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PNEUMONIA

DEFINITION:

1) Bronchopneumonia: a febrile illness with cough and respiratory distress with evidence of bilateral localized
or generalized patchy infiltrate

2) Lobar pneumonia: similar to bronchopneumonia except that the physical findings and radiographs indicate
lobar consolidation.

AETIOLOGY:

 The majority of lower respiratory tract infections are viral in origin,

eg: Respiratory syncytial virus, Influenza A or B, Adenovirus, Parainfluenza virus.

 Immunosuppressed children:
o have underlying illness: on corticosteroid (eg: leukaemia), or cortisol (eg: nephrotic)
o cystic fibrosis: having risk at specific pathogen (eg: pseudomonas spp.)

 Non-infectious causes:
o Aspiration of food/gastric acid (in cerebral palsy)
o Foreign bodies (causes wheezing on one side)
o Hydrocarbons
o Lipid substances
o Hypersensitivity rxn
o Drug/radiation (cause induced pneumonitis)

AETIOLOGICAL AGENTS:

Pathogens for Pneumonia


Age Bacterial Pathogens Viral causes:
Newborns Group B streptococcus, 1. Respiratory syncytial virus (also in bronchiolitis)
Escherichia coli, 2. Parainfluenza 1,2,3 (also in croup)
Klebsiella species,
3. Influenza A, B
Enterobacteriaceae
4. Adenovirus
Infants 1- 3 Chlamydia trachomatis
months
Preschool age **Streptococcus pneumoniae,
Haemophilus influenzae type b,
**most common
Staphylococcal aureus
p/s: Staph aureus can cause confluent bronchopneumonia
Less common: Group A Streptococcus,
-characterized by extensive areas of hemorrhagic necrosis +
Moraxella catarrhalis, Pseudomonas
irregular areas of cavitation of lung parenchyma
aeruginosa -this results in pneumatocele and empyema
School age **Mycoplasma pneumoniae,
Chlamydia pneumoniae
Assessment of Severity in Pneumonia
Age < 2 months Age 2 months - 5 Tachypnea:
years < 2 months age: > 60 /min
Severe Pneumonia Mild Pneumonia 2- 12 months age: > 50 /min
• Severe chest indrawing • Tachypnoea 12 months – 5 years age: > 40 /min
• Tachypnoea Severe Pneumonia
• Chest indrawing
Very Severe Pneumonia Very Severe
Pneumonia
• Not feeding • Not able to drink
• Convulsions • Convulsions
• Abnormally sleepy, difficult to • Drowsiness
wake
• Fever, or Hypothermia • Malnutrition

CFs:

Bacterial Pneumonia Viral Ix:


Pneumonia
↑fever ↓fever Ix Findings @ Purposes
URTI (cough, rhinitis) CXR -infiltrates
Tachypnea -confluent lobar consolidation
*infants: nasal flaring, grunting, hunger of air (pneumococcal)
↑work of breathing -viral pneumonia: hyperinflation with bilateral
(a/w recessions) interstitial infiltrates + peribronchial cuffing
Cyanosis (circumoral) Assessment -by pulse oximetry
Chest pain of -to avoid the need for ABG
Abdominal pain oxygenation -good indicator of severity of pneumonia
(common in lower lobe pneumonia) FBC -WBC count
Splinting on the affected side Bact : may be N/↑, not higher than 20k/mm3
(to reduce pleuritic pain, and improve ventilation) PMN predominant
Abdominal distension Viral : leukopenia
(gastric dilatation due to swallowed air)
Liver seems enlarged Blood culture In severe anaemia, poor response to 1st line
↑tactile vocal fremitus and resonance antibiotic
On percussion: dullness Pleural fluid If there is significant pleural eff.
On auscultation: diminished breath analysis +
sound/bronchial breathing, crackles + rhonci pleural tap

*mycoplasma pneumonia diagnosed by: 1)PCR


2)Seroconversion in IgG assay
*group A strep. Pneumonia diagnosed by: ASO titer
ANTIBIOTICS:

Pathogen Antimicrobial agent


Cx:
Beta-lactam susceptible
• Streptococcus Penicillin, cephalosporins
1. Pulm. Cx: 1)empyema 2)pyopneumothorax 3)lung
pneumonia
• Haemophilus influenzae Ampicillin, chloramphenicol,
abscess
type b cephalosporins
2. extrapulm. Cx : 1)pericarditis, myocarditis 2)HF 3)Resp
• Staphylococcus aureus Cloxacillin
• Group A Streptococcus Penicillin, cephalosporin failure 4)meningitis
Mycoplasma pneumoniae Macrolides, e.g. erythromycin,
azithromycin
Chlamydia pneumoniae Macrolides, e.g. erythromycin,
azithromycin
***ttt of empyema
Bordetella pertussis Macrolides, e.g. erythromycin,
1)antibiotic
azithromycin

2)drainage by tube thoracostomy

3)intrapleural fibrinolytic; urokinase, streptokinase


INPATIENT

First line Beta-lactams:


Benzylpenicillin, moxycillin,
ampicillin,
amoxycillin-clavulanate
Second line Cephalosporins:
Cefotaxime, cefuroxime,
ceftazidime
Third line Carbapenem:
Imipenam
Other agents Aminoglycosides:
Gentamicin, amikacin

Mx: