Image: Incidence of childhood clinical pneumonia at the country level from WHO

This page is part of Pediatric Infectious Diseases in India post

I will limit this discussion to pneumonia and tuberculosis (which isn’t solely respiratory) for the sake of brevity.

PNEUMONIA

Pneumonia is the leading global killer of children under five, responsible for almost 1.6 million deaths per year. In that vulnerable population, it is a disease of poverty and occurs most commonly when a child’s still-developing defense system is weakened by malnutrition, air pollution, co-infections with HIV/AIDS and measles, and low birthweight, with 43 million cases for children in India alone.

• Pneumonia is the leading cause of death in children worldwide.
• Pneumonia kills an estimated 1.2 million children under the age of five years every year – more than AIDS, malaria and tuberculosis combined.
• Pneumonia can be caused by viruses, bacteria or fungi.
• Pneumonia can be prevented by immunization, adequate nutrition and by addressing environmental factors.
• Pneumonia caused by bacteria can be treated with antibiotics, but around 30% of children with pneumonia receive the antibiotics they need. (source)

Pneumonia occurs when the sacs of the lungs, known as alveoli, become filled with pus and fluid, limiting oxygen intake and making it hard to breathe.

Causes: Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:

• Streptococcus pneumoniae– the most common cause of bacterial pneumonia in children;
• Haemophilus influenzaetype b (Hib) – the second most common cause of bacterial pneumonia;
• Respiratory syncytial virus is the most common viral cause of pneumonia;
• In infants infected with HIV, Pneumocystis jiroveci is one of the commonest causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.(source)

Best Bet Treatments: There are many treatments based on the cause of the pneumonia.

Famous Scientists: (This information is modified from Wikipedia here:)

• “Edwin Klebs was the first who observed bacteria in the airways of persons who died of pneumonia in 1875.
• Initial work identifying the two common bacterial causes Streptococcus pneumoniaeand Klebsiella pneumoniae was performed by Carl Friedländer and Albert Fränkel Friedländer’s initial work introduced the Gram stain, a fundamental laboratory test still used today to identify and categorize bacteria.
• Christian Gram‘s paper describing the procedure in 1884 helped to differentiate the two bacteria, and showed that pneumonia could be caused by more than one microorganism.”

I can’t think of a book to recommend to you, but there is a funny music video made by some medical students about different types of bacteria put to a Rhianna song you might recognize.

TUBERCULOSIS

“Tuberculosis causes nearly 2 million deaths every year, and WHO estimates that nearly 1 billion people will be infected between 2000 and 2020 if more effective preventive procedures are not adopted. The TB bacteria are most  often found in the lungs, where they can cause chest pain and a bad

cough that brings up bloody phlegm. Other symptoms include fatigue, weight loss, appetite loss, chills, fever, and night sweats.” (source) It is caused by Mycobacterium tuberculosis.

Childhood or pediatric tuberculosis is often unrecognized due to lack of health care and lack of education on symptoms to look for (watch this video about recognizing TB in kids). Tuberculosis has a safe haven in HIV patients, unfortunately, so eradication is difficult. Many cases of tuberculosis are also multi-drug resistant making it very difficult and expensive to treat.

 

Best Bet Treatment: Generally, a cocktail of antibiotics is administered, though this is becoming less effective as a treatment as the bacteria mutate and become resistant.

Prevention: There are several vaccines but the most common is the BCG vaccine which is only partially effective. New vaccines are constantly being tested.

Famous Scientists: The 1905 Nobel Prize in medicine and physiology went to Robert Koch for his investigations and discoveries in relation to tuberculosis. He is one of the founders of bacteriology. He discovered the anthrax disease cycle (1876) and the bacteria responsible for tuberculosis (1882) and cholera (1883)

The 1952 Nobel Prize in Medicine and Physiology went to Selman Abraham Waksman for his discovery of streptomycin, the first antibiotic effective against tuberculosis.

Book to Read: Spitting Blood: The history of tuberculosis (horrible title, very well done book!)

Of interest about India and TB is that there was an India-initiated crowd-sourced effort to map and annotate the genome of the bacteria that causes TB. In other words, effort was put in to read and evaluate the DNA sequence, hoping that if this information is freely available online, it might be of use to those who design drugs and maybe a cure could be found. Of such importance to the people of India to eradicate this disease that thousands of smart people volunteered their time to finish this project. Very impressive!

See also, Diarrheal Diseases in India and Other Diseases in India