{{infobox disease | name	Pneumonia | Image PneumonisWedge09.JPG | Caption A chest X-ray showing a very prominent wedge-shaped bacterial pneumonia in the right lung. | Alt A Xray showing a white wedge in the right lung field of a chest X-ray. | DiseasesDB 10166 | ICD10 , , , , , , , | ICD9 -, | ICDO | OMIM | MedlinePlus 000145 | eMedicineSubj search | eMedicineTopic pneumonia | MeshID D011014 }}

Pneumonia is an inflammatory condition of the lung, especially of the alveoli (microscopic air sacs in the lungs), associated with fever, chest symptoms, and consolidation on a chest radiograph. Pneumonia is typically caused by an infection but there are a number of non infectious causes. Infectious agents include: bacteria, viruses, fungi, and parasites.

Typical symptoms include cough, chest pain, fever, and difficulty breathing. Diagnostic tools include x-rays and examination of the sputum. Vaccines to prevent certain types of pneumonia are available. Treatment depends on the underlying cause with presumed bacterial pneumonia being treated with antibiotics.

Although pneumonia was regarded by William Osler in the 19th century as "the captain of the men of death", the advent of antibiotic therapy and vaccines in the 20th century have seen radical improvements in survival outcomes. Nevertheless, in the third world, and among the very old, the very young and the chronically ill, pneumonia remains a leading cause of death.

Classification

Pneumonitis refers to lung inflammation; pneumonia refers to pneumonitis, usually due to infection but sometimes non infectious, that has the additional feature of pulmonary consolidation. Pneumonia can be classified in several ways. It is most commonly classified by where or how it was acquired (community-acquired, aspiration, healthcare-associated, hospital-acquired, and ventilator-associated pneumonia), but may also be classified by the area of lung affected (lobar pneumonia, bronchial pneumonia and acute interstitial pneumonia), or by the causative organism. Pneumonia in children may additionally be classified based on signs and symptoms as non-severe, severe, or very severe.

Signs and symptoms

People with infectious pneumonia often have a productive cough, fever accompanied by shaking chills, shortness of breath, sharp or stabbing chest pain during deep breaths, confusion, and an increased respiratory rate. In the elderly, confusion may be the most prominent symptom. The typical symptoms in children under five are fever, cough, and fast or difficult breathing. Fever, however, is not very specific, as it occurs in many other common illnesses, and may be absent in those with severe disease or malnutrition. Additionally, a cough is frequently absent in children less than 2 months old. More severe symptoms may include: central cyanosis, decreased thirst, convulsions, persistent vomiting, or a decreased level of consciousness.

{|class="wikitable" align="right" !colspan=2| Symptoms frequency in pneumonia |- ! Symptom !! Frequency |- | Cough ||

79-91% |- | Fatigue || 90% |- | Fever || 71-75% |- | Shortness of breath || 67-75% |- | Sputum || 60-65% |- | Chest pain || 39-49% |- |} Some causes of pneumonia are associated with classic, but none specific, clinical characteristics. Pneumonia caused by ''Legionella'' may occur with abdominal pain, diarrhea, or confusion, while pneumonia caused by ''Streptococcus pneumoniae'' is associated with rusty colored sputum, and pneumonia caused by ''Klebsiella'' may have bloody sputum often described as "currant jelly".

Physical examination may sometimes reveal low blood pressure, a high heart rate, or a low oxygen saturation. Struggling to breathe, confusion, and blue-tinged skin are signs of a medical emergency. Findings from physical examination of the lungs may be normal, but often show decreased expansion of the chest on the affected side. Harsher sounds from the larger airways transmitted through the inflamed lung are heard as bronchial breathing on auscultation with a stethoscope. Rales (or crackles) may be heard over the affected area during inspiration. Percussion may be dulled over the affected lung, and increased, rather than decreased, vocal resonance distinguishes pneumonia from a pleural effusion. Because some of these signs are subjective, physical examination alone is insufficient to diagnose or rule out pneumonia.

Cause

Pneumonia is primarily due to infections, with less common causes including irritants and the unknown. Although more than one hundred strains of micro organism can cause pneumonia, only a few are responsible for most cases. The most common infectious causes are viruses and bacteria with less common being fungi and parasites. Mixed infections with both viruses and bacterial may occur in up to 45% of infections in children and 15% of infections in adults. The term pneumonia is sometimes more broadly applied to inflammation of the lung (for example caused by autoimmune disease, chemical burns or drug reactions), but this is more accurately referred to as pneumonitis.

Viruses

In adults viruses account for approximately a third of pneumonia cases. Commonly implicated agents include: rhinoviruses, coronaviruses, influenza virus, respiratory syncytial virus (RSV), adenovirus, and parainfluenza. Herpes simplex virus is a rare cause of pneumonia, except in newborns. People with weakened immune systems are at increased risk of pneumonia caused by cytomegalovirus (CMV).

Bacteria

Bacteria are the most common cause of community acquired pneumonia, with ''Streptococcus pneumoniae'' isolated in nearly 50% of cases. Other commonly isolated bacteria include: ''Haemophilus influenzae'' in 20%, ''Chlamydophila pneumoniae'' in 13%, and Mycoplasma pneumoniae in 3%.

Another important Gram-positive cause of pneumonia is ''Staphylococcus aureus'', and ''Streptococcus agalactiae'' is an important cause of pneumonia in newborn babies. Gram-negative bacteria cause pneumonia less frequently than gram-positive bacteria. Some of the gram-negative bacteria that cause pneumonia include ''Haemophilus influenzae'', ''Klebsiella pneumoniae'', ''Escherichia coli'', ''Pseudomonas aeruginosa'' and ''Moraxella catarrhalis''. These bacteria often live in the stomach or intestines, and may enter the lungs if vomit is inhaled. "Atypical" bacteria which cause pneumonia include ''Chlamydophila pneumoniae'', ''Mycoplasma pneumoniae'', and ''Legionella pneumophila''.

Fungi

Fungal pneumonia is uncommon, but it may occur in individuals with weakened immune systems due to AIDS, immunosuppressive drugs, or other medical problems. The pathophysiology of pneumonia caused by fungi is similar to that of bacterial pneumonia. Fungal pneumonia is most often caused by ''Histoplasma capsulatum'', blastomyces, ''Cryptococcus neoformans'', ''Pneumocystis jiroveci'', and ''Coccidioides immitis''. Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis is most common in the southwestern United States.

Parasites

A variety of parasites can affect the lungs. These parasites typically enter the body through the skin or the mouth. Once inside the body, they travel to the lungs, usually through the blood. In parasitic pneumonia, as with other kinds of pneumonia, a combination of cellular destruction and immune response causes disruption of oxygen transportation. One type of white blood cell, the eosinophil, responds vigorously to parasite infection. Eosinophils in the lungs can lead to eosinophilic pneumonia, thus complicating the underlying parasitic pneumonia. The most common parasites causing pneumonia are ''Toxoplasma gondii'', ''Strongyloides stercoralis'', and ''Ascariasis''.

Idiopathic

Idiopathic interstitial pneumonia or noninfectious pneumonia are a class of diffuse lung diseases. They include: diffuse alveolar damage, organizing pneumonia, nonspecific interstitial pneumonia, lymphocytic interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis interstitial lung disease, and usual interstitial pneumonia.

Pathophysiology

Viral

Viruses invade cells in order to reproduce. Typically, a virus reaches the lungs when airborne droplets are inhaled through the mouth or nose. Once in the lungs, the virus invades the cells lining the airways and alveoli. This invasion often leads to cell death, either from damage to the cell by the virus, or from a protective process called apoptosis in which the infected cell destroys itself before it can be used as a conduit for virus reproduction. When the immune system responds to the viral infection, even more lung damage occurs. White blood cells, mainly lymphocytes, activate certain chemical cytokines which allow fluid to leak into the alveoli. This combination of cell destruction and fluid-filled alveoli interrupts the normal transportation of oxygen into the bloodstream.

As well as damaging the lungs, many viruses affect other organs and thus disrupt many body functions. Viruses can also make the body more susceptible to other bacterial infections; in this way bacterial pneumonia can arrise as a co-morbid condition.

Bacterial

Bacteria typically enter the lung when airborne droplets are inhaled, but can also reach the lung through the bloodstream when there is an infection in another part of the body. Many bacteria live in parts of the upper respiratory tract, such as the nose, mouth and sinuses, and can easily be inhaled into the alveoli. Once inside, bacteria may invade the spaces between cells and between alveoli through connecting pores. This invasion triggers the immune system to send neutrophils, a type of defensive white blood cell, to the lungs. The neutrophils engulf and kill the offending organisms, and also release cytokines, causing a general activation of the immune system. This leads to the fever, chills, and fatigue common in bacterial and fungal pneumonia. The neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli and interrupt normal oxygen transportation.

Diagnosis

Pneumonia is typically diagnosed based on a combination of physical signs and a chest X-ray. Confirming the underlying cause can be difficult, however, with no definitive test able to distinguish between bacterial and not-bacterial origin. The World Health Organization has defined pneumonia in children clinically based on a either a cough or difficulty breathing and a rapid respiratory rate, chest indrawing, or a decreased level of consciousness. A rapid respiratory rate is defined as greater than 60 breaths per minute in children under 2 months old, 50 breaths per minute in children two months to one year old, or greater than 40 breaths per minute in children one to five years old. In children, an increased respiratory rate and lower chest indrawing are more sensitive than hearing chest crackles with a stethoscope.

Investigations are generally not needed in mild cases. In those requiring admission to a hospital, pulse oximetry, chest radiography, and blood tests including a complete blood count, serum electrolytes, C-reactive protein, and possibly liver function tests are recommended.

Imaging

A chest radiograph is frequently used in diagnosis. In people with mild disease imaging is only be needed in those with potential complications, those who have not improved with treatment, or those in which the cause in uncertain. If a person is sufficiently sick to require hospitalization, a chest radiograph is recommended. Findings do not always correlate with severity of disease and do not reliably distinguish between bacterial versus viral infection.

X-ray signs of bacterial community acquired pneumonia classically show lung consolidation of one lung segmental lobe. However, radiographic findings may be variable, especially in other types of pneumonia. Aspiration pneumonia may present with bilateral opacities primarily in the bases of the lungs and on the right side. Radiographs of viral pneumonia cases may appear normal, hyper-inflated, have bilateral patchy areas, or present similar to bacterial pneumonia with lobar consolidation. A CT scan can give additional information in indeterminate cases.

Microbiology

For people managed in the community figuring out the causative agent is not cost effective, and typically does not alter management. For those who do not respond to treatment, sputum culture should be considered, and culture for ''Mycobacterium tuberculosis'' should be carried out in those with a chronic productive cough. Testing for other specific organisms may be recommended during outbreaks, for public health reasons. In those who are hospitalized for severe disease both sputum and blood cultures are recommended. Viral infections can be confirmed via detection of either the virus or its antigens with culture or polymerase chain reaction (PCR) among other techniques. With routine microbiological testing a causative agent is determined in only 15% of cases.

Differential diagnosis

Several diseases can present similar to pneumonia, including: chronic obstructive pulmonary disease (COPD), asthma, pulmonary edema, bronchiectasis, lung cancer and pulmonary emboli. Unlike pneumonia, asthma and COPD typically present with wheezing, pulmonary edema presents with an abnormal electrocardiogram, cancer and bronchiectasis present with a cough of longer duration, and pulmonary emboli presents with acute onset sharp chest pain and shortness of breath.

Prevention

Prevention includes vaccination, environmental measures, and appropriately treating other diseases.

Vaccination

Vaccination is effective for preventing certain bacterial and viral pneumonias in both children and adults.

Influenza vaccines are modestly effective against influenza A and B. The Center for Disease Control and Prevention (CDC) recommends that everyone 6 months and older get yearly vaccination. When an influenza outbreak is occurring, medications such as amantadine, rimantadine, zanamivir, and oseltamivir can help prevent influenza.

Vaccinations against ''Haemophilus influenzae'' and ''Streptococcus pneumoniae'' in the first year of life have greatly reduced the role these bacteria play in causing pneumonia in children. Vaccinating children against ''Streptococcus pneumoniae'' has also led to a decreased incidence of these infections in adults, because many adults acquire infections from children. Hib vaccine is now widely used around the globe. A vaccine against ''Streptococcus pneumoniae'' is also available for adults, and has been found to decrease the risk of invasive pneumococcal disease.

Environmental

Reducing indoor air pollution is recommended as is smoking cessation.

Other

Appropriately treating underlying illnesses (such as AIDS) can decrease a person's risk of pneumonia.

There are several ways to prevent pneumonia in newborn infants. Testing pregnant women for Group B Streptococcus and ''Chlamydia trachomatis'', and giving antibiotic treatment, if needed, reduces pneumonia in infants. Suctioning the mouth and throat of infants with meconium-stained amniotic fluid decreases the rate of aspiration pneumonia.

Management

{|class="wikitable" align="right" |- !colspan=2| CURB-65 |- ! Symptom !! Points |- | Confusion ||1 |- | Urea>7mmol/l ||1 |- | Respiratory rate>30 ||1 |- | SBP<90mmHg, DBP<60mmHg||1 |- | Age>=65 ||1 |- |} Typically, oral antibiotics, rest, and fluids are sufficient for complete resolution. However, those with other medical conditions, the elderly, or those with significant trouble breathing may require more advanced care. If the symptoms worsen, the pneumonia does not improve with home treatment, or complications occur, hospitalization may be required. Worldwide, approximately 7-13% of cases in children result in hospitalization while in the developed world between 22-42% of adults with community acquired pneumonia are admitted. The CURB-65 score is useful for determining the need for admission. If the score is 0 or 1 people can typically be managed at home, if it is 2 a short hospital stay or close follow up is needed, if it is 3-5 hospitalization is recommended. The utility of chest physiotherapy in pneumonia has not yet been determined. Over the counter cough medicine has not been found to be effective.

Bacterial

Antibiotics improve outcomes in those with bacterial pneumonia. Initially antibiotic choice depends on the characteristics of the person affected, such as age, underlying health, and the location the infection was acquired. In the UK empiric treatment is usually with amoxicillin, erythromycin, or azithromycin for community-acquired pneumonia. In North America, where the "atypical" forms of community-acquired pneumonia are becoming more common, macrolides (such as azithromycin), and doxycycline have displaced amoxicillin as first-line outpatient treatment. The use of fluoroquinolones in uncomplicated cases is discouraged due to concerns of side effects and resistance. The duration of treatment has traditionally been seven to ten days, but there is increasing evidence that short courses (three to five days) are similarly effective. Antibiotics recommended for hospital-acquired pneumonia include third- and fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, and vancomycin. These antibiotics are often given intravenously, and may be used in combination.

Viral

Neuraminidase inhibitors may be used to treat viral pneumonia caused by influenza viruses (influenza A and influenza B). No specific antiviral medications are recommended for other types of community acquired viral pneumonias including SARS coronavirus, adenovirus, hantavirus, and parainfluenza virus. Influenza A may be treated with rimantadine or amantadine, while influenza A or B may be treated with oseltamivir, zanamivir or peramivir. These are of most benefit if they are started within 48 hours of the onset of symptoms. Many strains of H5N1 influenza A, also known as avian influenza or "bird flu," have shown resistance to rimantadine and amantadine. The use of antibiotics in viral pneumonia is recommended by some experts as it is impossible to rule out a complicating bacterial infection. The British Thoracic Society recommends that antibiotics be withheld in those with mild disease. The use of corticosteroids is controversial.

Aspiration

There is no evidence to support the use of antibiotics in chemical pneumonitis without bacterial superinfection. If infection is present in aspiration pneumonia, the choice of antibiotic will depend on several factors, including the suspected causative organism and whether pneumonia was acquired in the community or developed in a hospital setting. Common options include clindamycin, a combination of a beta-lactam antibiotic and metronidazole, or an aminoglycoside. Corticosteroids are commonly used in aspiration pneumonia, but there is no evidence to support their effectiveness.

Prognosis

With treatment, most types of bacterial pneumonia can be cleared within two to four weeks and mortality is very low. Viral pneumonia may last longer, and mycoplasmal pneumonia may take four to six weeks to resolve completely. The eventual outcome of an episode of pneumonia depends on how ill the person is when he or she was first diagnosed. Before the advent of antibiotics mortality was typically 30% for hospitalized patients.

In the United States, about 5% of those diagnosed with pneumococcal pneumonia will die. In cases where the pneumonia progresses to blood infection, just over 20% will die.

The death rate (or mortality) also depends on the underlying cause of the pneumonia. Pneumonia caused by ''Mycoplasma'', for instance, is associated with lower mortality. However, about half of the people who develop methicillin-resistant ''Staphylococcus aureus'' (MRSA) pneumonia while on a ventilator will die. In regions of the world without advanced health care systems, pneumonia is even more deadly. Limited access to clinics and hospitals, limited access to x-rays, limited antibiotic choices, and inability to diagnose and treat underlying conditions inevitably lead to higher rates of death from pneumonia. For these reasons, the majority of deaths in children under five due to pneumococcal disease occur in developing countries.

Adenovirus can cause severe necrotizing pneumonia in which all or part of a lung has increased translucency radiographically, which is called Swyer-James Syndrome. Severe adenovirus pneumonia also may result in bronchiolitis obliterans, a subacute inflammatory process in which the small airways are replaced by scar tissue, resulting in a reduction in lung volume and lung compliance. Sometimes pneumonia can lead to additional complications. Complications are more frequently associated with bacterial pneumonia than with viral pneumonia. The most important complications include respiratory and circulatory failure and pleural effusions, empyema or abscesses.

Clinical prediction rules

Clinical prediction rules have been developed to more objectively prognosticate outcomes in pneumonia. Although these rules are often used in deciding whether or not to hospitalize the person, they were derived simply to inform on prognosis; neither index was designed or tested as guide to determine whether the person would benefit by hospital admission. Pneumonia severity index (or ''PORT Score'') – online calculator CURB-65 score, which takes into account the severity of symptoms, any underlying diseases, and age – online calculator

Pleural effusion, empyema, and abscess

In pneumonia, a collection of fluid (pleural effusion) often forms in the space that surrounds the lung (the pleural cavity). Occasionally, microorganisms will infect this fluid, causing what is called an empyema. To distinguish an empyema from the more common simple parapneumonic effusion, the fluid is collected with a needle (thoracentesis), and examined. If this shows evidence of empyema, complete drainage of the fluid may be necessary, often requiring a chest tube. In severe cases of empyema, surgery may be needed. If the infected fluid is not drained, the infection may persist, because antibiotics do not penetrate well into the pleural cavity. If the fluid is sterile, it need only be drained if it is causing symptoms or remains unresolved.

Rarely, bacteria in the lung will form a pocket of infected fluid called a lung abscess. Lung abscesses can usually be seen with a chest x-ray or chest CT scan. Abscesses typically occur in aspiration pneumonia, and often contain several types of bacteria. Antibiotics are usually adequate to treat a lung abscess, but sometimes the abscess must be drained by a surgeon or radiologist.

Respiratory and circulatory failure

Because pneumonia affects the lungs, people with pneumonia often have difficulty breathing, sometimes to the point where mechanical assistance is required. Non-invasive breathing assistance may be helpful, such as with a bi-level positive airway pressure machine. In other cases, placement of an endotracheal tube (breathing tube) may be necessary, and a ventilator may be used to help the person breathe.

Pneumonia can also cause respiratory failure by triggering acute respiratory distress syndrome (ARDS), which results from a combination of infection and inflammatory response. The lungs quickly fill with fluid and become very stiff. This stiffness, combined with severe difficulties extracting oxygen due to the alveolar fluid, creates a need for mechanical ventilation.

Sepsis and septic shock are potential complications of pneumonia. Sepsis occurs when microorganisms enter the bloodstream and the immune system responds by secreting cytokines. Sepsis most often occurs with bacterial pneumonia; ''Streptococcus pneumoniae'' is the most common cause. Individuals with sepsis or septic shock need hospitalization in an intensive care unit. They often require intravenous fluids and medications to help keep their blood pressure up. Sepsis can cause liver, kidney, and heart damage, among other problems, and it is often fatal.

Epidemiology

thumb|[[Age adjustment|Age-standardized death from lower respiratory tract infections per 100,000 inhabitants in 2004. ]]

Pneumonia is a common illness affecting approximately 450 million people a year and occurring in all parts of the world. It is a major cause of death among all age groups resulting in 4 million deaths (7% of the world's yearly total). Rates are greatest in children less than five, and adults older than 75 years of age. It occurs about five times more frequently in the developing world versus the developed world. Viral pneumonia accounts for about 200 million cases.

Children

In 2008 pneumonia occurred in approximately 156 million children (151 million in the developing world and 5 million in the developed world). It resulted in 1.6 million deaths, or 28–34% of all deaths in those under five years of age, of which 95% occurred in the developing world. Countries with the greatest burden of disease include: India (43 million), China (21 million) and Pakistan (10 million). It is the leading cause of death among children in low income countries. Many of these deaths occur in the newborn period. The World Health Organization estimates that one in three newborn infant deaths are due to pneumonia. Approximately half of these deaths are theoretically preventable, as they are caused by the bacteria for which an effective vaccine is available.

History

Pneumonia has been a common disease throughout human history. The symptoms were described by Hippocrates (c. 460 BC – 370 BC): "Peripneumonia, and pleuritic affections, are to be thus observed: If the fever be acute, and if there be pains on either side, or in both, and if expiration be if cough be present, and the sputa expectorated be of a blond or livid color, or likewise thin, frothy, and florid, or having any other character different from the common... When pneumonia is at its height, the case is beyond remedy if he is not purged, and it is bad if he has dyspnoea, and urine that is thin and acrid, and if sweats come out about the neck and head, for such sweats are bad, as proceeding from the suffocation, rales, and the violence of the disease which is obtaining the upper hand." However, Hippocrates referred to pneumonia as a disease "named by the ancients." He also reported the results of surgical drainage of empyemas. Maimonides (1138–1204 AD) observed "The basic symptoms which occur in pneumonia and which are never lacking are as follows: acute fever, sticking [pleuritic] pain in the side, short rapid breaths, serrated pulse and cough." This clinical description is quite similar to those found in modern textbooks, and it reflected the extent of medical knowledge through the Middle Ages into the 19th century.

Bacteria were first seen in the airways of individuals who died from pneumonia by Edwin Klebs in 1875. Initial work identifying the two common bacterial causes ''Streptococcus pneumoniae'' and ''Klebsiella pneumoniae'' was performed by Carl Friedländer and Albert Fränkel in 1882 and 1884, respectively. 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 differentiate the two different bacteria, and showed that pneumonia could be caused by more than one microorganism.

Sir William Osler, known as "the father of modern medicine," appreciated the death and disability cause by pneumonia, describing it as the "captain of the men of death" in 1918, as it had overtaken tuberculosis as one of the leading causes of death in this time. This phrase was originally coined by John Bunyan in reference to "consumption" (tuberculosis). Osler also described pneumonia as "the old man's friend" as death was often quick and painless when there was many slower more painful ways to die.

Several developments in the 1900s improved the outcome for those with pneumonia. With the advent of penicillin and other antibiotics, modern surgical techniques, and intensive care in the twentieth century, mortality from pneumonia, which had approached 30%, dropped precipitously in the developed world. Vaccination of infants against ''Haemophilus influenzae'' type B began in 1988 and led to a dramatic decline in cases shortly thereafter. Vaccination against ''Streptococcus pneumoniae'' in adults began in 1977, and in children in 2000, resulting in a similar decline.

Society and culture

Because of the combination of a very high burden of disease in developing countries and a relatively low awareness of the disease in industrialized countries, the global health community has declared November 12 to be World Pneumonia Day, a day for concerned citizens and policy makers to take action against the disease.

References

* Category:Infectious diseases Category:Respiratory and cardiovascular disorders specific to the perinatal period

am:ኒሞንያ ar:ذات الرئة an:Pneumonía az:Ağciyər iltihabı bn:নিউমোনিয়া be:Пнеўманія be-x-old:Пнэўманія bs:Upala pluća bg:Пневмония ca:Pneumònia cs:Zápal plic cy:Niwmonia da:Lungebetændelse pdc:Bruschtfiewer de:Lungenentzündung dv:ނިއުމޯނިޔާ et:Kopsupõletik el:Πνευμονία es:Neumonía eo:Pneŭmonito eu:Pneumonia fa:سینه‌پهلو fr:Pneumonie gl:Pneumonía ko:폐렴 hi:निमोनिया hr:Pneumonija io:Pulmonito id:Radang paru-paru is:Lungnabólga it:Polmonite he:דלקת ריאות kk:Алаөкпе rn:Umusonga ku:Sîyê sokan la:Pneumonia lv:Pneimonija lb:Longenentzündung lt:Plaučių uždegimas hu:Tüdőgyulladás mk:Пневмонија ml:ന്യുമോണിയ ms:Paru-paru berair nl:Longontsteking ne:न्युमोनिया new:निमोनिया ja:肺炎 no:Lungebetennelse nn:Lungebetennelse oc:Pneumònia pnb:نمونیہ ps:نېمونيا pl:Zapalenie płuc pt:Pneumonia ro:Pneumonie ru:Пневмония sq:Pneumonia scn:Purmunìa si:නියුමෝනියාව simple:Pneumonia sl:Pljučnica sr:Упала плућа sh:Upala pluća fi:Keuhkokuume sv:Lunginflammation tl:Pulmonya ta:நுரையீரல் அழற்சி te:న్యుమోనియా th:โรคปอดบวม tr:Zatürre uk:Пневмонія vi:Viêm phổi wa:Peumoneye war:Pneumonia wuu:肺炎 yi:לונגען אנטצינדונג bat-smg:Plautiu oždegėms zh:肺炎

name	Lawrence (Larry) Brilliant
birth date	May 05, 1944
birth place	Detroit, Michigan, USA
residence	USA
field	medical doctor, epidemiologist, technologist, author and philanthropist
alma mater	MPH - University of Michigan M.D. - Wayne State University School of Medicine
known for	one of the leaders of the successful World Health Organization (WHO) smallpox eradication program.
footnotes	}}

Lawrence "Larry" Brilliant is an American physician, epidemiologist, technologist, author, and the former director of Google's philanthropic arm Google.org. Brilliant, a technology patent holder, has been CEO of two public companies and other venture backed start ups. From 1973 to 1976, he participated in the successful World Health Organization (WHO) smallpox eradication program. In April 2009, he was chosen to oversee the "Skoll Urgent Threats Fund" established by eBay co-founder Jeff Skoll.

Early life

Born in Detroit, Michigan (May 5, 1944), he received his undergraduate training as well as his MPH degree (Masters in Public Health) from the University of Michigan, where he worked on the staff of the Gargoyle Humor Magazine, and his M.D. from Wayne State University School of Medicine. He moved to California for his internship at the California Pacific Medical Center, and developed thyroid cancer from which he recovered. Brilliant is board certified in preventive medicine and public health.

In 1969, a group of American Indians from many different tribes, calling themselves Indians of All Tribes, occupied the Alcatraz island in San Francisco. A call went out for doctors to help a pregnant woman there give birth and Brilliant joined their occupation as unofficial doctor.

Career

After the US government forced the Indians of All Tribes off Alcatraz, Brilliant became a media darling which led to a movie company casting him in Medicine Ball Caravan—a sequel to the hit Woodstock Nation—playing a doctor in a film about a tribe of hippies who follow the Grateful Dead, Jefferson Airplane, Jethro Tull, and Joni Mitchell. The cast was paid with airline tickets to India. Brilliant and some others cashed their tickets in and rented a bus to drive around Europe, which then turned into a relief convoy to help victims of the 1970 Bhola cyclone in Bangladesh (then East Pakistan).

Civil unrest stopped the relief caravan so he spent several years in India studying at a Himalayan ashram with Neem Karoli Baba (a Hindu sage) from whom he received the name Subramanyum. After about a year Neem Karoli Baba told Brilliant to eradicate smallpox on which he would spend the next several years. He participated, as a medical officer, in the World Health Organization (WHO) smallpox eradication program that in 1980 certified the global eradication of smallpox.

When he returned to the United States, he became a professor of international health at the University of Michigan as well as starting numerous charitable and business ventures. He spent the first half of 2005 as a volunteer helping out in the tsunami in Sri Lanka and working in India with WHO in the campaign to eradicate polio.

December, 1978 – Co-founder and chairman of Seva, an International, non-profit, health foundation. Seva's projects in Tibet, Nepal, India, Bangladesh, Cambodia, Tanzania, Mexico and Guatemala have given back sight to more than 2 million blind people through surgery, self sufficient eye care systems, and low cost manufacturing of intraocular lenses. One important contribution of his was his helping to set up the Aravind Eye Hospital in Madurai, India.

1985 – He co-founded, with Stewart Brand, The Well, a prototypic online community that has been the subject of multiple books and studies. ''Time magazine'' said, "Well was a huge hit, a precursor of every online business from Amazon.com to eBay." July 2006 – He was awarded the TED Prize, granting him $100,000 and 'One Wish to Change the World' which he presented at TED in July 2006. As his prize nominator summed up, "'Dr. Brilliant' is a name to live up to, and he has." His one wish that he presented at the conference was, "To build a powerful new early warning system to protect our world from some of its worst nightmares." 22 February 2006 – Google Inc. appointed him as the Executive Director of Google.org, the philanthropic arm of Google, a position which he held until April, 2009.

Personal life

Brilliant is married to Girija (formerly Elaine) and has three children: Joe, Jon, and Iris. Girija holds a PhD in public health administration and is an equal partner in many of her husband's enterprises. Co-founder of Seva Foundation, she was instrumental in the World Health Organization's smallpox eradication program.

Film

Brilliant acted as an extra in the 1971 Bollywood movie ''Hare Rama Hare Krishna'', which depicts hippie culture. He said, "When shooting for the song sequence 'Dum Maro Dum' (which glorifies smoking marijuana), Dev Anand was looking for certain types of foreigners..."

References

External links

Are Social Entrepreneurs Heroes? Larry Brilliant on BBC The Forum

TED Prize Wish: Larry Brilliant wants to stop pandemics at TED in 2006

TED Talks: Larry Brilliant makes the case for optimism at TED in 2007

The Seva Foundation, Founded by Larry Brilliant

Video on the founding of the Seva Foundation.

Category:1944 births Category:Living people Category:American physicians Category:Epidemiologists Category:World Health Organization officials Category:Google employees Category:American philanthropists Category:American businesspeople Category:University of Michigan alumni Category:Wayne State University alumni Category:People from Detroit, Michigan Category:Converts to Hinduism

fr:Larry Brilliant id:Larry Brilliant it:Larry Brilliant ja:ラリー・ブリリアント