case

A 61-year-old woman presents to the emergency room complaining of cough for 2 weeks. The cough is productive of green sputum and is associated with sweating, shaking chills, and fever up to 102F (38,8C). She was exposed to her grandchildren who were told that they upper respiratory infections 2 weeks ago, but now are fine. Her past medical history is significant for diabetes for 10 years, which is under good control using oral hypoglycemics. She denies tobacco, alcohol, or drug use. On examination, she looks ill and distress, with continuous coughing and chills. Her blood pressure is 100/80 mmHg, her pulse is 100 beats/min, her temperature is 101F (38.3C), her respiratory are 24 breaths/min, and her oxygen saturation is 97% on room air. Examination of the head and neck is unremarkable. Her lungs have ronchi and decreased breath sound, with dullness to percussion in bilateral bases. Her heart is tachycardic but regular. Her extremities are without signs of cyanosis or edema. The remainder of her examination is normal. A complete blood count (CBC) shows a high white blood cell (WBC) count of 17.000 cells/mm3, with a differential of 85% neutrophils and 20% lymphocytes. Her blood sugar is 120 mg/dL

definition
Pneumonia is an infection in one or both lungs. The infection may be caused by fungi, bacteria, or viruses. Pneumonia causes inflammation in your lungs air sacs, also referred to as alveoli. The alveoli fill with fluid or pus, making it difficult to breathe. Symptoms of pneumonia can range from mild to life threatening. In fact, pneumonia causes more deaths worldwide than any other illness. The severity of pneumonia usually depends on the cause of the inflammation or by the type of organism causing the infection, a persons age, and their general health.

etiologi
Pneumonia is most commonly caused by an infection, usually a bacterial infection.However, many different bacteria, viruses and (rarely) fungi cause pneumonia; the germ depends on where the pneumonia began. For example, germs that cause pneumonia caught in hospitals are different to those that cause pneumonia caught in the community.The germs that cause an infection are usually breathed in. In rare cases, pneumonia can develop from an infection elsewhere in your body, when germs enter your lungs through your bloodstream

Cont...
Bacteria Haemophilus influenzae Staphylococcus aureus Chlamydophila psittac Chlamydophila pneumoniae Legionella pneumophila Virus respiratory syncytial virus (RSV) flu (influenza) type A or B virus. Viruses are a common cause of pneumonia in young children.

symptom
You are likely to have a cough. This can be dry, or may produce phlegm (thick mucus) that is yellow, green, brownish or blood-stained. Other common symptoms include: difficulty breathing your breathing may be rapid and shallow and you may feel breathless, even when resting rapid heartbeat fever feeling generally unwell sweating and shivering loss of appetite pain in your chest

Cont...
Less commonly, symptoms of pneumonia can include: coughing up blood (haemoptysis) headaches fatigue nausea vomiting wheezing pain in your joints and muscles feeling confused and disorientated (particularly in elderly people)

transmision
Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this has critical importance for treatment and prevention.

Risk factor
Risk factors associated with increased risk of pneumonia include age> 65 years, and age <5 years, chronic diseases (eg, kidney, and lung), diabetes mellitus, immunosuppression (eg, drugs, HIV), alcohol dependence, aspiration (eg epilepsy), a recent viral illness (eg influenza), malnutrition, mechanical ventilation, postoperative, environmental, employment, air-conditioning (Jeremy, 2007; Misnadirly, 2008).

Patophysiology
There are different categories of pneumonia. Two of these types are hospital-acquired and communityacquired. Common types of community-acquired pneumonia are pneumococcal pneumonia and Mycoplasma pneumonia. In some people, particularly the elderly and those who are debilitated, pneumonia may follow influenza. Hospital-acquired pneumonia tends to be more serious because defense mechanisms against infection are often impaired. Some of the specific pneumonia-related disorders include: aspiration pneumonia, pneumonia in immunocompromised host and viral pneumonia

Support examination
In laboratory tests a routine blood test there is an increase of white blood cells (White Blood Cells, WBC) WBC counts are usually obtained 15.000-40.000/mm3, if it is caused by a virus or mikoplasme WBC count may be normal or decreased (Supandi, 1992; Jeremy, 2007). In case of leukopenia erythrocyte sedimentation rate (ESR) usually rises to 100/mm3 Radiological features of pneumonia can not show significant differences between viral infections with bacteria. Pneumonia virus generally show a picture interstitial infiltrates and hyperinflation. Pneumonia, and C-reactive protein confirmed bacterial infection. Blood gas identifies respiratory failure (Jeremy, 2007). Blood cultures may be positive in 20-25% of untreated patients. Sometimes found elevated levels of blood urea, creatinine but still within normal limits (Supandi, 1992).

Diagnostic
Pneumonia can sometimes be difficult to diagnose as it shares many symptoms of other conditions, such as the common cold, bronchitis, TBC, and asthma. To make a diagnosis, your doctor may first ask: whether you are breathing faster than usual if you feel breathless how long you have had your cough whether you are coughing up sputum and what colour it is if the pain in your chest is worse when you breathe in or out Your doctor will probably take your temperature and listen to the back and front of your chest with a stethoscope, to check for any crackling or rattling sounds. They may also listen to your chest by tapping it. If the lungs are filled with fluid, this produces a different sound to normal, healthy lungs. Most people with mild pneumonia do not need to have a chest X-ray or other tests.

 Chest X-ray and other tests Your may arrange a chest X-ray or other tests if your symptoms have not started to improve within 48 hours of starting treatment. A chest X-ray can show how much your lungs are affected. It can also help the doctor distinguish between pneumonia and other chest infections, such as bronchitis. Your may also arrange: a sputum test blood tests Analysing samples of sputum or blood can help identify the bacterium or virus causing the infection.

Complication
Complications of pneumonia are more common in older people, young children and people with existing health conditions such as diabetes. If you develop complications, you will be admitted to hospital for treatment. The most common complications of pneumonia are pleurisy, a lung abscess and blood poisoning (septicaemia),

Treatment
Most cases of pneumonia can be treated at home. However babies, children, and people with severe pneumonia may need to be admitted to hospital for treatment.Pneumonia is usually treated with antibiotics, even if viral pneumonia is suspected as there may be a degree of bacterial infection as well. The type of antibiotic used and the way it is given will be determined by the severity and cause of the pneumonia.If able to be treated at home, treatment usually includes:
Antibiotics - given by mouth as tablets or liquid Pain relieving medications Paracetamol to reduce fever Rest.

Life style

Conclution
pneumonia is a lung infection with a variety of clinical features that could threaten kehidupan.hal can happen in that time lama.penyakit can strike at any age. This disease affects the respiratory system, especially the way we breathe. to avoid pneumonia, we recommend that in the not smoking, drinking alcohol, exercise. prevention is better than cure