Running Head: PNEUMONIA

Pneumonia: The Ongoing Fight

Peijun Zhao

Clear Horizons Early College High School

ISM Period B6

Mentor Dr. Bay V. Nguyen

November 4, 2018
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Abstract

The aim of the study is to understand the different ways pneumonia spreads throughout

the immune system as well as the type of penicillin-based antibiotics used to fight against this

disease. Pneumonia has affected millions of civilians for hundreds of years and adding to the

continuous research conducted to fight against this disease will benefit the community’s

awareness. This study involves intensive research concerning recent articles, scientific

references, and magazines on the causes, symptoms, vaccination, and treatments for pneumonia.

I will then type this information for a conclusive and thorough research paper with clear

citations. Eventually, I will condense this information into a pamphlet for usage at the doctor’s

office which benefits daily patients concerned about pneumonia. If the resulting pamphlet is not

suited for the doctor’s office, then I will provide them to students at Clear Horizons as an

informative tool. By completing this project, I will both form a solid understanding of this illness

for future references during my studies for medical school while informing the community about

preventative measures against pneumonia.

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Introduction

This literature review covers the history and overview of pneumonia as well as its current

antibiotics used for treatment. Additionally, there will be information provided about the

vaccination and what pneumonia means in terms of the future.

Pneumonia, at its basis, is the infection of the lungs with over 30 different causes and acts

as the leading cause of death in children under the age of five. It is a very common infection that

often occurs in the young, the elderly, and those comprised by a weak immune system. Despite

the large death rate, the bacteria Streptococcus pneumonia was not discovered until the late

1800s, which allowed for researchers to identify it and associate the bacteria with the lung

infection. Research grew, allowing scientists to procure antibiotics in the late 1900s to treat

pneumonia. However, the battle is still ongoing as pneumonia is still prominent across the world,

and the method to treat this infection is costly (Chow, 2018).

Pneumonia’s common symptoms consist of cough, fever, chills, and a shortness of

breath. These symptoms may slightly differ between patients with viral or bacterial pneumonia.

Once these symptoms are ongoing, the physician may suggest an X-ray to determine the extent

and treatment options of pneumonia. The patient may then be prescribed antibiotics to lessen the

inflammation. If the infection was caused due to a virus, then the physician may treat the

symptoms and allow the body to naturally fight against the virus (Dallas, 2018).

Despite the resourcefulness of the antibiotics, there are still millions of cases of

pneumonia that affect individuals across the world, especially in 3rd world countries. Pneumonia

strains continue to develop resistances against our current antibiotic treatment, and due to both

the costs of continually conducting research and the amount of time necessary to develop these

medicines, the fight against pneumonia is still ongoing, similar to the flu (Reynolds, 2014)
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Literature Review

This review establishes three main parts of pneumonia: the history, the overview, and

current prospects over using antibiotics to treat the disease. This information will provide the

reader with a general but thorough understanding over the different aspects over the disease.

Background

Starting History. Pneumonia has plagued the country for centuries, causing millions of

children to contract coughing, wheezing, and fevers with the potential of death. Even since the

early 300BC, the disease was described as the Winter Fever, as this was the time where most

immune systems were compromised, allowing the disease to spread rapidly. This disease

remained widely unknown until 1875 when the first researcher, Edwin Klebs identified the

bacteria. However, this recorded disease was never truly understood until two microbiologists,

George Sternberg and Louis Pasteur, discovered the bacteria form, Streptococcus pneumonia.

This allowed for researchers to diagnose who had pneumonia and understand different properties

of the disease. Further research in the early 1900s identified the interaction of the bacteria with

the immune system, its structure, and how the body’s immune system could fight against the

infection. In 1913, there was an antiserum used to treat patients with evident decreased mortality.

The antiserum was composed of antibodies that could be injected into the patient, but the venture

was costly and inefficient at assisting most patients. Pneumonia remained the leading cause of

death during this period

First Major Change. One of the biggest proponents of a new treatment for pneumonia

was Alexander Fleming’s discover of penicillin in which the researcher noticed that penicillin

could be harvested as a liquid from mold. The penicillin could be used to kill off certain bacteria

in a test tray, depending on the strain. Based on this discovery, Fleming published his discovery
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and allowed other research groups to take the helm. There were three other main notable

individuals that contributed to the rise of penicillin-based antibiotics. The next individual,

Howard Florey, conducted research on the purification of the drug and promoted the drug

production across the United States. Florey, with backing from the Rockefeller Foundation,

could conduct additional research and form a synthesized product that could be used to treat

patients. He tested the antibiotics, which showed stunning results of treating patients on their

death beds. As these results became clearer, more companies started to invest in penicillin

antibiotics and assisted in concocting ways to manufacture the drug efficiently. Over time, the

drug became widespread, curing millions of citizens. The final individual was Ernst Chain who

established the chemical structure of penicillin, allowing for other antibiotics to base its chemical

compound off this drug such of that of amoxicillin. Thus, with the push of these three main

individuals, penicillin-based antibiotics were formed, allowing for dozens of illnesses to be

cured, especially that of pneumonia.

Continuing History. Yet, despite the prevalence of this new drug, the pneumonia

infection eventually developed immunities against these penicillin-based antibiotics. Although

many strong antibiotics now still treat bacterial pneumonia, viral and fungal infections of

pneumonia are often different and require additional resources to cure. In 1977, a vaccine called

pneumococcal polysaccharide vaccine (PPV) was developed against certain strains of pneumonia

(Chow, 2018). Pneumococcal represented the type of bacteria while polysaccharide represented

the type of structure. The second vaccine pneumococcal conjugate vaccine (PCV13) was formed

in 2013 against additional strains, but even with this vaccine, the overall prevalence of

pneumonia remained. Currently, pneumonia remains as the leading cause of death for children

under the age of five, especially in developing countries. Cases of pneumonia still affect our
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system each year, and until we develop a common vaccine against multiple types of pneumonia,

more strains will develop, and people will contract the disease.

Overview

Pneumonia is the infection of the lungs, causing inflammation, and if left untreated, will

compromise the body’s respiratory capabilities (Gupta, 2016). As a result, it is vital to

understand the different aspects of the system to provide preventative measures.

Causes. Pneumonia can be caused by a variety of different things. In fact, there are

multiple types of pneumonia which can range from bacteria, viral, fungi, or chemicals found in

the surrounding environment. However, the causes tend to differ between countries. In

developed countries, the most common cause of pneumonia comes from viral infections,

typically the common flu, while in developed countries, the cause comes from bacterial

infections (UNICEF, 2018). The primary reason behind this pattern derives from the level of

sanitation and health resources within the country. In the United States, there is a higher level of

healthcare and sanitation where everyone has relatively close access to clean water and living

conditions. However, due to close living quarters high population density, there is a higher

chance of contracting the flu. In developing countries such as Africa, sanitation standards are low

where impure water and living circumstances are dire. As a result, people are more likely to

contract a pneumonia infection from bacteria. Generally, when a virus or bacteria infects the

lungs, white blood cells, neutrophils, and plasma proteins, called opsonins, attempt to kill the

bacteria or virus causing the infection. During this process, products created by these combat

cells are damaging to both the enemy cells and the lungs, causing inflammation and fluid-

buildup called pulmonary edema (Boston University, 2012). Over time, this may cause an excess

amount of fluid to fill the lungs, preventing oxygen distribution throughout the entire body. If
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left untreated, this infection can cause death. This process may have minor differences between

each type of pneumonia, but the general inflammation process and fluid-buildup is the same.

Symptoms and Risk Factors. Children under the age of five along with those over the

age of 65 are more likely to contract pneumonia due to a weakened immune system. Yet,

everyone can contract pneumonia if their immune system is compromised or if they have been

untreated for various illnesses such as bronchitis or the common flu. With pneumonia, there are a

few primary symptoms such as cough, fever (a sign of infection), chills, shortness of breath,

mucus, and chest pain when breathing or coughing. Typically, these symptoms are similar to that

of the common flu, and it is possible for the flu to develop into pneumonia once the flu infection

reaches the lungs (American Lung Association, 2018). However, pneumonia lasts longer than the

common flu, and if the illness continues, then there is a higher chance of the illness being

pneumonia. Risks are also increased if a person smokes or has damaged lungs. This is due to the

weakened lungs unable to produce the same level of combat against foreign bodies in the lungs.

Finally, those who obtain vaccinations such as the PCV and the annual flu shot are less likely to

develop pneumonia due to their higher immunity.

Figure 3 and 4. Normal Chest X-ray vs Pneumonia X-ray. (Radiologist, 2016)

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Diagnosis. There are several different signs that a doctor may use to diagnose

pneumonia. The first sign comes from a patient with fever, congestion, coughs, and difficulty

breathing. A fever is a typical sign of an infection and difficulty breathing usually results from

the lungs. Afterwards, the doctor may listen to the patient’s lungs and prescribe some medication

to help with the infection, especially those to ease the symptoms. Usually with a stethoscope, the

doctor may hear a slight scratching or crunching such as hair bristling against each other or feet

crunching on snow. This is usually the first indicator that the doctor would have. However, it is

difficult for a doctor to automatically assume if a patient has pneumonia unless the patient

obtains a chest x-ray which will determine if there is fluid buildup in the lungs. Above is an

example image of pneumonia in which you can compare it directly to a clear chest x-ray. The

chest x-ray with pneumonia has a slightly whitish layer which represents liquid deposits.

Although it may be difficult to see, radiologists can often identify these small differences and

will issue a small report. Afterwards, the report will then be provided to the doctor to issue their

treatment of choice.

Treatment. There are two main types of treatment options: outpatient and inpatient

treatment. Most cases, roughly 80% of the time, doctors can treat patients without admitting

them to the hospital. An outpatient saves the patient a large amount of time and energy from

going to the hospital, waiting overnight, and paying the hospital thousands of dollars for

medicinal treatment. Through this process the doctor first observes the patient through a checkup

and once they detect specific symptoms, they may prescribe either Tamiflu or other steroids to

reduce inflammation of the lung (American Lung Association, 2018). Viral pneumonia can’t be

treated by antibiotics, so doctor treat the symptoms to allow the patient’s immune system to

develop and fight the virus safely. Additionally, the doctor will prescribe the patient several days
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of rest with plenty of fluid and medication for fever. For bacterial pneumonia, the doctor will

prescribe antibiotics such as amoxicillin or co-trimoxazole. Antibiotics work by either breaking

the cell wall of bacteria cells or preventing the bacteria from reproducing. This process usually

takes between a few days and a week for the patient to start recovering from pneumonia. If the

patient does not recover during this process, the doctor will then admit the patient into the

hospital for monitoring where the patient will receive stronger medication and machinery in the

ICU (intensive care unit) if patient has difficulty breathing (Vernadakis, 2018). Additionally,

patients that are under the age of five, over the age of 65, or have a weakened immune system

are also admitted to the hospital for possibility of emergent cases. If the patient recovers, then the

doctor will recommend the patient to finish their medication and another x-ray to verify the

success of the treatment. Once pneumonia is no longer detected and the patient has recovered

from their symptoms, the patient is released from treatment. There are always other treatment

options for different types of pneumonia. For example, in fungal pneumonia, require antifungal

medication, and the provider may request a culture sample to identify the exact type of fungal

infection. This may take more time, and if the fungal treatment is detected late, the patient may

require hospitalization or urgent care.

Prevention. One of the best preventative measures for pneumonia are through

vaccinations and sanitary living conditions. Vaccinations such as PCV will provide resistances

towards certain pneumonia strains, but patients should also invest in the flu shot each year for

further protection against newer strains. In fact, roughly a “third of all pneumonia cases in this

country are caused by respiratory viruses, most commonly influenza” which severity can be

reduced through immunization shots (Gupta, 2016). Flu shots are synthesized RNA or

recombinant DNA that replicate a virus’s structure, and when the structure is introduced into the
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immune system, the body develops a resistance towards the flu. By obtaining this early

resistance, an individual’s susceptibility to infections are lowered. Additionally, those who

smoke develop higher chances of pneumonia in the future. When someone smokes, they

introduce chemicals that clog the lung’s breathing capacities. The lung’s mechanisms are then

paralyzed or unable to fully defend the lung when an infection arrives. For bacterial pneumonia,

sanitation is vital to keeping a healthy lifestyle. If an individual drinks dirty water, work in a coal

factory, or breathes in a poorly ventilated environment. Each of these incidents have the capacity

to lower the efficiency of the lungs or introduce bacterial strains into the system. Thus, there are

many considerations to take in pneumonia prevention.

Antibiotics Prospect

Penicillin-based antibiotics are one of the main treatment options for those infected by

bacterial pneumonia. However, resistances have developed to the point where some of these

antibiotics no longer hold the same value. Thus, there is reason in looking into why resistances

have developed and how society can limit the chances of resistant bacteria spreading.

Antibiotic Resistances. Despite the possible treatments for pneumonia, many issues still

arise with the continuation of antibiotic resistant bacteria. When a patient doesn’t consume

enough antibiotics, some of the bacteria may survive. As some bacteria reproduces, one of these

bacteria stains may mutate to produce DNA to code for a specific resistance. When that occurs,

the antibiotic no longer works on that specific bacteria, allowing the bacteria to multiply. When

this bacteria spreads, the antibiotic’s effectiveness lessens through the infected population. As a

result, bacterial pneumonia becomes more difficult to treat. For example, although penicillin was

a breakthrough in the 1940s against different bacterial strains including pneumonia, resistance
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against the antibiotic started in 1965, rendering the basic form of penicillin virtually useless

(Ventola, 2015).

Figure 3 and 4. Chemical Structure for Penicillin and Amoxicillin (Ventola, 2015)

To counter the resistance, other antibiotics based on the same penicillin structure have

been created as seen in the figures above. However, despite these similarities, bacterial

resistances have grown significantly over the last few years, and there are a few measures to

counter this growth. The first being the introduction of trustworthy prescriptions. In countries

such as Vietnam or Mexico, prescriptions are often unregulated, and it is possible to gain greater

access to antibiotics without the word of a doctor. This practice is highly dangerous as patients

may abuse these substances, causing resistant strains to be more prominent. The next step into

preventing antibiotic resistance derives from the patient’s responsibility to finish prescriptions

from the doctor. Often, whenever a patient recovers considerably from an illness, they may stop

feeling certain symptoms and stop taking the medication afterwards. However, unless the

prescription informs the patient to “take as needed,” the patient must finish the prescription.

Remaining living bacteria could regenerate and mutate. Over time, the bacteria could form a

resistance, causing the medication to have less impact on the strain. In addition, farmers and

livestock owners tend to overuse antibiotics, which often adds to the growing issue of antibiotic

resistance. Around “80% of antibiotics sold in the U.S. are used in animals, primarily to promote
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growth and prevent infection,” which leads to a heavy cause of the resistant bacteria (Ventola,

2015). Antibiotic-resistant bacteria may survive through the continuous usage of these

antibiotics, and when humans consume meat products infected with this bacterium, humans may

contract several illnesses without many antibiotic options. Finally, the last step involves safely

throwing away old medication and restraining from sharing antibiotics with other individuals. In

one case, if a patient acquires similar symptoms as a previous illness, and uses that same

prescription medication from before, the medication may not be strong enough. As time passes,

concentration of medication increases since the vitality of a bacteria also changes. In fact, an

adult male may be given twice the amount of amoxicillin than they would be given a decade ago.

This same policy follows in which the prescription of antibiotics may have changed, and the

patient should check with their doctor of what type of medication to use before they start on a

certain medication.

Current Research. The importance of documenting and raising awareness of this type of

antibiotic resistance derives from the fact that most individuals in developing countries are

affected by bacterial pneumonia. When these resistances become rampant, researchers find it

difficult to fund and identify new alternatives for pneumonia medication. According to a 2014

BMC central article, antibiotic resistance pneumonia treatment costs roughly $233 million

dollars for the American public each year with Streptococcus pneumoniae representing one of

the most common strains of bacteria to form continuous resistances (Reynolds, 2014). This trend

continues to grow as researchers must spend more money to keep up with the evolution of

bacterial strains. Over time, this may cost the United States millions of dollars in patients paying

for hospital nights, purchasing expensive medication, and funding for additional research in
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medication. Thus, with this type of information in mind, patients should abide by doctor

prescription to prevent future outbreaks of antibiotic resistant bacteria.

Conclusion

Pneumonia remains prominent in our current society, representing most reasons for

hospitalizations and causes of death for children under the age of five. With symptoms similar to

the common flu and a multitude of treatment options, providers may have difficulties providing

patients with the proper level of care, especially with patients in developing countries. Antibiotic

bacterial resistances only represent a fraction of the issue with most viral pneumonia untreatable

by antibiotics and doctors only treating the symptoms. Perhaps there are further options of

having government-mandated changes to prevent continuous overuse of antibiotics or conduct

research to test how often proper antibiotic prescriptions are provided improperly. However,

unless our current society stays informed about the prominence of pneumonia, vaccinations, and

antibiotic treatment, the medical field will continue to see the resurgence of pneumonia-related

cases. Thus, there is no other option but to stay educated about such matters.
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References

Alexander Fleming Discovery and Development of Penicillin - Landmark. American Chemical

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20, 2018.

Chow S. Pneumonia History. News Medical Life Sciences. https://www.news-

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Dallas ME. Pneumonia 101: What You Need to Know | Everyday Health. Stroke Center -

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Gupta S. Q: Can the flu turn into pneumonia? Stroke Center - EverydayHealth.com.

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