title: Canary Islands

text: The regional executive body, the Parliament of the Canary Islands, is presided over by Ángel Víctor Torres (PSOE), the current President of the Canary Islands. The latter is invested by the members of the regional legislature, the Parliament of the Canary Islands, that consists of 70 elected legislators. The last regional election took place in May 2019.


title: Canary Islands

text: The islands have 14 seats in the Spanish Senate. Of these, 11 seats are directly elected (3 for Gran Canaria, 3 for Tenerife, and 1 each for Lanzarote (including La Graciosa), Fuerteventura, La Palma, La Gomera and El Hierro) while the other 3 are appointed by the regional legislature.


title: Canary Islands

text: The Autonomous Community of the Canary Islands consists of two provinces ("provincias"), Las Palmas and Santa Cruz de Tenerife, whose capitals (Las Palmas de Gran Canaria and Santa Cruz de Tenerife) are capitals of the autonomous community. Each of the seven major islands is ruled by an island council named "Cabildo Insular". Each island is subdivided into smaller municipalities ("municipios"); Las Palmas is divided into 34 municipalities, and Santa Cruz de Tenerife is divided into 54 municipalities.


title: Canary Islands

text: The international boundary of the Canaries is one subject of dispute in the Morocco Spain relations. Moreover, in 2022 the UN has declared the Canary Island's territorial waters as Moroccan coast and Morocco has authorised gas and oil exploration in what the Canary Islands states to be Canarian territorial waters and Western Sahara waters. Morocco's official position is that international laws regarding territorial limits do not authorise Spain to claim seabed boundaries based on the territory of the Canaries, since the Canary Islands enjoy a large degree of autonomy. In fact, the islands do not enjoy any special degree of autonomy as each one of the Spanish regions is considered an autonomous community with equal status to the European ones.


title: Canary Islands

text: There are some pro-independence political parties, like the National Congress of the Canaries (CNC) and the Popular Front of the Canary Islands, but their popular support is almost insignificant, with no presence in either the autonomous parliament or the "cabildos insulares". According to a 2012 study by the Centro de Investigaciones Sociológicas, when asked about national identity, the majority of respondents from the Canary Islands (53.8%) consider themselves Spanish and Canarian in equal measures, followed by 24% who consider themselves more Canarian than Spanish. Only 6.1% of the respondents consider themselves only Canarian while 7% consider themselves only Spanish.


title: Canary Islands

text: The defence of the territory is the responsibility of the Spanish Armed Forces. As such, various components of the Army, Navy, Air Force and the Civil Guard are based in the territory.


title: Canary Islands

text: Before the arrival of humans, the Canaries were inhabited by prehistoric animals; for example, the giant lizard ("Gallotia goliath"), the Tenerife and Gran Canaria giant rats, and giant prehistoric tortoises, "Geochelone burchardi" and "Geochelone vulcanica".


title: Canary Islands

text: Although the original settlement of what are now called the Canary Islands is not entirely clear, linguistic, genetic, and archaeological analyses indicate that indigenous peoples were living on the Canary Islands at least 2000 years ago but possibly one thousand years or more before, and that they shared a common origin with the Berbers on the nearby North African coast. Reaching the islands may have taken place using several small boats, landing on the easternmost islands Lanzarote and Fuerteventura. These groups came to be known collectively as the Guanches, although "Guanches" had been the name for only the indigenous inhabitants of Tenerife.


title: Canary Islands

text: As José Farrujia describes, 'The indigenous Canarians lived mainly in natural caves, usually near the coast, 300-500m above sea level. These caves were sometimes isolated but more commonly formed settlements, with burial caves nearby'. Archaeological work has uncovered a rich culture visible through artefacts of ceramics, human figures, fishing, hunting and farming tools, plant fibre clothing and vessels, as well as cave paintings. At Lomo de los Gatos on Gran Canaria, a site occupied from 1,600 years ago up until the 1960s, round stone houses, complex burial sites, and associated artefacts have been found. Across the islands are thousands of Libyco-Berber alphabet inscriptions scattered and they have been extensively documented by many linguists.


title: Canary Islands

text: The social structure of indigenous Canarians encompassed 'a system of matrilineal descent in most of the islands, in which inheritance was passed on via the female line. Social status and wealth were hereditary and determined the individual's position in the social pyramid, which consisted of the king, the relatives of the king, the lower nobility, villeins, plebeians, and finally executioners, butchers, embalmers, and prisoners'. Their religion was animist, centring on the sun and moon, as well as natural features such as mountains.


title: Canary Islands

text: The islands may have been visited by the Phoenicians, the Greeks, and the Carthaginians. King Juba II, Caesar Augustus's Numidian protégé, is credited with discovering the islands for the Western world. According to Pliny the Elder, Juba found the islands uninhabited, but found "a small temple of stone" and "some traces of buildings". Juba dispatched a naval contingent to re-open the dye production facility at Mogador in what is now western Morocco in the early first century AD. That same naval force was subsequently sent on an exploration of the Canary Islands, using Mogador as their mission base.


title: Canary Islands

text: The names given by Romans to the individual islands were "Ninguaria" or "Nivaria" (Tenerife), "Canaria" (Gran Canaria), "Pluvialia" or "Invale" (Lanzarote), "Ombrion" (La Palma), "Planasia" (Fuerteventura), "Iunonia" or "Junonia" (El Hierro) and "Capraria" (La Gomera).


title: Canary Islands

text: From the 14th century onward, numerous visits were made by sailors from Majorca, Portugal and Genoa. Lancelotto Malocello settled on Lanzarote in 1312. The Majorcans established a mission with a bishop in the islands that lasted from 1350 to 1400.


title: Canary Islands

text: In 1402, the Castilian colonisation of the islands began with the expedition of the French explorers Jean de Béthencourt and Gadifer de la Salle, nobles and vassals of Henry III of Castile, to Lanzarote. From there, they went on to conquer Fuerteventura (1405) and El Hierro. These invasions were 'brutal cultural and military clashes between the indigenous population and the Castilians' lasting over a century due to formidable resistance by indigenous Canarians. Professor Mohamed Adhikari has defined the conquest of the islands as a genocide of the Guanches.


title: Canary Islands

text: Béthencourt received the title King of the Canary Islands, but still recognised King Henry III as his overlord. It was not a simple military enterprise, given the aboriginal resistance on some islands. Neither was it politically, since the particular interests of the nobility (determined to strengthen their economic and political power through the acquisition of the islands) conflicted with those of the states, particularly Castile, which were in the midst of territorial expansion and in a process of strengthening of the Crown against the nobility.


title: Canary Islands

text: Aristocratic conquest ("Conquista señorial"). This refers to the early conquests carried out by the nobility, for their own benefit and without the direct participation of the Crown of Castile, which merely granted rights of conquest in exchange for pacts of vassalage between the noble conqueror and the Crown. One can identify within this period an early phase known as the Betancurian or Norman Conquest, carried out by Jean de Bethencourt (who was originally from Normandy) and Gadifer de la Salle between 1402 and 1405, which involved the islands of Lanzarote, El Hierro and Fuerteventura. The subsequent phase is known as the Castilian Conquest, carried out by Castilian nobles who acquired, through purchases, assignments and marriages, the previously conquered islands and also incorporated the island of La Gomera around 1450.


title: Canary Islands

text: Royal conquest ("Conquista realenga"). This defines the conquest between 1478 and 1496, carried out directly by the Crown of Castile, during the reign of the Catholic Monarchs, who armed and partly financed the conquest of those islands which were still unconquered: Gran Canaria, La Palma and Tenerife. This phase of the conquest came to an end in the year 1496, with the dominion of the island of Tenerife, bringing the entire Canarian Archipelago under the control of the Crown of Castile.


title: Canary Islands

text: Béthencourt also established a base on the island of La Gomera, but it would be many years before the island was fully conquered. The natives of La Gomera, and of Gran Canaria, Tenerife, and La Palma, resisted the Castilian invaders for almost a century. In 1448 Maciot de Béthencourt sold the lordship of Lanzarote to Portugal's Prince Henry the Navigator, an action that was accepted by neither the natives nor the Castilians. Despite Pope Nicholas V ruling that the Canary Islands were under Portuguese control, the crisis swelled to a revolt which lasted until 1459 with the final expulsion of the Portuguese. In 1479, Portugal and Castile signed the Treaty of Alcáçovas, which settled disputes between Castile and Portugal over the control of the Atlantic. This treaty recognized Castilian control of the Canary Islands but also confirmed Portuguese possession of the Azores, Madeira, and the Cape Verde islands, and gave the Portuguese rights to any further islands or lands in the Atlantic that might be discovered.


title: Canary Islands

text: The Castilians continued to dominate the islands, but due to the topography and the resistance of the native Guanches, they did not achieve complete control until 1496, when Tenerife and La Palma were finally subdued by Alonso Fernández de Lugo. As a result of this 'the native pre-Hispanic population declined quickly due to war, epidemics, and slavery'. The Canaries were incorporated into the Kingdom of Castile.


title: Canary Islands

text: After the conquest, the Castilians imposed a new economic model, based on single-crop cultivation: first sugarcane; then wine, an important item of trade with England. Gran Canaria was conquered by the Crown of Castile on 6 March 1480, and Tenerife was conquered in 1496, and each had its own governor. There has been speculation that the abundance of "Roccella tinctoria" on the Canary Islands offered a profit motive for Jean de Béthencourt during his conquest of the islands. Lichen has been used for centuries to make dyes. This includes royal purple colors derived from roccella tinctoria, also known as orseille.


title: Canary Islands

text: The objective of the Spanish Crown to convert the islands into a powerhouse of cultivation required a much larger labour force. This was attained through a brutal practice of enslavement, not only of indigenous Canarians but large numbers of Africans who were forcibly taken from North and Sub-Saharan Africa. Whilst the first slave plantations in the Atlantic region were across Madeira, Cape Verde, and the Canary Islands, it was only the Canary Islands which had an indigenous population and were therefore invaded rather than newly occupied.


title: Canary Islands

text: This agriculture industry was largely based on sugarcane and the Castilians converted large swaths of the landscape for sugarcane production, and the processing and manufacturing of sugar, facilitated by enslaved labourers. The cities of Santa Cruz de Tenerife and Las Palmas de Gran Canaria became a stopping point for the Spanish traders, as well as conquistadors, and missionaries on their way to the New World. This trade route brought great wealth to the Castilian social sectors of the islands and soon were attracting merchants and adventurers from all over Europe. As the wealth grew, enslaved African workers were also forced into demeaning domestic roles for the rich Castilians on the islands such as servants in their houses. Research on the skeletons of some of these enslaved workers from the burial site of Finca Clavijo on Gran Canaria have showed that 'all of the adults buried in Finca Clavijo undertook extensive physical activity that involved significant stress on the spine and appendicular skeleton' that result from relentless hard labour, akin to the physical abnormalities found with enslaved peoples from other sugarcane plantations around the world. These findings of the physical strain that the enslaved at Finca Clavijo were subjected to in order to provide wealth for the Spanish elite has inspired a poem by British writer Ralph Hoyte, entitled "Close to the Bone".


title: Canary Islands

text: The method of forcibly relocating Africans to the Canary Islands in order to provide intensive labour, the first time this had been attempted, was looked at favourably by other European powers and was the inspiration behind the Transatlantic Slave Trade whereby around 12 million Africans were taken from their homelands in order to enter forced labour as plantation workers and domestic servants in the Americas over a period of 400 years.


title: Canary Islands

text: As a result of the huge wealth generated by enslaved labour, magnificent palaces and churches were built on La Palma during this busy, prosperous period. The Church of El Salvador survives as one of the island's finest examples of the architecture of the 16th century. Civilian architecture survives in forms such as Casas de los Sánchez-Ochando or Casa Quintana.


title: Canary Islands

text: The Canaries' wealth invited attacks by pirates and privateers. Ottoman Turkish admiral and privateer Kemal Reis ventured into the Canaries in 1501, while Murat Reis the Elder captured Lanzarote in 1585.


title: Canary Islands

text: The most severe attack took place in 1599, during the Dutch Revolt. A Dutch fleet of 74 ships and 12,000 men, commanded by Pieter van der Does, attacked the capital Las Palmas de Gran Canaria (the city had 3,500 of Gran Canaria's 8,545 inhabitants). The Dutch attacked the Castillo de la Luz, which guarded the harbor. The Canarians evacuated civilians from the city, and the Castillo surrendered (but not the city). The Dutch moved inland, but Canarian cavalry drove them back to Tamaraceite, near the city.


title: Canary Islands

text: The Dutch then laid siege to the city, demanding the surrender of all its wealth. They received 12 sheep and 3 calves. Furious, the Dutch sent 4,000 soldiers to attack the Council of the Canaries, who were sheltering in the village of Santa Brígida. 300 Canarian soldiers ambushed the Dutch in the village of Monte Lentiscal, killing 150 and forcing the rest to retreat. The Dutch concentrated on Las Palmas de Gran Canaria, attempting to burn it down. The Dutch pillaged Maspalomas, on the southern coast of Gran Canaria, San Sebastián on La Gomera, and Santa Cruz on La Palma, but eventually gave up the siege of Las Palmas and withdrew.


title: Canary Islands

text: In 1618 the Barbary pirates from North Africa attacked Lanzarote and La Gomera taking 1000 captives to be sold as slaves. Another noteworthy attack occurred in 1797, when Santa Cruz de Tenerife was attacked by a British fleet under Horatio Nelson on 25 July. The British were repulsed, losing almost 400 men. It was during this battle that Nelson lost his right arm.


title: Canary Islands

text: The sugar-based economy of the islands faced stiff competition from Spain's Caribbean colonies. Low sugar prices in the 19th century caused severe recessions on the islands. A new cash crop, cochineal ("cochinilla"), came into cultivation during this time, reinvigorating the islands' economy. During this time the Canarian-American trade was developed, in which Canarian products such as cochineal, sugarcane and rum were sold in American ports such as Veracruz, Campeche, La Guaira and Havana, among others.


title: Canary Islands

text: By the end of the 18th century, Canary Islanders had already emigrated to Spanish American territories, such as Havana, Veracruz, and Santo Domingo, San Antonio, Texas and St. Bernard Parish, Louisiana. These economic difficulties spurred mass emigration during the 19th and first half of the 20th century, primarily to the Americas. Between 1840 and 1890 as many as 40,000 Canary Islanders emigrated to Venezuela. Also, thousands of Canarians moved to Puerto Rico where the Spanish monarchy felt that Canarians would adapt to island life better than other immigrants from the mainland of Spain. Deeply entrenched traditions, such as the Mascaras Festival in the town of Hatillo, Puerto Rico, are an example of Canarian culture still preserved in Puerto Rico. Similarly, many thousands of Canarians emigrated to the shores of Cuba. During the Spanish–American War of 1898, the Spanish fortified the islands against a possible American attack, but no such event took place.


title: Canary Islands

text: Sirera and Renn (2004) distinguish two different types of expeditions, or voyages, during the period 1770–1830, which they term "the Romantic period":


title: Canary Islands

text: First are "expeditions financed by the States, closely related with the official scientific Institutions. characterised by having strict scientific objectives (and inspired by) the spirit of Illustration and progress". In this type of expedition, Sirera and Renn include the following travellers:


title: Canary Islands

text: The second type of expedition identified by Sirera and Renn is one that took place starting from more or less private initiatives. Among these, the key exponents were the following:


title: Canary Islands

text: Sirera and Renn identify the period 1770–1830 as one in which "In a panorama dominated until that moment by France and England enters with strength and brio Germany of the Romantic period whose presence in the islands will increase".


title: Canary Islands

text: At the beginning of the 20th century, the British introduced a new cash-crop, the banana, the export of which was controlled by companies such as Fyffes.


title: Canary Islands

text: 30 November 1833 the Province of Canary Islands had been created with the capital being declared as Santa Cruz de Tenerife. The rivalry between the cities of Las Palmas de Gran Canaria and Santa Cruz de Tenerife for the capital of the islands led to the division of the archipelago into two provinces on 23 September 1927.


title: Canary Islands

text: During the time of the Second Spanish Republic, Marxist and anarchist workers' movements began to develop, led by figures such as Jose Miguel Perez and Guillermo Ascanio. However, outside of a few municipalities, these organisations were a minority and fell easily to Nationalist forces during the Spanish Civil War.


title: Canary Islands

text: In 1936, Francisco Franco was appointed General Commandant of the Canaries. He joined the military revolt of 17 July which began the Spanish Civil War. Franco quickly took control of the archipelago, except for a few points of resistance on La Palma and in the town of Vallehermoso, on La Gomera. Though there was never a war in the islands, the post-war suppression of political dissent on the Canaries was most severe.


title: Canary Islands

text: During the Second World War, Winston Churchill prepared plans for the British seizure of the Canary Islands as a naval base, in the event of Gibraltar being invaded from the Spanish mainland. The planned operation was known as Operation Pilgrim.


title: Canary Islands

text: Opposition to Franco's regime did not begin to organise until the late 1950s, which experienced an upheaval of parties such as the Communist Party of Spain and the formation of various nationalist, leftist parties.


title: Canary Islands

text: During the Ifni War, the Franco regime set up concentration camps on the islands to extrajudicially imprison those in Western Sahara suspected of disloyalty to Spain, many of whom were colonial troops recruited on the spot but were later deemed to be potential fifth columns and deported to the Canary Islands. These camps were characterised by the use of forced labour for infrastructure projects and highly unsanitary conditions resulting in the widespread occurrence of tuberculosis.


title: Canary Islands

text: After the death of Franco, there was a pro-independence armed movement based in Algeria, the Movement for the Independence and Self-determination of the Canaries Archipelago (MAIAC). In 1968, the Organisation of African Unity recognized the MAIAC as a legitimate African independence movement, and declared the Canary Islands as an African territory still under foreign rule.


title: Canary Islands

text: After the establishment of a democratic constitutional monarchy in Spain, autonomy was granted to the Canaries via a law passed in 1982, with a newly established autonomous devolved government and parliament. In 1983, the first autonomous elections were held. The Spanish Socialist Workers' Party (PSOE) won. In the 2007 elections, the PSOE gained a plurality of seats, but the nationalist Canarian Coalition and the conservative Partido Popular (PP) formed a ruling coalition government.


title: Canary Islands

text: At present, the Canary Islands is the only autonomous community in Spain that has two capitals: Santa Cruz de Tenerife and Las Palmas de Gran Canaria, since the was created in 1982.


title: Canary Islands

text: The political capital of the archipelago did not exist as such until the nineteenth century. The first cities founded by the Europeans at the time of the conquest of the Canary Islands in the 15th century were: Telde (in Gran Canaria), San Marcial del Rubicón (in Lanzarote) and Betancuria (in Fuerteventura). These cities boasted the first European institutions present in the archipelago, including Catholic bishoprics. Although, because the period of splendor of these cities developed before the total conquest of the archipelago and its incorporation into the Crown of Castile never had a political and real control of the entire Canary archipelago.


title: Canary Islands

text: The function of a Canarian city with full jurisdiction for the entire archipelago only exists after the conquest of the Canary Islands, although originally "de facto", that is, without legal and real meaning and linked to the headquarters of the Canary Islands General Captaincy.


title: Canary Islands

text: Las Palmas de Gran Canaria was the first city that exercised this function. This is because the residence of the Captain General of the Canary Islands was in this city during part of the sixteenth and seventeenth centuries. In May 1661, the Captain General of the Canary Islands, Jerónimo de Benavente y Quiñones, moved the headquarters of the captaincy to the city of San Cristóbal de La Laguna on the island of Tenerife. This was due to the fact that this island since the conquest was the most populated, productive and with the highest economic expectations. La Laguna would be considered the "de facto" capital of the archipelago until the official status of the capital of Canary Islands in the city of Santa Cruz de Tenerife was confirmed in the 19th century, due in part to the constant controversies and rivalries between the bourgeoisies of San Cristóbal de La Laguna and Las Palmas de Gran Canaria for the economic, political and institutional hegemony of the archipelago.


title: Canary Islands

text: Already in 1723, the Captain General of the Canary Islands Lorenzo Fernandez de Villavicencio had moved the headquarters of the General Captaincy of the Canary Islands from San Cristóbal de La Laguna to Santa Cruz de Tenerife. This decision continued without pleasing the society of the island of Gran Canaria. It would be after the creation of the Province of Canary Islands in November 1833 in which Santa Cruz would become the first fully official capital of the Canary Islands ("De jure" and not of "de facto" as happened previously). Santa Cruz de Tenerife would be the capital of the Canary archipelago until during the Government of General Primo de Rivera in 1927 the Province of Canary Islands was split in two provinces: Las Palmas with capital in Las Palmas de Gran Canaria, and Santa Cruz de Tenerife with capital in the homonymous city.


title: Canary Islands

text: Finally, with the Statute of Autonomy of the Canary Islands in 1982 and the creation of the Autonomous Community of the Canary Islands, the capital of the archipelago between Las Palmas de Gran Canaria and Santa Cruz de Tenerife is fixed, which is how it remains today.


title: Canary Islands

text: The Canary Islands have a population of 2,153,389 inhabitants (2019), making it the eighth most populous of Spain's autonomous communities. The total area of the archipelago is , resulting in a population density of 287.4 inhabitants per square kilometre.


title: Canary Islands

text: The Canary Islands have become home to many European residents, mainly coming from Italy, Germany and the UK. Because of the vast immigration to Venezuela and Cuba during the second half of the 20th century and the later return to the Canary Islands of these people along with their families, there are many residents whose country of origin was Venezuela (66,593) or Cuba (41,807). Since the 1990s, many illegal migrants have reached the Canary Islands, Melilla and Ceuta, using them as entry points to the EU.


title: Canary Islands

text: The Catholic Church has been the majority religion in the archipelago for more than five centuries, ever since the Conquest of the Canary Islands. There are also several other religious communities.


title: Canary Islands

text: The overwhelming majority of native Canarians are Roman Catholic (76.7%) with various smaller foreign-born populations of other Christian beliefs such as Protestants.


title: Canary Islands

text: The appearance of the Virgin of Candelaria (Patron of Canary Islands) was credited with moving the Canary Islands toward Christianity. Two Catholic saints were born in the Canary Islands: Peter of Saint Joseph de Betancur and José de Anchieta. Both born on the island of Tenerife, they were respectively missionaries in Guatemala and Brazil.


title: Canary Islands

text: Separate from the overwhelming Christian majority are a minority of Muslims. Among the followers of Islam, the Islamic Federation of the Canary Islands exists to represent the Islamic community in the Canary Islands as well as to provide practical support to members of the Islamic community. For its part, there is also the Evangelical Council of the Canary Islands in the archipelago.


title: Canary Islands

text: Other religious faiths represented include Jehovah's Witnesses, The Church of Jesus Christ of Latter-day Saints as well as Hinduism. Minority religions are also present such as the Church of the Guanche People which is classified as a neo-pagan native religion. Also present are Buddhism, Judaism, Baháʼí, African religion, and Chinese religions.


title: Canary Islands

text: Ordered from west to east, the Canary Islands are El Hierro, La Palma, La Gomera, Tenerife, Gran Canaria, Fuerteventura, and Lanzarote. In addition, north of Lanzarote are the islets of La Graciosa, Montaña Clara, Alegranza, Roque del Este and Roque del Oeste, belonging to the Chinijo Archipelago, and northeast of Fuerteventura is the islet of Lobos. There are also a series of small adjacent rocks in the Canary Islands: the Roques de Anaga, Garachico and Fasnia in Tenerife, and those of Salmor and Bonanza in El Hierro.


title: Canary Islands

text: El Hierro, the westernmost island, covers , making it the second smallest of the major islands, and the least populous with 10,798 inhabitants. The whole island was declared Reserve of the Biosphere in 2000. Its capital is Valverde. Also known as Ferro, it was once believed to be the westernmost land in the world.


title: Canary Islands

text: Fuerteventura, with a surface of , is the second-most extensive island of the archipelago. It has been declared a Biosphere reserve by Unesco. It has a population of 113,275. Being also the most ancient of the islands, it is the one that is more eroded: its highest point is the Peak of the Bramble, at a height of . Its capital is Puerto del Rosario.


title: Canary Islands

text: Gran Canaria has 846,717 inhabitants. The capital, Las Palmas de Gran Canaria (377,203 inhabitants), is the most populous city and shares the status of capital of the Canaries with Santa Cruz de Tenerife. Gran Canaria's surface area is . In the center of the island lie the Roque Nublo and Pico de las Nieves ("Peak of Snow") . On the south of the island are the Maspalomas Dunes (Gran Canaria), these are the biggest tourist attractions.


title: Canary Islands

text: La Gomera has an area of and is the second least populous island with 21,136 inhabitants. Geologically it is one of the oldest of the archipelago. The insular capital is San Sebastian de La Gomera. Garajonay's National Park is located on the island.


title: Canary Islands

text: Lanzarote is the easternmost island and one of the most ancient of the archipelago, and it has shown evidence of recent volcanic activity. It has a surface of , and a population of 149,183 inhabitants, including the adjacent islets of the Chinijo Archipelago. The capital is Arrecife, with 56,834 inhabitants.


title: Canary Islands

text: The Chinijo Archipelago includes the islands La Graciosa, Alegranza, Montaña Clara, Roque del Este and Roque del Oeste. It has a surface of , and only La Graciosa is populated, with 658 inhabitants. With , La Graciosa, is the smallest inhabited island of the Canaries, and the major island of the Chinijo Archipelago.


title: Canary Islands

text: La Palma, with 81,863 inhabitants covering an area of , is in its entirety a biosphere reserve. For long it showed no signs of volcanic activity, even though the volcano Teneguía entered into eruption last in 1971. On September 19, 2021, the volcanic Cumbre Vieja on the island erupted. It is the second-highest island of the Canaries, with the Roque de los Muchachos at as its highest point. Santa Cruz de La Palma (known to those on the island as simply "Santa Cruz") is its capital.


title: Canary Islands

text: Tenerife is, with its area of , the most extensive island of the Canary Islands. In addition, with 904,713 inhabitants it is the most populated island of the archipelago and Spain. Two of the islands' principal cities are located on it: the capital, Santa Cruz de Tenerife and San Cristóbal de La Laguna (a World Heritage Site). San Cristóbal de La Laguna, the second city of the island is home to the oldest university in the Canary Islands, the University of La Laguna. Teide, with its is the highest peak of Spain and also a World Heritage Site. Tenerife is the site of the worst air disaster in the history of aviation, in which 583 people were killed in the collision of two Boeing 747s on 27 March 1977.


title: Canary Islands

text: Graciosa Island or commonly La Graciosa is a volcanic island in the Canary Islands of Spain, located 2 km (1.2 mi) north of the island of Lanzarote across the Strait of El Río. It was formed by the Canary hotspot. The island is part of the Chinijo Archipelago and the Chinijo Archipelago Natural Park (Parque Natural del Archipiélago Chinijo). It is administrated by the municipality of Teguise. In 2018 La Graciosa officially became the eighth Canary Island. Before then, La Graciosa had the status of an islet, administratively dependent on the island of Lanzarote. It is the smallest and least populated of the main islands, with a population of about 700 people.


title: Canary Islands

text: The economy is based primarily on tourism, which makes up 32% of the GDP. The Canaries receive about 12 million tourists per year. Construction makes up nearly 20% of the GDP and tropical agriculture, primarily bananas and tobacco, are grown for export to Europe and the Americas. Ecologists are concerned that the resources, especially in the more arid islands, are being overexploited but there are still many agricultural resources like tomatoes, potatoes, onions, cochineal, sugarcane, grapes, vines, dates, oranges, lemons, figs, wheat, barley, maize, apricots, peaches and almonds.


title: Canary Islands

text: Water resources are also being overexploited, due to the high water usage by tourists. Also, some islands (such as Gran Canaria and Tenerife) overexploit the ground water. This is done in such degree that, according to European and Spanish legal regulations, the current situation is not acceptable. To address the problems, good governance and a change in the water use paradigm have been proposed. These solutions depend largely on controlling water use and on demand management. As this is administratively difficult and politically unpalatable, most action is currently directed at increasing the public offer of water through import from outside; a decision which is economically, politically and environmentally questionable.


title: Canary Islands

text: To bring in revenue for environmental protection, innovation, training and water sanitation a tourist tax was considered in 2018, along with a doubling of the ecotax and restrictions on holiday rents in the zones with the greatest pressure of demand.


title: Canary Islands

text: The economy is € 25 billion (2001 GDP figures). The islands experienced continuous growth during a 20-year period, up until 2001, at a rate of approximately 5% annually. This growth was fueled mainly by huge amounts of foreign direct investment, mostly to develop tourism real estate (hotels and apartments), and European Funds (near €11 billion in the period from 2000 to 2007), since the Canary Islands are labelled Region Objective 1 (eligible for euro structural funds). Additionally, the EU allows the Canary Islands Government to offer special tax concessions for investors who incorporate under the Zona Especial Canaria (ZEC) regime and create more than five jobs.


title: Canary Islands

text: Spain gave permission in August 2014 for Repsol and its partners to explore oil and natural gas prospects off the Canary Islands, involving an investment of €7.5 billion over four years, to commence at the end of 2016. Repsol at the time said the area could ultimately produce 100,000 barrels of oil a day, which would meet 10 percent of Spain's energy needs. However, the analysis of samples obtained did not show the necessary volume nor quality to consider future extraction, and the project was scrapped.


title: Canary Islands

text: Despite currently having very high dependence on fossil fuels, research on the renewable energy potential concluded that a high potential for renewable energy technologies exists on the archipelago. This, in such extent even that a scenario pathway to 100% renewable energy supply by 2050 has been put forward.


title: Canary Islands

text: The Canary Islands have great natural attractions, climate and beaches make the islands a major tourist destination, being visited each year by about 12 million people (11,986,059 in 2007, noting 29% of Britons, 22% of Spanish (from outside the Canaries), and 21% of Germans). Among the islands, Tenerife has the largest number of tourists received annually, followed by Gran Canaria and Lanzarote. The archipelago's principal tourist attraction is the Teide National Park (in Tenerife) where the highest mountain in Spain and third largest volcano in the world (Mount Teide), receives over 2.8 million visitors annually.


title: Canary Islands

text: The combination of high mountains, proximity to Europe, and clean air has made the Roque de los Muchachos peak (on La Palma island) a leading location for telescopes like the Grantecan.


title: Canary Islands

text: The islands, as an autonomous region of Spain, are in the European Union and the Schengen Area. They are in the European Union Customs Union but outside the VAT area. Instead of VAT there is a local Sales Tax (IGIC) which has a general rate of 7%, an increased tax rate of 13.5%, a reduced tax rate of 3% and a zero tax rate for certain basic need products and services. Consequently, some products are subject to additional VAT if being exported from the islands into mainland Spain or the rest of the EU.


title: Canary Islands

text: Canarian time is Western European Time (WET) (or GMT; in summer one hour ahead of GMT). So Canarian time is one hour behind that of mainland Spain and the same as that of the UK, Ireland and mainland Portugal all year round.


title: Canary Islands

text: The number of tourists who visited the Canary Islands had been in 2018 16,150,054 and in the year 2019 15,589,290.


title: Canary Islands

text: The Gross Domestic Product (GDP) in the Canary Islands in 2015 was , per capita. The figures by island are as follows:


title: Canary Islands

text: The Canary Islands have eight airports altogether, two of the main ports of Spain, and an extensive network of autopistas (highways) and other roads. For a road map see multimap. Traffic congestion is sometimes a problem in Tenerife and on Grand Canaria.


title: Canary Islands

text: Large ferry boats and fast ferries link most of the islands. Both types can transport large numbers of passengers, cargo, and vehicles. Fast ferries are made of aluminium and powered by modern and efficient diesel engines, while conventional ferries have a steel hull and are powered by heavy oil. Fast ferries travel in excess of ; conventional ferries travel in excess of , but are slower than fast ferries. A typical ferry ride between La Palma and Tenerife may take up to eight hours or more while a fast ferry takes about two and a half hours and between Tenerife and Gran Canaria can be about one hour.


title: Canary Islands

text: The largest airport is the Gran Canaria Airport. Tenerife has two airports, Tenerife North Airport and Tenerife South Airport. The island of Tenerife gathers the highest passenger movement of all the Canary Islands through its two airports. The two main islands (Tenerife and Gran Canaria) receive the greatest number of passengers. Tenerife 6,204,499 passengers and Gran Canaria 5,011,176 passengers.


title: Canary Islands

text: The port of Las Palmas is first in freight traffic in the islands, while the port of Santa Cruz de Tenerife is the first fishing port with approximately 7,500 tons of fish caught, according to the Spanish government publication Statistical Yearbook of State Ports. Similarly, it is the second port in Spain as regards ship traffic, only surpassed by the Port of Algeciras Bay. The port's facilities include a border inspection post (BIP) approved by the European Union, which is responsible for inspecting all types of imports from third countries or exports to countries outside the European Economic Area. The port of Los Cristianos (Tenerife) has the greatest number of passengers recorded in the Canary Islands, followed by the port of Santa Cruz de Tenerife. The Port of Las Palmas is the third port in the islands in passengers and first in number of vehicles transported.


title: Canary Islands

text: The SS America was beached at the Canary islands on 18 January 1994. However, the ocean liner broke apart after the course of several years and eventually sank beneath the surface.


title: Canary Islands

text: The Tenerife Tram opened in 2007 and is currently the only one in the Canary Islands, travelling between the cities of Santa Cruz de Tenerife and San Cristóbal de La Laguna.


title: Canary Islands

text: The "Servicio Canario de Salud" is an autonomous body of administrative nature attached to the Ministry responsible for Health of the Government of the Canary Islands. The majority of the archipelago's hospitals belong to this organization:


title: Canary Islands

text: Before the arrival of the Aborigines, the Canary Islands were inhabited by a variety of endemic animals, such as extinct giant lizards ("Gallotia goliath"), giant tortoises ("Centrochelys burchardi" and "C. vulcanica"), and Tenerife and Gran Canaria giant rats ("Canariomys bravoi" and "C. tamarani"), among others. Extinct birds known only from Pleistocene and Holocene age bones include the Canary Islands quail ("Coturnix gomerae"), Dune shearwater ("Puffinus holeae"), Lava shearwater ("P. olsoni"), Trias greenfinch ("Chloris triasi"), Slender-billed greenfinch ("C. aurelioi") and the Long-legged bunting ("Emberiza alcoveri"). In addition are some unidentified bird eggshell fragments from the Miocene of Lanzarote, which have been suggested to be from an extinct ratite species.


title: Canary Islands

text: With a range of habitats, the Canary Islands exhibit diverse plant species. The bird life includes European and African species, such as the black-bellied sandgrouse; and a rich variety of endemic (local) taxa including the:


title: Canary Islands

text: Terrestrial fauna includes geckos, wall lizards, and three endemic species of recently rediscovered and critically endangered giant lizard: the El Hierro giant lizard (or Roque Chico de Salmor giant lizard), La Gomera giant lizard, and La Palma giant lizard. Mammals include the Canarian shrew, Canary big-eared bat, the Algerian hedgehog (which may have been introduced) and the more recently introduced mouflon. Some endemic mammals, the lava mouse, Tenerife giant rat and Gran Canaria giant rat, are extinct, as are the Canary Islands quail, long-legged bunting, the eastern Canary Islands chiffchaff and the giant prehistoric tortoises; Geochelone burchardi and Geochelone vulcanica.


title: Canary Islands

text: The marine life found in the Canary Islands is also varied, being a combination of North Atlantic, Mediterranean and endemic species. In recent years, the increasing popularity of both scuba diving and underwater photography have provided biologists with much new information on the marine life of the islands.


title: Canary Islands

text: Fish species found in the islands include many species of shark, ray, moray eel, bream, jack, grunt, scorpionfish, triggerfish, grouper, goby, and blenny. In addition, there are many invertebrate species, including sponge, jellyfish, anemone, crab, mollusc, sea urchin, starfish, sea cucumber and coral.


title: Canary Islands

text: There are a total of five different species of marine turtle that are sighted periodically in the islands, the most common of these being the endangered loggerhead sea turtle. The other four are the green sea turtle, hawksbill sea turtle, leatherback sea turtle and Kemp's ridley sea turtle. Currently, there are no signs that any of these species breed in the islands, and so those seen in the water are usually migrating. However, it is believed that some of these species may have bred in the islands in the past, and there are records of several sightings of leatherback sea turtle on beaches in Fuerteventura, adding credibility to the theory.


title: Canary Islands

text: Marine mammals include the large varieties of cetaceans including rare and not well-known species (see more details in the "Marine life of the Canary Islands"). Hooded seals have also been known to be vagrant in the Canary Islands every now and then. The Canary Islands were also formerly home to a population of the rarest pinniped in the world, the Mediterranean monk seal.


title: Canary Islands

text: Some holidays of those celebrated in the Canary Islands are international and national, others are regional holidays and others are of insular character. The official day of the autonomous community is Canary Islands Day on 30 May. The anniversary of the first session of the Parliament of the Canary Islands, based in the city of Santa Cruz de Tenerife, held on 30 May 1983, is commemorated with this day.


title: Canary Islands

text: In addition, each of the islands has an island festival, in which it is a holiday only on that specific island. These are the festivities of island patrons saints of each island. Organized chronologically are:


title: Canary Islands

text: The most famous festivals of the Canary Islands is the carnival. It is the most famous and international festival of the archipelago. The carnival is celebrated in all the islands and all its municipalities, perhaps the two busiest are those of the two Canarian capitals; the Carnival of Santa Cruz de Tenerife ("Tourist Festival of International Interest") and the Carnival of Las Palmas de Gran Canaria. It is celebrated on the streets between the months of February and March. But the rest of the islands of the archipelago have their carnivals with their own traditions among which stand out: The Festival of the Carneros of El Hierro, the Festival of the Diabletes of Teguise in Lanzarote, Los Indianos de La Palma, the Carnival of San Sebastián de La Gomera and the Carnival of Puerto del Rosario in Fuerteventura.


title: Canary Islands

text: In the 1960s, Gran Canaria was selected as the location for one of the 14 ground stations in the Manned Space Flight Network (MSFN) to support the NASA space program. Maspalomas Station, located in the south of the island, took part in a number of space missions including the Apollo 11 Moon landings and Skylab. Today it continues to support satellite communications as part of the ESA network.


title: Canary Islands

text: Because of the remote location, a number of astronomical observatories are located in the archipelago, including the Teide Observatory on Tenerife, the Roque de los Muchachos Observatory on La Palma, and the Temisas Astronomical Observatory on Gran Canaria.


title: Canary Islands

text: Tenerife is the home of the Instituto de Astrofísica de Canarias (Astrophysical Institute of the Canaries). There is also an Instituto de Bio-Orgánica Antonio González (Antonio González Bio-Organic Institute) at the University of La Laguna. Also at that university are the Instituto de Lingüística Andrés Bello (Andrés Bello Institute of Linguistics), the Centro de Estudios Medievales y Renacentistas (Center for Medieval and Renaissance Studies), the Instituto Universitario de la Empresa (University Institute of Business), the Instituto de Derecho Regional (Regional Institute of Law), the Instituto Universitario de Ciencias Políticas y Sociales (University Institute of Political and Social Sciences) and the Instituto de Enfermedades Tropicales (Institute of Tropical Diseases). The latter is one of the seven institutions of the Red de Investigación de Centros de Enfermedades Tropicales (RICET, "Network of Research of Centers of Tropical Diseases"), located in various parts of Spain. The Instituto Volcanológico de Canarias (Volcanological Institute of the Canary Islands) is based in Tenerife.


title: Canary Islands

text: A unique form of wrestling known as Canarian wrestling ("lucha canaria") has opponents stand in a special area called a "terrero" and try to throw each other to the ground using strength and quick movements.


title: Canary Islands

text: Another sport is the "game of the sticks" (palo canario) where opponents fence with long sticks. This may have come about from the shepherds of the islands who would challenge each other using their long walking sticks.


title: Canary Islands

text: Furthermore, there is the shepherd's jump ("salto del pastor"). This involves using a long stick to vault over an open area. This sport possibly evolved from the shepherd's need to occasionally get over an open area in the hills as they were tending their sheep.


title: Canary Islands

text: The two main football teams in the archipelago are: the CD Tenerife (founded in 1912) and UD Las Palmas (founded in 1949). As of the 2018/2019 season, both Tenerife and Las Palmas play in Segunda División. When in the same division, the clubs contest the Canary Islands derby. There are smaller clubs also playing in the mainland Spanish football league system, most notably UD Lanzarote and CD Laguna, although no other Canarian clubs have played in the top flight.


title: Canary Islands

text: The mountainous terrain of the Canary Islands also caters to the growing popularity of ultra running and ultramarathons as host of annual competitive long-distance events including CajaMar Tenerife Bluetrail on Tenerife, Transvulcania on La Palma, Transgrancanaria on Gran Canaria, and the Half Marathon des Sables on Fuerteventura. A yearly Ironman Triathlon has been taking place on Lanzarote since 1992.


title: Pneumonia

text: Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity of the condition is variable.


title: Pneumonia

text: Pneumonia is usually caused by infection with viruses or bacteria, and less commonly by other microorganisms. Identifying the responsible pathogen can be difficult. Diagnosis is often based on symptoms and physical examination. Chest X-rays, blood tests, and culture of the sputum may help confirm the diagnosis. The disease may be classified by where it was acquired, such as community- or hospital-acquired or healthcare-associated pneumonia.


title: Pneumonia

text: Risk factors for pneumonia include cystic fibrosis, chronic obstructive pulmonary disease (COPD), sickle cell disease, asthma, diabetes, heart failure, a history of smoking, a poor ability to cough (such as following a stroke), and a weak immune system.


title: Pneumonia

text: Vaccines to prevent certain types of pneumonia (such as those caused by "Streptococcus pneumoniae" bacteria, linked to influenza, or linked to COVID-19) are available. Other methods of prevention include hand washing to prevent infection, not smoking, and social distancing.


title: Pneumonia

text: Treatment depends on the underlying cause. Pneumonia believed to be due to bacteria is treated with antibiotics. If the pneumonia is severe, the affected person is generally hospitalized. Oxygen therapy may be used if oxygen levels are low.


title: Pneumonia

text: Each year, pneumonia affects about 450 million people globally (7% of the population) and results in about 4 million deaths. With the introduction of antibiotics and vaccines in the 20th century, survival has greatly improved. Nevertheless, pneumonia remains a leading cause of death in developing countries, and also among the very old, the very young, and the chronically ill. Pneumonia often shortens the period of suffering among those already close to death and has thus been called "the old man's friend".


title: Pneumonia

text: 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, and an increased rate of breathing. In elderly people, confusion may be the most prominent sign.


title: Pneumonia

text: The typical signs and symptoms in children under five are fever, cough, and fast or difficult breathing. Fever is not very specific, as it occurs in many other common illnesses and may be absent in those with severe disease, malnutrition or in the elderly. In addition, a cough is frequently absent in children less than 2 months old. More severe signs and symptoms in children may include blue-tinged skin, unwillingness to drink, convulsions, ongoing vomiting, extremes of temperature, or a decreased level of consciousness.


title: Pneumonia

text: Bacterial and viral cases of pneumonia usually result in similar symptoms. Some causes are associated with classic, but non-specific, clinical characteristics. Pneumonia caused by "Legionella" may occur with abdominal pain, diarrhea, or confusion. Pneumonia caused by "Streptococcus pneumoniae" is associated with rusty colored sputum. Pneumonia caused by "Klebsiella" may have bloody sputum often described as "currant jelly". Bloody sputum (known as hemoptysis) may also occur with tuberculosis, Gram-negative pneumonia, lung abscesses and more commonly acute bronchitis. Pneumonia caused by "Mycoplasma pneumoniae" may occur in association with swelling of the lymph nodes in the neck, joint pain, or a middle ear infection. Viral pneumonia presents more commonly with wheezing than bacterial pneumonia. Pneumonia was historically divided into "typical" and "atypical" based on the belief that the presentation predicted the underlying cause. However, evidence has not supported this distinction, therefore it is no longer emphasized.


title: Pneumonia

text: Pneumonia is due to infections caused primarily by bacteria or viruses and less commonly by fungi and parasites. Although more than 100 strains of infectious agents have been identified, only a few are responsible for the majority of cases. Mixed infections with both viruses and bacteria may occur in roughly 45% of infections in children and 15% of infections in adults. A causative agent may not be isolated in about half of cases despite careful testing. In an active population-based surveillance for community-acquired pneumonia requiring hospitalization in five hospitals in Chicago and Nashville from January 2010 through June 2012, 2259 patients were identified who had radiographic evidence of pneumonia and specimens that could be tested for the responsible pathogen. Most patients (62%) had no detectable pathogens in their sample, and unexpectedly, respiratory viruses were detected more frequently than bacteria. Specifically, 23% had one or more viruses, 11% had one or more bacteria, 3% had both bacterial and viral pathogens, and 1% had a fungal or mycobacterial infection. "The most common pathogens were human rhinovirus (in 9% of patients), influenza virus (in 6%), and "Streptococcus pneumoniae" (in 5%)."


title: Pneumonia

text: The term "pneumonia" is sometimes more broadly applied to any condition resulting in inflammation of the lungs (caused for example by autoimmune diseases, chemical burns or drug reactions); however, this inflammation is more accurately referred to as pneumonitis.


title: Pneumonia

text: Factors that predispose to pneumonia include smoking, immunodeficiency, alcoholism, chronic obstructive pulmonary disease, sickle cell disease (SCD), asthma, chronic kidney disease, liver disease, and biological aging. Additional risks in children include not being breastfed, exposure to cigarette smoke and other air pollution, malnutrition, and poverty. The use of acid-suppressing medications – such as proton-pump inhibitors or H2 blockers – is associated with an increased risk of pneumonia. Approximately 10% of people who require mechanical ventilation develop ventilator-associated pneumonia, and people with a gastric feeding tube have an increased risk of developing aspiration pneumonia. For people with certain variants of the FER gene, the risk of death is reduced in sepsis caused by pneumonia. However, for those with TLR6 variants, the risk of getting Legionnaires' disease is increased.


title: Pneumonia

text: Bacteria are the most common cause of community-acquired pneumonia (CAP), 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% of cases; "Staphylococcus aureus"; "Moraxella catarrhalis"; and "Legionella pneumophila". A number of drug-resistant versions of the above infections are becoming more common, including drug-resistant "Streptococcus pneumoniae" (DRSP) and methicillin-resistant "Staphylococcus aureus" (MRSA).


title: Pneumonia

text: The spreading of organisms is facilitated by certain risk factors. Alcoholism is associated with "Streptococcus pneumoniae", anaerobic organisms, and "Mycobacterium tuberculosis"; smoking facilitates the effects of "Streptococcus pneumoniae", "Haemophilus influenzae", "Moraxella catarrhalis", and "Legionella pneumophila". Exposure to birds is associated with "Chlamydia psittaci"; farm animals with "Coxiella burnetti"; aspiration of stomach contents with anaerobic organisms; and cystic fibrosis with "Pseudomonas aeruginosa" and "Staphylococcus aureus". "Streptococcus pneumoniae" is more common in the winter, and it should be suspected in persons aspirating a large number of anaerobic organisms.


title: Pneumonia

text: In adults, viruses account for about one third of pneumonia cases, and in children for about 15% of them. Commonly implicated agents include rhinoviruses, coronaviruses, influenza virus, respiratory syncytial virus (RSV), adenovirus, and parainfluenza. Herpes simplex virus rarely causes pneumonia, except in groups such as newborns, persons with cancer, transplant recipients, and people with significant burns. After organ transplantation or in otherwise immunocompromised persons, there are high rates of cytomegalovirus pneumonia. Those with viral infections may be secondarily infected with the bacteria "Streptococcus pneumoniae", "Staphylococcus aureus", or "Haemophilus influenzae", particularly when other health problems are present. Different viruses predominate at different times of the year; during flu season, for example, influenza may account for more than half of all viral cases. Outbreaks of other viruses also occur occasionally, including hantaviruses and coronaviruses. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can also result in pneumonia.


title: Pneumonia

text: Fungal pneumonia is uncommon, but occurs more commonly in individuals with weakened immune systems due to AIDS, immunosuppressive drugs, or other medical problems. It is most often caused by "Histoplasma capsulatum", "Blastomyces", "Cryptococcus neoformans", "Pneumocystis jiroveci" (pneumocystis pneumonia, or PCP), and "Coccidioides immitis". Histoplasmosis is most common in the Mississippi River basin, and coccidioidomycosis is most common in the Southwestern United States. The number of cases of fungal pneumonia has been increasing in the latter half of the 20th century due to increasing travel and rates of immunosuppression in the population. For people infected with HIV/AIDS, PCP is a common opportunistic infection.


title: Pneumonia

text: A variety of parasites can affect the lungs, including "Toxoplasma gondii", "Strongyloides stercoralis", "Ascaris lumbricoides", and "Plasmodium malariae". These organisms typically enter the body through direct contact with the skin, ingestion, or via an insect vector. Except for "Paragonimus westermani", most parasites do not specifically affect the lungs but involve the lungs secondarily to other sites. Some parasites, in particular those belonging to the "Ascaris" and "Strongyloides" genera, stimulate a strong eosinophilic reaction, which may result in eosinophilic pneumonia. In other infections, such as malaria, lung involvement is due primarily to cytokine-induced systemic inflammation. In the developed world, these infections are most common in people returning from travel or in immigrants. Around the world, parasitic pneumonia is most common in the immunodeficient.


title: Pneumonia

text: Idiopathic interstitial pneumonia or noninfectious pneumonia is 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. Lipoid pneumonia is another rare cause due to lipids entering the lung. These lipids can either be inhaled or spread to the lungs from elsewhere in the body.


title: Pneumonia

text: Pneumonia frequently starts as an upper respiratory tract infection that moves into the lower respiratory tract. It is a type of pneumonitis (lung inflammation). The normal flora of the upper airway give protection by competing with pathogens for nutrients. In the lower airways, reflexes of the glottis, actions of complement proteins and immunoglobulins are important for protection. Microaspiration of contaminated secretions can infect the lower airways and cause pneumonia. The progress of pneumonia is determined by the virulence of the organism; the amount of organism required to start an infection; and the body's immune response against the infection.


title: Pneumonia

text: Most bacteria enter the lungs via small aspirations of organisms residing in the throat or nose. Half of normal people have these small aspirations during sleep. While the throat always contains bacteria, potentially infectious ones reside there only at certain times and under certain conditions. A minority of types of bacteria such as "Mycobacterium tuberculosis" and "Legionella pneumophila" reach the lungs via contaminated airborne droplets. Bacteria can also spread via the blood. Once in the lungs, bacteria may invade the spaces between cells and between alveoli, where the macrophages and neutrophils (defensive white blood cells) attempt to inactivate the bacteria. The neutrophils also release cytokines, causing a general activation of the immune system. This leads to the fever, chills, and fatigue common in bacterial pneumonia. The neutrophils, bacteria, and fluid from surrounding blood vessels fill the alveoli, resulting in the consolidation seen on chest X-ray.


title: Pneumonia

text: Viruses may reach the lung by a number of different routes. Respiratory syncytial virus is typically contracted when people touch contaminated objects and then touch their eyes or nose. Other viral infections occur when contaminated airborne droplets are inhaled through the nose or mouth. Once in the upper airway, the viruses may make their way into the lungs, where they invade the cells lining the airways, alveoli, or lung parenchyma. Some viruses such as measles and herpes simplex may reach the lungs via the blood. The invasion of the lungs may lead to varying degrees of cell death. When the immune system responds to the infection, even more lung damage may occur. Primarily white blood cells, mainly mononuclear cells, generate the inflammation. As well as damaging the lungs, many viruses simultaneously affect other organs and thus disrupt other body functions. Viruses also make the body more susceptible to bacterial infections; in this way, bacterial pneumonia can occur at the same time as viral pneumonia.


title: Pneumonia

text: Pneumonia is typically diagnosed based on a combination of physical signs and often a chest X-ray. In adults with normal vital signs and a normal lung examination, the diagnosis is unlikely. However, the underlying cause can be difficult to confirm, as there is no definitive test able to distinguish between bacterial and non-bacterial cause. The overall impression of a physician appears to be at least as good as decision rules for making or excluding the diagnosis.


title: Pneumonia

text: The World Health Organization has defined pneumonia in children clinically based on 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, greater than 50 breaths per minute in children 2 months to 1 year old, or greater than 40 breaths per minute in children 1 to 5 years old.


title: Pneumonia

text: In children, low oxygen levels and lower chest indrawing are more sensitive than hearing chest crackles with a stethoscope or increased respiratory rate. Grunting and nasal flaring may be other useful signs in children less than five years old.


title: Pneumonia

text: Lack of wheezing is an indicator of "Mycoplasma pneumoniae" in children with pneumonia, but as an indicator it is not accurate enough to decide whether or not macrolide treatment should be used. The presence of chest pain in children with pneumonia doubles the probability of "Mycoplasma pneumoniae".


title: Pneumonia

text: In general, in adults, investigations are not needed in mild cases. There is a very low risk of pneumonia if all vital signs and auscultation are normal. C-reactive protein (CRP) may help support the diagnosis. For those with CRP less than 20 mg/L without convincing evidence of pneumonia, antibiotics are not recommended.


title: Pneumonia

text: Procalcitonin may help determine the cause and support decisions about who should receive antibiotics. Antibiotics are encouraged if the procalcitonin level reaches 0.25 μg/L, strongly encouraged if it reaches 0.5 μg/L, and strongly discouraged if the level is below 0.10 μg/L. In people requiring hospitalization, pulse oximetry, chest radiography and blood tests – including a complete blood count, serum electrolytes, C-reactive protein level, and possibly liver function tests – are recommended.


title: Pneumonia

text: The diagnosis of influenza-like illness can be made based on the signs and symptoms; however, confirmation of an influenza infection requires testing. Thus, treatment is frequently based on the presence of influenza in the community or a rapid influenza test.


title: Pneumonia

text: Physical examination may sometimes reveal low blood pressure, high heart rate, or low oxygen saturation. The respiratory rate may be faster than normal, and this may occur a day or two before other signs. Examination of the chest may be normal, but it may show decreased expansion on the affected side. Harsh breath sounds from the larger airways that are transmitted through the inflamed lung are termed bronchial breathing and are heard on auscultation with a stethoscope. Crackles (rales) 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.


title: Pneumonia

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


title: Pneumonia

text: X-ray presentations of pneumonia may be classified as lobar pneumonia, bronchopneumonia, lobular pneumonia, and interstitial pneumonia. Bacterial, community-acquired pneumonia classically show lung consolidation of one lung segmental lobe, which is known as lobar pneumonia. However, findings may vary, and other patterns are common 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 may appear normal, appear hyper-inflated, have bilateral patchy areas, or present similar to bacterial pneumonia with lobar consolidation. Radiologic findings may not be present in the early stages of the disease, especially in the presence of dehydration, or may be difficult to interpret in the obese or those with a history of lung disease. Complications such as pleural effusion may also be found on chest radiographs. Laterolateral chest radiographs can increase the diagnostic accuracy of lung consolidation and pleural effusion.


title: Pneumonia

text: A CT scan can give additional information in indeterminate cases. CT scans can also provide more details in those with an unclear chest radiograph (for example occult pneumonia in chronic obstructive pulmonary disease) and can exclude pulmonary embolism and fungal pneumonia and detect lung abscess in those who are not responding to treatments. However, CT scans are more expensive, have a higher dose of radiation, and cannot be done at bedside.


title: Pneumonia

text: Lung ultrasound may also be useful in helping to make the diagnosis. Ultrasound is radiation free and can be done at bedside. However, ultrasound requires specific skills to operate the machine and interpret the findings. It may be more accurate than chest X-ray.


title: Pneumonia

text: In people managed in the community, determining the causative agent is not cost-effective and typically does not alter management. For people who do not respond to treatment, sputum culture should be considered, and culture for "Mycobacterium tuberculosis" should be carried out in persons with a chronic productive cough. Microbiological evaluation is also indicated in severe pneumonia, alcoholism, asplenia, immunosuppression, HIV infection, and those being empirically treated for MRSA of pseudomonas. Although positive blood culture and pleural fluid culture definitively establish the diagnosis of the type of micro-organism involved, a positive sputum culture has to be interpreted with care for the possibility of colonisation of respiratory tract. Testing for other specific organisms may be recommended during outbreaks, for public health reasons. In those hospitalized for severe disease, both sputum and blood cultures are recommended, as well as testing the urine for antigens to "Legionella" and "Streptococcus". Viral infections, can be confirmed via detection of either the virus or its antigens with culture or polymerase chain reaction (PCR), among other techniques. "Mycoplasma", "Legionella", "Streptococcus", and "Chlamydia" can also be detected using PCR techniques on bronchoalveolar lavage and nasopharyngeal swab. The causative agent is determined in only 15% of cases with routine microbiological tests.


title: Pneumonia

text: 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 is most commonly classified by where or how it was acquired: community-acquired, aspiration, healthcare-associated, hospital-acquired, and ventilator-associated pneumonia. It may also be classified by the area of the 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.


title: Pneumonia

text: The setting in which pneumonia develops is important to treatment, as it correlates to which pathogens are likely suspects, which mechanisms are likely, which antibiotics are likely to work or fail, and which complications can be expected based on the person's health status.


title: Pneumonia

text: Community-acquired pneumonia (CAP) is acquired in the community, outside of health care facilities. Compared with healthcare-associated pneumonia, it is less likely to involve multidrug-resistant bacteria. Although the latter are no longer rare in CAP, they are still less likely.


title: Pneumonia

text: Health care–associated pneumonia (HCAP) is an infection associated with recent exposure to the health care system, including hospitals, outpatient clinics, nursing homes, dialysis centers, chemotherapy treatment, or home care. HCAP is sometimes called MCAP (medical care–associated pneumonia).


title: Pneumonia

text: People may become infected with pneumonia in a hospital; this is defined as pneumonia not present at the time of admission (symptoms must start at least 48 hours after admission). It is likely to involve hospital-acquired infections, with higher risk of multidrug-resistant pathogens. People in a hospital often have other medical conditions, which may make them more susceptible to pathogens in the hospital.


title: Pneumonia

text: Ventilator-associated pneumonia occurs in people breathing with the help of mechanical ventilation. Ventilator-associated pneumonia is specifically defined as pneumonia that arises more than 48 to 72 hours after endotracheal intubation.


title: Pneumonia

text: Several diseases can present with similar signs and symptoms to pneumonia, such as: chronic obstructive pulmonary disease, 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 present with acute onset sharp chest pain and shortness of breath. Mild pneumonia should be differentiated from upper respiratory tract infection (URTI). Severe pneumonia should be differentiated from acute heart failure. Pulmonary infiltrates that resolved after giving mechanical ventilation should point to heart failure and atelectasis rather than pneumonia. For recurrent pneumonia, underlying lung cancer, metastasis, tuberculosis, a foreign bodies, immunosuppression, and hypersensitivity should be suspected.


title: Pneumonia

text: Prevention includes vaccination, environmental measures, and appropriate treatment of other health problems. It is believed that, if appropriate preventive measures were instituted globally, mortality among children could be reduced by 400,000; and, if proper treatment were universally available, childhood deaths could be decreased by another 600,000.


title: Pneumonia

text: Vaccination prevents against certain bacterial and viral pneumonias both in children and adults. Influenza vaccines are modestly effective at preventing symptoms of influenza, The Center for Disease Control and Prevention (CDC) recommends yearly influenza vaccination for every person 6 months and older. Immunizing health care workers decreases the risk of viral pneumonia among their patients.


title: Pneumonia

text: Vaccinations against "Haemophilus influenzae" and "Streptococcus pneumoniae" have good evidence to support their use. There is strong evidence for vaccinating children under the age of 2 against "Streptococcus pneumoniae" (pneumococcal conjugate vaccine). Vaccinating children against "Streptococcus pneumoniae" has led to a decreased rate of these infections in adults, because many adults acquire infections from children. A "Streptococcus pneumoniae" vaccine is available for adults, and has been found to decrease the risk of invasive pneumococcal disease by 74%, but there is insufficient evidence to suggest using the pneumococcal vaccine to prevent pneumonia or death in the general adult population. The CDC recommends that young children and adults over the age of 65 receive the pneumococcal vaccine, as well as older children or younger adults who have an increased risk of getting pneumococcal disease. The pneumococcal vaccine has been shown to reduce the risk of community acquired pneumonia in people with chronic obstructive pulmonary disease, but does not reduce mortality or the risk of hospitalization for people with this condition. People with COPD are recommended by a number of guidelines to have a pneumococcal vaccination. Other vaccines for which there is support for a protective effect against pneumonia include pertussis, varicella, and measles.


title: Pneumonia

text: When influenza outbreaks occur, medications such as amantadine or rimantadine may help prevent the condition, but they are associated with side effects. Zanamivir or oseltamivir decrease the chance that people who are exposed to the virus will develop symptoms; however, it is recommended that potential side effects are taken into account.


title: Pneumonia

text: Smoking cessation and reducing indoor air pollution, such as that from cooking indoors with wood, crop residues or dung, are both recommended. Smoking appears to be the single biggest risk factor for pneumococcal pneumonia in otherwise-healthy adults. Hand hygiene and coughing into one's sleeve may also be effective preventative measures. Wearing surgical masks by the sick may also prevent illness.


title: Pneumonia

text: Appropriately treating underlying illnesses (such as HIV/AIDS, diabetes mellitus, and malnutrition) can decrease the risk of pneumonia. In children less than 6 months of age, exclusive breast feeding reduces both the risk and severity of disease. In people with HIV/AIDS and a CD4 count of less than 200 cells/uL the antibiotic trimethoprim/sulfamethoxazole decreases the risk of "Pneumocystis pneumonia" and is also useful for prevention in those that are immunocompromised but do not have HIV.


title: Pneumonia

text: Testing pregnant women for Group B Streptococcus and "Chlamydia trachomatis", and administering antibiotic treatment, if needed, reduces rates of pneumonia in infants; preventive measures for HIV transmission from mother to child may also be efficient. Suctioning the mouth and throat of infants with meconium-stained amniotic fluid has not been found to reduce the rate of aspiration pneumonia and may cause potential harm, thus this practice is not recommended in the majority of situations. In the frail elderly good oral health care may lower the risk of aspiration pneumonia, even though there is no good evidence that one approach to mouth care is better than others in preventing nursing home acquired pneumonia. Zinc supplementation in children 2 months to five years old appears to reduce rates of pneumonia.


title: Pneumonia

text: For people with low levels of vitamin C in their diet or blood, taking vitamin C supplements may be suggested to decrease the risk of pneumonia, although there is no strong evidence of benefit. There is insufficient evidence to recommend that the general population take vitamin C to prevent or treat pneumonia.


title: Pneumonia

text: For adults and children in the hospital who require a respirator, there is no strong evidence indicating a difference between heat and moisture exchangers and heated humidifiers for preventing pneumonia. There is tentative evidence that laying flat on the back compared to semi-raised increases pneumonia risks in people who are intubated.


title: Pneumonia

text: Antibiotics by mouth, rest, simple analgesics, and fluids usually suffice 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, whereas in the developed world between 22 and 42% of adults with community-acquired pneumonia are admitted. The CURB-65 score is useful for determining the need for admission in adults. 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. In children those with respiratory distress or oxygen saturations of less than 90% should be hospitalized. The utility of chest physiotherapy in pneumonia has not yet been determined. Over-the-counter cough medicine has not been found to be effective, nor has the use of zinc in children. There is insufficient evidence for mucolytics. There is no strong evidence to recommend that children who have non-measles related pneumonia take vitamin A supplements. Vitamin D, as of 2018 is of unclear benefit in children.


title: Pneumonia

text: Pneumonia can cause severe illness in a number of ways, and pneumonia with evidence of organ dysfunction may require intensive care unit admission for observation and specific treatment. The main impact is on the respiratory and the circulatory system. Respiratory failure not responding to normal oxygen therapy may require heated humidified high-flow therapy delivered through nasal cannulae, non-invasive ventilation, or in severe cases invasive ventilation through an endotracheal tube. Regarding circulatory problems as part of sepsis, evidence of poor blood flow or low blood pressure is initially treated with 30 mL/kg of crystalloid infused intravenously. In situations where fluids alone are ineffective, vasopressor medication may be required.


title: Pneumonia

text: For adults with moderate or severe acute respiratory distress syndrome (ARDS) undergoing mechanical ventilation, there is a reduction in mortality when people lie on their front for at least 12 hours a day. However, this increases the risk of endotracheal tube obstruction and pressure sores.


title: Pneumonia

text: Antibiotics improve outcomes in those with bacterial pneumonia. The first dose of antibiotics should be given as soon as possible. Increased use of antibiotics, however, may lead to the development of antimicrobial resistant strains of bacteria. Antibiotic choice depends initially on the characteristics of the person affected, such as age, underlying health, and the location the infection was acquired. Antibiotic use is also associated with side effects such as nausea, diarrhea, dizziness, taste distortion, or headaches. In the UK, treatment before culture results with amoxicillin is recommended as the first line for community-acquired pneumonia, with doxycycline or clarithromycin as alternatives. In North America, amoxicillin, doxycycline, and in some areas a macrolide (such as azithromycin or erythromycin) is the first-line outpatient treatment in adults. In children with mild or moderate symptoms, amoxicillin taken by mouth is the first line. The use of fluoroquinolones in uncomplicated cases is discouraged due to concerns about side-effects and generating resistance in light of there being no greater benefit.


title: Pneumonia

text: For those who require hospitalization and caught their pneumonia in the community the use of a β-lactam such as cephazolin plus macrolide such as azithromycin is recommended. A fluoroquinolone may replace azithromycin but is less preferred. Antibiotics by mouth and by injection appear to be similarly effective in children with severe pneumonia.


title: Pneumonia

text: The duration of treatment has traditionally been seven to ten days, but increasing evidence suggests that shorter courses (3–5 days) may be effective for certain types of pneumonia and may reduce the risk of antibiotic resistance. Research in children showed that a shorter, 3-day course of amoxicillin was as effective as a longer, 7-day course for treating pneumonia in this population. For pneumonia that is associated with a ventilator caused by non-fermenting Gram-negative bacilli (NF-GNB), a shorter course of antibiotics increases the risk that the pneumonia will return. Recommendations for hospital-acquired pneumonia include third- and fourth-generation cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, and vancomycin. These antibiotics are often given intravenously and used in combination. In those treated in hospital, more than 90% improve with the initial antibiotics. For people with ventilator-acquired pneumonia, the choice of antibiotic therapy will depend on the person's risk of being infected with a strain of bacteria that is multi-drug resistant. Once clinically stable, intravenous antibiotics should be switched to oral antibiotics. For those with "Methicillin resistant Staphylococcus aureus" (MRSA) or "Legionella" infections, prolonged antibiotics may be beneficial.


title: Pneumonia

text: The addition of corticosteroids to standard antibiotic treatment appears to improve outcomes, reducing death and morbidity for adults with severe community acquired pneumonia, and reducing death for adults and children with non-severe community acquired pneumonia. A 2017 review therefore recommended them in adults with severe community acquired pneumonia. A 2019 guideline however recommended against their general use, unless refractory shock was present. Side effects associated with the use of corticosteroids include high blood sugar. There is some evidence that adding corticosteroids to the standard PCP pneumonia treatment may be beneficial for people who are infected with HIV.


title: Pneumonia

text: The use of granulocyte colony stimulating factor (G-CSF) along with antibiotics does not appear to reduce mortality and routine use for treating pneumonia is not supported by evidence.


title: Pneumonia

text: 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.


title: Pneumonia

text: In general, aspiration pneumonitis is treated conservatively with antibiotics indicated only for 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.


title: Pneumonia

text: Corticosteroids are sometimes used in aspiration pneumonia, but there is limited evidence to support their effectiveness.


title: Pneumonia

text: The British Thoracic Society recommends that a follow-up chest radiograph be taken in people with persistent symptoms, smokers, and people older than 50. American guidelines vary, from generally recommending a follow-up chest radiograph to not mentioning any follow-up.


title: Pneumonia

text: With treatment, most types of bacterial pneumonia will stabilize in 3–6 days. It often takes a few weeks before most symptoms resolve. X-ray findings typically clear within four weeks and mortality is low (less than 1%). In the elderly or people with other lung problems, recovery may take more than 12 weeks. In persons requiring hospitalization, mortality may be as high as 10%, and in those requiring intensive care it may reach 30–50%. Pneumonia is the most common hospital-acquired infection that causes death. Before the advent of antibiotics, mortality was typically 30% in those that were hospitalized. However, for those whose lung condition deteriorates within 72 hours, the problem is usually due to sepsis. If pneumonia deteriorates after 72 hours, it could be due to nosocomial infection or excerbation of other underlying comorbidities. About 10% of those discharged from hospital are readmitted due to underlying co-morbidities such as heart, lung, or neurological disorders, or due to new onset of pneumonia.


title: Pneumonia

text: Complications may occur in particular in the elderly and those with underlying health problems. This may include, among others: empyema, lung abscess, bronchiolitis obliterans, acute respiratory distress syndrome, sepsis, and worsening of underlying health problems.


title: Pneumonia

text: Clinical prediction rules have been developed to more objectively predict outcomes of pneumonia. These rules are often used to decide whether to hospitalize the person.


title: Pneumonia

text: In pneumonia, a collection of fluid may form in the space that surrounds the lung. Occasionally, microorganisms will infect this fluid, causing an empyema. To distinguish an empyema from the more common simple parapneumonic effusion, the fluid may be collected with a needle (thoracentesis), and examined. If this shows evidence of empyema, complete drainage of the fluid is necessary, often requiring a drainage catheter. 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 must be drained only if it is causing symptoms or remains unresolved.


title: Pneumonia

text: In rare circumstances, 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 but frequently require a chest CT scan to confirm the diagnosis. Abscesses typically occur in aspiration pneumonia, and often contain several types of bacteria. Long-term antibiotics are usually adequate to treat a lung abscess, but sometimes the abscess must be drained by a surgeon or radiologist.


title: Pneumonia

text: Pneumonia can 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 stiff. This stiffness, combined with severe difficulties extracting oxygen due to the alveolar fluid, may require long periods of mechanical ventilation for survival. Other causes of circulatory failure are hypoxemia, inflammation, and increased coagulability.


title: Pneumonia

text: Sepsis is a potential complication of pneumonia but usually occurs in people with poor immunity or hyposplenism. The organisms most commonly involved are "Streptococcus pneumoniae", "Haemophilus influenzae", and "Klebsiella pneumoniae". Other causes of the symptoms should be considered such as a myocardial infarction or a pulmonary embolism.


title: Pneumonia

text: 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 total death) yearly. Rates are greatest in children less than five, and adults older than 75 years. It occurs about five times more frequently in the developing world than in the developed world. Viral pneumonia accounts for about 200 million cases. In the United States, as of 2009, pneumonia is the 8th leading cause of death.


title: Pneumonia

text: In 2008, pneumonia occurred in approximately 156 million children (151 million in the developing world and 5 million in the developed world). In 2010, it resulted in 1.3 million deaths, or 18% of all deaths in those under five years, 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 is due to pneumonia. Approximately half of these deaths can be prevented, as they are caused by the bacteria for which an effective vaccine is available. In 2011, pneumonia was the most common reason for admission to the hospital after an emergency department visit in the U.S. for infants and children.


title: Pneumonia

text: Pneumonia has been a common disease throughout human history. The word is from Greek πνεύμων (pneúmōn) meaning "lung". The symptoms were described by Hippocrates (–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 (1135–1204 AD) observed: "The basic symptoms that occur in pneumonia and that 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.


title: Pneumonia

text: Edwin Klebs was the first to observe bacteria in the airways of persons having died of pneumonia in 1875. Initial work identifying the two common bacterial causes, "Streptococcus pneumoniae" and "Klebsiella pneumoniae", was performed by Carl Friedländer and Albert Fraenkel 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 to differentiate the two bacteria, and showed that pneumonia could be caused by more than one microorganism. In 1887, Jaccond demonstrated pneumonia may be caused by opportunistic bacteria always present in the lung.


title: Pneumonia

text: Sir William Osler, known as "the father of modern medicine", appreciated the death and disability caused 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 were much slower and more painful ways to die.


title: Pneumonia

text: Viral pneumonia was first described by Hobart Reimann in 1938. Reimann, Chairman of the Department of Medicine at Jefferson Medical College, had established the practice of routinely typing the pneumococcal organism in cases where pneumonia presented. Out of this work, the distinction between viral and bacterial strains was noticed.


title: Pneumonia

text: 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 20th 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.


title: Pneumonia

text: Due to the relatively low awareness of the disease, 12 November was declared as the annual World Pneumonia Day, a day for concerned citizens and policy makers to take action against the disease, in 2009.


title: Pneumonia

text: The global economic cost of community-acquired pneumonia has been estimated at $17 billion annually. Other estimates are considerably higher. In 2012 the estimated aggregate costs of treating pneumonia in the United States were $20 billion; the median cost of a single pneumonia-related hospitalization is over $15,000. According to data released by the Centers for Medicare and Medicaid Services, average 2012 hospital charges for inpatient treatment of uncomplicated pneumonia in the U.S. were $24,549 and ranged as high as $124,000. The average cost of an emergency room consult for pneumonia was $943 and the average cost for medication was $66. Aggregate annual costs of treating pneumonia in Europe have been estimated at €10 billion.


title: NASA

text: The National Aeronautics and Space Administration (NASA ) is an independent agency of the US federal government responsible for the civil space program, aeronautics research, and space research.


title: NASA

text: NASA was established in 1958, succeeding the National Advisory Committee for Aeronautics (NACA), to give the U.S. space development effort a distinctly civilian orientation, emphasizing peaceful applications in space science. NASA has since led most American space exploration, including Project Mercury, Project Gemini, the 1968-1972 Apollo Moon landing missions, the Skylab space station, and the Space Shuttle. NASA supports the International Space Station and oversees the development of the Orion spacecraft, the Space Launch System, Commercial Crew vehicles, and the planned Lunar Gateway space station. The agency is also responsible for the Launch Services Program, which provides oversight of launch operations and countdown management for uncrewed NASA launches.


title: NASA

text: NASA's science is focused on better understanding Earth through the Earth Observing System; advancing heliophysics through the efforts of the Science Mission Directorate's Heliophysics Research Program; exploring bodies throughout the Solar System with advanced robotic spacecraft such as "New Horizons" and planetary rovers such as "Perseverance"; and researching astrophysics topics, such as the Big Bang, through the James Webb Space Telescope, and the Great Observatories and associated programs.


title: NASA

text: The agency's administration is located at NASA Headquarters in Washington, DC, and provides overall guidance and direction. Except under exceptional circumstances, NASA civil service employees are required to be US citizens.


title: NASA

text: NASA's administrator is nominated by the President of the United States subject to the approval of the US Senate, and serves at the President's pleasure as a senior space science advisor. The current administrator is Bill Nelson, appointed by President Joe Biden, since May 3, 2021.


title: NASA

text: NASA budget requests are developed by NASA and approved by the administration prior to submission to the U.S. Congress. Authorized budgets are those that have been included in enacted appropriations bills that are approved by both houses of Congress and enacted into law by the U.S. president.


title: NASA

text: Center-wide activities such as the Chief Engineer and Safety and Mission Assurance organizations are aligned to the headquarters function. The MSD budget estimate includes funds for these HQ functions. The administration operates 10 major field centers with several managing additional subordinate facilities across the country. Each is led by a Center Director (data below valid as of September 1, 2022).