A strong and consistence
association has been demonstrated between malnutrition, mortality from
respiratory infections; further, malnutrition is considered to be a more
important risk factor for pneumonia than for diarrhea [Victora, C. et al.,
1990] , [Berkowitz, F. 1992].
Acute
respiratory infections (ARIS) are leading cause of high mortality and morbidity
among children under 5 years of age [Graham, NMH. 1990]. They are also the most
frequent causes of health services used around the world. ARIS represent
between 30-50% of pediatric medical consultant and between 20-40% of
hospitalization in children. The risk factors to acquiring respiratory
infections are poverty, restarted family income, low parental education level,
lack of breastfeeding
and most importantly, malnutrition [Cashat-Cruz, M.; et al., 2005].
As above mentioned, the establishment of malnutrition
depends on the cause and duration of the any nutritional deficiency. It can be
caused secondarily, by increases in demand of nutrients [.Gomez, F ; et al.,
1986]
The infection nutritional may Be either aggravating a
previously existing deficient nutritional status or triggering malnutrition
through diseases pathogenesis [Borelli , p,;
et al., 2004]. It has been
demonstrated that certain infectious diseases cause malnutrition. These diseases cause a reduction in food
intake. One example of how respiratory infection can contribute to malnutrition
is that chronic infections may because Cachexia [Melenctez, G. (accesed on 31 January 2011]. The respiratory
infections, as pneumonia, occurs more frequently during the first 24-36 months
of life when immunocompetence is impaired and when a child are first being
exposed to pathogens. The stimulation of an immune response by respiratory
infection increases the demand for metabolically derived anabolic energy, this
lead to adverse nutritional status. Moreover, a respiratory infection itself
can cause a less of critical body stores of protein and energy. During an
immune response, energy expenditures increases at the same time that the
infected host experiences a decreases in nutrient intake [Brown, K. H. 2003].
Additionally, negative nitrogen balance occurs after induced increases nitrogen
excretion [Wumore, D. W. 1999] ,
[Powanda, M. C.; 2003].
During an
infection, negative nitrogen balances occur after fever induction and the it
increases and persist for days to weeks after the fabric phase. Therefore the
malnutrition maybe a consequence of repeated respiration infections, common in
young children [Cunba, A. L. 2000].
The incidence of streptococcus pneumonia in children
younger than 5 years of age in developing countries varies greatly [Cashat-Cruz
M.; et al., 2005]. In developing countries more than 8,
795 million children die each year. In 2008, more than 5, 970 million children
died due to infectious diseases; approximately 18% (1,575 million) of these
deaths were caused by pneumonia [Black, R. E.; et al., 2010]. In contrast, other data show that there
are more than 9 million deaths among children under the age of five globally
each year of which about three million deaths are due to pneumonia [Mpndal, D.;
et
al., 2009], [ Bryce, J.; et al., 2005]. Regardless of the total number, the
majority of ARi-related deaths occur in developing countries. Although these
numbers represent the most rigorous estimate of child deaths caused by S. Pneumonia,
they are probably an under estimate [O’ Brien, et al., 2009].
In America,
approximately 100,000 deaths per year caused by ARI in children less than 1
year of age have been reported since the 1980s. Five countries contributed to
85% of these deaths. Brazil
(40%). Mexico (19%), Peru
(14%), Bolivla (7%) and Halta (5%). The Pan American Health Organization (PAHO)
estimates that the percentage of deaths attributed to ARi varies from 2% too
16%. Meanwhile in countries such as Canada
and United States,
the percentage of deaths attributed to ARi in this age group is 2%
[Cashat-Cruz, M.; et al., 2005].
Childhood clinical pneumonia is caused by combination of
risk factors related to the host, the environment and infectious agent [Rudan,
I: et al.,
2008]. In developing countries, identifying the etiology is difficult,
and WHO recommends diagnosing pneumonia based on clinical parameters. However,
based on available evidence, several studies have identified Streptococcus pneumoniae and Haemophilus
influenzae as the most important
pathogens associated with childhood pneumonia [Selwyn, B. J. 1990,], [Bemnan, S. 1991].
Further, Staphylococcus
aureus, and Klebsiella pneumoniae
have also been linked to cases of severe pneumonia [Sham, F. 1986].
In
microbiologic studies, Streptoccous
penumonlae has been identified in 30-3% of pneumonia
cases and H. Influenza type bin 10-30% of cases. S. aureus and K. penumponiae were the next most
prevalent etiologic agent pneumonia [Rudan, I.;
et al., 2008]. However, with the
increased use of penumoncoccal and influenza type b vaccines in the developing
countries, it is likely that these pathogens will become relatively less
important as causative agents of pneumonia [Chisti, M. J. et al., 2009]. Bacteria pathogens in children with pneumonia in
developing countries obtained form several studies are shown in figures.
Figure 5: Agent pathogens
in children with pneumonia and several malnutrition in developing countries
Adopted from Chirsti et al [Christi, M. J.; Tebruegge, M.; et al., 2009].
Kleibesella spp = 26%
S. aureus = 25%
S. pneumoniae = 18%
E. coli = 8%
H. influemae = 8%
Satmonella spp = 5%
Other = 10%
Strepcoccus pneumoniae is a leading cause of bacteria
pneumonia, meminglitis, and sepsis in children worldwide, pneumococcal disease
is preceded by asympomatic nacopharyngeal colonization, which is especially
high in children. The natural route of infection with S. pneumoniae starts with colonization, which may progress to
invasive disease if immunological barriers are crossed [Bogaert, D.t. et al., 2004].
Heamphilus influenzae types b (Hib) is mostly an optunistic
pathogen that causes invasive infections, such as pneumonia in children under 5
years of age. The incidence of Hib pneumonia and Hib invasive disease in
children younger than the age 8 years in developing countries is 7 and 21-60
per 100,000 per year, respectively [Silvermen, M.; et al., 1977],[
Halfon-Yaniv, I.; et al., 1990]. Rudan equal [Rudan, I.;
et
al., 2008]
Up to two-thirds of malnourished children that are hospitalized
are diagnosed with pneumonia [Slimless, D.; and Lulseged, S. 1994], generally the ethiologic agent S. pneumoniae.
Despite the
availability of antibiotics, mortality rates remain high especially in high
–risk groups like malnourished children (Hammerschmidt, S.; et al., 1999]. Pneumonia is common in
malnourished is frequently associated with fatal outcome [Loeb, M.; 2005],
especially in malnourished children younger than 24 months of age [Tupasi, T.
E.; et al., 1988]. Although as are
caused by acute variety of bacterial agents, studies consistently reported a
two-to three fold greater risk of mortality associated with malnutrition [Rice,
A. L.; et al., 2000]. Therefore, pneumonia and malnutrition
are two of the biggest killers in childhood disease [Chisti M. J.; et al.,
2009].
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