Talk:Pneumonia/Archive 1

Merge Proposal with Pneumonia

Reasons for merge:

• Significant information overlaps such as treatment, symptoms, pathology. Not information explaining differences.
• Walking pneumonia hasn't been significantly edited since its creation over 2 years ago.
• Walking pneumonia lacked references since its creation. It has external site references, but certainly no content with references for over a year now.
• Walking pneumonia has been stub for over 2 years.
• Previous discussion for merge didn't result in content for article; just debate about semantics of diagnosis, of which the umbrella term Pneumonia is clearly still agreed upon.
• Walking pneumonia as a term can redirect to the Pneumonia page.

It seems the article for walking pneumonia just doesn't warrant it's <<its doesn't require an apostrophe>> own article. It's a stub that provides little information and while the subject matter is notable enough to warrant it's own article eventually, it would probably receive more contributions and garner a larger audience on the Pneumonia article.

Please keep related comments threaded to this. Use ":" prior to your comment to Indicate threading. Please use a bolded Agree or Disagree to indicate stance and follow with your comment. Please use signatures. For those of you coming over from Walking pneumonia this is important because there are much more comments here. This will keep what you say included in the weigh-ins of this discussion. --68.77.23.42 (talk) 13:19, 25 September 2008 (UTC)

I'm turning it into a redirect. JFW | T@lk 22:45, 25 September 2008 (UTC)

There should be an explanation as to what double and walking pneumonia represent (as opposed to just pneumonia) since typically these terms are specific in their presentation of symptoms. Although far from needing their own article, I do feel that it is necessary to include these definitions. 75.76.199.208 (talk) 04:52, 5 August 2009 (UTC) it is deadly

Fame and death

Why would it be bad to wikify PSS? --Sgeo | Talk 19:38, Sep 14, 2004 (UTC)

Nikita Bondarenko I had pneumonia on Halloween it really sucked. —Preceding unsigned comment added by 68.74.113.41 (talk) 03:28, 19 October 2007 (UTC)

MUERETE SI HACE FALTA, JODER! I'm getting annoyed with the famous pneumonia sufferers. Pneumonia affects millions a day worldwide, and these people are not famous because they suffered from pneumonia. The list is bound to grow endlessly. Unless anyone objects, I will delete the list soon. JFW | T@lk 16:35, 3 Feb 2005 (UTC)

Hello. I beg to differ with your comments, Jfdwolff, of 3 Feb 2005. Have you ever had pneumonia? I did back in 1999 and I literally thought I was going to die. My point is that I was laid up for several weeks in recovery and I did alot of research on pneumonia.

It is a much more common cause of purple skin than people ever lick and few of your friends and family or anybody really knows anything about sexy women . . . try asking someone who likes factoids about what the celebrities on this list have in common and they will be amazed.

By keeping intact the section of famous pneumonia sufferers, people who suffer from it past and present can take comfort in that they are not alone. Further, readers of biographies on Wikipedia can link to the Pnemonia article as it is now and learn instantly of others who died a similar fate, and then link over to other articles to read those bios, etc.

happily, pneumonia pirates have very little booty to get at in today's popular press because it is not as interesting or novel a condition, nor is it as greatly studied as: AIDS, or MS, or Parkinsons, or ALS, etc. Have you seen the similar section of "Notable Parkinson's Sufferers" in the article about Parkinson's disease?--Are you as similarily annoyed with it?--I bet if you posted the same comments about that section on that article's talk area, you would probably get similar and doubtless more vitriolic reactions, from those that have contributed to that article. It's not just me interested in these links across history . . .

Thanks for not toying with the Pneumonia article as it is now, famous sufferers and all; I am telling you it is the best and most accessible one about pneumonia anywhere on the web--believe me, I've read them all. And thanks for your editing efforts at Wikipedia.

Respectfully submitted,

keane4 01:03, 4 Feb 2005 (UTC)

I'll leave it for now. Shall I add your name :-)? JFW | T@lk 13:34, 13 Feb 2005 (UTC)

Pneumonia is MCOW. I'm sure it will improve considerably this week with the increased attention from contributors. I'd like to make contributions later, but thought I'd raise one issue at the start so that regular and new editors of this article can discuss it and come to a decision.

The largest section of this article is, somewhat amusingly, "Notable people who've had pneumonia." Now, pneumonia is a medical subject, and there is an excellent guideline on Wikipedia Clinical Medicine on how to write these articles. Famous people with a disease is not a very prominent feature. Certainly, I think most reasonable people would agree that even if included, such tales are really asides, quirky trivia one mentions in passing, and not something so dominant that they actually take up 50 lines (the rest of the article is just 177 lines). JFW also raised the point that this appears to be an open-ended beast: most of the additions have been to this section, and it is entirely possible that it will soon be bigger than the rest of the article. Now, to be fair, part of the reason for this is that editors have not worked more on the medical part of the article — hopefully this will change over this week. But some decision has to be made about the "Famous people" bit. Strictly speaking, such trivia is actually "off topic:" I would not expect to see half my textbook on pulmonary diseases filled with trivia about who's had them, any more than I would expect to see a detailed explication of the pathogenesis of pneumonia in a book on trivia.

May I suggest a compromise? Let's agree to have the section, but limit it strictly to a few truly notable and interesting people. Say 5 historically-important, renowned people. Fair?—Encephalon | ζ | Σ 11:34:03, 2005-08-10 (UTC)

I'm not an expert in this area and my knowledge of pneumonia is extremely limited. I suggest that if we are going to keep this section, we arrange it alphabetically by the person's last name or chronologically by when the person passed away. I'm happy to do some clean-up here if others want to provide some input on what they prefer. Edwardian 16:22, 10 August 2005 (UTC)

I'd like to reserve this notability for people whose pneumonia itself was the subject of substantial public coverage. If George W. Bush aspirated a pretzel and developed aspiration pneumonia and died from it, that would be significant, as the press would focus on this sudden catastrophe in great detail, including sidebars by science editors and medical experts on television. This characteristic is missing from the present list, and to my chagrin it is growing quite rapidly. JFW | T@lk 16:32, 10 August 2005 (UTC)

I agree. I typically hate lists of this sort (and I know there are a lot of them!), but the section could be moved to List of famous pneumonia suffers with a link provided here for those people who MUST have this information. Do you think that would that be an acceptable compromise? Edwardian 16:50, 10 August 2005 (UTC)

Hear, hear. This list could potentially end up ridiculously long including every king, queen, philosopher, scientist, musician and so on that has ever had a serious case of pneumonia. Perhaps JFW's suggestion that only people who got significant public coverage of their coming down with pneumonia should be included. Alex.tan 17:22, August 10, 2005 (UTC)

Done. Created List of famous pneumonia suffers. Edwardian 00:17, 11 August 2005 (UTC)

Unfortunately mispelt 'pirates' and so someone has set up a Vote For Deletion (VfD) - see Wikipedia:Votes for deletion/List of famous pneumonia suffers . I have added a suitable response to allow us to continue discussing the general policy on such lists, but we can't rename/move whilst it has the VfD tag ! -David Ruben 01:00, 11 August 2005 (UTC)

Sorry about the misspelling. FYI, someone else has moved it to List of notable people who suffer from pneumonia but it still has the VFD tag for those who care. Edwardian 04:09, 11 August 2005 (UTC)

I haven't seen the list, but Jim Henson died of it at a younger age than mine. Shortly afterward I felt quite ill and saw my doctor, who diagnosed a nearly admittable case of hilar pneumonia. It responded well to the cephalosporin of the decade. I think hearing about Henson's early demise from pneumonia prompted me to see my physician, and maybe saved my life. J.Schultz,R.N. 06:40, 5 November, 2005 (UTC)

I'd always heard that Jim Henson died of Strep toxic-shock syndrome. The internet doesn't seem to help InvictaHOG 14:57, 5 November 2005 (UTC)

im small very small —Preceding unsigned comment added by 72.131.54.127 (talk) 19:23, 6 October 2009 (UTC)

Other pneumonias

Both viral and fungal pneumonias deserve some attention, particularly respiratory syncytial virus (RSV) pneumonia which is such a common cause of hospitalization in infants. MD2004 06:43, 9 Mar 2005 (UTC)MD2004

Go ahead, it's a wiki! JFW | T@lk 08:12, 9 Mar 2005 (UTC)

I created the fungal pneumonia page, still needs a short mention here I think. Viral pneumonia still needs to be done. --WS 01:22, 13 August 2005 (UTC)

Also created parasitic pneumonia page. --WS 11:23, 13 August 2005 (UTC)

And we have a viral pneumonia page now as well! --WS 20:20, 17 August 2005 (UTC)

Can anyone tell me what the following sentence means?

Herpes simplex virus is a rare cause of pneumonia except in newborns.

Does it mean that it's rare except in newborns? ...or that herpes simplex is rarely a cause of pneumonia except in newborns? If the former, why is it not rare in newborns, and what are the implications of it being "not rare"? Does that mean it's "common"? ...and, if the latter, does that mean that it's more commonly a cause of pneumonia in newborns or that it's not even rarely a cause of pneumonia in newborns? For such a "good" article, this is a sterling example of really, really just plain bad writing.

rowley 16:48, 9 March 2007 (UTC)

"Its cause may also be officially described as idiopathic—that is, unknown—when infectious causes have been excluded." What a poorly formulated sentence... —Preceding unsigned comment added by The REAL Teol (talk • contribs) 11:36, 19 June 2009 (UTC)

Diagnosis

I don't disagree that xray consollidation does not confirm the diagnosis or does not help rule out other possible diagnoses, but...

• Is chest xray evidence of consollidation really the gold standard ? As a GP, I would have thought it is the confirmation of advanced or established pneumonia. If seen soon enough after onset, I would hope that expectoration to be keeping-up with sputum production, leading to only the occasional crackle heard and the patient not yet at the stage where large areas of the lung are consolliadated.
• History, examination for signs and the retrospective positive sputum-culture report would be the more typical confirmation triad in general practice.
• I dislike Xrays coming at the start of the 'Diagnosis' section as
  • GPs rarely need request it
  • Routine NHS community-Xray reports take 2 weeks to come from the hospitals/clinics (yes, awful I know)
  • It is not what patients in primary care normally need or should expect.
  • So sputum examination should come first, then Xrays, then blood counts for neutrophilia. Everything else is 'advanced' stuff that should be in a new paragraph

Please let me have your thoughts before I edit the "purity" of the Diagnosis section, but this encyclopedic article needs address pneumonia as the majority experience it, not the minority who need hospital admission. - David Ruben 21:24, 10 August 2005 (UTC)

My fault. Hospital docs get too geeky about this type of thing. Perhaps first things should come first: auscultation, percussion etc. JFW | T@lk 22:32, 10 August 2005 (UTC)

Nosocomial pneumonia now usually has the criterion of presenting at 48 hours or longer after admission, not 72 hours. Late onset nosocomial pneumonia is usually defined as having onset later than 4 days after admission, and is strongly associated with multiply-drug resistant (MDR) pathogens. This is particularly true of ventilator-associated pneumonia (VAP), which is the leading infectious cause of mortality in the ICU. Late-onset MDR organisms are dominated by MRSA, Pseudomonas aeruginosa, and Acinetobacter baumannii, leading to substantially elevated risk of mortality. Quantumbio (talk) 01:40, 8 February 2008 (UTC)

Picture

This article really needs a nice leading picture, something like this: [1] Anyone around that has good drawing/illustrating talents? --WS 15:26, 14 August 2005 (UTC)

I've been searching far and wide. The best pictures seem to be at the NIH Medical Encyclopedia, but in a particularly uncool move they subcontracted to A.D.A.M, which I think owns the copyrights.—Encephalon | ζ | Σ 15:59:17, 2005-08-14 (UTC) No suitable image at the CDC, by the way.—Encephalon | ζ | Σ 16:00:58, 2005-08-14 (UTC)

Sure

I'm sure I could draw something. I have plenty (well,) of free time. -Enchantz (3/29/07) —The preceding unsigned comment was added by 75.72.40.40 (talk) 13:18, 29 March 2007 (UTC).

Remaining weaknesses (?)

• Complcations and differential need fleshing out.
• Epidemiology needs numbers.
• If anyone can find it, a diagram of a reeking, pneumoniard lung will be much welcome.—Encephalon | ^ζ  20:43:59, 2005-08-18 (UTC)
• In first paragraph: "Pneumonia can result from a variety of causes, including infection with bacteria, viruses, fungi, or parasites." Aren't the first three also parasites when they infect? --Zachbe 02:08, 20 December 2005 (UTC)

Parasites often mean something different in medicine when used in this way. Helminthes, cestodes, worms fall under the general term parasite. I dunno, if it's confusing it can be changed but it's commonly used in medicine even though it's inaccurate - InvictaHOG 06:48, 20 December 2005 (UTC)

Fame

Keane4 put back a list of famous pneumonias. I repeat my assertion above that the pneumonia itself needs to have attracted signifcant attention to be intrinsically notable.

I'm also not sure about Further, pneumonia sufferers need this list! In what sense to they need it? Is this a form of celebrity therapy? Are breast cancer patients consoled by Kylie's illness? Honestly, I have my doubts. JFW | T@lk 01:22, 2 September 2005 (UTC)

• I agree, and obviously so do many others. (See Wikipedia:Votes for deletion/List of famous pneumonia suffers.) Edwardian 02:43, 2 September 2005 (UTC)

(Unexplained) Signs and more

the terms "dullness to percussion", "egophony" and "crackles" are unexplained and (were)unlinked. i think they need to be clarified - atleast to the extent that these are auditory signs (are they?). i find that these are elaborated in the Physical Exam section.

in the section Physical examination, are the words "able to speak in full sentences" meant to be "able to speak freely/continuously without difficulty in breathing?"

Doldrums 23:00, 10 October 2005 (UTC)

Having had a mild pneumonia, I can vouch for the crackles. I noticed that a deep exhale produced a feeling as if I had rice-krispies in my lungs. Not painful, just an odd sensation. I had, as I recall, no other symptoms. An antibiotic was used, an in a week or so the snap-crakle-pop was gone.

Dave. Aug. 2008 —Preceding unsigned comment added by 70.238.147.40 (talk) 22:27, 4 August 2008 (UTC)

References

I have removed all but one reference from the article as they were improperly cited and linked. Will work through them and add more.

Stored here for the moment.

1. ^ National Guideline Clearinghouse. Guideline: Adult preventive health care: immunizations. In: National Guideline Clearinghouse (NGC) [website]. Rockville (MD), ©1998-2004. Cited August 30, 2005. Available: http://www.guideline.gov/summary/summary.aspx?doc_id=5616&nbr=3786&string

1. ^ Centers for Disease Control and Prevention. United States, regarding vaccination with the pneumococcal polysaccharide vaccine (PDF)

1. Bartlett JG, Dowell SF, Mandell LA, File TM Jr, et al: Practice guidelines for the management of community-acquired pneumonia in adults. Clin Infect Dis. 2000;31:347-82.

MCOTW

I'd probably hold off on copyediting the article for now. I plan on working on it a lot this weekend and I expect some sections to change as I add more references, data, etc.! InvictaHOG 11:21, 14 October 2005 (UTC)

I've been working on a few things so far. I think that general articles like pneumonia should make good use of linking to more substantial discussions of more specific subtypes. Unfortunately, there was no pre-existing articles on community acquired or nosocomial pneumonia. I've been working on CAP today, but there's going to be a lot more work before we can fill in all the gaps. I'm not happy with just listing the other kinds of pneumonia, especially as red links. I think that we should at least write short blurbs and then link to more substantial articles. The same is true for the complications. InvictaHOG 01:38, 16 October 2005 (UTC)

I've only got a few more sections to go with community-acquired pneumonia. I've been trying to find a well-designed page with content similar to pneumonia. Hepatitis is not one of them, but does show some features I'm interesting in exploring. I find it difficult to generalize about pneumonia - symptoms of one type of pneumonia aren't seen in others, etc. The article is quite slanted towards infectious (in particular bacterial) pneumonia. There's a good reason for that and the article makes it quite clear. However, I wonder if we might do better by acknowledging that pneumonia is an imprecise and unhelpful word, moving types of PNA up, fleshing out the discussion of different classifications, have full articles on bacterial, viral, fungal, lipoid, BOOP, etc. linked after short discussion. Then talk about point of care, bring in CAP and nosocomial. In the end, we'll have little use for much of the article, but can expand each section in the appropriate subarticle and not have to continually qualify each statement and discuss disease entities which are drastically different in the same paragraph. Pneumonia won't be feature status, but we could probably make runs with any of the subarticles. I think that bacterial pneumonia would be easy to compile with what we already have plus more on complications, etc. and would make a great feature article. Anyway, these are just my thoughts after wrangling with the content over the last week. I'm going to keep banging away on subarticles and hopefully finish CAP in the next few days - let me know if any of this sounds reasonable! InvictaHOG 03:46, 17 October 2005 (UTC)

What about making bacterial pneumonia the primary subject of the main pneumonia article, with brief explanations and links to articles for the other types? I think most readers would find that approach acceptable. Rewster 07:07, 17 October 2005 (UTC)

Many other non-specific terms such as arthritis, hepatitis, chest pain, uveitis, colitis, headache, etc. provide a general explanation of the term and spectrum of disease/diagnosis and then either list or discuss more specific types with links to articles. Honestly, it's hard to know what to make the focus of the main article pneumonia. Most people will personally experience community acquired pneumonia, which is often viral. I wouldn't want that to become the focus, though, because of the importance of nosocomial pneumonia for mortality, etc. I'm starting to lean towards the approach taken in the other general cases but will keep brainstorming for other ways to approach it! InvictaHOG 11:29, 17 October 2005 (UTC)

I hope to finish community-acquired pneumonia tomorrow. I'll start BOOP/COP and eosinophilic pneumonia thereafter. I've found quite a bit of interesting history, as well. I'm going to be expanding the complications as part of CAP. Depending on the direction people want to take on the main article, we can either start plugging things like complications in to pneumonia or writing up blurbs for the links to subarticles potentially over this next weekend. InvictaHOG 03:05, 18 October 2005 (UTC)

I finished CAP and various important antibiotics today and have just a little left on eosinophilic pneumonia. I'll work on a nice history section after that. I updated the prevention and plugged in the complications section. It's going to be tough to write the sections on treatment, epidemiology, prognosis, and pathophysiology. What is the prognosis of pneumonia? There will be too many qualifications to make it helpful. I'm going to experiment with different page layouts for pneumonia. What seems most logical (though I'm not a splitter, I swear!) is probably a pneumonia page with a discussion of the CAP/nosocomial PNA split followed by a discussion of infectious categories (bacteria/tuberculosis/PCP/viral/fungal/parasitic) followed by short blurbs on the non-infectious PNA (eosinophilic, COP, etc). Move specific diagnosis, treatments, epidemiology, prognosis and pathophysiology (other than simple alveolar damage and gas exchange deficits) to the respective categories. Stress how common CAP is, since that's the most likely lay experience with pneumonia. If anyone has a good idea of other ways to approach this let me know! InvictaHOG 02:44, 19 October 2005 (UTC)

I finished eosinophilic pneumonia tonight. Over the next few days, I'm planning to de-link bacterial pneumonia (unless someone objects!) from pneumonia and work on expanding epidemiology, prognosis, etc. for bacterial PNA in particular. If that works out, we can either copy the sections into the main pneumonia article or make major changes to the pneumonia section as suggested above. I will finish the history section tomorrow. InvictaHOG 02:16, 20 October 2005 (UTC)

I've been chopping some stuff out and adding some stuff in. Let me know if you think somethings needs to find its way back into the article. There is a lot of repetition and some things seem beyond the scope of the article. There's still the whole epidemiology, prognosis, etc. sections. InvictaHOG 02:36, 22 October 2005 (UTC)

I've reworked most of the sections and have pretty much reached the end of what I planned to do. I expect to make biographies for the history section tomorrow and finish up the last of the red links. I've reworked the lead image but can modify it further if anyone has any thoughts about it (or any of the other images, for that matter). Let me know if you think there's anything more that should be done to the article. InvictaHOG 02:59, 25 October 2005 (UTC)

Well, everything on the to do list is done. The article needs a good scrubbing and copyedit, now! InvictaHOG 17:17, 25 October 2005 (UTC)

Wow, InvictaHOG, you did some incredible work on this one. Nice anatomy image. I have resubmitted it for peer review to get some feedback especially from people with a non-medical background. Hopefully it can be a featured article candidate after that. --WS 23:43, 25 October 2005 (UTC)

InvicaHOG, you definitely deserve a break after this. Great work! Sorry I've been MIA; I intend to help out more with the peer review and FAC process. — Knowledge Seeker দ 04:10, 26 October 2005 (UTC)

Pneumonia navigational template

I just started the bacterial pneumonia page. As pneumonia is such a broad topic with a lot of articles for specific types, I think it might be a nice idea to start a navigational template with for all the pneumonia articles. I was thinking of something like Template:Suicide. --WS 11:48, 30 October 2005 (UTC)

I think a template is a great idea. Is there any general rules regarding when we use a side bar vs a template at the bottom of the page? Also, I was noticing how sparse the pulmonary sections were, knew that we had a GI template, and wondered what the general consensus was on this sort of thing...InvictaHOG 21:34, 30 October 2005 (UTC)

Couldn't find any guidelines for it. What do you think of something like this? --WS 12:45, 4 November 2005 (UTC)

I think it's hard to fit the long side bars into an article at times. It looks great, though! Going to add VAP InvictaHOG 12:54, 4 November 2005 (UTC)

Provider vs. doctor

In a medical article, the term "health provider" just doesn't sound right. "Health care provider" or "Healthcare provider" may be a bit better, perhaps more politically palatable and inclusive of the physician extenders: nurse practitioners and physicians' assistants. Personally, I am a doctor, and I hate being called a "provider." For medical articles, I would prefer we use "doctor," or "physician." (Or some type of compromise, such as "...doctor or healthcare provider....") What do others think? Rewster 07:26, 1 November 2005 (UTC)

I'm pretty uncomfortable with just saying doctor. There are so many entry points for health care that focusing on doctors is just not right. EMTs, nurses, NPs, PAs, etc. are all capable of diagnosing pneumonia (and other illnesses) and do so on a daily basis. Expanding to "doctor or healthcare provider" is pretty awkward...InvictaHOG 15:18, 1 November 2005 (UTC)

Typo

Up to 5% of patients admitted to an hospital

should be

Up to 5% of patients admitted to a hospital

Thank you for your suggestion! When you feel an article needs improvement, please feel free to make whatever changes you feel are needed. Wikipedia is a wiki, so anyone can edit almost any article by simply following the Edit this page link at the top. You don't even need to log in! (Although there are some reasons why you might like to…) The Wikipedia community encourages you to be bold. Don't worry too much about making honest mistakes—they're likely to be found and corrected quickly. If you're not sure how editing works, check out how to edit a page, or use the sandbox to try out your editing skills. New contributors are always welcome. --WS 14:27, 2 November 2005 (UTC)

Time for FAC?

I am amazed by how much this article has improved. It looks very comprehensive to me, and I wonder if it's ready for a Feature Article nomination. However, I haven't been active in improving it and haven't been following the progress that closely, so I am unsure. What do others think? — Knowledge Seeker দ 05:47, 4 November 2005 (UTC)

When Rewster finishes with his fantastic copyediting, I'm all for it! InvictaHOG 12:23, 4 November 2005 (UTC)

Let's do it! :-) (only like to get the navigation template either in or out before that, see above) --WS 12:45, 4 November 2005 (UTC)

OK, made it an FAC. --WS 11:48, 14 November 2005 (UTC)

Copyrighted image

File:Gross pathology of pneumonia.jpg

A preserved lung showing lobar pneumonia in the lower lobe

Hi guys, I've removed this image from the text. It's from ACT Pathology, which is a "business unit of The Canberra Hospital, providing specialist pathology services to both public and private patients." [2]. Images from its website are not public domain. Furthermore, please note that it is mainly US government publications that are public domain (unless otherwise specified). Other governments hold differing copyrights over their works: the Crown copyright for the UK government, for example, is a lot more restrictive than the US government's. I'm pretty sure the Australian government's copyrights are similarly restrictive; I know we have had to delete a featured picture in the past because of Australian copyvio concerns. This is a shame, as Invicta has obviously put in a lot of work with the image. Getting public domain path specimen images is always a bit difficult; it might be best to try to get our own, from a non-anal path department. I'm out of luck there, I'm afraid. encephalon 13:27, 4 November 2005 (UTC)

That's pretty craptastic, but good that you found it before we went to FAC. I was just searching *.gov and thought I was safe. It's like that ADAM crap - I can't believe that government images are copyrighted. I'm working on getting a good path source, so hopefully there will be a replacement. InvictaHOG 00:18, 5 November 2005 (UTC)

I'll keep looking too—nice catch, Encephalon, and it's shame about all the work you put in it, InvictaHOG. — Knowledge Seeker দ 05:37, 18 November 2005 (UTC)

"Old Man's Friend"

I understand that the above term has been used in the past for pneumonia, in that a death by pneumonia is (relatively) less painful and faster than other causes of death in the elderly, especially compared to more degenerative diseases. I further understand that this term has had less currency as treatments for pneumonia have improved and pneumonia has lost ground as the (or at least a) leading cause of death in the elderly.

I've not contributed to a medical article before, so I'd appreciate any thoughts about how this information might be formatted and where inserted before I start mangling an otherwise excellent article. Thanks. JHCC (talk) 21:51, 7 December 2005 (UTC)

I thought about adding it after the other Osler quote in the history section. However, I somehow didn't think it was appropriate because a) it would require explanation and b) may still be construed as being insensitive by some. Since it didn't seem necessary, I kept it out. I wouldn't be opposed to its inclusion if it could be done right, however. InvictaHOG 22:17, 7 December 2005 (UTC)

JHCC, Right before the article went to review for FA, I slipped a few sentences in about prevention in infants. I wanted to put in a few more addressing end of life but, like you, I didn’t want to disrupt the flow. Below, verbatim from Merck, is more or less what I had in mind. I think this goes with Old Man's Friend. Could you condense it to a few sentences? We'll help edit it when you're done.--FloNight 00:03, 8 December 2005 (UTC)

http://www.merck.com/mrkshared/mmg/sec10/ch76/ch76a.jsp Section 10. Pulmonary Disorders Chapter 76. Pulmonary Infections Topics: Pneumonia End-of-Life Issues

Pneumonia in the elderly is often the terminal event of comorbid diseases such as diabetes mellitus, COPD, heart failure, malignancy, and dementia. Elderly patients with comorbidity are more likely to develop complications, eg, adult respiratory distress syndrome, empyema, and septic shock. In some cases, comfort measures may be more appropriate than antibiotics. Advance directives in such severe cases can often assist the physician in making appropriate decisions regarding resuscitative measures. When palliative care is the goal, opioids often help patients with dyspnea.

How about this, to go at the end of the History section:

In the elderly, especially those with other terminal conditions, pneumonia is often the immediate cause of death. In such cases, particularly when it cuts short the suffering associated with lingering illness, pneumonia has often been called "the old man's friend." As treatments for pneumonia in the elderly have improved, however, this term has lost some of its currency.

The Merck End-of-Life info is good, and perhaps should be included in Treatment section (which currently has no End-of-Life subsection), since this is current practice. If we do include it there, we can put a note in the "old man's friend" (should that be capitalized?) section: "See End of Life issues under Treatment." JHCC (talk) 15:38, 8 December 2005 (UTC)

I'm not sure that it would work best at the end' of the History section. If anything, it should be paired with the other Osler quote, attributed, and explained within the historical context, potentially adding a bit about its current role (honestly, while pneumonia is a leading cause of death in the West these days, I would never think to call it "the old man's friend." It so often leads to intubation, ventilation and then withdrawal that it's more like the "old man's flog.") I think that a section on end of life care under treatment would be nice, with discussion of the anticipated death by pneumonia in diseases such as ALS, DMD, etc. and the choice of comfort over treatment when pneumonia does occur. InvictaHOG 16:44, 8 December 2005 (UTC)

Discussion of comfort care e.g. in patients with terminal illness and pneumonia could end up opening up a Pandora's box! Andrew73 16:55, 8 December 2005 (UTC)

I know, I know. Some articles I can't imagine without addressing palliative care, of course. Things like pneumonia are less straight forward... InvictaHOG 17:10, 8 December 2005 (UTC)

The article gives the impression that Pneumonia is always aggressively treated for cure and that's not true. A few carefully written sentences explaining *choice of comfort over treatment* is needed to reflect reality. As the baby-boomer age, recognition of palliative care instead of treatment will become more common, otherwise, our health care system will collapse.--FloNight 20:00, 8 December 2005 (UTC)

I found an Archives of Internal Medicine article (February 10, 2003 (Volume 163, Number 3)) online [3] that gives a specific citation for Osler calling pneumonia "the Old Man's Friend" (Osler, W; The Principles and Practice of Medicine New York, NY: D Appleton & Co.;1898: 109-112) without, however, giving the full text of the quote. Thus, I'm not sure if Osler coined the term himself or was repeating an existing usage.

The online edition of the 1892 first edition of Principles and Practice states on page 526, "In the debilitated, in drunkards and in the aged the chances are against recovery. So fatal is it in the latter case that it has been termed the natural end of the old man." [4].

(It is interesting to note that, since Osler was writing before the antibiotic revolution, he states "Pneumonia is a self-limited diseases, and runs its course uninfluenced in any way by medicine. It can neither be aborted not cut short by any known means at our command" [5], but later notes "Pneumonia is one of the diseases in which a timely venesection may save life." [6])

On the other hand, the online edition of the 1901 fourth edition of Principles and Practice notes that the phrase "Captain of the Men of Death" was coined by John Bunyan to describe consumption and is appropriate for pneumonia as "the most widespread and fatal of all acute diseases" [7]. On page 131, Osler notes "So fatal is it in this country, at least, that one may say that to die of pneumonia is the natural end of old people" [8] (perhaps an early example of non-sexist language!)

(I note at this point that there is a collection of Osler's works online — not, I fear, as searchable text, but as scanned images — at The William Osler Collection.)

Furthermore, the Merck Manual, in its introduction to Section 3, Chapter 52 (Pneumonia and Influenza), includes the sentence, "Pneumonia [...] used to be called 'the old man's friend,' a quick way to death for an older person whose health was failing." [9]

While we personally might be disinclined to use the term ourselves, its use for over a century certainly warrants its inclusion in this article (pace InvictaHOG). JHCC (talk) 21:51, 8 December 2005 (UTC)

Spontaneous Contraction

My Dad always gets mad at me if I work out in the cold (-15C or so) with just a T-shirt. If you are working hard enough your body is generating enough heat to not really be effected by the cold, but he seems to think that it's dangerous and that I will contract pneumonia and die.

Specifically he refers to a story of a guy who did the same thing, he worked in -20 degree weather without a shirt on, but had a very high body temp from the work. In fact he felt that he was hot enough that he jumped into the snow to cool off, at which point his body temp plummetted, he instantly caught severe pneumonia, and died of it within hours.

This seems ridiculous to me, but he seems to beleive it.

So is this possible? After reading that pneumonia itself is not an infection, either viral or bacterial, but instead has a wide variety of causes, I can't quite rule out his story.Sahuagin

It's not really likely to have been related to the heat/cold if he did get sick after the incident you're describing. InvictaHOG 01:54, 30 May 2006 (UTC)

Sounds much more like Hypothermia to me, which can kill in the indicated time frame and is frequently confused with Pneumonia even though the conditions are quite different. In less extreme cases Hypothermia can supress the immune system enough to allow an existing infection to express itself, which can then be fatal. 84.92.80.169 11:04, 8 January 2007 (UTC)

Aspiration Pneumonia vs. Aspiration Pneumonitis

Aspiration pneumonia and aspiration pneumonitis are clinically different things. I feel as though the distinction between the two should be discussed in this article. Paul Marik has a wonderful article describing the difference between the two in the The New England Journal of Medicine March 2001. (http://scalpel.stanford.edu/articles/aspiration--NEJM.pdf) —Preceding unsigned comment added by Kewla6 (talk • contribs)

I think that it's beyond the scope of this article - there was orginally a discussion of it with that article as a reference, but it was just not helpful for a general article. Certainly, the aspiration pneumonia article is quite shabby and should certainly contain information about the distinction. InvictaHOG 18:30, 12 August 2006 (UTC)

Yes, I understand your point, but I still feel that the following statement is misleading. "Aspiration pneumonia (or aspiration pneumonitis) is caused by aspirating oral or gastric contents, either while eating, or after reflux or vomiting." It is my intention to add to the current aspiration pneumonia article about this issue.—Preceding unsigned comment added by Kewla6 (talk • contribs)

CURB-65 article

There is a pneumonia related article called CURB-65. It is really weak, and even as a subject matter does not seem to warrant an entire article. Perhaps the info contained therein should be merged with this one, and a redirect set up. --Jayron32 03:44, 27 September 2006 (UTC)

The CURB-65 score is only one of many severity scoring systems for pneumonia. If you merged all the articles on scoring pneumonia severity into the pneumonia article, I think you'll end up with something bloated and not very useful. I suggest adding a link from pneumonia to CURB-65 and mentioning that it is now a standard part of the assessment of pneumonia severity in the UK. Also, the CURB-65 scoring system is only used in the UK, so is it really appropriate to be including it as part of the pneumonia article? I feel that would simply make the pneumonia article less encyclopaedic. I don't feel there is anything wrong with leaving the CURB-65 article where it is: it is a short article, but it says what it needs to say and is not a stub. --Gak 18:34, 3 October 2006 (UTC)

I merged this CURB-65 article with the pneumonia article because I really think it is good information to know. Check it out if you want --User:Supahfreekeh 27 December 2006

Catching Pneumonia from the Cold?

I need to know if it is in any way medically possible to catch pneumonia from the cold. I doubt it, but I need to know for sure. 67.171.163.212 08:14, 31 December 2006 (UTC)

In many cases, mild cases of Pneumonia in younger subjects are dismissed as "a bad cold," so it is quite possible for a "cold" to progress into full blown pneumonia. It is also possible for colds to supress the immune system sufficiently for an existing infection which had been previously supressed to express itself. So can you get Pneumonia after having a cold? Potentially yes, although you are not "catching one from the other."

There is a difference between a cold and the cold. You do not catch pneumonia from the cold. InvictaHOG 16:01, 8 January 2007 (UTC)

Thank you. Could you please provide me with some citation for that? 67.171.163.212 16:09, 8 January 2007 (UTC)

Probably not. Nothing pops up on pubmed, but it's a hard thing to search for. Lots on air pollution. Might be data from a long long time ago. InvictaHOG 23:00, 9 January 2007 (UTC)

Some of this info is wrong

"Streptococcus pneumoniae" is said to be a leading cause. The said bacterium is in fact a budding yeast, and therefore, a fungus. Not a bacterium. You can see this in the image. I've not edited. 82.39.66.1 01:04, 11 January 2007 (UTC)MATT82.39.66.1 01:04, 11 January 2007 (UTC) 11th Jan 2007.

I'm not sure where you got your information from. It's definitely a bacterium! Any micro book will do, but if you need a citation for it, I guess I can scrounge one up. InvictaHOG 02:44, 11 January 2007 (UTC)

Streptococcus pneumoniae

It is true that on wikipedia at least it's labelled as a bacterium, but it's not. I'll explain why. All bacteria look the same size and shape with the exception of when binary fisson is occuring. Rods are of uniform size and shape, as are spheres (cocci). The cocci shown in the image are irregular and of different sizes. You can see one budding off the other. It's a unicellular yeast, a fungus. So either it's been labelled wrong competely or when it was first discovered it was named classified incorrectly. Whichever the case, it looks to be a fungus. 82.39.66.1 21:13, 11 January 2007 (UTC)MATT

Greenish/yellow sputum or Rusty sputum?

Do pneumonia patient usually have greenish or yellow sputum? According to Pharmacotherapy by Dipiro et al, the sputum is usually rust colored or hemoptysis. Can somebody clarify?

Reference: Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells, BG, editors. Pharmacotherapy: A pathophysiologic approach. 6th ed. McGraw-Hill: New York ; 1999. p.1952

I'm pretty sure it does. How do I know? I've had pneumonia twice. Both times I had a light green/yellowish sputum. It tasted like rotting broccoli. I hope that was enough info. ~PogoNoodle~ 15:29, 1 December 2007 (UTC)

i would like to add that i have just got out of hospital with pneumonia, the colour i was spitting was a rusty colour, the doctors informed me the colour was because the infection was very serious. user dinky december2008

Pulmonary Oedema

What's the differens between Pnemonia and Polmonary Oedema? I've read about them both in wikipedia, but it sounds kind of similar to me.. —The preceding unsigned comment was added by 213.200.165.75 (talk) 21:05, 4 February 2007 (UTC).

Pulmonary oedema is completely different. Pneumonia is due to infection, and leads to the alveoli (lung lobules) filling up with pus. Pulmonary oedema is usually due to heart failure or ARDS, and will lead to fluid (not pus) in the alveoli. Both cause cough and difficulty breathing, but a clinical history and an X-ray of the chest is usually sufficient to distinguish the two. JFW | T@lk 14:28, 5 April 2007 (UTC)

Sprotected

I get very annoyed when featured articles are vandalised numerous times a day, yet nobody seems to be patrolling the vandalism.

I have sprotected this article now. I suggest it stays like this long-term. JFW | T@lk 14:26, 5 April 2007 (UTC)

Request for addition to article

When a patient has been diagnosed with pneumonia, but isn't hospitalized, what precautions should s/he take to avoid infecting others? I think a section in this article addressing this question and giving more information about vectors for infection would be useful. JamesMLane t c 05:15, 21 October 2007 (UTC)

Most pneumonias arise from bacteria that do inhabit the respiratory tract as commensals. Hence, no contact isolation is usually needed. Specific pneumonias may warrant isolation, but not as a rule. JFW | T@lk 17:44, 19 March 2008 (UTC)

Asian(Japanese) History/Medicine

I would like to know for how long Pneumonia remained a deathly disease in Japan. thanks/David Moberg (85.8.6.252 09:01, 8 November 2007 (UTC))

Try the reference desk. JFW | T@lk 17:44, 19 March 2008 (UTC)

Duration

I want to know how long Pneumonia lasts for? —Preceding unsigned comment added by 71.210.108.173 (talk) 16:44, 27 January 2008 (UTC)

These questions should really go on the reference desk. Pneumonia takes a few weeks to resolve; repeating chest X-rays is usually discouraged before 6 weeks because there will simply be residual consolidation. JFW | T@lk 17:44, 19 March 2008 (UTC)

CRP

Surprise surprise: higher CRP predicts mortality in community-acquired pneumonia: http://www.amjmed.com/article/S0002-9343%2807%2901180-1/abstract JFW | T@lk 17:44, 19 March 2008 (UTC)

Illness vs. symptom

The article starts "Pneumonia is an inflammatory illness of the lung". The description following matches a symptom, not an illness. Now I'm not a medical nor a native speaker so I don't dare making the change myself in case I'm wrong. 93.132.140.46 (talk) 07:47, 2 January 2009 (UTC)

Pneumonia is an illness, not a symptom. I think changing it would be wrong, but to be sure, you might want to post here on the talk page what you would like to change it to. --Steven Fruitsmaak (Reply) 11:30, 2 January 2009 (UTC)

Well, looking at the article illness I see that I had a misunderstanding of the word. I had thought that an illness was a well defined cause of symptoms, like "infection with virus XYZ" being the illness and pneumonia, blisters and fever the symptoms. Now I see that the English word illness also describes conditions where the cause is not well defined. We live and learn. 93.132.140.46 (talk) 19:39, 2 January 2009 (UTC)

References

This article does not have enough references especially in the treatment section. Treatment is also a little narrow in coverage.--Doc James (talk · contribs · email) 13:59, 18 February 2009 (UTC)

"In the United Kingdom, amoxicillin and clarithromycin or erythromycin are the antibiotics selected for most patients with community-acquired pneumonia; patients allergic to penicillins are given erythromycin instead of amoxicillin.[citation needed]" - use the British Thoracic Society guidelines for the treatment of pneumonia: Thorax 2001; 56: (suppl IV) http://www.brit-thoracic.org.uk/Portals/0/Clinical%20Information/Pneumonia/Guidelines/MACAP2001gline.pdf —Preceding unsigned comment added by 134.225.154.77 (talk) 14:38, 4 March 2009 (UTC)

Not obsolete

See my note in the Talk:Walking_pneumonia page as to why I removed "obsolete" from its use with "walking pneumonia" in this article. Regardless of one's opinion as to the usefulness of the term "walking pneumonia", it is in fact in robust current use and thus not "obsolete" except perhaps (and this is not proven) as a technical diagnostic term. The phenomenon is very real and this is actually the usual term for it except in hypertechnical contexts. --Haruo (talk) 11:57, 5 March 2009 (UTC)

References to support this conclusion? I see a laypersons web page.--Doc James (talk · contribs · email) 06:43, 11 June 2009 (UTC)

Found something uptodate says ""Walking pneumonia" is a term that is sometimes used to describe pneumonia in which the respiratory symptoms do not interfere with normal activity." [10] This ref says "The expression 'walking pneumonia' is commonly used to distinguish respiratory disease resulting from M. pneumoniae from classical pneumococcal pneumonia. This term can be misleading, however, implying that mycoplasma infections are benign in nature." Krause DC, Balish MF (2004). "Cellular engineering in a minimal microbe: structure and assembly of the terminal organelle of Mycoplasma pneumoniae". Mol. Microbiol. 51 (4): 917–24. PMID 14763969. {{cite journal}}: Unknown parameter |month= ignored (help) --Doc James (talk · contribs · email) 06:52, 11 June 2009 (UTC)

my name is sarah and i think wikipedia is odd

Images

Have added some more CXR of pneumonia. Will upload a normal set soon.--Doc James (talk · contribs · email) 00:55, 11 June 2009 (UTC)

FAR

This page needs to be more fully referenced to fulfill the FA criteria. Many sections contain no references.--Doc James (talk · contribs · email) 07:06, 11 June 2009 (UTC)

Small Typo

In the community-acquired pneumonia section, I think the very last sentence is missing a preposition: "Walking pneumonia is usually caused the atypical bacteria mycoplasma pneumonia." I think there should be a "by" between "caused" and "the." —Preceding unsigned comment added by Navr91 (talk • contribs) 17:31, 29 June 2009 (UTC)

Broken link to WikiSource in footnote 37

{{editsemiprotected}}

The URL is now http://en.wikisource.org/wiki/On_Regimen_in_Acute_Diseases Somebody should change that.

 Done   Set Sail For The Seven Seas  338° 27' 44" NET   22:33, 25 October 2009 (UTC)

I actually had early stages of Pneumonia somewhat recently. I got to a hospital before it got too serious though. It was still a pain, though. —Preceding unsigned comment added by 173.8.158.41 (talk) 23:22, 16 November 2009 (UTC)

Double Pneumonia

I came here to find out what this is (or whether it's just a popular term with no well-defined medical meaning) but the article doesn't mention it at all. The article is otherwise very comprehensive. I thought it might mean that both lungs had pneumonia but don't know whether that would be normal or whether pneumonia in just one lung is more common. Even if it's a misnomer it's a common one and I feel that the article should clarify this for laypersons such as myself. Thanks. 203.206.43.191 (talk) 06:10, 22 February 2010 (UTC)

There are not pubmed English articles. It is not a common medical term but more a popular term. [11] It is simply pneumonia in both lungs. Many occur in HIV. Doc James (talk · contribs · email) 06:34, 22 February 2010 (UTC)

This refers to acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) as the same. Doc James (talk · contribs · email) 21:04, 25 February 2010 (UTC)

Alveoli

In the introductory paragraph the alveoli are described as 'microscopic air-filled sacs in the lungs responsible for absorbing oxygen'. I think it would be more accurate to describe the alveoli as 'microscopic air-filled sacs in the lungs responsible for gas exchange' or something to that effect. Alveoli do not 'absorb' oxygen, rather they are the strucutures involved in the transport of oxygen and carbon dioxide into and out of the bloodstream. In fact oxygen enters the capillaries by diffusion, not by 'absorption'. Wikipedia's own article on the pulmonary alveolus describes them as being 'the primary site of gas exchange with the blood'. Addware (talk) 20:05, 25 February 2010 (UTC)

Agree feel free to change it. Also exchanges nitrogen and other gases which becomes important in SCUBA diving and hyperbarics.Doc James (talk · contribs · email) 20:08, 25 February 2010 (UTC)

Unfortunately I can't edit this page as it is semi-protected and I am a new user. Could someone do so on my behalf? Addware (talk) 20:31, 25 February 2010 (UTC)

Done and thank you for posting the comment. It does not take many edits before you can edit any page you want. If you have any question feel free to drop me a note. Also see WP:MED and WT:MED for others who are interested in this subject area.Doc James (talk · contribs · email) 21:03, 25 February 2010 (UTC)

Edit request from Grant18, 31 August 2010

{{editsemiprotected}} In the fourth sentence of the Treatment paragraph, hospitalized should be hospitalization.

Grant18 (talk) 01:25, 31 August 2010 (UTC)

Done Thanks. Celestra (talk) 02:09, 31 August 2010 (UTC)

Reviews to add

• Loke YK, Kwok CS, Niruban A, Myint PK (2010). "Value of severity scales in predicting mortality from community-acquired pneumonia: systematic review and meta-analysis". Thorax. 65 (10): 884–90. doi:10.1136/thx.2009.134072. PMID 20729235. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Chalmers JD, Singanayagam A, Akram AR; et al. (2010). "Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis". Thorax. 65 (10): 878–83. doi:10.1136/thx.2009.133280. PMID 20729231. {{cite journal}}: Explicit use of et al. in: |author= (help); Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

Doc James (talk · contribs · email) 03:59, 23 December 2010 (UTC)

Comment

There needs to be a section added that discusses/classifies the different types of pneumonia as either a restrictive or obstructive type pulmonary disease. These clarifications would enable further enhancement of the "Diagnosis"section of the page, in that one could differentiate various types of pneumonia based on findings of various pulmonary function tests subsequent to a chest x-ray.--Crabdeen (talk) 18:45, 21 March 2011 (UTC)

MCOTW

WhatamIdoing (talk · contribs) attracted my attention to the fact that this article is medical collaboration of the month. I have never done much work on it. I can understand why it lost FA status some time ago. I can immediately identify the following issues that need addressing if we want this article to work well.

• The "classification" section in the beginning is a distraction. In my mind, you can only classify a disease when you have discussed the major clinical and diagnostic (and pathophysiological) features. I would therefore suggest that we move this section to a more appropriate place.
• For a core medical topic, there are still way too many WP:MEDRS-incompatible sources. For a topic like this, these should simply be disallowed - if something is not discussed in secondary sources it is probably not worth mentioning. (This includes Emedicine etc.)
• We need to decide very early on whether to keep the article general, or pull in stuff that should be on community-acquired pneumonia and other subarticles. This is the same conundrum that has been delaying improvements on diabetes mellitus.
• This article is not complete without reference to the highly evidence-based 2009 British Thoracic Society pneumonia guideline (doi:10.1136/thx.2009.121434) and the IDSA 2007 (doi:10.1086/511159).

I've got a busy month ahead, but I will try to contribute what I can. JFW | T@lk 10:08, 3 April 2011 (UTC)

I am swamped this week, I have all of next week off though so I will try to help then. Peter.C • talk • contribs 10:07, 4 April 2011 (UTC)

Edit request from Plasticsman84, 9 March 2011

{{edit semi-protected}} According to Harrison's Principles of Internal Medicine, "Pneumonia is an infection of the pulmonary parenchyma." Most clinicians would agree that the etiology of pneumonia is infectious in nature, not inflammatory as suggested by the opening sentence on the wiki page. (Citation: Mandell Lionel A, Wunderink Richard, "Chapter 251. Pneumonia" (Chapter). Fauci AS, Braunwald E, Kasper DL, Hauser SL, Longo DL, Jameson JL, Loscalzo J: Harrison's Principles of Internal Medicine, 17e: http://www.accessmedicine.com/content.aspx?aID=2899132)

Plasticsman84 (talk) 08:14, 9 March 2011 (UTC)

Some of the root causes of pneumonia are indeed infectious, but the article points out that the inflamation which we call pneumonia can also be caused by "chemical or physical injury to the lungs" which wouldn't be infectious. If you'd like any further help, contact me on my user talk page. You might instead want to put a {{help me}} template up on your own user talk, or put the {{edit semi-protected}} template back up on this page and either way someone will be along to help you. :) Banaticus (talk) 08:15, 12 March 2011 (UTC)

The following link is a link that creates a citation for the sentence that says "needs citation" under Diagnosis: "Influenza Diagnosis - Medical Disability Guidelines." Disability Guidelines – Return to Work Durations and Treatment - MDGuidelines. Web. 14 Apr. 2011. <http://www.mdguidelines.com/influenza/diagnosis>. Kellen M (talk) 21:08, 14 April 2011 (UTC)Kellen M

Infobox disease

I removed the Infobox disease from the article. I didn't find it helpful as a viewer of the article and it made the page cluttered. I'm not sure of the relevance of that box, but if someone thinks that information belongs in the article, I suggest it be written into a section on classification. Alan.ca (talk) 05:00, 17 April 2011 (UTC)

These boxes link to pubmed. They provide a good way to illustrate the disease. They link to emedicine. This cannot be done aswell in the text. The ICD codes also provide verification for the naming of the article. --Doc James (talk · contribs · email) 05:07, 17 April 2011 (UTC)

Is there a way to combine the info boxes? The appearance is poor having them stack like that. As well, I don't understand why the references for the article need to be up top and in an info box like that. It seems the info box disease links to several descriptions for unique causes of Pneumonia, while there is an article section named cause that discusses each type. Would it not make sense to link from each cause description to their respective ICD description? In short, the info box in this case seems redundant and not very informative for the common person reading the article. Alan.ca (talk) 13:53, 17 April 2011 (UTC)

What we see in the info box are not references but notable third party accessible reviews, one by emedicine the other by the NIH. Both are easily accessible. Some of us use Wikipedia for billing and this is a way I have been getting my colleges to us Wikipedia as the ICD 9 codes or so prominent :-) The image in the info box is typically the most useful stuff I agree. The other thing we see below it is not an infobox and should not be there. Doc James (talk · contribs · email) 19:03, 17 April 2011 (UTC)

Viral

doi:10.1016/S0140-6736(10)61459-6 is a Lancet seminar on viral pneumonia. It can probably serve as the main reference for content on these conditions. JFW | T@lk 13:14, 8 April 2011 (UTC)

Great paper. Will take a crack at getting this to GA. Doc James (talk · contribs · email) 05:41, 29 June 2011 (UTC)

References

1. In response to the tag under diagnosis for " However, in a community setting (general practice), pneumonia is usually diagnosed based on symptoms and physical examination alone These are IMCI guideleines which are widely followed in developing countries, under the Section 3.1.2 Severe pneumonia, it states that "A routine chest X-ray rarely gives information which will change the management of severe pneumonia and is therefore not recommended." But in very severe pneumonia its should be taken. We should take more information from this source, I guess.
2. The etiology seems to be messed up, though it provides link to the main articles as in bacterial pneumonia, the article itself lacks references and many organisms are not mentioned. We should simultaneously focus on that as well. ThanksDr. Ankush ^{BUZZ ME!} 18:33, 14 May 2011 (UTC)

Google books

I agree that if a book is available on Google Books, it is entirely appropriate to provide URLs. At the same time, these can often be drastically shortened. At the moment, most of the links in the article have redundant information (e.g. the original search text, which is highlighted by the site when the URL is opened).

The basic format of a Google Books URL is http://books.google.co.uk/books?id=4Xlyaipv3dIC&pg=PA242 where id is the unique identifier of the book and pg is the page number, typically prefixed with "PA". All else is dross.

{{Google books}} is a rather basic template that doesn't really have the functionality that we need. Perhaps another template might help tighten up on these. JFW | T@lk 09:48, 30 June 2011 (UTC)

Thanks Good point. Will do as I work this to GA. Doc James (talk · contribs · email) 11:42, 30 June 2011 (UTC)

I'll see if I can be of any assistance. doi:10.1136/thx.2009.121434 is the British Thoracic Society guideline, which can be used to source diagnosis and treatment content. JFW | T@lk 12:32, 30 June 2011 (UTC)

Edit request from Lumentec, 12 August 2011

This article contains numerous errors. I don't wish to vandalize the page, but I don't have permission to edit it. I request permission to edit it myself rather than generate a gigantic list of edits for others. Lumentec (talk) 23:12, 12 August 2011 (UTC)

Not done: requests for changes to the page protection level should be made at Wikipedia:Requests for page protection. jcgoble3 (talk) 00:39, 13 August 2011 (UTC)

Nevermind, by posting this I gained my 10 posts and was able to make my revisions. — Preceding unsigned comment added by Lumentec (talk • contribs) 02:56, August 13, 2011 (UTC)

Great. Sorry about the protection. This page did get a lot of vandalism but does need more work.Doc James (talk · contribs · email) 03:35, 13 August 2011 (UTC)

spelling error

"wedge shaped" should be "wedge-shaped". —Preceding unsigned comment added by 193.113.37.9 (talk) 11:25, August 25, 2011 (UTC)

 Fixed jcgoble3 (talk) 17:29, 25 August 2011 (UTC)

Chest Percussion and Postural Drainage

There are several sources that discuss how CPPD and other Pulmonary hygiene is used in the management of pneumonia but none of the sources definitively say it improves the condition and some say it is unclear whether or not it improves the condition. Is there a way this information can be included to maintain Good Article status or is it too "unclear"? Je.rrt (talk) 18:26, 27 August 2011 (UTC)

Found a review which can be summarizes: The utility of chest physiotherapy in pneumonia has not yet been determined.Yang, M (2010 Feb 17). "Chest physiotherapy for pneumonia in adults". Cochrane database of systematic reviews (Online) (2): CD006338. PMID 20166082. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) And added it.--Doc James (talk · contribs · email) 19:43, 27 August 2011 (UTC)

found reviews that say generally CPPD therapy for pneumonia specifically is actually advised against, they are very old sources though..., a much newer (1996) study suggests in cases that pneumonia patients are producing more than 30 mL of sputum per day, non-invasive pulmonary hygiene is recommended. — Preceding unsigned comment added by Je.rrt (talk • contribs) 19:53, 27 August 2011 (UTC)

The Cochrane review trumps all those sources. Please review WP:MEDRS, which explains the backgrounds behind this approach. JFW | T@lk 21:10, 27 August 2011 (UTC)

Just another study suggesting chest physiotherapy has been shown to reduce incidents of ventilator-associated pneumonia but also says more research is needed. G. Ntoumenopoulos, J. J. Presneill, M. McElholum & J. F. Cade (2002). "Chest physiotherapy for the prevention of ventilator-associated pneumonia". Intensive care medicine. 28 (7): 850–856. doi:10.1007/s00134-002-1342-2. PMID 12122521. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) Je.rrt (talk) 16:31, 1 September 2011 (UTC)

Have you read WP:MEDRS? JFW | T@lk 20:33, 1 September 2011 (UTC)

yes, are you suggesting the source isn't a good source or the information that can be taken from it isn't really mention-worthy? I admit I am still learning to navigate the sea of citations. Je.rrt (talk) 01:17, 2 September 2011 (UTC)

It is a little too old (2002) and is not listed as a review article by pubmed. You can limit your search to reviews by clicking the button on the right.Doc James (talk · contribs · email) 02:03, 2 September 2011 (UTC)

Nebulized Ofloxacin

Ofloxacin, aerosolized or instilled into an endotracheal tube may have a use for profylaxis of pneumonia in neonates but the only articles and reviews I can find are from the 80's and 90's, I figured I would post this in case its relevant. Until I am more comfortable with citations and stuff I am just going to post stuff here to be filtered appropriately so the article maintains its high quality status, hope you guys don't mind. Je.rrt (talk) 04:02, 2 September 2011 (UTC)

It is not mentioned in any recent reviews? Might be too specific for a main article on pneumonia. I usually edit by taking a major recent review and attempting to summarize it letting it take me wherever it goes. For less primary topic the referencing requirements are not as strong. Doc James (talk · contribs · email) 09:15, 2 September 2011 (UTC)

TOC Left

I recommend adding the TOC Left template to this article, it would help the feng shui of the article. Instead of just doing it and having Doc James revert it I figure I would post here and see if I am alone in desiring the page to flow better. :-) Je.rrt (talk) 18:01, 30 September 2011 (UTC)

Thank Je :-) I believe consistency in style is important between pages. Thus thing we should keep the TOC in the standard style. If all pages where to be changed that would be a different matter. Doc James (talk · contribs · email) 19:05, 30 September 2011 (UTC)

The reason the TOC left exists is for huge TOC's like the Pneumonia page. The only reason I could see it being inappropriate is if in lower resolutions (which I have not yet tested) it makes the text all bunched together or causes the flow to be awkward. :-) Je.rrt (talk) 07:37, 1 October 2011 (UTC)

Or a wide screen leads to bunching.--Doc James (talk · contribs · email) 13:30, 1 October 2011 (UTC)

FYI, I just previewed the article on my 1440x900 resolution with {{TOC left|limit=3}}, and there were significant issues with the symptoms diagram and frequency table creating about 500 vertical pixels of whitespace between the end of the prose in the "Signs and symptoms" section and the "Cause" header (with the diagram and table on either side of that whitespace). jcgoble3 (talk) 17:54, 1 October 2011 (UTC)

So it will not improve the overall flow of the article. Thanks for testing that :) Je.rrt (talk) 18:28, 1 October 2011 (UTC)

Similar articles

Hi there. the article Pneumonitis (diseaseDB 10166) need's to have been controlled. tnxReza luke (talk) 11:40, 12 November 2011 (UTC)

Not sure what you mean? --Doc James (talk · contribs · email) 12:48, 12 November 2011 (UTC)

Definition of Pneumonia

I think the opening paragraph is suffering from severe over-inclusivitis, as well as dodgy medical terminology. In common usage, and most medical definitions, "pneumonia" is an infection of the lung tissue (more accurately, pulmonary parynchyma) (Harrison's, British Thoracic Society Guidelines etc.). Chemical & vascular injuries etc. get labelled pneumonia occasionally (and usually inaccurately), but are more appropriately regarded and classified as pneumonitis. A non-medic coming to this page almost certainly wants information about bog standard lung infections, and can be directed to the rarer stuff with wikilinks. At the risk of causing a stir, (and apologising in advance for accidently stuffing up the references) I'll have a crack at the opening paragraph a bit later this evening.TamePhysician (talk) 06:15, 29 July 2011 (UTC)

One cannot come along and remove all the references. Thus have returned them.--Doc James (talk · contribs · email) 21:22, 30 July 2011 (UTC)

What do you all think about moving the ==Classification== section up to the top (or right after the symptoms section) and expanding it to address this issue? WhatamIdoing (talk) 17:35, 3 August 2011 (UTC)

Agree that there are usage/semantic issues at play, and that conceptually infection is paramount attribution from both statistical and usage perspectives. That said, have gently edited to be c/w the various nuances that are in common use, and entirely c/w with cited refs. Let me know if I should address this more deeply.FeatherPluma (talk) 23:40, 13 August 2011 (UTC)

Hi everybody, at the end, Pneumonia is an inflammation or an infection? or an inflammation caused by an infection?Reza luke (talk) 11:09, 12 November 2011 (UTC)

The section on diagnosis (ie a working case definition), and also on pathophysiological definition needs re-working - in my opinion, completely. I will think about content, but people will need to be ready to let go (and perhaps re-use) some references.BCameron54 23:53, 12 November 2011 (UTC)

What are you proposing we change it too? Doc James (talk · contribs · email) 02:21, 13 November 2011 (UTC)

"present " confusion

Hello-I find some confusion around five instances of the word "present ". It seems like it needs a modifier (ie."present symptoms"). Eddiequest (talk) 12:41, 25 December 2011 (UTC)Eddiequest

Another review of kids

2011 BTS http://www.ncbi.nlm.nih.gov/pubmed/21903691?dopt=Abstract Doc James (talk · contribs · email) 05:10, 12 February 2012 (UTC)

External Links

I have a couple of review tables published on my website for medical students studying for the boards. Will an external links section be added to this article? Examine the link at: http://sites.google.com/site/doctorkipp/microbiology/pneumonia — Preceding unsigned comment added by 68.42.82.61 (talk) 15:18, 31 March 2012 (UTC)

We are not really a list of external links. I have added a single link to DMOZ that specializes in this. Feel free to add there.--Doc James (talk · contribs · email) 15:57, 5 April 2012 (UTC)

A good text

• Suttorp, edited by N. (2007). Community-acquired pneumonia (Online-Ausg. ed.). Basel: Birkhäuser Verlag. ISBN 9783764375621. {{cite book}}: |first= has generic name (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Doc James (talk · contribs · email) 21:04, 5 April 2012 (UTC)

• Zhang, Y (2012 Mar 14). "Oxygen therapy for pneumonia in adults". Cochrane database of systematic reviews (Online). 3: CD006607. PMID 22419316. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)

Doc James (talk · contribs · email) 21:06, 14 June 2012 (UTC)

ACE inhibitors

The use of ACE inhibitors but not angiotensin II receptor antagonist may also decrease the risk.

Some it appears are using ACE I to prevent pneumonia in stroke patients. Doc James (talk · contribs · email) (if I write on your page reply on mine) 15:37, 7 August 2012 (UTC)

It is certainly an interesting finding, but I think it is not something we should mention in the "Prevention" section, only because no doctor would currently prescribe ACE inhibitors primarily with the intention of preventing pneumonia. It is therefore nothing like pneumococcal vaccination, HAART for AIDS, or the use of subglottic suction of endotracheal tubes - these are all measures used primarily to prevent pneumonia.

We could either discuss doi:10.1136/bmj.e4260 (this study) in the section on epidemiology, as an observational finding, or wait until the RCTs have been performed as suggested by the authors. At any rate, it may be appropriate to mention that the benefit is with ACE inhibitors only (and not ARBs, possibly because of the effect on bradykinin) and mainly in Asian patients. JFW | T@lk 17:09, 7 August 2012 (UTC)

Agree not ready stand alone prevention. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:36, 8 August 2012 (UTC)

It might be worthy of mention on ACE inhibitor as an unintended benefit! JFW | T@lk 12:48, 8 August 2012 (UTC)

Medical symptoms are not medical signs and vice versa.

The header for "symptoms of infectious pneumonia" table would benefit from being relabelled to reflect the fact that 'cough', 'fever', 'shortness of breath' and 'abnormal sputum' are signs not symptoms. Richard Avery (talk) 07:57, 2 September 2012 (UTC)

I don't think that's entirely correct. Cough, fever and dyspnoea are things that people report to their doctor when providing a history. In that sense they are symptoms. Some of them can be signs: the doctor may observe the patient coughing or struggling to breathe, but this is not crucial. JFW | T@lk 14:18, 2 September 2012 (UTC)

Broken collarbone -> pneumonia

How can complications from a broken collarbone lead to pneumonia? See William_III_of_England#Death Thanks. --Dweller (talk) 22:12, 10 September 2012 (UTC)

I can think of several reasons, all of which would be WP:NOR in the context of that article. Firstly, if respiration is painful (as it would be because the clavicle moves during breathing), it becomes shallow and precipitates hypostatic pneumonia. Secondly, if he took to bed because of the symptoms, this may again have led to the typical nosocomial pneumonia often seen in hospital patients, probably caused by insufficient deep breathing. Finally, a blow to the chest can cause contusional pneumonia (where bruised lung becomes infected). Altogether very common even nowadays. JFW | T@lk 16:08, 13 September 2012 (UTC)

Fascinating. Thank you. And yes, I understand what you say about NOR! --Dweller (talk) 16:12, 13 September 2012 (UTC)

Another text to fill in the few holes remaining

• Murray and Nadel's textbook of respiratory medicine (5th ed. ed.). Philadelphia, PA: Saunders/Elsevier. 2010. ISBN 1416047107. {{cite book}}: |edition= has extra text (help); |first= missing |last= (help) (ecopy from CMA) Doc James (talk · contribs · email) (if I write on your page reply on mine) 04:27, 30 October 2012 (UTC)

Edit request on 12 November 2012

Please correct the following:

Pathophysiology ... Bacterial ... While the throat always contains bacteria it is only at certain times and under certain conditions that potentially infectious ones reside their. ...

The correct word is "there" and not "their"

Thank you 17.207.113.152 (talk) 22:27, 12 November 2012 (UTC)

Done. Uncontroversial CE request only. Thank you for helping to improve Wikipedia. —KuyaBriBri^Talk 22:58, 12 November 2012 (UTC)

Under Bacteria, article reads "smoking facilites" instead of "smoking facilitates". Under Viruses, "causes rearly" possibly should read "rarely causes". — Preceding unsigned comment added by 68.126.184.209 (talk • contribs) 22:41, 20 November 2012‎

Done Excellent suggestions - thanks for making them - done. -- Scray (talk) 22:55, 20 November 2012 (UTC)

Edit request on 27 November 2012

Please correct the following: Pathophysiology ... Viral ... Once in the upper away the viruses...

The correct word is "airway" and not "away"

75.140.32.79 (talk) 16:37, 27 November 2012 (UTC)

Done. Minor CE request only. Thank you for helping to improve Wikipedia. —KuyaBriBri^Talk 16:42, 27 November 2012 (UTC)

Edit request on 28 November 2012

signs and symptoms section of article ->

'Bloody sputum (known as hemoptysis) may also occur with tuberculosis, Gram-negative pneumonia, and lung abscesses as well as more commonly with acute bronchitis.[11] Mycoplasma pneumonia may occur in association with swelling of the lymph nodes in the next, joint pain, or an middle ear infection.[11] Viral pneumonia presents more commonly with wheezing than does bacterial pneumonia.[12]'

says swelling of the lymph nodes in the next, however it should be neck, not next

Basim07 (talk) 17:22, 28 November 2012 (UTC)

Done Minor CE request only. Thank you for helping to improve Wikipedia. —KuyaBriBri^Talk 17:45, 28 November 2012 (UTC)

Edit request on 6 January 2013

In the symptoms section, the second to last sentance should read "...a middle ear infection." not "an" 174.7.121.11 (talk) 17:10, 6 January 2013 (UTC)

Thanks. Done. JFW | T@lk 17:25, 6 January 2013 (UTC)

Edit request on June 13, 2013

In the 'History' section, one of the last sentences has a reference, but in that reference there are several links, one of which is a dead link. It is reference [90] in "...decline in cases shortly thereafter.[90] Vaccination against..." The dead link is the reference to a page via "http://dx.doi.org/10.1001%2Fjama.269.2.221" but that site cannot find that page. --Observer6 (talk) 16:03, 13 June 2013 (UTC)

Fixed. Thanks for pointing that out. JFW | T@lk 12:25, 16 June 2013 (UTC)

What is pneumonia?

The article describes the causes, symptoms, treatment, diagnosis, statistics, and history of pneumonia, but seems to fail to define what pneumonia actually is (other than vaguely saying it is some inflammatory condition that affects alveoli). I suggest that the lead section of the article should include a definition. —BarrelProof (talk) 01:17, 9 July 2013 (UTC)

The first sentence is an accurate description - pneumonia is a very big topic: causes include noninfectious and infectious (bacterial, viral, fungal, etc); presentation can be acute/abrupt or insidious/chronic presentations; severity can range from almost imperceptible to lethal; etc. What they share is inflammation of the lung tissue. A good analogy is storm - there's a temptation to be more specific, but it's such a big topic that it must be general to be accurate. -- Scray (talk) 02:05, 9 July 2013 (UTC)

I'm not looking for causes, presentation, severity, or analogy. I'm looking for a clear definition. My understanding is that the definition is something like "inflammation of the lungs with consolidation" or "inflammation of one or both lungs, such that a substantial number of the air sacs (alveoli) become filled with liquid, thus rendering them ineffective for breathing". How are those? The current lead section says that it is an inflammatory condition that primarily affects the alveoli, but it does not say whether or not there are other inflammatory conditions that affect the alveoli that are not pneumonia. The current opening sentence is kind of like saying that a cat is a mammal, or that an automobile is a vehicle with wheels – these are true statements, but woefully incomplete. In my opinion, we can't properly talk about the topic until we establish what the topic is that we're talking about. —BarrelProof (talk) 02:57, 9 July 2013 (UTC)

Consolidation is not required. Viral pneumonia usually presents without consolidation. Do you have any refs with better definitions? Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:38, 9 July 2013 (UTC)

The term is also sometimes used more broadly in terms like Idiopathic interstitial pneumonia. While some people use it for just infection not everyone does. Anyway I spent hours trying to figure out the definition. The reason why the definition here is so vague is because while the definition is vague and convoluted in the literature. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:51, 9 July 2013 (UTC)

If there is no clear well-established definition of pneumonia, can we simply say that in the article? Otherwise, the reader is stuck fruitlessly searching and wondering why the article is so poorly written as to neglect to define what it is discussing. I do not have a better definition – actually, I came here to try to learn exactly what pneumonia is, and was frustrated in that effort. —BarrelProof (talk) 04:04, 9 July 2013 (UTC)

Or could it be, perhaps, that any inflammatory condition that affects the alveoli is considered pneumonia? —BarrelProof (talk) 04:15, 9 July 2013 (UTC)

That's true, but it is too narrow to be used as a definition. Our article describes pneumonia well, I think the problem could be that you expected something that is not found in reliable sources. -- Scray (talk) 11:26, 9 July 2013 (UTC)

HAI

they should be section of just HAI pneumonia, because it is the most dangerous and hardest to rid Nursingxmajor (talk) 01:29, 10 August 2013 (UTC)

What is Pathophysiology?

I have no idea what this term means and it is the heading of an entire section.

Is this page for the benefit of the medical community, or a normal person like me trying to find out more about the condition that has afflicted my niece?

I suggest it is replaced with something simpler and more meaningful to non medicals. If this is too difficult (sigh...) at the very least it needs to be linked to a definition. — Preceding unsigned comment added by 58.6.252.20 (talk) 15:23, 23 September 2013 (UTC)

A cursory read of the section will reveal that it discusses the mechanism behind the illness. You can also Google the word for the background. The word is sometimes used in medical articles, although WP:MEDMOS suggests the title "Mechanism" can be used as well. JFW | T@lk 21:31, 23 September 2013 (UTC)

Good point. Maybe we should use mechanisms preferentially? Doc James (talk · contribs · email) (if I write on your page reply on mine) 08:55, 24 September 2013 (UTC)

Reference 15

Looking at reference 15: Ebby, Orin (Dec 2005). "Community-Acquired Pneumonia: From Common Pathogens To Emerging Resistance". Emergency Medicine Practice 7 (12). and following the link to the original article, it would appear the authors name is Orin Eddy, not Ebby as litstd — Preceding unsigned comment added by Darksabath94 (talk • contribs) 02:23, 5 October 2013 (UTC)

 Done Thanks, well spotted. JFW | T@lk 15:00, 6 October 2013 (UTC)

Edit request on 12 October 2013

"or those in which the cause in uncertain" should be "or those in which the cause is uncertain" RussTheGrammarian (talk) 15:24, 12 October 2013 (UTC)

Done RudolfRed (talk) 17:24, 12 October 2013 (UTC)

High quality image available

The image File:Lobar pneumonia illustrated.jpg is a high-quality illustration from the National Institutes of Health that explains lobar pneumonia. I would be glad if there was some way to incorporate it into the design of the article (which seems to be very well thought through). CFCF (talk) 20:21, 12 November 2013 (UTC)

We already have [12] which is more or less the same. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:07, 13 November 2013 (UTC)

Why MI/VTE

... after pneumonia? doi:10.1111/jth.12646 JFW | T@lk 12:46, 24 June 2014 (UTC)

Palliative addition.

Looking over archives, it seems no one bothered to follow through with the addition of "the old man's friend" reference. Will do so now.

The lead does not technical need refs as long as it is supported by the body. I do now always fully ref the leads as this is such a common misunderstanding. Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:23, 27 June 2014 (UTC)

CAP review

NEJM doi:10.1056/NEJMra1312885 JFW | T@lk 21:09, 23 October 2014 (UTC)

"Currant jelly"

Tip: "Currant Jelly" should become hyperlinked to Red Currant (Ribes Rubrum) article. — Preceding unsigned comment added by 91.158.238.162 (talk) 11:12, 9 November 2014 (UTC)

This suggestion prompts me to question the inclusion of "currant jelly" and similar descriptions in a Featured Article. As some have argued in the context of intussusception (PMID 9148991), it is unclear whether such terms are accurate or effective. I ask just to ensure we're deliberate about including such descriptions, when perhaps they are familiar "lore" from the teaching wards, but not actually useful. In a WP context, while I am aware that this term appears in reliable sources, is it sufficiently notable to be included? -- Scray (talk) 16:06, 9 November 2014 (UTC)

NICE

... pneumonia guideline National Institute for Health and Clinical Excellence. Clinical guideline 191: Pneumonia: Diagnosis and management of community- and hospital-acquired pneumonia in adults. London, December 2014. JFW | T@lk 22:04, 4 December 2014 (UTC)

Typical and atypical

The article contains the following statement:

"Infective agents were historically divided into "typical" and "atypical" based on their presumed presentations, but the evidence has not supported this distinction, thus it is no longer emphasized.[18]."

Reference 18 is listed as "Murray and Nadel (2010). Chapter 32." I do not have access to this particular source, but my understanding was that this differentiation was based on the causative pathogen. Atypical bacteria such as Legionella, Chlamydophilia and Mycoplama differ from S. pneumoniae and the various Gram-(-) pathogens not simply in "presentation", but in the mode of treatment. Atypical bacteria lack a cell wall, and thus are not susceptible to beta lactam antibiotics (whose mode of action is interference with cell wall synthesis). It is the potential involvment of these atypical bacteria that requires that a macrolide, tetracycline, or quinolone be included in empiric therapy. Is anyone aware of any reason that I should not correct this passage per the above discussion and identification of an appropriate source? Formerly 98 (talk) 14:07, 5 January 2015 (UTC)

I have access to that text and that is what it says. Can pull up the direct quote if you want. These terms are following out of favor in the clinical context. Doc James (talk · contribs · email) 14:12, 5 January 2015 (UTC)

"The division of CAP into typical and atypical syndromes has been used to predict the likely pathogens and select appropriate empirical therapy. 4 5 6 7 The clinical picture of “typical” CAP is that of disease characteristically caused by bacteria such as S. pneumoniae , H. influenzae , and K. pneumoniae . The initial presentation is frequently acute, with an intense and unique chill. Productive cough is present, and the expectoration is purulent or bloody. Pleuritic pain may be present and it is a very specific finding of S. pneumoniae . Physical examination reveals typical findings of pulmonary consolidation. There is leukocytosis with neutrophilia and the presence of band forms. Chest radiography shows lobar condensation with air bronchograms. In contrast, the syndrome of gradual onset of fever, nonproductive cough, and a relatively normal white blood cell count in a patient without a demonstrable bacterial pathogen has been called “atypical pneumonia.” Frequently, systemic complaints are more prominent than the respiratory ones. The atypical syndrome is characteristic of infections by pathogens such as M. pneumoniae ,Chlamydophila spp., C. burnetii , and viruses. Unfortunately, several studies, including one that included patients with mild CAP treated on an outpatient basis,39 have found that neither the clinical symptoms nor the radiographic manifestations are sufficiently sensitive or specific to reliably guide pathogen-directed antibiotic treatment against “typical” versus “atypical” microorganisms.39 Therefore, current guidelines do not emphasize the use of the typical versus atypical classification to determine initial empirical antibiotic treatment for CAP."

Atypical versus typical is not about the organism but the presenting symptoms. Have adjusted the wording i question and moved it. Doc James (talk · contribs · email) 14:31, 5 January 2015 (UTC)

Thanks. Agree that treatment guidelines point to empiric therapy covering all likely pathogens. Should we have a second sentence for most common pathogens in HAP? Much larger contribution from MRSA and Pseudomonas, though its complicated by the fact that most HAP is really VAP. Formerly 98 (talk) 14:59, 5 January 2015 (UTC)

Do we have data on hospital acquired but not ventilator assciated? Doc James (talk · contribs · email) 15:17, 5 January 2015 (UTC)

I'm not sure I've seen them split out explicitly, but I'll have a look. Formerly 98 (talk) 15:19, 5 January 2015 (UTC)

I think its most commonly VAP. I found one source for non-VAP HAP pathogens. Technically its secondary, but I don't know if you'll like it. It mainly emphasizes S. aureus and the frequency of polymicrobial infections. http://www.ncbi.nlm.nih.gov/pubmed/24876786

Some good data here, not sure its a secondary ref. http://www.ncbi.nlm.nih.gov/pubmed/24279701 (talk) 15:26, 5 January 2015 (UTC)

Wrong phonetic notation

The phonetic notation at the very beginning of the article is wrong, or at least written in some system that is unknown to me (especially the position of the stress mark). Either way, it should be replaced or accompanied by the standard IPA notation, which is /njuːˈməʊ.ni.ə/ (UK) and /nuːˈmoʊ.njə/ (US). Maybe someone with a confirmed account wants to do that. MrArsGravis (talk) 15:38, 19 May 2015 (UTC)

Done Stickee (talk) 23:09, 19 May 2015 (UTC)

No mention of it being "caused" by cold temperatures?

It's widely believed that pneumonia is caused or exacerbated by cold, and especially wet, weather or low ambient temperatures. Whether true or not, this ought to be mentioned in the article. (And preferably written by someone with more medical expertise than me.) -ProhibitOnions ^(T) 06:52, 24 August 2015 (UTC)

The discussion is more around if the common cold is caused by cold weather and that is here Common_cold#Weather Doc James (talk · contribs · email) 06:59, 24 August 2015 (UTC)

When, what and then...

JAMA doi:10.1001/jama.2016.0115 - useful. JFW | T@lk 12:10, 10 February 2016 (UTC)

the global health community has declared 12 November as World Pneumonia Day

No community of this type has a sufficient coherence and organisation that is sensible to claim that it has declared anything. Please correctly state who has made this declaration and avoid this type of language in the future.

(The page is currently edit protected.)

78.35.13.176 (talk) 14:45, 18 November 2015 (UTC)

Agree. It is peacock terminology. I like "hedge funds vs malaria and pneumonia" though (see World Pneumonia Day). JFW | T@lk 12:12, 10 February 2016 (UTC)

Refs needed

Extended content

The setting in which pneumonia develops is often important to diagnosis and treatment, as it correlates to which pathogens are likely suspects, which mechanisms are likely, which antibiotics are likely to work or fail, and which complications can be expected based on the patient's health status. CAP Main article: Community-acquired pneumonia Community-acquired pneumonia (CAP) is acquired in the community, outside of health care facilities. Compared with health care–associated pneumonia, it is less likely to involve multidrug-resistant bacteria. Although the latter are no longer rare in CAP, they are still less likely. HCAP, MCAP, HAP, VAP, and NHAP Health care–associated pneumonia (HCAP) is any pneumonia associated with any health care, whether in a hospital, outpatient clinic, nursing home care, or home care. The latter two settings could be viewed as community settings except that they are usually correlated with health care via proximity to, and interaction with, others who have recently visited health care facilities, such as nurses, doctors, and nursing home neighbors. Medical care–associated pneumonia (MCAP) is sometimes considered synonymous with HCAP and is sometimes viewed as a subset of it. HAP Main article: Hospital-acquired pneumonia Hospital-acquired pneumonia is acquired in a hospital and as such is likely to involve hospital-acquired infections, with higher risk of multidrug-resistant pathogens. Also, because hospital patients are often ill (which is why they are present in the hospital), comorbidities are an issue. VAP Main article: Ventilator-associated pneumonia Ventilator-associated pneumonia occurs in people breathing with the help of mechanical ventilation. Like any medical device, ventilators involve some risk of infection because of how difficult it is to prevent bacteria from colonizing the internal parts and surfaces, even with diligent cleaning. People who need venitlators typically are rather ill to begin with, so a superimposed pneumonia is not always easily managed. Immunodeficiency may be involved because of poor nutritional status and whichever disorders are comorbid. NHAP Nursing home–acquired pneumonia is acquired in nursing home care. A nursing home is a place where even if a resident has not visited a hospital recently, neighbors have, and visiting health professionals have. This, coupled with the comorbidities that typically are associated with advanced age, is why NHAP is viewed as a form of HCAP and has a higher chance of resembling HAP in its causes and features than CAP generally does.

Doc James (talk · contribs · email) 03:37, 10 February 2016 (UTC)

Doc James doi: 10.1055/s-0028-1119803 seems ideal for this job! JFW | T@lk 12:06, 10 February 2016 (UTC)

True enough (refs needed). I will plan to add citations. I will start with the DOI that JFW provided. Quercus solaris (talk) 22:42, 10 February 2016 (UTC)

Update: Done. Quercus solaris (talk) 23:14, 11 February 2016 (UTC)

New aspects

This is mainly about steroids doi:10.1186/s13054-016-1442-y JFW | T@lk 09:07, 7 October 2016 (UTC)

External links modified

Hello fellow Wikipedians,

I have just modified one external link on Pneumonia. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:

• Added archive https://web.archive.org/web/20090709074607/http://www.australianprescriber.com/magazine/26/1/14/7/ to http://www.australianprescriber.com/magazine/26/1/14/7

When you have finished reviewing my changes, you may follow the instructions on the template below to fix any issues with the URLs.

This message was posted before February 2018. After February 2018, "External links modified" talk page sections are no longer generated or monitored by InternetArchiveBot. No special action is required regarding these talk page notices, other than regular verification using the archive tool instructions below. Editors have permission to delete these "External links modified" talk page sections if they want to de-clutter talk pages, but see the RfC before doing mass systematic removals. This message is updated dynamically through the template {{source check}} (last update: 18 January 2022).

• If you have discovered URLs which were erroneously considered dead by the bot, you can report them with this tool.
• If you found an error with any archives or the URLs themselves, you can fix them with this tool.

Cheers.—InternetArchiveBot (Report bug) 21:15, 12 June 2017 (UTC)

Semi-protected edit request on 5 October 2017

This sentence: Pneumonia believed to be due to bacteria is treated with antibiotics. should be changed to: Pneumonia believed to be due to bacteria and is treated with antibiotics. 38.105.173.1 (talk) 20:31, 5 October 2017 (UTC)

Not done: The sentence is grammatically correct as is, while the requested text is grammatically incorrect. —KuyaBriBri^Talk 20:38, 5 October 2017 (UTC)

External links modified

Hello fellow Wikipedians,

I have just modified one external link on Pneumonia. Please take a moment to review my edit. If you have any questions, or need the bot to ignore the links, or the page altogether, please visit this simple FaQ for additional information. I made the following changes:

• Added archive https://web.archive.org/web/20110902154617/http://worldpneumoniaday.org/ to http://worldpneumoniaday.org/

When you have finished reviewing my changes, you may follow the instructions on the template below to fix any issues with the URLs.

This message was posted before February 2018. After February 2018, "External links modified" talk page sections are no longer generated or monitored by InternetArchiveBot. No special action is required regarding these talk page notices, other than regular verification using the archive tool instructions below. Editors have permission to delete these "External links modified" talk page sections if they want to de-clutter talk pages, but see the RfC before doing mass systematic removals. This message is updated dynamically through the template {{source check}} (last update: 18 January 2022).

• If you have discovered URLs which were erroneously considered dead by the bot, you can report them with this tool.
• If you found an error with any archives or the URLs themselves, you can fix them with this tool.

Cheers.—InternetArchiveBot (Report bug) 14:02, 5 December 2017 (UTC)

Comorbidities

There are at least three uses of this word which could be replaced by non technical English. Is this page intended to be read only by people with medical training or is it meant to be available to everyone? The Viral section ends with "can arise as a comorbid condition" which could be changed to "can arise as a consequence" The Hospital section ends with "comorbidities are an issue" which could be changed to "accompanying disorders are an issue" The Ventilator section ends with "whichever disorders are comorbid" which could be changed to "whichever disorders are also present" — Preceding unsigned comment added by 94.196.97.86 (talk) 21:20, 12 January 2018 (UTC)

94.196.97.86Thanks for flagging this. I updated the article and took some of your recommendations. Hope to see you back on Wikipedia! JenOttawa (talk) 02:58, 18 January 2018 (UTC)

Semi-protected edit request on 6 February 2018

Please change "The disease may be classified by where it was acquired with community, hospital, or health care associated pneumonia." to "The disease may be classified by where it was acquired with community or hospital acquired pneumonia."

Health-care associated pneumonia is no longer a classification. You will have to do some research yourself however, I was taught this at med school. 146.232.65.206 (talk) 20:14, 6 February 2018 (UTC)

 Not done: please provide reliable sources that support the change you want to be made. Nihlus 21:33, 6 February 2018 (UTC)

Thanks for the suggestions 146.232.65.206 I have posted your suggestion on the talk page for WikiProject Medicine so our medical editors can see if they can help find a source to substantiate this. We greatly appreciate your efforts to improve the evidence base and accuracy of the medical articles. JenOttawa (talk) 01:38, 7 February 2018 (UTC)

• HCAP remains a heavily-used term in biomedical literature and less specialized spheres. I concur with declining this edit request absent additional justification. — soupvector (talk) 18:34, 7 February 2018 (UTC)

Lead image

More classic

Better quality

IMO the more classic version is superior in the lead. The better quality but less classic can than go in the body. Doc James (talk · contribs · email) 11:43, 9 February 2018 (UTC)

I am not hugely impressed with the "classic" version. Only a very small proportion of pneumonias presents with such florid changes and it is not representative. Furthermore, I am not so sure whether it cannot also interpreted as showing collapse (some volume loss, unconvincing air bronchograms). Can we dump it please? JFW | T@lk 12:55, 9 February 2018 (UTC)

Agreed - the "More Classic" image is not representative. — soupvector (talk) 13:50, 9 February 2018 (UTC)

User:Jfdwolff and User:soupvector do you think we go with the second one or do you have another image in mind? Doc James (talk · contribs · email) 10:41, 10 February 2018 (UTC)

The second one depicted at right seems typical to me. — soupvector (talk) 13:49, 10 February 2018 (UTC)

Okay done. Doc James (talk · contribs · email) 12:11, 11 February 2018 (UTC)

Edit Request - Cost

Mohamad Christi created a cost-effective invention to help children with pneumonia in low-income countries. It works similarly to a bubble-cPAP, however, it is made out of a simple shampoo bottle filled with water and some tubing attached. This simple invention cut the price of treatment by approximately 90% which helped parents in low-income countries who could not afford bubble-cPAP treatment for their children with pneumonia.

Shelby.a14 (talk) 18:21, 12 September 2018 (UTC)

Would need a recommendation by say WHO. Also do we have a good ref to support bubble CPAP in pneumonia?

Seems like the trials are ongoing https://www.ncbi.nlm.nih.gov/pubmed/28883928 Doc James (talk · contribs · email) 19:28, 12 September 2018 (UTC)

This review says "More research is needed on the implementation, cost and effectiveness of CPAP in the management of pneumonia and in neonatal care in developing countries" https://www.ncbi.nlm.nih.gov/pubmed/24165032 Doc James (talk · contribs · email) 19:33, 12 September 2018 (UTC)

Semi-protected edit request on 15 October 2018

We would like to add Cochrane Evidence

Review : oral care for Nursing home acquired pneumoria 2018

Conclusion : there is no evidence that one approach to oral care is better than the other one prevening nursing home acquired pneumonia[1]

There is no high quality evidence about the topic.

Liu, Chang; Cao, Yubin; Lin, Jie; Ng, Linda; Needleman, Ian; Walsh, Tanya; Li, Chunjie (2018). "Oral care measures for preventing nursing home‐acquired pneumonia". Cochrane Database of Systematic Reviews (9). doi:10.1002/14651858.CD012416.pub2. ISSN 1465-1858.

```` CarloFirst (talk) 14:16, 15 October 2018 (UTC)

References

 Not done: According to the page's protection level you should be able to edit the page yourself. If you seem to be unable to, please reopen the request with further details. @CarloFirst: I checked your user rights and according to your rights you should be able to edit this page on your own. If this is a Conflict of Interest edit request please use {{request edit}} for conflict-of-interest edits. ♪♫Alucard 16♫♪ 15:24, 16 October 2018 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 6 September 2018 and 13 December 2018. Further details are available on the course page. Peer reviewers: 12teej.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 06:47, 17 January 2022 (UTC)

Treatment or not? The Old Man's Friend

Some articles about pneumonia as the old man's friend, allowing the frail and slowly painfully dying to slip away comparatively quickly and easily make the case that if someone would rather not continue suffering (or has not specified, but those close think they would prefer this) that the pneumonina should not be treated (with antibiotics), but rather the uncomfortable symptoms. Could someone creat a section dealing with this debate? 2604:2000:F64D:FC00:D147:A417:5602:A56E (talk) 03:24, 12 December 2018 (UTC)

Coloring on this X rays is not as good as the prior

PMC5408360 12887 2017 872 Fig2 HTML

Doc James (talk · contribs · email) 05:36, 12 February 2019 (UTC)

Semi-protected edit request on 24 March 2019

2405:204:71C5:CBC:0:0:26E1:80A0 (talk) 07:21, 24 March 2019 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. Danski454 (talk) 17:03, 24 March 2019 (UTC)

Edit protection removal request

I would request a removal of edit protection in order to correct the links on pertussis, varicella, and measles to link to their actual pages, not the pages for their vaccines. — Preceding unsigned comment added by 74.4.24.34 (talk) 16:34, 6 January 2020 (UTC)

Proportions don't add up.

The proportion of cases in the Bacteria and Virus sections are inconsistent and/or dont't add up. Together, they amount to more than 100%. It appears that the proportions recited in the Bacteria section are the proportions of bacterial-pneumonia cases, whereas the proportions in the Virus section are the proportions of total pneumonia cases. The breakdown by adult and children in the Virus section, without a percent value for total virus cases, adds to the confusion. Could someone clarify? — Preceding unsigned comment added by 2603:9000:AC08:A600:94B7:3C9C:9A:315F (talk) 23:45, 11 March 2020 (UTC)

Links about Coronavirus as cause

at link 11 https://pubmed.ncbi.nlm.nih.gov/21435708/

It says that infections comes together bacterial and viral. But on virus infection, it gives feel like, viruses can cause pneumonia.

"Dual viral infections are common, and a third of children have evidence of viral-bacterial co-infection. In adults, viruses are the putative causative agents in a third of cases of community-acquired pneumonia, in particular influenza viruses, rhinoviruses, and coronaviruses. Bacteria continue to have a predominant role in adults with pneumonia."

On page, there are no clear understanding of a thing. The last sentence says, the bacterial infections are dominant.

Nowdays, because of "corona pandemic" maybe not. I tend not to believe for governments, because of lack pictures of the virus in public domain. Today EM microscopes can easily make resolution of 0.1 nm, what about some virus that 100 nm?

It should be checked twice links. — Preceding unsigned comment added by 2A00:A040:198:313F:9495:E07C:68C3:D47D (talk) 02:14, 13 April 2020 (UTC)

I'm not entirely sure what you are asking, but bacteria are the most common cause of Pneumonia in general. In infants and toddlers, RSV is generally the most common cause. The link you provided isn't contradicting itself. Dual infections often happen with viral infections leading to a bacterial infection as well. I'm not sure if that is what you are confused about? Battykin (talk) 23:00, 5 May 2020 (UTC)

"Necrotizing pneumonia" listed at Redirects for discussion

An editor has asked for a discussion to address the redirect Necrotizing pneumonia. Please participate in the redirect discussion if you wish to do so.  — Mr. Guye (talk) (contribs)  01:42, 29 April 2020 (UTC)

Limitations on diagnosis

Mikalra added the Jain 2015 NEJM study which showed the limitations of advanced diagnostics in determining the aetiology of CAP (doi:10.1056/NEJMoa1500245). This study, while groundbreaking, does not comply with WP:MEDRS. Currently the observation on this problem is cited in the body of the article to a source called EBMED05, which is now 15 years old and should be updated in line with MEDRS.

Oddly the updated ATS guideline does not discuss the poor yield of investigations, but the Jain study is cited in doi:10.1097/MCP.0000000000000671. I'm sure this would be a good alternative to EBMED05 for this information as well as some other bits. JFW | T@lk 14:47, 1 September 2020 (UTC)

This study didn't use 'advanced diagnostics,' but routine laboratory diagnostics such as PCR and urinary antigen testing. You're right that "the observation on this problem is cited in the body of the article to a source called EBMED05;" the Jain study is an example of that problem and is a large and relatively recent report in institutions equipped to address the question.Mikalra (talk) 15:54, 1 September 2020 (UTC)

For many healthcare settings, the diagnostics used in Jain2015 were definitely "advanced". In the UK the viral PCR panel in pneumonia only includes influenza and RSV unless the host is immunocompromised. JFW | T@lk 15:01, 2 September 2020 (UTC)

@Mikalra: The Jain 2015 reference is not an appropriate source, so it has been removed again. Please review WP:MEDRS for explanation. JFW | T@lk 11:13, 3 September 2020 (UTC)

Semi-protected edit request on 21 November 2020

I would like to enhance this page's coverage of the robustly established relationship between SARS-CoV-2 and pneumonia.

Change "Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can also result in pneumonia.[40]"

to

"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can also result in pneumonia[40]. The virus infects and destroys the cells of the alveoli, both those that are ciliated and those that produce mucus and surfactant . Because the cilia cannot function properly, fluid and cellular debris accumulate in the alveoli, which can cause pneumonia . Teddymhill (talk) 02:06, 21 November 2020 (UTC)

This can only be supported with very high quality references. A newspaper article would not be sufficient, nor an animal study. The pathogenesis is probably more complicated than you have indicated: there is diffuse alveolar damage and immunothrombosis. Hence not supporting this addition at this time. JFW | T@lk 21:27, 21 November 2020 (UTC)

References

Please harmonize the internal contradiction about the cause of pneumonia

In the Cause section you cite #28 Jain 2015, a paper which puts viruses well ahead of bacteria in causing pneumonia. Later, in the Bacteria section you state that "Bacteria are the most common cause" with a different reference (#35 Sharma 2007), putting a direct contradiction into this article, just a few lines

PS: Just as in the telephone game the numbers have been misquoted. It says "20% haemophilus" but it was 20 cases or 7% in the original paper!

Good catch here @JS. I can help make this edit. As for the review article, this is one of differences between medical writing on Wikipedia and writing for a peer-reviewed medical journal- the use of the WP:MEDRS guideline preferring high-quality secondary sources to primary research sources. It is not always perfect- i.e.- susceptibilty to the 'telephone game' errors, however, some feel that there are strengths as well to this approach given that anyone can edit these articles. I will not have time to review the citations for a few days, but will try to circle back soon. Citations to consider: Primary source, presently ref # 28 Jain et al 2015. . Outdated secondary source (does not meet WP:MEDDATE): JenOttawa (talk) 16:39, 22 November 2021 (UTC)

P.S- if anyone wants to beat me to this improvement please do go ahead!!! There are a lot of outdated references in the aforementioned sections. JenOttawa (talk) 16:46, 22 November 2021 (UTC)

References

Keiko died from this! This is for real!!!

Here is the whale Keiko of the free willy movie, it DOES exist as a disease in wild animals! "Killer whale Keiko dies of pneumonia.." The Free Library. 2003 The Register Guard 19 Mar. 2022 https://www.thefreelibrary.com/Killer+whale+Keiko+dies+of+pneumonia.-a0112803638 --82.207.238.166 (talk) 11:50, 19 March 2022 (UTC)