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H5N1 Pheumonia Viral or Bacterial?

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  • H5N1 Pheumonia Viral or Bacterial?

    I have a question. Is the pneumonia that kills in BF primarily Viral or bacterial? Can you explain the difference? I was on another forum and everyone is saying that if you get the pneumonia vaccine, you'll be protected against the pneumonia that occurs with H5N1. It was my understanding that it is viral and vaccines and antibiotics are not useful.

  • #2
    Re: H5N1 Pheumonia Viral or Bacterial?

    I've read, that there is some chance to be protected.
    Yes, viral pneumonia may also occur (or not) and the
    pneumovax doesn't protect against all bacteria.
    Maybe only 70% of them or such.

    So you need some luck too
    I'm interested in expert panflu damage estimates
    my current links: http://bit.ly/hFI7H ILI-charts: http://bit.ly/CcRgT

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    • #3
      Re: H5N1 Pheumonia Viral or Bacterial?

      H5N1 have the strenght to provoque a viral pneumonia.

      So in this case antibiotics and vaccine for bacterial pneumonia are useless and can only prevent bacterial complication that can occure after the viral pneumonia has ended if the patient have not died already.

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      • #4
        Re: H5N1 Pheumonia Viral or Bacterial?

        From the WHO website:

        Almost all patients develop pneumonia. During the Hong Kong outbreak, all severely ill patients had primary viral pneumonia, which did not respond to antibiotics. Limited data on patients in the current outbreak indicate the presence of a primary viral pneumonia in H5N1, usually without microbiological evidence of bacterial supra-infection at presentation. Turkish clinicians have also reported pneumonia as a consistent feature in severe cases; as elsewhere, these patients did not respond to treatment with antibiotics.

        And another:


        The initial clinical presentation of influenza A(H5N1) infection was similar to that of other influenza viruses, typically with fever, malaise, myalgia, sore throat and cough. The appropriate management consists of adequate rest, fluid replacement and antipyretic as necessary. Aspirin should be avoided. Persistent high fever (>39 C) is a common sign among the cases in 1997. In some cases, influenza A(H5N1) caused a rapid downhill course ending with viral pneumonia, respiratory distress syndrome and multi-organ failure. If there are signs of complications such as pneumonia, the patient should be hospitalized. Nasopharyngeal aspirate should be taken from patients suspected to have severe influenza illness. There are rapid screening tests for detection of influenza A antigen. Virus isolation by culture is required for confirmation and subtyping. A four-fold or greater rise in antibody titre from the acute phase to the convalescent phase serum samples is indicative of recent infection. The use of antiviral therapy such as amantadine is discussed in the attached note.


        And Yet Another: from the New England Journal of Medicine


        Clinical Course
        Lower respiratory tract manifestations develop early in the course of illness and are usually found at presentation (Table 3). In one series, dyspnea developed a median of 5 days after the onset of illness (range, 1 to 16).15 Respiratory distress, tachypnea, and inspiratory crackles are common. Sputum production is variable and sometimes bloody. Almost all patients have clinically apparent pneumonia; radiographic changes include diffuse, multifocal, or patchy infiltrates; interstitial infiltrates; and segmental or lobular consolidation with air bronchograms. Radiographic abnormalities were present a median of 7 days after the onset of fever in one study (range, 3 to 17).15 In Ho Chi Minh City, Vietnam, multifocal consolidation involving at least two zones was the most common abnormality among patients at the time of admission. Pleural effusions are uncommon. Limited microbiologic data indicate that this process is a primary viral pneumonia, usually without bacterial suprainfection at the time of hospitalization. Progression to respiratory failure has been associated with diffuse, bilateral, ground-glass infiltrates and manifestations of the acute respiratory distress syndrome (ARDS). In Thailand,15 the median time from the onset of illness to ARDS was 6 days (range, 4 to 13). Multiorgan failure with signs of renal dysfunction and sometimes cardiac compromise, including cardiac dilatation and supraventricular tachyarrhythmias, has been common.14,15,16,24 Other complications have included ventilator-associated pneumonia, pulmonary hemorrhage, pneumothorax, pancytopenia, Reye's syndrome, and sepsis syndrome without documented bacteremia.

        All the research I have done has said Viral Pneumonia. Anything I post I always back up what I say with my research sited and with references. So far I have not seen any research from any source preferably from a scientific/ medical/ source, you get my drift, that says bacterial. Can anyone help?

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        • #5
          Re: H5N1 Pheumonia Viral or Bacterial?

          I will do some research. but I have adopted Erytro in case of infections of the lungs.

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          • #6
            Re: H5N1 Pheumonia Viral or Bacterial?

            Here is a post made by Mellie on Erythromycin

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            • #7
              Re: H5N1 Pheumonia Viral or Bacterial?

              WHAT IS PNEUMONIA?
              Pneumonia is an inflammation of the lung, usually caused by infection. (Another term often used interchangeably with pneumonia is pneumonitis from "pneumo" meaning "of the lung" and "itis", "inflammation".) Pneumonia can also be due to causes other than infection, such as chemical irritants, radiation, aspiration of stomach contents, and so forth, In such cases the pneumonia or pneumonitis is qualified (radiation pneumonitis, chemical pneumonia, aspiration pneumonia, and so on). Unless so qualified in this chapter, "pneumonia" refers to the inflammation caused by infection.
              Infection may occur in only a small part of the lung or may involve an entire lung or both lungs (so*called double pneumonia). The infecting organism grows in the lung tissue, causing the body to defend itself by mobilizing infection*fighting cells. In the process the patient develops symptoms such as chills, fever, cough, and general malaise.
              These symptoms may range from very mild (often called "walking pneumonia" because the patient can walk around with it) to very severe and even fatal. Pneumonia can be caused by almost any type of organism, although a few specific viruses and bacteria are responsible for most cases, and can occur at any age.
              One of the great medical advances has been the development of antibiotics for treating some of the pneumonias. Penicillin, erythromycin, and tetracycline are among the most useful. Despite this miracle group of drugs pneumonia remains a very important problem. In 1936, before the advent of antibiotics, pneumonia was the number one cause of death in the United States. Today pneumonia and influenza (a viral infection frequently complicated by pneumonia) are listed as the fifth leading cause of death.
              Most pneumonia fatalities occur in elderly or debilitated patients, or in those who have compromised body defenses as may occur from chronic lung disease, cancer, or after kidney transplantation. However, pneumonia can also be fatal in young adults, particularly when due to organisms such as viruses that do not respond to antibiotics. Fortunately, most viral pneumonias are self*limiting and patients fully recover.

              WHAT ARE THE INFECTIOUS CAUSES OF PNEUMONIA?
              Pneumonia is caused by microscopic and submicroscopic organisms that infect the lung tissue. There are four main groups of organisms capable of causing this infection:

              Bacteria: These are the relatively large organisms that can usually be seen under the microscope. They can invariably be killed or retarded with antibiotics; otherwise healthy patients who develop bacterial pneumonia respond favorably when given the appropriate antibiotic. One unusual bacterium has recently been shown to be responsible for Legionnaire's disease (discussed in a later section).

              Bacteria*Like: Bacteria*like organisms fall somewhere between viruses and bacteria. They share features of both, and microbiologists do not all agree on their classification. One such organism, called mycoplasma, causes a characteristic pneumonia manifested by cough, chest pain, and a patchy infiltrate on the chest x*ray. Such lung infections are called "atypical pneumonia" to distinguish them from "typical" bacterial pneumonia. We now know that pneumonia of any particular cause can have either typical or atypical features, so the terminology is not very helpful.
              Fortunately, the biochemical nature of mycoplasma and other bacteria*like organisms allows them to be destroyed or inhibited by antibiotics. Mycoplasma infections usually respond to either erythromycin or tetracycline; penicillin is ineffective.

              Viruses: These are sub*microscopic organisms very different from the above two groups. They live only in cells and do not respond to antibiotics. However, the body makes a powerful anti*viral substance, interferon, that helps to control most viral infections. Viral infections are difficult to diagnose in the early stages, in part because the organisms cannot be seen with an ordinary microscope. On clinical grounds they cannot be separated from mycoplasma and other bacteria*like infections, and for this reason all patients with presumed viral pneumonia are still treated with antibiotics, usually erythromycin or tetracycline.

              Miscellaneous: A large group of miscellaneous organisms may infect the lungs, including fungi, molds, parasites, and other unusual organisms that are not classified into one of the three groups above. This miscellaneous group usually infects only patients who are immuno*compromised**whose natural immune system is depressed or compromised enough to allow unusual organisms to gain a foothold. Immune depression may occur either from an underlying disease or from treatment for the disease. Examples include kidney transplant patients who are receiving immunosuppressive agents to help prevent rejection of the kidney, cancer patients receiving drugs that depress the immune system while attacking cancer cells, and patients with blood disorders such as multiple myeloma that directly affect the body's immune system.

              HOW IS PNEUMONIA DIAGNOSED?
              Doctors generally go through four steps to make the diagnosis. As in any disease, the diagnosis must first be suspected before it can be made. This is not usually difficult. In fact patients will often suspect the diagnosis even before consulting a physician, because of symptoms different from any flu or cold ever experienced. High fever, chills, chest pain, and coughing up dark or foul*smelling sputum are often present in pneumonia and should always make one suspect the diagnosis. By using a stethoscope the physician can hear a "noisy" chest as air goes in and out of the inflamed passages.
              In step two the physician confirms the diagnosis by chest x*ray. The chest x*ray is an invaluable test for both diagnosing and following patients with pneumonia, since it shows the extent of the disease as well as any subsequent progression or relapse. Figures 1 through 4 show some typical x*ray presentations or pneumonia.
              In step three the physician attempts to find the cause. This involves ordering certain tests to help determine which organism is responsible for the infection. Such tests may include a microscopic examination of the sputum, a culture of the sputum, a count of the white blood cells (it goes up in pneumonia), and cultures of the blood to see if the pneumonia organisms have invaded the blood stream. Other tests may be ordered depending on the extent of the pneumonia, degree of symptoms, and past history of the patient.
              Finally, step four is to treat with antibiotics. Rapid recovery helps to confirm the diagnosis and type of pneumonia even though the specific organism may not have been identified.

              <hr> Figure 1. X-ray involving part of the right lung. The dark area is the pneumonia. Lobar pneumonia results from infection with a bacterial organism and can involve any part of either lung.

              <center></center>


              <hr> Figure 2. X*ray appearance of bilateral (double) bronchopneumonia, also due to bacterial infection.

              <center></center>


              <hr> Figure 3. Extensive broncho*pneumonia with pleural effusion.

              <center></center>



              <hr> Figure 4. Patchy viral pneumonia.

              <center></center>

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              • #8
                Re: H5N1 Pheumonia Viral or Bacterial?

                Am. J. Respir. Crit. Care Med., Volume 157, Number 3, March 1998, 853-857

                <atl> Therapeutic Effect of Erythromycin on Influenza Virus-induced Lung Injury in Mice </atl>

                <nowrap> KEIZO SATO,</nowrap> <nowrap> MORITAKA SUGA,</nowrap> <nowrap> TAKAAKI AKAIKE,</nowrap> <nowrap> SHIGEMOTO FUJII,</nowrap> <nowrap> HIROYUKI MURANAKA,</nowrap> <nowrap> TOSHINORI DOI,</nowrap> <nowrap> HIROSHI MAEDA,</nowrap> <nowrap>and MASAYUKI ANDO</nowrap>
                First Department of Internal Medicine and Department of Microbiology, Kumamoto University School of Medicine, Kumamoto, Japan <hw_fcode> <!-- Lung Injury and Pathology --> </hw_fcode> <abs> </abs>
                Erythromycin (EM) is an antibiotic with potent antiinflammatory effects that is used for treating chronic lower respiratory<sup> </sup>tract infections. It has been shown that free radicals, such as<sup> </sup>the superoxide anion and nitric oxide (NO), are pathogenic molecules<sup> </sup>in viral disease. Much attention has been given to a critical<sup> </sup>role of NO in the pathologic events of various inflammatory diseases.<sup> </sup>In the present study, we evaluated the effects of EM on influenza-virus-induced<sup> </sup>pneumonia in mice infected with a lethal dose of influenza virus<sup> </sup>A/Kumamoto/Y5/67 (H2N2). The administration of EM at a dose of<sup> </sup>3.3 mg/kg/d (intraperitoneally, from Days 1 to 6 after infection),<sup> </sup>significantly improved the survival rate of mice infected with<sup> </sup>influenza virus, and the survival rate of the virus-infected mice<sup> </sup>at Day 20 after infection increased in a dose-dependent fashion<sup> </sup>with EM administered to the animals, from 14% among controls to<sup> </sup>42% among animals given EM at 1.0 mg/kg/d and 57% among those<sup> </sup>given EM at 3.3 mg/kg/d. The induction of interferon- (IFN-)<sup> </sup>in the mouse lung was inhibited by EM treatment on Day 6 after<sup> </sup>infection. Simultaneously, the number of inflammatory cells recovered<sup> </sup>in lung lavage fluid 6 d after virus infection was significantly<sup> </sup>reduced by the treatment with EM. The EM treatment resulted in<sup> </sup>a dose-dependent decrease in the level of nitrite/nitrate (metabolites<sup> </sup>of NO) in the serum and the NO synthase (NOS)-inducting potential<sup> </sup>in the lungs of the virus-infected mice. These results indicate<sup> </sup>that EM may have substantial therapeutic value for various acute<sup> </sup>inflammatory disorders such as influenza-virus-induced pneumonia,<sup> </sup>by inhibiting inflammatory-cell responses and suppressing NO overproduction<sup> </sup>in the lung.
                <!-- Pages created by the Electronic Press Engine from Atypon Systems, Inc. Visit http://www.atypon.com/ -->


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                • #9
                  Re: H5N1 Pheumonia Viral or Bacterial?

                  Atypical Pneumonia (Mycoplasma and Viral)

                  (Walking Pneumonia)

                  by Rosalyn Carson-DeWitt, MD
                  <hr noshade="noshade" size="1">Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention<hr noshade="noshade" size="1">Definition

                  Atypical pneumonia is a lung infection.
                  ?Typical pneumonia? is a severe illness. It is usually caused by bacteria such as Streptococcus pneumoniae, Haemophilus influenzae, or Klebsiellae pneumoniae. Typical pneumonia tends to strike older individuals, especially those with heart or lung conditions.
                  In contrast, atypical pneumonia tends to be a milder illness. It is caused by a different assortment of bacteria or viruses, and it usually strikes healthy young people.
                  All types of pneumonia are potentially serious conditions that require care from your doctor.
                  The Lungs (Cut-away View)
                  Copyright ? 2005 Nucleus Communications, Inc. All rights reserved. www.nucleusinc.com

                  Causes

                  Atypical pneumonia is usually caused by:
                  • Bacteria
                    • Mycoplasma pneumoniae
                    • Chlamydia bacteria
                    • Coxiella burnetii
                  • Viruses
                  Risk Factors

                  The following factors increase your chances of developing atypical pneumonia:
                  • Being a child, adolescent, or young adult
                  • Living in closed communities, such as dormitories in boarding schools or colleges, and military barracks
                  • Cigarette smoking
                  • Lung disease
                  • Weakened immune system
                  Symptoms

                  If you experience any of these symptoms do not assume it is due to pneumonia. These symptoms may be caused by other, less serious health conditions.
                  • Fever
                  • Chills
                  • Cough, often dry
                  • Phlegm (sputum) production
                  • Muscle aches and pains
                  • Decreased appetite
                  • Headache
                  • Chest pain
                  • Shortness of breath
                  • Fast breathing
                  • Intense fatigue
                  • Weakness
                  • Vomiting
                  • Diarrhea
                  • Skin rash
                  Diagnosis

                  Your doctor will ask about your symptoms and medical history, and perform a physical exam. Tests may include the following:
                  • Chest x-ray - looking at your lungs with a chest x-ray may reveal pneumonia
                  • Blood tests - Testing your white blood cells can determine whether you are experiencing a bacterial or a viral infection. Other blood tests can identify the presence of certain bacteria or viruses.
                  • Blood cultures - Bacteria or viruses may be grown from samples of your blood in a laboratory. The specific type of bacteria or virus can then be identified, so that you can receive appropriate treatment.
                  • Sputum test - If you are coughing up sputum, you may be asked to collect some in a sterile container for testing. This can reveal what type of bacteria or virus is causing your illness, so the correct treatment can be started.
                  Treatment

                  Talk with your doctor about the best treatment plan for you. Treatment options include the following:
                  Antibiotics
                  Usually, atypical pneumonia due to bacteria can be treated with oral antibiotics at home. However, more severe pneumonia may require intravenous antibiotics in the hospital. Some of the antibiotics used to treat ayptical pneumonia include erythromycin, azithromycin, and clarithromycin.
                  Viral pneumonia will not respond to antibiotic treatment.
                  Oxygen
                  If you are severely ill from pneumonia, you may need extra oxygen.
                  Prevention

                  To help reduce your chances of getting pneumonia, take the following steps:
                  • Use good hand washing techniques
                  • Avoid contact with other ill people
                  • Follow your doctor?s recommendations for treating any chronic conditions
                  RESOURCES: American Lung Association
                  http://www.lungusa.org/
                  National Institute for Allergies and Infectious Disease
                  http://www3.niaid.nih.gov/
                  CANADIAN RESOURCES:BC Children?s Hospital
                  http://www.bcchildrens.ca/default.htm
                  The Canadian Lung Association
                  http://www.lung.ca/
                  REFERENCES:

                  Donowitz GR, Mandell GL, eds. In: Principles and Practice of Infectious Diseases.5th ed. London: Churchill Livingstone Inc; 2000.
                  Goetz MB et al, eds. Pyogenic Bacterial Pneumonia, Lung Abscess, and Empyema. In: Mason R J et al, eds. Murray & Nadel?s Textbook of Respiratory Medicine. 4th ed. London: Elsevier; 2005.
                  Schlossberg D. Mycoplasmal Infection. In: Goldman L, et al, eds.Cecil Textbook of Medicine. 22nd ed. Philadelphia: W.B. Saunders Company; 2004.

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                  • #10
                    Re: H5N1 Pheumonia Viral or Bacterial?

                    Great info, all of it. Thanks Snowy. You always come through. I am aware of the different kinds and their differentiation. Good to have through clarification. I will continue to look for evidence of H5N1 pneumonia being either predomenently viral or bacterial. My pediatrician says it's viral, and that "the Pneumonia Vac. will do no good".

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                    • #11
                      Re: H5N1 Pheumonia Viral or Bacterial?

                      Originally posted by Scrat
                      ......... I will continue to look for evidence of H5N1 pneumonia being either predomenently viral or bacterial. My pediatrician says it's viral, and that "the Pneumonia Vac. will do no good".
                      Since most deaths in 1918 H1N1 were from secondary bacterial pneumonia, that's enough reason for me to want a pneumovax.

                      Just read a Taubenberger paper today (sorry I don't have the link), where he said that the secondary bacterial caused most deaths, however there were all 3 types - viral, bacterial, and mixed.

                      .
                      "The next major advancement in the health of American people will be determined by what the individual is willing to do for himself"-- John Knowles, Former President of the Rockefeller Foundation

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