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STREPTOCOCCAL PNEUMONIA
Infection of lung by GrpA beta hemolytic
streptococci is secondary to measles,
chickenpox, influenza or whooping cough
GrpB streptococci is an imp cause of resp
distress in newborns
Pathologically it cause interstitial pneumonia
Tracheobronchial mucosa may be ulcerated
and lymph nodes enlarged
CLINICAL FEATURES
Onset is abrupt with fever, chills, dyspnea,
rapid respiration, blood streaked sputum,
cough and extreme prostration
X-ray film shows interstitial pneumonia,
segmental involement, diffuse peribronchial
densities or an effusion
COMPLICATIONS
Serosanguineous or purulent empyema
Pulmonary suppuration (less frequent)
Bacteremia
PRIMARY ATYPICAL PNEUMONIA
Etiological agent is Mycoplasma pneumoniae
Transmitted by droplet infection (winter)
Uncommon in children below 4yrs
It involves interstitial tissue with round cell
infiltration
Alveolar space are edematus and mucosa of
the bronchiole inflamed and ulcerated
Obstruction of the terminal bronchioles
causes emphysema and atelectasis
Pleura shows patchy fibrinous exudates
CLINICAL FEATURES
IP : 12-14days
Malaise, headache, fever, sore throat, myalgia
and cough
Cough is dry 1st later associated with mucoid
expectoration, may be blood streaked
Hemolytic anemia can be seen
X-ray poorly defined hazy or fluffy exudates
radiate from hilar regions
Enlargement of hilar lymph nodes and pleural
effusion are reported
DIAGNOSIS
Cold agglutinins are elevated
Demonstration of IgM Abs by ELISA during
aute stage
IgG are seen on compliment fixation test after
one week of illness
TREATMENT
Macrolide antibiotics
(erythromycin,azithromycin or clarithromycin)
or tetracycline (for older children) for 7 to 10
days
CHLAMYDIA PNEUMONIA
Pneumonia in young infants
C/F include spasmodic cough
H/O purulent conjuctivitis during early
neonatal period may be present
PNEUMONIA DUE TO GRAM
NEGATIVE ORGANISMS
Etiological agents are
E.coli
Klebsiella
Pseudomonas
Affects small children or children with
malnutrition and deficient immunity
X-ray shows unilateral or bilateral
consolidation
TREATMENT
IV third generation cephalosporins with or
without an aminoglycosides is recommended
for 10-14 days
Ceftazidime or piperacillin-tazobactam are
effective in patients with pseudomonas
infection
VIRAL PNEUMONIA
Respiratory syncytial virus is the imp cause in
infants under 6months of age
At other ages, influenza, parainfluenza, and
adenovirus are common
Features of consolidation are not present
Radiological signs consists of perihilar and
peribronchial infiltrates
INGESTION OF ALIPHATIC
HYDROCARBONS
Kerosene exerts its toxic effects on lungs and
CNS
Poorly absorbed from GIT
C/F of hydrocarbon pneumonia are cough,
dyspnea, high fever, vomiting, drowsiness
and coma
X-ray films shows ill defined homogeneous or
patchy opacities
LOEFFLER SYNDROME
Due to larvae of many nematodes
Some cases may be due to drug reaction to
aspirin, penicillin, sulfonamide or imipramine
C/F are cough, low fever, feeling unwell,
scattered crepitations
Eosinophilia
X-ray shows pulmonary infiltrates varying
size
ACUTE RESPIRATORY
TRACT INFECTION (ARTI)
CONTROL PROGRAM
Acute lower respiratory tract infection is a
leading cause of mortality in children below
5yrs of age
Clinical criteria for diagnosis of pneumonia
include rapid respiration with or without
difficulty in respiration
Rapid respiration is defined as respiratory
rate more than 60,50 or 40 per minute in
children below 2months of age ,2 months to
1 yr, 1 to 5yrs respectively
The WHO recommends that in a primary care
setting if a child between 2months and 5yrs
of age presents with cough he should be
examined for rapid respiration, difficulty in
breathing, presence of cyanosis or difficulty
in feeding
If the respiration is normal and there is no
chest indrawing and difficulty in feeding, the
patient is assessed to be having an upper
resp tract infection and can be managed at
home
If the child has rapid respiration but there is
no chest indrawing he/she is suffering from
pneumonia and can be managed at home
with oral cotrimoxazole for 5days
Patients with chest indrawing are considerd to
have severe pneumonia and treated with
parenteral penicillin
Severe chest indrwaing or cyanosis indicates
very severe pneumonia and treated in
hospital with IV penicillin with gentamycin
and supportive care
In children below 2months of age the
presence of :fever ,convulsions ,abnormally
sleepy, stridor in a calm child, wheezing, not
feeding, tachypnea, chest indrawing ,altered
sensorium, central cyanosis, grunting and
distended abdomen indicates severe d/s and
are admitted to hospital and treated with
parenteral ampicillin and gentamycin along
with supportive care
This post was last modified on 12 August 2021