Download ACUTE PNEUMONIA IN CHILDREN

ACUTE PNEUMONIA IN
CHILDREN
Department of pediatrics
ACUTE PNEUMONIA IN
CHILDREN
• Pneumonia is an inflammation of the
parenchyma of the lung,
• Incidence 0.026 episodes per child/year in
USA,
• 0.28 episodes per child/year in developed
countries
SYMPTOMS AND SIGNS
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Raised respiratory rate
- 50 per minute or more if child 2mo up to 12mo;
- 40 per minute or more if child 12 mo up to 5 yr
- 30 per minute or more if child above 5 yr
Stridor in calm child or wheezing
Fever >37.5o
Dry cough or production of sputum
Worse signs:
the child is not able to drink or feeding wall, vomit everything, is lethargic or
had convulsions
Focal chest signs- chest indrawing
- decreased expansion
- dullness on percussion
- bronchial breathing
- pleural chest pain in older children
ETIOLOGY
• Viruses: influenza A and B, RS, adenovirus,
parainfluenza
• Gram + bacteria: Str.pneumoniae, Str.pyogenes,
Staph.aureus
• Gram- bacteria: H.influenzae, Kl.pneumoniae,
Ps.aeruginosa, Morax. catarrhalis, Neis. meningitides,
E.coli, Proteus, Enterobacter.
• Atypical nonbacterial bacilli: Mycoplasma or Chlamydia
pneumoniae,Legionella (acquired by breathing droplets
or contaminated water)
• Specific pneumonia in infants: aspiration (diminished gag
reflex), gastroesophagal reflux, heart defects, genetic
disorders, asthma, impaired immune system.
CLINICAL MANIFESTATIONS
• History- recent respiratory infection, exposure to people with
pneumonia, fever, acute or persistent cough, dry/productive, related
to feeding (aspiration), choking/ staccato/paroxysmal (foreign body
aspiration, pertussis).
• Worse signs: not able to drink or feeding, vomit everything, is
lethargic or had convulsions
• Physical examination-confusions, abnormally sleepy, cyanosis, fast
breathing, nasal flaring, respiratory distress, grunting, stridor,
wheezing;
- vomiting, diarrhea, abdominal pain in paralytic ileus;
- dullness on percussion: -consolidation or pleural effusion,
empyema;
- auscultation- rales, crackles, crepitations, rhonchi (rumblings).
- clinical signs that predict death in children:worse signs, prolonged
illness, severe X-ray changes, cyanosis, leukocytosis,
hepatomegaly.
PNEUMONIA- DIAGNOSIS
• Chest X-ray confirms pneumonia and pleural effusion or empyema
- Confluent lobar consolidation is typically in pneumococcal causes
- Viral pneumonia- hyperinflation with bilateral interstitial infiltrates
• Bronchoscopy, USG, CT scan in malformation or tumors
• WBC in viral pneumonia are normal or <15,000/ml, with lymphocyte
rises; in bacterial WBC>20,000/ml, granulocyte rises
• Atypical pneumonia: a higher WBC, ESR and C-reactive protein
• DNA, RNA, antibodies tests for the rapid detection of viruses
• PCR test or seroconversion in an IgG assay
• Serologic evidence of the ASL-O
• Serum IgE in recurrent wheezing
• Isolation of the bacteria from the blood, pleural fluid or lung
• Culture of sputum and susceptibility of the antibiotics
• Urinary antigen test positive
PNEUMONIA -TREATMENT
ANTIBIOTIS:
1.Penicillins and betalactams: Amoxycillin, Amoxi/Clav,
Sulbactam
2.Cephalosporines- Cefazolin, Cefuroxim, Ceftriaxon,
Ceftazidizime
3.Penems- Imipenem/Cilastatin, Meropenem, Ertapenem
4.Quinolones-Ciprofloxacin, Levofloxacin, Moxifloxacin,
Gatifloxacin- more effective in Gram- bacteria
5.In atypical pneumonia – macrolides: Clarithromycin,
Roxithromycin, Azithromycin (7.5-15mg/kg/day)
6.Aminoglycosides- dosage according to age, weight and
kidney function (Gentamicin, Tobramycin, Amikacin)
7.In viral pneumonia treatment withhold antibiotics
SUPPORTIVE TREATMENT
1. good hydration, cough remedies, antipyretics,
oxygen in the central cyanosis or worse signs
2. For children with wheeze- rapid acting
bronchodilator(Salbutamol)
3. Drainage with tube in empyema, fibrinolytic
therapy: urokinase, streptokinase, alteplase
4. Indications for hospitalization: age <6mo,
persistent fever, worse signs, severe
respiratory distress, toxic appearance, no
response to antibiotic
RESPONSE TO TREATMENT
• The factors then patients leads to “Slowly
resolving pneumonia”:
1. complications such as empyema
2 .bacterial resistance 3.viral causes, foreign
bodies or food aspiration
4. bronchial obstruction 5.pre-existing
immunodeficiencies
6. cyliary dyskinesia, cystic fibrosis, other
noninfectious causes.
The first step- repeat chest X-ray
COMPLICATIONS
● The result of direct spread in the thoracic
cavity: pleural effusion, empyema,
pneumothorax, pericarditis
● Hematologic spread:sepsis, meningitis,
arthritis, osteomyelitis
PREVENTION OF PNEUMONIA
● Immunization against H. influenzae type b
● Influenza vaccine
● Heptavalent pneumococcal conjugate
vaccine
● Health education of the community
● Messages for mothers to recognize the
signs of pneumonia
REFERENCES
1.Nelson textbook of pediatrics, 18-th edition,
2007, p.1795-1800
2.Dr Herman Laferi-Community acquired
pneumonia, diagnosis, treatment, Satellite
Symposium “Update in Infectious Pathology”,
2006, Chisinau
3.Technical bases for WHO recommendations on
the management of pneumonia in children at
first-level health facilities, Geneva, 2001