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Wednesday, 27 November 2013

Lower respiratory tract infection – Pneumonia - The Risk Factors

Lower respiratory tract infection The lower respiratory tract infection are the infection consisting of the trachea (wind pipe), bronchial tubes, the bronchioles, and the lungs, including the bronchitis and pneumonia. According to The World Health Report 2004 – Changing History(1), in 2002 lower respiratory track infection were still the leading cause of deaths among all infectious diseases, and accounted for 3.9 million deaths worldwide and 6.9% of all deaths that year.
Pneumonia is defined as a condition of the inflammation of the lung as a result of infection, caused by bacteria, such as bacteria Streptococcus pneumoniae or influenza viruses in most cases. Fungi, such as Pneumocystis jiroveci, certain medication such as PPI Stomach Acid Drugs and other conditions such as impaired immune systems can also induced the disease.
Risk factors
1. In Hospitalization
If you are being hospitalized, you are at increased risk to acquire the diseases. According to the study by Shanghai Jiao Tong University School of Medicine, Shanghai, Klebsiella pneumoniae is a member of the family Enterobacteriaceae, opportunistic pathogens that are among the eight most prevalent infectious agents in hospitals. The emergence of multidrug-resistant strains of K. pneumoniae has became a public health problem globally(21).
2. Certain chronical conditions
a. Chronic obstructive pulmonary disease (COPD)
Patients with chronic obstructive pulmonary disease are at inscreased risk of Chlamydia pneumoniae.
There is a correlation between Chlamydia pneumonia (Cpn) infection and chronic obstructive pulmonary disease (COPD), according to the study by Department of Respiratory Medicine of People’s Hospital of Jiangyin(22).
b. Asthma
Asthma is a chronic inflammatory disease affecting the air way of the lung with recurring symptoms, such as wheezing, chest tightness, shortness of breath, and coughing. Of 18 controlled epidemiologic studies (over 4000 cases/controls), 15 found significant associations between Cpn infection and asthma using organism detection (polymerase chain reaction (PCR) testing (n = 2 studies) or fluorescent antigen testing (n = 1)), Cpn-specific secretory IgA (sIgA) antibody testing (n = 1), and/or specific serum IgE (n = 2), IgA (n = 4), IgG (n = 3) or other antibody criteria (n = 7). According to the studyby Dean Medical Center, Madison(23).
c. Cystic fibrosis
Cystic fibrosis (SIS-tik fi-BRO-sis), or CF, is an inherited disease of the secretory (
see-KREH-tor-ee) glands. Pulmonary infection with Pseudomonas aeruginosa and neutrophilic lung inflammation significantly contribute to morbidity and mortality in cystic fibrosis (CF), according to the study by St. John’s University College of Pharmacy and Allied Health Professions(24). d. Congestive heart failure (CHF) and diabetes
Congestive heart failure (CHF) is defined as a condition of that the heart’s function can enough oxgen to the body. According to the study of the estimation of the economic impact of community-acquired pneumonia (CAP) for adults with asthma, diabetes, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) by Dr. Polsky D, and research team, in adults with certain comorbid conditions have a higher risk of pneumonia than the overall population. If treatment of pneumonia is more costly in certain predictable situations, this would affect the value proposition of populations for pneumonia prevention(25).
e. Sickle cell anemia
Sickle cell anemia is defined as a codition of which the body produces abnormally shaped like a crescent or sickle red blood cells. Patient with sickle cell disease are at high risk of developing an acute infection of the pulmonary parenchyma called community-acquired pneumonia(26).
g. Bronchiectasis
There is a report of a case of a 76-year-old man with a community-acquired pneumonia, in whom both sputum samples and bronchial secretions obtained with bronchoscopic protected catheter brush grew pure culture of N. sicca with abundant polymorphonuclear neutrophils. Bronchiectasis underlying lesions were disclosed by computed tomography. N. sicca should be added to the list of commensal organisms able to cause pulmonary infection(27).
h. Inmune deficiency
Pneumocystis jiroveci pneumonia (PJP) is a potentially fatal fungal infection occurring in immunocompromised patients. There are a number of case reports in the literature, the only collagen vascular disease with an increased incidence of PJP is Wegener granulomatosis.(28).
g. Etc.
3. Smoking
Smoking increases the risk of hospitalization for pneumonia. Tobacco cessation is likely important in reducing hospital admissions for pneumonia, but its benefit depends on duration of smoking cessation and is likely attenuated in the presence of COPD., according to the study of 25,235 participants, whom are identified 6720 current, 13,625 former, and 4890 never smokers(29).
4. Heavy alcohol drinking
Regular moderate alcohol intake is not associated with increased risk of hospitalisation for pneumonia. High weekly alcohol consumption in males and infrequent heavy drinking in both sexes may increase pneumonia risk(30).
5. Enhanced drug users
Epidemic of severe Streptococcus pyogenes infections in injecting drug users in the UK, 2003-2004 were reported and injecting drug users (IDUs) presented with a wide range of clinical manifestations, including pneumonia(31).
6. Older age
Older ages are at the increased risk to develop as a result of weakened immune system.
7. New born and young children
New and under age children are at the increased risk to develop as a result of immature immune system.
8. Season related
According to the study included 243 patients, 64.6% men and 54.7% over the age of 65. The highest incidence of CAP was in the winter. Streptococcus pneumoniae was the most common causative agent for all seasons except in summer when the main agent was Legionella pneumophila. We observed a significant correlation between the lowest seasonal average temperature and pneumococcal etiology of CAP; inversely, with higher temperatures, Legionella pneumophila was more common. No etiological differences were found by season when related with environmental humidity(32).
9. Certain chemicals exposure
Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by the inhalation of organic substances and certain inorganic chemicals(33).
10. Travellers
According to the investigation of travel-associated morbidity in European travellers in 2009 in comparison with 2008, with a particular emphasis on emerging infectious diseases with the potential for introduction into Europe, respiratory illnesses, in particular pandemic A(H1N1) influenza, influenza-like syndromes, and tuberculosis, were also observed more frequently. A significant increase in reported dengue cases in 2009 as compared with 2008 was observed (n = 172, 2.7% vs. n = 131, 1.90%) (p 0.002). The numbers of malaria and chikungunya cases were also increasing, although not significantly. Two deaths were recorded: visceral leishmaniasis and sepsis in a Sudanese migrant, and Acinetobacter sp. pneumonia in a patient who had visited Spain(34).
11. Etc.
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Sources
(21) http://www.ncbi.nlm.nih.gov/pubmed/23166250
(22) http://www.ncbi.nlm.nih.gov/pubmed/23290855
(23) http://www.ncbi.nlm.nih.gov/pubmed/10541419
(24) http://www.ncbi.nlm.nih.gov/pubmed/22314397
(25) http://www.ncbi.nlm.nih.gov/pubmed/23113880
(26) http://www.ncbi.nlm.nih.gov/pubmed/23076916
(27) http://www.ncbi.nlm.nih.gov/pubmed/2776875
(28) http://www.ncbi.nlm.nih.gov/pubmed/19919808
(29) http://www.ncbi.nlm.nih.gov/pubmed/22541719
(30) http://www.ncbi.nlm.nih.gov/pubmed/21659417
(31) http://www.ncbi.nlm.nih.gov/pubmed/19040471
(32) http://www.ncbi.nlm.nih.gov/pubmed/23305778
(33) http://www.ncbi.nlm.nih.gov/pubmed/19228646
(34) http://www.ncbi.nlm.nih.gov/pubmed/21848975