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ACUTE PNEUMONIA IN CHILDREN

ACUTE PNEUMONIA IN CHILDREN. Department of pediatrics. ACUTE PNEUMONIA IN CHILDREN. Pneumonia is an inflammation of the parenchyma of the lung, Incidence 0.026 episodes per child/year in USA, 0.28 episodes per child/year in developed countries. SYMPTOMS AND SIGNS.

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ACUTE PNEUMONIA IN CHILDREN

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  1. ACUTE PNEUMONIA IN CHILDREN Department of pediatrics

  2. ACUTE PNEUMONIA IN CHILDREN • Pneumonia is an inflammation of the parenchyma of the lung, • Incidence 0.026 episodes per child/year in USA, • 0.28 episodes per child/year in developed countries

  3. SYMPTOMS AND SIGNS • Raised respiratory rate - 50 per minute or more if child 2mo up to 12mo; - 40 per minute or more if child 12 mo up to 5 yr - 30 per minute or more if child above 5 yr • Stridor in calm child or wheezing • Fever >37.5o • Dry cough or production of sputum • Worse signs: • the child is not able to drink or feeding wall, vomit everything, is lethargic or had convulsions • Focal chest signs- chest indrawing - decreased expansion - dullness on percussion - bronchial breathing - pleural chest pain in older children

  4. ETIOLOGY • Viruses: influenza A and B, RS, adenovirus, parainfluenza • Gram + bacteria: Str.pneumoniae, Str.pyogenes, Staph.aureus • Gram- bacteria: H.influenzae, Kl.pneumoniae, Ps.aeruginosa, Morax. catarrhalis, Neis. meningitides, E.coli, Proteus, Enterobacter. • Atypical nonbacterial bacilli: Mycoplasma or Chlamydia pneumoniae,Legionella (acquired by breathing droplets or contaminated water) • Specific pneumonia in infants: aspiration (diminished gag reflex), gastroesophagal reflux, heart defects, genetic disorders, asthma, impaired immune system.

  5. CLINICAL MANIFESTATIONS • History- recent respiratory infection, exposure to people with pneumonia, fever, acute or persistent cough, dry/productive, related to feeding (aspiration), choking/ staccato/paroxysmal (foreign body aspiration, pertussis). • Worse signs: not able to drink or feeding, vomit everything, is lethargic or had convulsions • Physical examination-confusions, abnormally sleepy, cyanosis, fast breathing, nasal flaring, respiratory distress, grunting, stridor, wheezing; - vomiting, diarrhea, abdominal pain in paralytic ileus; - dullness on percussion: -consolidation or pleural effusion, empyema; - auscultation- rales, crackles, crepitations, rhonchi (rumblings). - clinical signs that predict death in children:worse signs, prolonged illness, severe X-ray changes, cyanosis, leukocytosis, hepatomegaly.

  6. PNEUMONIA- DIAGNOSIS • Chest X-ray confirms pneumonia and pleural effusion or empyema - Confluent lobar consolidation is typically in pneumococcal causes - Viral pneumonia- hyperinflation with bilateral interstitial infiltrates • Bronchoscopy, USG, CT scan in malformation or tumors • WBC in viral pneumonia are normal or <15,000/ml, with lymphocyte rises; in bacterial WBC>20,000/ml, granulocyte rises • Atypical pneumonia: a higher WBC, ESR and C-reactive protein • DNA, RNA, antibodies tests for the rapid detection of viruses • PCR test or seroconversion in an IgG assay • Serologic evidence of the ASL-O • Serum IgE in recurrent wheezing • Isolation of the bacteria from the blood, pleural fluid or lung • Culture of sputum and susceptibility of the antibiotics • Urinary antigen test positive

  7. PNEUMONIA -TREATMENT ANTIBIOTIS: 1.Penicillins and betalactams: Amoxycillin, Amoxi/Clav, Sulbactam 2.Cephalosporines- Cefazolin, Cefuroxim, Ceftriaxon, Ceftazidizime 3.Penems- Imipenem/Cilastatin, Meropenem, Ertapenem 4.Quinolones-Ciprofloxacin, Levofloxacin, Moxifloxacin, Gatifloxacin- more effective in Gram- bacteria 5.In atypical pneumonia – macrolides: Clarithromycin, Roxithromycin, Azithromycin (7.5-15mg/kg/day) 6.Aminoglycosides- dosage according to age, weight and kidney function (Gentamicin, Tobramycin, Amikacin) 7.In viral pneumonia treatment withhold antibiotics

  8. SUPPORTIVE TREATMENT • good hydration, cough remedies, antipyretics, oxygen in the central cyanosis or worse signs • For children with wheeze- rapid acting bronchodilator(Salbutamol) • Drainage with tube in empyema, fibrinolytic therapy: urokinase, streptokinase, alteplase • Indications for hospitalization: age <6mo, persistent fever, worse signs, severe respiratory distress, toxic appearance, no response to antibiotic

  9. RESPONSE TO TREATMENT • The factors then patients leads to “Slowly resolving pneumonia”: 1. complications such as empyema 2 .bacterial resistance 3.viral causes, foreign bodies or food aspiration 4. bronchial obstruction 5.pre-existing immunodeficiencies 6. cyliary dyskinesia, cystic fibrosis, other noninfectious causes. The first step- repeat chest X-ray

  10. COMPLICATIONS ● The result of direct spread in the thoracic cavity: pleural effusion, empyema, pneumothorax, pericarditis ● Hematologic spread:sepsis, meningitis, arthritis, osteomyelitis

  11. PREVENTION OF PNEUMONIA ● Immunization against H. influenzae type b ● Influenza vaccine ● Heptavalent pneumococcal conjugate vaccine ● Health education of the community ● Messages for mothers to recognize the signs of pneumonia

  12. REFERENCES 1.Nelson textbook of pediatrics, 18-th edition, 2007, p.1795-1800 2.Dr Herman Laferi-Community acquired pneumonia, diagnosis, treatment, Satellite Symposium “Update in Infectious Pathology”, 2006, Chisinau 3.Technical bases for WHO recommendations on the management of pneumonia in children at first-level health facilities, Geneva, 2001

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