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PNEUMONIA
It is a consolidation of alveoli or infiltration of
the interstitial tissue with inflammatory cell or
both
TYPES
*Lobar
*Lobular
*Bronchopneumonia
*Interstitial pneumonia
Chlamydia and mycoplasma cause community
acquired pneumonia
Pneumocystis jiroveci, histoplasmosis and
coccidioidomycosis cause pneumonia in
immunocompromised children
ETIOLOGY
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
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
adenovirus
Risk factors :Low birth wt, malnutrition, vit A
deficiency ,lack of breast feeding, passive
smoking, large family size, family h/o
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
lower chest and intercoastal spaces
Signs of consolidation are present in the lobar
pnemonia
PNEUMOCOCCAL PNEUMONIA
? More common in winter months
? Overcrowding and diminished host resistance
predisposes the children to infection with
pneumococci
? 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
? There is no tissue necrosis
? Pathological stages are stage of congestion, red
and grey hepatisation and stage of resolution
CLINICAL FEATURES
IP : 1 to 3days
Onset is abrupt with headache chills, cough, high
fever
Cough may be associated with thick rusty sputum
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
areas of consolidation
DIAGNOSIS
Based on history, physical examination, X-
ray findings, leukocytosis, sputum examined
by Gram staining and culture and
polysaccharide Ag demonstrated in urine.
TREATMENT
Treatment of choice PENICILLIN
Alternative : AMOXYCILLIN with or without
CLAVULANIC ACID
The need for oxygen administration is guided
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
STAPHYLOCOCCAL PNEUMONIA
RISK FACTORS
Primary infection of the parenchyma,secondary
to generalised staphylococcal septicemia,
measles or influenza, cystic fibrosis,
malnutrition and diabetes
In infants the illness is characterised by
formation of multiple pneumatocele
Staphylococcal abscesses may erode into the
pericardium causing purulent pericarditis
CLINICAL FEATURES
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
rapid
DIAGNOSIS
Characteristic complications of
pyopneumothorax and pericarditis are highly
suggestive
Pneumatoceles are present in X-ray films
Staphylococci can be cultured from the blood
TREATMENT
The child should be hospitalised and isolated
Fever is controlled with antipyretics
Oxygen is administered to relieve dyspnoea and
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
cephalosporin
If the symptoms are not improved within 48hrs
start with vancomycin,teicoplanin or linezolid
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
As the infants have transplacentally
transferred Abs during the first 3 to 4 months
of life, infections are relatively less during
this period
CLINICAL FEATURES
Gradual onset with nasopharyngeal infection
Certain viral infection such as Influenza virus
acts synergistically with H.influenzae
Child has moderate fever, dyspnoea, grunting
respiration and retraction of the lower
intercostal spaces
COMPLICATIONS
Bacteremia
Pericarditis
Empyema
Menigitis
Polyarthritis
TREATMENT
Ampicillin 100mg/kg/day or Co amoxiclav
Cefotaxime 100mg/kg/day
Ceftriaxone 50-75mg/kg/day
This post was last modified on 12 August 2021