STREPTOCOCCAL PNEUMONIA
Infection of lung by GrpA beta hemolytic
streptococci is secondary to measles,
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chickenpox, influenza or whooping coughGrpB streptococci is an imp cause of resp
distress in newborns
Pathologically it cause interstitial pneumonia
Tracheobronchial mucosa may be ulcerated
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and lymph nodes enlargedCLINICAL FEATURES
Onset is abrupt with fever, chills, dyspnea,
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rapid respiration, blood streaked sputum,cough and extreme prostration
X-ray film shows interstitial pneumonia,
segmental involement, diffuse peribronchial
densities or an effusion
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COMPLICATIONS
Serosanguineous or purulent empyema
Pulmonary suppuration (less frequent)
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BacteremiaPRIMARY ATYPICAL PNEUMONIA
Etiological agent is Mycoplasma pneumoniae
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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
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the bronchiole inflamed and ulceratedObstruction of the terminal bronchioles
causes emphysema and atelectasis
Pleura shows patchy fibrinous exudates
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CLINICAL FEATURES
IP : 12-14days
Malaise, headache, fever, sore throat, myalgia
and cough
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Cough is dry 1st later associated with mucoidexpectoration, may be blood streaked
Hemolytic anemia can be seen
X-ray poorly defined hazy or fluffy exudates
radiate from hilar regions
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Enlargement of hilar lymph nodes and pleuraleffusion are reported
DIAGNOSIS
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Cold agglutinins are elevatedDemonstration of IgM Abs by ELISA during
aute stage
IgG are seen on compliment fixation test after
one week of illness
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TREATMENT
Macrolide antibiotics
(erythromycin,azithromycin or clarithromycin)
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or tetracycline (for older children) for 7 to 10days
CHLAMYDIA PNEUMONIA
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Pneumonia in young infantsC/F include spasmodic cough
H/O purulent conjuctivitis during early
neonatal period may be present
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PNEUMONIA DUE TO GRAM
NEGATIVE ORGANISMS
Etiological agents are
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E.coliKlebsiella
Pseudomonas
Affects small children or children with
malnutrition and deficient immunity
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X-ray shows unilateral or bilateralconsolidation
TREATMENT
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IV third generation cephalosporins with orwithout an aminoglycosides is recommended
for 10-14 days
Ceftazidime or piperacillin-tazobactam are
effective in patients with pseudomonas
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infectionVIRAL PNEUMONIA
Respiratory syncytial virus is the imp cause in
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infants under 6months of ageAt other ages, influenza, parainfluenza, and
adenovirus are common
Features of consolidation are not present
Radiological signs consists of perihilar and
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peribronchial infiltratesINGESTION OF ALIPHATIC
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HYDROCARBONSKerosene exerts its toxic effects on lungs and
CNS
Poorly absorbed from GIT
C/F of hydrocarbon pneumonia are cough,
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dyspnea, high fever, vomiting, drowsinessand coma
X-ray films shows ill defined homogeneous or
patchy opacities
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LOEFFLER SYNDROME
Due to larvae of many nematodes
Some cases may be due to drug reaction to
aspirin, penicillin, sulfonamide or imipramine
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C/F are cough, low fever, feeling unwell,scattered crepitations
Eosinophilia
X-ray shows pulmonary infiltrates varying
size
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ACUTE RESPIRATORY
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TRACT INFECTION (ARTI)CONTROL PROGRAM
Acute lower respiratory tract infection is a
leading cause of mortality in children below
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5yrs of ageClinical criteria for diagnosis of pneumonia
include rapid respiration with or without
difficulty in respiration
Rapid respiration is defined as respiratory
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rate more than 60,50 or 40 per minute inchildren below 2months of age ,2 months to
1 yr, 1 to 5yrs respectively
The WHO recommends that in a primary care
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setting if a child between 2months and 5yrsof age presents with cough he should be
examined for rapid respiration, difficulty in
breathing, presence of cyanosis or difficulty
in feeding
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If the respiration is normal and there is nochest indrawing and difficulty in feeding, the
patient is assessed to be having an upper
resp tract infection and can be managed at
home
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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
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Patients with chest indrawing are considerd tohave severe pneumonia and treated with
parenteral penicillin
Severe chest indrwaing or cyanosis indicates
very severe pneumonia and treated in
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hospital with IV penicillin with gentamycinand supportive care
In children below 2months of age the
presence of :fever ,convulsions ,abnormally
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sleepy, stridor in a calm child, wheezing, notfeeding, tachypnea, chest indrawing ,altered
sensorium, central cyanosis, grunting and
distended abdomen indicates severe d/s and
are admitted to hospital and treated with
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parenteral ampicillin and gentamycin alongwith supportive care