Download MBBS Pneumonia in Children Lecture PPT

PNEUMONIA
It is a consolidation of alveoli or infiltration of
the interstitial tissue with inflammatory cell or

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both
TYPES
*Lobar
*Lobular
*Bronchopneumonia

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*Interstitial pneumonia

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Chlamydia and mycoplasma cause community
acquired pneumonia
Pneumocystis jiroveci, histoplasmosis and

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coccidioidomycosis cause pneumonia in
immunocompromised children

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ETIOLOGY

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In the 1st 2 months the common agents
causing pneumonia include Gram neg
bacteria such as Klebsiella, E.coli and Gram
pos organisms like pneumococci and
staphylococci

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b/w 3months and 3yrs: S.pneumoniae,
H.influenzae and staphylococci
After 3yrs: pneumococci and staphylococci
Viral pneumonia caused by respiratory
syncytial virus, influenza, parainfluenza or

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adenovirus

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Risk factors :Low birth wt, malnutrition, vit A
deficiency ,lack of breast feeding, passive
smoking, large family size, family h/o

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bronchitis , advance birth order,over
crowding, young age and air pollution
Symptoms include high grade fever,dyspnoea
and grunting respiration.
o/e ,there is flaring of alae nasi,retraction of

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lower chest and intercoastal spaces
Signs of consolidation are present in the lobar
pnemonia

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PNEUMOCOCCAL PNEUMONIA
? More common in winter months
? Overcrowding and diminished host resistance
predisposes the children to infection with
pneumococci

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? Bacteria multiply in the alveoli and an
inflammatory exudate is formed
? Scattered areas of consolidation occur which
coalesce around the bronchi and become lobar or
lobular

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? There is no tissue necrosis
? Pathological stages are stage of congestion, red
and grey hepatisation and stage of resolution

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CLINICAL FEATURES
IP : 1 to 3days
Onset is abrupt with headache chills, cough, high
fever
Cough may be associated with thick rusty sputum

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Child may develop pleuritic chest pain, rapid
respiration, grunting ,chest indrawing, difficulty
in breathing and cyanosis
Percussion note impaired ,air entry is diminished
Crepitation and bronchial breathing heard over

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areas of consolidation

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DIAGNOSIS
Based on history, physical examination, X-

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ray findings, leukocytosis, sputum examined
by Gram staining and culture and
polysaccharide Ag demonstrated in urine.

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TREATMENT
Treatment of choice PENICILLIN
Alternative : AMOXYCILLIN with or without
CLAVULANIC ACID
The need for oxygen administration is guided

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by signs of resp distress(rapid breathing
chest retraction nasal flare), presence of
cyanosis or hypoxemia
Fever managed with PARACETAMOL
If dehydrated IV fluids given

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STAPHYLOCOCCAL PNEUMONIA
RISK FACTORS
Primary infection of the parenchyma,secondary

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to generalised staphylococcal septicemia,
measles or influenza, cystic fibrosis,
malnutrition and diabetes
In infants the illness is characterised by
formation of multiple pneumatocele

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Staphylococcal abscesses may erode into the
pericardium causing purulent pericarditis

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CLINICAL FEATURES

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Usually follows upper respiratory tract
infections,pyoderma or purulent d/s.
Patient is toxic and ill looking.
Cyanosis may be present
Progression of the symptoms and signs is

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rapid

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DIAGNOSIS
Characteristic complications of

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pyopneumothorax and pericarditis are highly
suggestive
Pneumatoceles are present in X-ray films
Staphylococci can be cultured from the blood

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TREATMENT
The child should be hospitalised and isolated
Fever is controlled with antipyretics
Oxygen is administered to relieve dyspnoea and

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cyanosis
Empyema is aspirated and pus is sent for culture
and sensitivity
antibiotic therapy initiated with coamoxiclav or
combination of cloxacillin and a 3rd generation

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cephalosporin
If the symptoms are not improved within 48hrs
start with vancomycin,teicoplanin or linezolid

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HAEMOPHILUS PNEUMONIA
Occurs between the age of 3months and 3yrs
Nearly always associated with bacteremia
Usually begins in the nasopharynx and
spreads locally or through the blood stream

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As the infants have transplacentally
transferred Abs during the first 3 to 4 months
of life, infections are relatively less during
this period

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CLINICAL FEATURES
Gradual onset with nasopharyngeal infection
Certain viral infection such as Influenza virus
acts synergistically with H.influenzae

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Child has moderate fever, dyspnoea, grunting
respiration and retraction of the lower
intercostal spaces

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COMPLICATIONS
Bacteremia
Pericarditis
Empyema
Menigitis

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Polyarthritis

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TREATMENT
Ampicillin 100mg/kg/day or Co amoxiclav

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Cefotaxime 100mg/kg/day
Ceftriaxone 50-75mg/kg/day

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