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CLASSIFICATION OF PNEUMONIA KLASSIFIKATION DER LUNGENENTZÜNDUNG Orthodox Medicine Schulmedizin Homeopathic Medicine Homöopathische Medizin CLASSIFICATION OF PNEUMONIA Classifications try to systematize diseases in order to simplify the clinical routine of diagnosis, prognosis, and therapy. Of course, in different medical systems such as homeopathy and orthodox medicine, different classifications may be useful. The classification of pneumonia into Community Acquired Pneumonia (CAP), Hospital Acquired Pneumonia (HAP) or Ventilator Associated Pneumonia (VAP) in conventional medicine is based on the different microorganisms involved and their - mostly antibiotic - treatment. Further factors might be relevant. We are looking forward to receive further important symptom descriptions or features regarding pneumonia, to be able to enhance the various classifications. Orthodox Medicine Community Acquired Pneumonia (CAP) kroe1,2014 This is defined as pneumonia developed outside a hospital or within the first 48 hours in hospital. Respiratory viruses (especially influenza viruses (and SarsCoV2 Ed.) more rarely RSV, Adenoviruses, Rhinoviruses, Parainfluenza viruses) are detectable in about 5 - 10% of all CAP cases. While primary viral pneumonias are often mild, mixed viral-bacterial infections may be associated with a higher mortality. In principle, the same spectrum as in bacterial CAP - i.e. predominantly pneumococci - can be expected. Only staphylococcus aureus infections occur more frequently in context with a superinfection. Pneumonias due to enterobacteria are rare in CAP (1.3%) and are found only in patients with risk factors (like concomitant cardiac and cerebrovascular disease), but are associated with high lethality. These pathogens usually produce beta-lactamases and are macrolide resistant. Pseudomonas aeruginosa is very rarely detected as a causal agent of CAP (0.4%), but should be initially included if risk factors are present (e.g. bronchiectasis, severe COPD with antibiotic pretreatment, known respiratory colonization with P. aeruginosa, gastric tube). Clinical evaluation mur1,2016: The clinical findings that best differentiate CAP from other acute respiratory tract infections are cough, fever, tachypnea, tachycardia, and pulmonary crackles; CAP is present in 20% to 50% of persons who have all five factors. Specific signs of pulmonary consolidation are present in only one third of the cases that warrant hospitalization and are frequently absent in patients that are less ill. Early in the evolution of disease, pain and cough may be absent and the physical examination may be normal other than for fever. mur1,2016 Hospital Acquired Pneumonia (HAP) kroe1,2014 This is defined as the patient developed pneumonia at least 48 hours after admission to a hospital. It is often a ventilator-associated pneumonia (VAP) in intensive care units. This has been observed in Germany in 5.44 episodes per 1,000 ventilator days compared with a pneumonia rate in patients on noninvasive ventilation of 1.6 per 1,000 ventilator days and 0.6 per 1,000 patient days without ventilation. The lethality rate for VAP is 20-30%. (Data on the incidence and prognosis of HAP refer to the Hospital Infection Surveillance System (KISS), which provides the most reliable figures in Germany.) Risk factors for multidrug-resistant pneumonia pathogens include antimicrobial treatment during the preceding 90 days, acute hospitalization longer than 4 days, high prevalence rates of antibiotic resistance in the individual setting or specific ward, and immunosuppression and/or immunosuppressive therapy. Pneumonia in immunosuppressed Patients Ed. Immunosuppression is a simple term for a generally very elusive group of problems or situations. It refers to a reduced activity of the humoral and/or cellular defenses of the immune system. Numerous factors can reduce this activity. Since every bio-psycho-social stress has an impact on the immune system, "immune suppression" should rather be understood as a dynamic term. The longer and more massive stress or exhaustion lasts, the more the immune system is weakened. A distinction can be made between congenital (genetic) and acquired immunosuppression. The congenital form includes immune-deficiencies and diseases such as cystic fibrosis, which promote infections and invasion of microorganisms by altering bronchial mucus. Diabetes (type 1 or 2) is also a disease with increased risk of infection. Acquired immune-suppressions include physical exhaustion, acute and chronic infections of microorganisms, and malignancies, as well as psychologically and iatrogenically induced diseases. For example, prolonged stress, such as anxiety, can cause a reduction of immunocompetent cells. The relatively new field of psychoneuroimmunology intensively deals with this topic. (See reference for examples. 14,15) Iatrogenically induced immunosuppression includes any form of therapy that lowers immunity to microorganisms. Examples are drugs like cortisone, classical immune-suppressants but also modern so-called biologics. Of course, alcohol and drugs can also have a significant impact on the immune system. [Development of pneumonia critically depends on host exposure to pathogenic microorganisms and predisposition to infectious disease. Congenital and acquired immune-deficiencies, along with structural lesions, e.g. bronchiectasis and ciliary dyskinesia are among the most significant predisposing factors for pneumonia. The spectrum of pathogens is becoming more diverse, from CAP, in which pneumococci predominate, to HAP (additionally multidrug-resistant pathogens) to pneumonia under immunosuppression (additionally opportunistic pathogens). Accordingly, each of the above entities requires specific diagnostic measures as well as specific calculated anti-infective therapy. Even with extensive microbiological diagnostics, however, pathogen detection is successful in only 30-50% of cases.] kroe1,2014 Homeopathic Medicine Lobar Pneumonia This is an acute onset inflammation of the lung parenchyma that is infectious in origin. It typically affects one lobe of the lung and can be divided into three stages. Ed. Broncho-Pneumonia This is inflammation secondary to bronchial extension into the lung parenchyma and typically occurs in multiple lobules. For a more detailed definition see at chapter "Broncho-pneumonia". Ed. Paige pew1,1904: Broncho-pneumonia is a catarrhal inflammation attacking the air cells in various lobules of the lungs. It is usually bilateral [frequently lower lobes, right side more often than left, evolving from borders of lobes of the lung glt1,2023] and is the result of an [often slow onset and progression over weeks glt1,2023] extension from a bronchitis of the smaller tubes and is therefore secondary in character. [It is characterized by an inflammation of the lobules and an exudation into the alveoli which consists of an albuminous liquid, degenerated epithelial cells, red blood corpuscles, and leukocytes. bwax,1902] Bronchiolitis Bronchiolitis is a catarrhal inflammation of the bronchioles and the smaller bronchial tubes. NOTE - It is probable that there is no case of bronchiolitis without some degree of accompanying broncho-pneumonia, and there are many cases of intermediate forms in which the inflammation involves both the medium-sized bronchial tubes, the bronchioles and the alveoli. But there are also cases, especially in infants and young children, in which the condition of bronchiolitis predominates to such an extent as to almost be a clinical entity. Although this distinction has been abandoned by some high authorities, it is still retained by others out of convenience and for simple definition. In addition to germs, physical causes such as inhaled noxious agents may also be involved in inflicting this disease. Ed. [Bronchiolitis refers to a nonspecific cellular and mesenchymal reaction of the bronchioles. Developing a straightforward classification, however, is difficult. Perhaps most importantly, bronchiolitis is a catchall term subsuming several unique clinical syndromes as well as a histopathologically diverse set of lesions identifiable in many diseases. Next, there are many diseases that, in addition to causing bronchiolitis, also cause disease proximal (e.g., bronchiectasis) or distal (e.g., organizing pneumonia) to the bronchioles.] mur1,2016 SPECIAL FORMS OF PNEUMONIA The following is a descriptive phenomenological classification of the most important clinical signs and disease progressions helpful for the homeopathic choice of remedies. We realize that these are historically evolved terms which are no longer used in modern medicine. Still they describe important features, which are still relevant for the homeopathic choice of remedies. Ed. Bilious Pneumonia Here we found various definitions in homeopathic literature: Inflammation of the lungs, accompanied by gastric fever, and not uncommonly by typhoid symptoms. dunx,1860 Pneumonia accompanied by congestion of the liver and jaundice. gccx,1902 This is a term applied to a type of pneumonia in which there is occurence of jaundice with the pneumonia. The chill is of longer duration; the pain in the side is more pronounced, due to pleurisy; the fever is more remittent; and jaundice and vomiting are present. Many of these patients are suffering from malarial poisoning. bwax,1902 Cerebral Pneumonia Pneumonia with meningeal and/or encephalitic involvement. In some cases cerebral symptoms predominate. There may be great restlessness and delirium, interrupted by repeated convulsions. The accompanying symptoms are: Rolling of the head; high fever; great prostration; vomiting; and other symptoms of meningitis gccx,1902 Typhoid Pneumonia In certain cases it develops into typhoid pneumonia, by which we mean the occurrence of symptoms peculiar to typhoid fever; low muttering delirium, sordes, etc. dicx,1893 Pneumonia attended by marked prostration and low delirium. gccx,1902 [This term is used in a double meaning; it may be applied to an adynamic form of pneumonia with typhoid symptoms, or to an occurence of pneumonia during typhoid fever. It occurs in those who are very exhausted and are in poor health, and in those who live in unhygienic conditions. People with Bright's disease, with septicemia or addicted to alcohol are prone to suffer this form of illness. The characteristics of this form are the great physical prostration, the weak heart action, the high fevers, the frequency of the respiration and pulse, the marked delirium, and frequent vomiting. The skin has a dusky hue, the tongue is heavily coated or may be dry and brown, while sordes collect on the teeth. The sputum may be the usual prune juice color, or it may be nearly pure blood. It may be rapidly fatal, or the patient may linger for a long time and recovery be very slow. The prognosis is always grave.] bwax,1902 Look for further explanations in the glossary. ◄ DEFINITION OF PNEUMONIA | ▲ | THE PATHOGNOMONIC COURSE AND SYMPTOMS ► |