PNEUMONIA
Pneumonia is the inflammatory condition of lungs
primarily affecting the alveoli.
Pneumonia can be classified anatomically as
--- Content provided by FirstRanker.com ---
?Lobar pneumonia?Bronchopneumonia
?Interstitial pneumonia
? Pathologically there is consolidation of alveoli or
infiltration of interstitial tissue with inflammatory
--- Content provided by FirstRanker.com ---
cellsETIOLOGY
Viral
?RSV
?Influenza
--- Content provided by FirstRanker.com ---
?Parainfluenza?Adenovirus
?Seen in 40% Cases
Bacterial
Common bacterial agents in first 2 months are gram
--- Content provided by FirstRanker.com ---
negative klebsiella ,E.coli and gram positivepneumococci and staphylococci
Between 3month to 3 years ?Pneumococci,H.influenza
And staphylococci
? After 3 years-Pneumococci and staphylococci
--- Content provided by FirstRanker.com ---
? Chlamydia and Mycoplasma may cause communityacquired pneumonia in adolescents and children
RISK FACTORS
Low Birth weight
Malnutrition
--- Content provided by FirstRanker.com ---
Vitamin A deficiencyLack of breast feeding
Passive smoking
Large Family size
Family history of bronchitis
--- Content provided by FirstRanker.com ---
Advanced birth orderCrowding
Young age
Clincal features
? Onset of pneumonia is insidious starting with
--- Content provided by FirstRanker.com ---
upper Respiratory tract infection or acute withhigh fever , Tachypnea,dyspnea and grunting
respiration
? Flaring of ala nasi and retraction of lower chest
and intercoastal spaces
--- Content provided by FirstRanker.com ---
? Signs of consolidation are observed in lobarpneumonia
Pneumococcal Pneumonia
Respiratory infection due to S.pneumonia
Transmitted by droplet
--- Content provided by FirstRanker.com ---
Common in winterIncubation period in 1-3 days
Clinical Features
Onset is abrupt with headache,chills ,cough and
high fever
--- Content provided by FirstRanker.com ---
Cough-initaly dry and later with thick rusty sputum? Chest pain radiating to shoulder or abdomen
? Severe Cases-Grunting,Chest indrawing, difficulty in
feeding and cyanosis
? Percussion note is impaired ,air entry is diminished
--- Content provided by FirstRanker.com ---
? Crepitations and bronchial breathing heard overareas of consolidation
DIAGNOSIS
History
Examination
--- Content provided by FirstRanker.com ---
X-ray-finding of lobar consolidationLeukocystosis
Sputum-Gram staining and culture
Blood culture
TREATMENT
--- Content provided by FirstRanker.com ---
Penicillin G 50000IU/kg/- IV or IM individed doses -7 days
Therapy with IV cefotaxime, ceftriaxone or
coamoxiclav
Staphylococcal Pneumonia
--- Content provided by FirstRanker.com ---
Infancy and childhoodPrimary infection or secondary to staphylococcal
septicemia
Complication ? measles, influenza,cystic fibrosis
Empyema below 2 years of age is nearly always
--- Content provided by FirstRanker.com ---
staphylcoccal in etilogyPathology
Multiple micro abscesses are formed which erode the
Bronchial wall and discharge their content in bronchi
? Air enters the abscesses during inspiration
--- Content provided by FirstRanker.com ---
? Progressive inflation results in formation ofpneumatoceles ?pathognomonic
TREATMENT
Fever is controlled by antipyretics
Hydration maintained by IV fluids
--- Content provided by FirstRanker.com ---
Oxygen administered to relive the dyspnea andcyanosis
Antibiotic therapy with penicillin G ,Coamoxiclav or
Ceftriaxone-2-6 weeks
Treatment of complications
--- Content provided by FirstRanker.com ---
Empyema and pyopneumothorax ?intercostaldrainage under water seal or low pressure aspiration
Metastatic abscess ?surgical drainage.
Significant pleural thickening-thoracotomy or
thoracoscopic surgery
--- Content provided by FirstRanker.com ---
Hemophilus pneumonia
? Occurs between age of 3 month-3 year
? Always associated with bacteremia
? Presents with moderate fever, dyspnea, grunting and
Retraction of lower intercoastal space
--- Content provided by FirstRanker.com ---
Complications-Bacteremia, pericarditis, empyema,meningitis and polyarthritis.
Treatment- parental ampicillin 100mg/kg/day and
coamoxiclav.
Streptococcal Pneumonia
--- Content provided by FirstRanker.com ---
Infection by group A beta-hemolyticstreptococci
Occurs following measles,varicella,influenza
or petrusis
Most important cause of respiratory distress
--- Content provided by FirstRanker.com ---
in NewbornsClinical features
onset is abrupt with fever ,chills, dyspnea, rapid
respiration and blood streaked sputum
Signs of bronchopneumonia is less pronounced as
--- Content provided by FirstRanker.com ---
pathology is usually interstitialDiagnosis
Radiograph- shows interstitial pneumonia with
segmental involvement, diffuse peribronchial
densities or a effusion
--- Content provided by FirstRanker.com ---
Blood count shows neutrophilic leucocystosis.TREATMENT
Penicillin G -50000-100000IU/kg/day -7 to 10 days
Second generation or third generation
Cephalosporins
--- Content provided by FirstRanker.com ---
Like cefaclor, cefuroxime,ceftriaxoneTHANK YOU
Primary Atypical Pneumonia
Etiological agents-Mycoplasma pneumonia
Chlamydia
--- Content provided by FirstRanker.com ---
Legionella sppTransmitted-droplet infection
Incubation period-12-14 days
Common in winter among children in overcrowding
living
--- Content provided by FirstRanker.com ---
Clinical features
Symptoms
Malaise, headache, fever, sore throat, myalgia and
Cough.
Cough is dry at first later with mucoid expectoration
--- Content provided by FirstRanker.com ---
With blood streakedSigns
Mild pharyngeal congestion, cervical
lymphadenopathy
Crepitations
--- Content provided by FirstRanker.com ---
Diagnosis
X-ray finding show infiltrates involving one lobe,
usually lower
Poorly defined fluffy or hazy exudates radiates from
the hilar region with enlarged hilar lymphnodes and
--- Content provided by FirstRanker.com ---
pleural effusionIgM antibody by ELISA during acute stage
IgG antibody after 1 week
Confirmed by PCR
TREATMENT
--- Content provided by FirstRanker.com ---
Macrolide antibiotics-erythromycin,azithromycinClarithromycin for 7-10 days
Pneumonia due to Gram negative
organisms
Etiology-E.coli , klebsiella, pseudomonas
--- Content provided by FirstRanker.com ---
Affects small children with malnutrition andimmunity
Gradual onset
Constitutional symptoms are more prominent than
respiratory distress
--- Content provided by FirstRanker.com ---
Radiograph shows multiple areas of consolidationTreatment-IV Cefotaxime or ceftriaxone 75-
100mg/kg/day with or with out aminoglycoside of 10-
14 days
Pseudomonas ? treated with Ceftazadine
--- Content provided by FirstRanker.com ---
VIRAL PNEUMONIA
Etiology- Respiratory syncytial Virus is chief cause
under 6 months of age
Others-para influenza, influenza and adenovirus
Presents with extensive interstitial pneumonia
--- Content provided by FirstRanker.com ---
Clinical signs of consolidation are absentRadiological signs consist of perihilar and
peribronchial infiltrates
ALIPHATIC HYDROCARBON
ASSOCIATED PNEUMONIA
--- Content provided by FirstRanker.com ---
Kerosene exerts toxic effects on lungs and CNSMilk and alcohol promotes absorption
Since kerosene has low viscosity and low surface
tension ,it diffuses quickly from pharynx to lungs.
Clinical features-Cough, dyspnea, high fever,
--- Content provided by FirstRanker.com ---
Vomiting, drowsiness and comaPhysical signs are minimal
X-ray chest-ill-defined homogenous or patchy
opacities
Treatment
--- Content provided by FirstRanker.com ---
Vomiting is not inducedGastric lavage is avoided to prevent inadvertent
aspiration.
The patient is kept on oxygen
Routine antibiotics are not indicated
--- Content provided by FirstRanker.com ---
Loefflers Syndrome
Larvae of many nematodes enter portal circulation
and pass through the hepatic vein and inferior vein
cava into heart and lungs.
In lungs it enters capillaries, enter alveoli and block
--- Content provided by FirstRanker.com ---
Bronchi with mucus and eosinophilic materialClinical features include cough,low fever scattered
crepitations
Eosinophilia
Treatment is symptomatic
--- Content provided by FirstRanker.com ---
ACUTE RESPIRATORY TRACT
INFECTION CONTROL PROGRAM
Acute lower respiratory tract infection is chief cause of
mortality in children below 5 years of age
Common bacteria causing LRTI in preschool children
--- Content provided by FirstRanker.com ---
like H influenza,S.pneumonia are sensitive toantibacterial agents like cotrimoxazole and
amoxicillin
To control death due to LRTI,WHO has
recommended a criteria for diagnosis of pnumonia
--- Content provided by FirstRanker.com ---
where IMR is >40/1000 live births.Criteria for diagnosis include rapid respiration
Rapid respiration is rate more than 60,50,40/min in
Children below 2 months,2-12 months and 1-5 years of age
? WHO recommends that in primary setting,children with
--- Content provided by FirstRanker.com ---
cough(2months-5years of age) should be examined forrapid respiration and difficulty in breathing,cyanosis or
difficulty in feeding.
? If respiratory rate is normal ,there is no chestindrawing
and feeding is well, the child is assessed to be suffering
--- Content provided by FirstRanker.com ---
from URT infection and treated symptomaticallyIf the child has rapid respiration and chest indrawing,
But no hypoxia, feeding well and does not have danger
signs,child may be treated with amoxicillin 40mg/kg
twice daily for 5 days
--- Content provided by FirstRanker.com ---
? Chest indrawing, evidence of hypoxia or dangersigns(lethargy,cyanosis, poor feeding, seizures),it is
severe pnumonia
? Patient require admission, and treatment with iv
penicillin or ampicillin and gentamycin for least
--- Content provided by FirstRanker.com ---
5days.IV ceftriaxone can be used as 2nd line drug
For Children below 2 months old,the presence of any
of following indicate pneumonia:fever>38
degree,seizures,abnormally sleepy or difficult to
--- Content provided by FirstRanker.com ---
wake,stridor ,wheezing,not feeding,tachypnea,chestindrawing, altered sensorium, central
cyanosis,grunting
apneic spells or distended abdomen
THANK YOU
--- Content provided by FirstRanker.com ---