PNEUMONIA - pediatria1.wum.edu.pl · Pneumonia is an acute inflammatory disease of the distal part...
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PNEUMONIA
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Definition
Pneumonia is an acute inflammatory disease
of the distal part of respiratory tract, which
manifests usually with fever, cough, dyspnea
and infiltrations on a chest x ray.
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Etiology according to age
Newborns > 5 y 3 w. - 3 m. 4 m – 4y
Bacterias are the most common etiologic
factors
• group B Streptococci,
• Enterobacteriacae,
• Chlamydia trachomatis,
• Listeria monocytogenes
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Etiology according to age
Newborns > 5 y. 3 w. - 3 m. 4 m. – 4y.
• Streptococcus pneumoniae
• Chlamydia trachomatis
• Bordetella pertussis
• Staphylococcus aureus
• RSV
• Parainfluenza
Bacterias are the most common etiologic
factors
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Etiology according to age
Newborns > 5 y. 3 w. - 3 m. 4 m. – 4 y.
Viruses are the most common etiologic
factors
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Etiology of viral lower respiratory tract
infections in children
RSV
Parainfluenza 1, 2, 3
Influenza A i B
Adenovirus
Rhinovirus
Human metapneumovirus
Coronavirus
Human bocavirus
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Streptococcus pneumoniae the most common
bacteria Mycoplasma pneumoniae is not an unusual cause of pneumonias in
this age group
Viruses are the most common etiologic
factors
Newborns > 5 y. 3 w. - 3 m. 4 m. – 4 y.
Etiology according to age
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Newborns > 5 y. 3 w. - 3 m. 4 m. – 4 y.
• Streptococcus pneumoniae
• Mycoplasma pneumoniae
• Chlamydophila pneumoniae
• Heamophilus influenzae
• Moraxella catarrhalis
Bacterias are the most common etiologic
factors
Etiology according to age
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Symptoms of pneumonia
Fever and difficulty with breathing are the
most common presenting symptoms of
pneumonia.
The absence of fever has a negative predictive
value of up to 97%.
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Symtoms of pneumonia
• Cough, lethargy, poor feeding and an
‘unwell’ child.
• Localized chest or abdominal pain is a
feature of pleural irritation.
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Percussion and auscultation findings
- Dullness to percussion
- Crackles
- Bronchial breathing
- Wheeze - more suggestive of viral and mycoplasma infection.
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Objective clinical signs
• Skin colour
• Retractions and use of accessory muscles.
• The presence of conjunctivitis in infants
less than 3 months old with prominent
cough suggests Chlamydia trachomatis
infection
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headache, malaise, fever, sore throat
aseptic meningitis, cerebellar ataxia, transverse myelitis, peripheral
neuropathy, Guillain-Barre syndrome
hemolytic anemia, thrombocytopenia
erythema multiforme, erythema nodosum, urticaria
arthralgia, arthritis
pericarditis, myocarditis
nusea, vomiting, diarrhea, pancreatitis (rarely)
Extrapulmonary symptoms of
M. pneumoniae infection
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The WHO has defined tachypnoea as
a) more than 60 breaths/min in children < 2 months of age
b) more than 50 breaths/min in children aged 2 -12 months
c) more than 40 breaths/min in children aged >12 months
d) more than 30 breaths/min in children > 5 years
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Indications for hospital admission
• hypoxaemia (SaO2 92%), cyanosis,
• in infants, respiratory rate > 70/min, dyspnoea, intermittent
apnoea, grunting and feeding difficulty,
• in older children, respiratory rate > 50/min, dyspnea, grunting
and signs of dehydration,
• prolonged capillary refill time > 2 s,
• chronic conditions (e.g. congenital heart disease)
• significant tachycardia
• inability of family to provide appropriate care,
BTS Guidelines 2011
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Investigations
Acute phase reactants
• Total leukocyte and neutrophil count,
• CRP
• Procalcitonine
• Erytrocyte sedimentation rate
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Investigations
• Electrolites: should be done if the patient is severely ill or
shows the evidence of dehydration.
• Inappropriate secretion of antidiuretic hormone - results
hyponatremia and low plasma osmolality (less than 280
m.osm./l).
• Treatment is with fluid restriction.
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Microbiological investigations
Community: There is no indication for
microbiological investigation of the child with
pneumonia in the community.
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Microbiological investigations
in hospital
• Blood culture.
• Nasopharyngeal secretions and/or nasal swabs for viral
detection by PCR and/or immunofluorescence.
• Acute and convalescent serology for respiratory viruses,
Mycoplasma and Chlamydia.
• If present, pleural fluid should be sent for microscopy,
culture, pneumococcal antigen detection and/or PCR.
• Urinary pneumococcal antigen detection should not be
done in young children.
BTS Guidelines 2011
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Radiological investigations
Follow up chest radiography should only be
performed in case of
lobar collapse
round pneumonia
continuing symptoms
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Pediatrics 2015
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2015
Denmark – 0,9% - 2,9%
Germany – 3% - 3,6%
USA – 8,2%
Canada - 12,1%
Italy – 26%
Belgium – 53%
Spain – 54%
China - 95%
Tetracycline >12y.
Fluoroquinolones >18y.
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Treatment of pneumonias
BTS guidelines 2011
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Newborns > 5 y. 3 w. - 3 m. 4 m. – 4 y.
Treatment of pneumonias
• ampicyllin iv (+/-) aminoglycosid iv
• III generation cephalosporin (+/-) aminoglycosid
Antibiotics
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Newborns > 5 y. 3 w. - 3 m. 4 m. – 4 y.
Ampicyllin, Amoxicillin
Streptococcus pneumoniae
C. trachomatis or B. pertussis
Erytromycin
Hale K, Isaacs D. Pediatr Respir Rev 2006;7:145-151
Treatment of pneumonias
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Newborns > 5 y. 3 w. - 3 m. 4 m. – 4 y.
Treatment of pneumonias
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Newborns > 5 y. 3 w. - 3 m. 4 m. – 4 y.
Amoxicillin
Treatment of pneumonias
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Newborns > 5 y. 3 w.- 3 m. 4 m. – 4 y.
Amoxicillin Macrolides
Treatment of pneumonias