Chemokine-like IL-8 (interleukin-8) and colony-stimulating factors like G-CSF (granulocyte colony-stimulating factor) promote chemotaxis and neutrophil maturation, respectively, resulting in leukocytosis on serological lab and purulent secretions. Cytokines are released in response to the inflammatory reaction and cause constitutional symptoms for example, IL-1 (interleukin-1) and TNF (tumor necrosis factor) cause fever. This inflammatory response is the main reason for the clinical manifestation of bacterial pneumonia. In this setting, the alveolar macrophages kickoff the inflammatory response to strengthen the lower respiratory tract defenses. Another component of the pulmonary defense system is made up of immune cells such as alveolar macrophages, which work to engulf and kill proliferating bacteria, but once bacteria overcome the capacity of host defenses, they start proliferating. To prevent this proliferation of microorganisms, several host defenses work together in the lungs, such as mechanical (e.g., hair in nostrils and mucus on nasopharynx and oropharynx) and chemical (e.g., proteins produced by alveolar epithelial cells like surfactant protein A and D, which have the intrinsic property of opsonizing bacteria). The body's inflammatory response against it causes the clinical syndrome of pneumonia. Invasion and propagation of the above-mentioned bacteria into lung parenchyma at the alveolar level causes bacterial pneumonia. The lower respiratory tract is not sterile, and it always is exposed to environmental pathogens. The mortality rate is variable among different regions, such as 7.3% for the United States and Canada, 9.1% for Europe, and 13.3% for Latin America. In 2005, influenza and pneumonia combined were the eighth most common cause of death in the United States and the seventh most common cause of death in Canada. The incidence rates are higher at extremes of age the adult rate is usually 5.15 to 7.06 cases per 1000 persons per year, but in the population of age less than 4 years and greater than 60 years, the rate is more than 12 cases per 1000 persons. However, the total number of deaths has been on the rise among females. The incidence of CAP varies among different genders for example, it is more common in males and African Americans than in females and other Americans. The incidence of CAP in the United States is more than 5 million per year 80% of these new cases are treated as outpatients with a mortality rate of less than 1%, and 20% are treated as inpatients with a mortality rate of 12% to 40%. US Pharm. 2015 Jul 40(7):54-6.In the United States, lower respiratory tract infections account for more morbidity and mortality than any other infection. Pneumococcal Vaccination in Older Adults: An Update for Pharmacists. Pneumococcal vaccines for preventing pneumonia in chronic obstructive pulmonary disease. Walters JA, Tang JN, Poole P, Wood-Baker R. Inhaled steroids, Circulating eosinophils, chronic airway infection and pneumonia risk in chronic obstructive pulmonary disease: A network analysis. Martinez-garcia MA, Faner R, Oscullo G, et al. Haemophilus influenza and Streptococcus pneumoniae: living together in a biofilm. Pneumonia in immunocompromised patients: updates in clinical and imaging features. Convergence in the epidemiology and pathogenesis of COPD and pneumonia.
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