, especially in people with a compromised immune system, or pulmonary abnormality such as cystic fibrosis. Ventilation tubes and other hospital equipment can become contaminated and spread the infection, unless thoroughly cleansed of Pseudomonas; it is very sensitive to acidic solutions, and those who need nasal CPAP for sleep apnea may recall that they have to rinse their equipment in vinegar, or acetic acid. Swimmers can get an external ear infection with this organism, and the drops for swimmers ear often contains acetic acid.
The next rogue to consider is a frightful yeast called Candida auris.
Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.
Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.
Cancer is a huge problem, since it is actually a collection of a lot of different diseases in different places, resulting from mutation of the genes and invasiveness as the common characteristic. All cancers are different.
Carcinoid tumor is a good illustration. These are so called neutoendocrine tumors. They are slow growing, and are usually not detected until they are quite advanced. They can be located in different organs such as the gastrointestinal tract and the lung.
In their vicinity they produce symptoms characteristic of the area; trouble swallowing, nausea, vomiting, constipation and abdominal pain for gastrointestinal carcinoid, and cough, wheezing, shortness of breath and chest pain for those located in the lung.
Many advanced cancers can produce weight loss, muscle pain and fatigue In addition to symptoms characteristic of their location. The special characteristic of carcinoid tumors is that they may secrete substances that produce diverse symptoms such as flushing of the skin, sudden diarrhea and vomiting and, strangest of all, heart valve leakages.
Diagnosis of carcinoid tumors is often made by checking for serotonin or chromogranin-A in the blood, and 5-Hydroxy indolacetic acid ( 5-HIAA) in the urine, and locating the tumor with Imaging such as CT and MRI.
It is usually treated best for surgery, but cell surface somatostatin can be targeted for hormone therapy, and targeted radiotherapy with PRRT. It is very much to the advantage of the patient if she has a tumor with specific hormone or other marker that can be targeted for treatment, such as a breast cancer with estrogen receptors that can be targeted by tamoxifen.
Please check the accompanying mayo clinic article for more information.
Cryptococcus neoformans and gattii are fungi that most commonly infect people with immunodeficiency, especially AIDS, which is highly prevalent in Africa. Cryptococcus is the final cause of death in perhaps 25% of AIDS patients and preventative treatment is sometimes used if the lymphocyte count is too low.
It is an opportunistic fungus, with similarities to pneumocystis carina, which is discussed in a previous entry.
The areas in the body most commonly affected are the lungs, the skin, and the brain. The lung and skin, being exposed to the environment, are the most common entry points for the fungus, and the brain is a frequently involved area. Chronic meningitis, where the symptoms include headache, blurred vision, and confusion, is frequently caused by cryptococcus.
Sometimes, in healthy people, the skin can be infected with “pigeon breeders disease”. Pigeon droppings are a very common source of cryptococcus organisms.
Infection In the lung is usually restricted to immunocompromised individuals, who develop cough, shortness of breath, and fever. Pulmonary cryptococcosis is a slowly developing disease, can be mistaken for tuberculosis, and frequently gets into the bloodstream and then into the brain.
Treatment is usually with amphotericin B and flucytosine.
Pneumocystis is found in the respiratory tract of most mammals and Man. Pneumonia from this organism was extremely rare or unknown before the advent of AIDS.
When the lymphocyte count of a person with AIDS drops below 500, or especially 200, pneumocystis pneumonia is a frequent complication. Symptoms include cough, fever, rapid breathing, and shortness of breath.. The chest x-ray typically shows a “ground glass” appearance, caused by fluid inside the air sacs and throughout the lung. Treatment is usually with trimethoprim sulfa.
Immunosuppressive therapy is often given for organ transplants and auto immune diseases these days. Patients and doctors should be on the lookout for pneumocystis symptoms in this situation. Even long-term corticosteroids can produce enough immunosuppression to allow pneumocystis to invade the body.
Pneumocystis Jeroveci is the causative organism, and used to be called pneumocystis Carini. Doctors suspect this disease when an immuno-suppressed patient, especially AIDS , has a dry cough, with pneumonia and a very low oxygen concentration, more severe than expected. Fluid taken from the lung shows several organisms in little sacks or cysts.
Treatment is with sulfonamids, if they are tolerated. Cortisone must be given not the same time to prevent a severe reaction from absorption of the dead organisms. Pneumocystis is a yeast-like fungus and is also discussed under opportunistic fungal infections.
The following article will give you more information.