PATHOPHYSIOLOGY

When aspiration of secretions containing microbes induced by the risk factors happens, bacteria will
begin to multiply to the lung parenchyma. Once the bacteria start to accumulate the lungs the body will
try to fight it. If the body’s status of the local defenses, and overall health of the patient is weak, the
patient may be made more susceptible to infection because of a failure of defense mechanism and because
of this there will be a total invasion of bacteria to the lower respiratory tract.

However, if the body has strong local defenses, the body will force to activate the B cells. B cells fights
bacteria and viruses call antibodies that are able to lock onto the surface of an invading cell and mark it
for destruction by other immune cells and B cells are activated when their B cell receptor (BCR) binds to
either soluble or membrane bound antigen. This activates the BCR to form micro clusters and trigger
downstream signaling cascades. The micro cluster eventually undergoes a contraction phase and forms an
immunological synapse, this allows for a stable interaction between B and T cells to provide bidirectional
activation signals.

Once activated, B cells may undergo class switch recombination. In their inactivated state B cells express
IgM/IgD but once activated they may express IgA, IgE, IgG or retain IgM expression. These are now the
antibodies that are being released to help the body to fight the bacteria. While the body tries to fight the
bacteria using these antibodies, there is an antigen-antibody reaction. Antigen-antibody reaction is a
specific chemical interaction between antibodies produced by B cells of the white blood cells
and antigens during immune reaction. During the reaction, neutrophils and cytokines are being produced.
The migration and activation of neutrophils could cause inflammation and sensitization directly or
indirectly on the airways. The airways will then secrete Goblet cells that secrete mucus on the surface of
mucous membranes of the airways. The primary function of goblet cells is to secrete mucin and create a
protective mucus layer to protect the airway wall from the inflammation caused by neutrophils.
Therefore, there will be an increase in mucos production. When there is an excessive production of mucus
in the airway there will be an occlution of the airway thus decreasing the oxygen supply of the body.

During infection, the immune cells form the antigen-antibody reaction release cytokines, Cytokines are a
broad group of signalling proteins that are produced transiently, after cellular activation, and act as
humoral regulators which modulate the functions of individual cells, and regulate processes taking place
under normal, developmental and pathological conditions. These cytokines can reach the brain by several
routes causing alteration of the brain thus leading to a change in the body functions.
The symptoms of pneumonia are caused by inflammation of the lungs due to infection or irritation. In
response, the lungs produce excessive amounts of thick phlegm, which must be coughed up in order to
keep the airways open for effective breathing. In the production of mucus, some symptoms can develop
suddenly over 24 to 48 hours, or they come on more slowly over several days. A cough may be dry, or
produce thick yellow, green, brown, or blood-stained mucus. Wheezing may occur when the bronchial
tubes inflamed and narrowed.
Crackling or bubbling arises made by movement of mucus in the tiny air sacs of the lungs. A dull thud
will be heard when the chest is tapped, which indicate that there is fluid in the lung or collapse of part of a
lung. This crackle occurs when the small air sacs in the lungs fill with blood and there’s any air
movement in the sacs, such as when breathing. It is also developed nasal flaring, which is an enlargement
of the opening of nostrils when breathing. This is cause of difficulty breathing due to the swelling and
mucus build-up in the smallest air passages in the lungs.
Mucus production will affect the occlusion of airway where in the infection causes the lung air sacs
(alveoli) to become inflamed and fill up with fluid. That can make it hard for the oxygen in breathing in to
get into the bloodstream. The breathing may be rapid and shallow and may feel breathless, even when
resting. Chest pain is developed which get worse when breathing and coughing. The lung is affected, and
it can reduce oxygen in the blood or raise the level of carbon dioxide, causing tachypnea.

In the alteration of the brain function, cytokines will send signals to the brain causing changes in the
body, this includes fever which may cause sweating, chills, flushed skin, and general discomfort. It is an
increase in temperature due to the presence of infection. Inflammatory response occurs due to the
invasion of pathogens in the respiratory tract. As the body responds to the infection, it increases the
release of cytokines that acts at the level of the organum vasculosum of the lamina terminalis in the
central nervous system, including synthesis of prostaglandins, which are the central mediators of the
coordinated responses leading to fever.
The child may also lose her appetite where in cytokines affect the hypothalamus and this may result in
feeding suppression or loss of appetite that may cause the child to experience malnutrition wherein
nutrients on the body to maintain healthy tissues and organs are deprived. The elevated cytokines cause
harmful levels of inflammation throughout the body, which disrupts normal bodily functions. The
inflammation may interfere with organ function and cause severe symptoms, this is a collection of
symptoms that can vary from fever to vomiting. These symptoms are the results of abnormally high
cytokine levels. A cyanosis occurs due to the incomplete saturation of venous blood with oxygen in the
lungs, and that the various shade of blue observed in the distal parts are caused by an admixture of
reduced hemoglobin and oxyhemoglobin in the superficial capillaries.
This is signaled by a blueish appearance to a child’s lips, nose, and fingers, which means there’s not
enough oxygen in the blood. A child with pneumonia experience gastrointestinal symptoms and has a
stomach upset such as nausea, vomiting which is due to labored breathing and coughing, and diarrhea that
may lead to dehydration caused by too much loss of fluid in the body.

COMPLICATIONS:

Pneumonia can be a life threatening illness, even without treatment, some people with pneumonia,
especially those in high risk groups, may experience complications including (Mayo Clinic, 2020):
More vulnerable to infection- Mucus contains dead cells and debris from the upper and lower respiratory
tract, trapping it ( any organism such as bacteria) so they can be coughed and cleared from the lungs, and
it is beneficial to the body, but if there is an over production of mucus it may lead to increased risk of
infection (Deborah Leader,RN, 2020)

 Hypoxemia- It is principally caused by persistence of pulmonary artery blood flow to

consolidated lung resulting in an intrapulmonary shunt, but also, to a varying degree, it is caused
by intrapulmonary oxygen consumption by the lung during the acute phase and by ventilation.
 Pleural effusion- it is an abnormal collection of fluid in the pleural space because it excessive
filtration or defective absorption of accumulated fluid. It is also referred to as “water on the
lungs”
 Lung Abscess- it is the modification of the pulmonary tissue and formulation of cavities
containing necrotic debris or fluid that is caused by microbial infection
 Sepsis- a complication when our body tries o fight off an infection, a urinary tract infection or a
gastrointestinal infection. The immune system goes into overdrive, releasing chemicals into the
bloodstream to fight infection. There will be an overgrowth of bacteria or other germs in the
bloodstream.
 Respiratory Acidosis- Failure of ventilation and an accumulation of carbon dioxide. This causes
body fluids, especially the blood, to become too acidic.
 Malnutrition- condition that develops when the body is deprived of vitamins, minerals and other
nutrients it needs to maintain healthy tissues and organ function, occurs in people who are either
undernourished or over nourished
 Dehydration- a condition caused by the loss of too much fluid from the body. It happens when
you are losing more fluids than you are taking in, and your body does not have enough fluids to
work properly.