Gibertas, Samantha Lie Catherine II B.

BSN-4

Pediatric Community Acquired Pneumonia

INTRODUCTION

Pediatric community-acquired pneumonia (PCAP)Pneumonia

is a general term that refers to an infection of the lungs, which can be caused by a variety of
microorganisms, including viruses, bacteria, fungi, and parasites. Pneumonia is the infection of the
pulmonary tissue, including the interstitial spaces, the alveoli,
and the bronchioles. Pneumonia can be community-acquired or hospital-acquired.

Community acquired pneumonia

occurs either in the community setting or within the first 48 hours after hospitalization or
institutionalization.

Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The
most common are: Streptococcus pneumonia
– the most common cause of bacterial pneumonia in children; Haemophilus influenzae type b (Hib)
– the second most common cause of bacterial pneumonia; respiratory syncytial virus is the most
common viral cause of pneumonia.

Environmental Risk Factors

include: indoor air pollution caused by cooking and heating with biomass fuels (such as wood or
dung), living in crowded homes, parental smoking.

Signs and Symptoms

vary depending on the age of the child and the cause of the pneumonia, but common ones include:
fever, chills, cough, nasal congestion, unusually rapid breathing (in some cases, this is the only
symptom), breathing with grunting or wheezing sounds, labored breathing that makes the rib muscles
retract(when muscles under the ribcage or between ribs draw inward with each breath) and causes
nasal flaring, vomiting, chest pain, abdominal pain, loss of appetite (in older kids) or poor feeding (in
infants), which may lead to dehydration, in extreme cases, bluish or gray color of the lips and
fingernails.

Incidence:
Pneumonia is the single largest cause of death in children worldwide. Every year, it kills an estimated
1.2 million children under the age of five years, accounting for 18% of all deaths of children under five
years old worldwide. Pneumonia affects children and families everywhere, but is most prevalent in
South Asia and sub-Saharan Africa.
Review Related Literature

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air
sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus,
fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses
and fungi, can cause pneumonia.

Individuals who are treated for PCAP outside of the hospital have a mortality rate
less than 1%. Fever typically responds in the first two days of therapy and other
symptoms resolve in the first week. The X-ray , however, may remain abnormal for at
least a month, even when PCAP has been successfully treated. Among individuals who
require hospitalization, the mortality rate averages 12% overall, but is as much as 40%
in people who have bloodstream infections or require intensive care. Factors which
increase mortality are the same as those which increase the need for hospitalization
and are listed above.

When CAP does not respond as expected, there are several possible causes. A
complication of CAP may have occurred or previously unknown health problem may be
playing a role. Additional causes include inappropriate antibiotics for the causative
organism, a previously unsuspected microorganism such as tuberculosis or a condition
which mimics PCAP such as Wegener’s granulomatosis. Adittional testing may be
performed and may include additional radiologic imaging (such as computed
tomography scan or a procedure such as bronchoscopy or lung biopsy.

Pneumonia affects children and adults everywhere, however most child deaths
occur in the world’s poorest regions with highest incidence in sub-Saharan Africa
and South Asia.

Streptococcus pneumonia, Haemophillus influenza type b (Hib) and

respiratory syncytial virus are the most common causes of pneumonia in health
people. Pneumocystis jiroveci is one of the most common causes of pneumonia in
immunocompromised infant and it is responsible for one quarter of all pneumonia
deaths in HIV-infected infants.

Pertussis and measles have also a respiratory tract component and can
complicate with pneumonia

The Philippines is one of the 12 countries that together account for 75% of
childhood pneumonia cases worldwide. In children aged under 5 years, pneumonia is
the leading cause of mortality with a mortality rate if 23.4 x 100,000 population
recorded in 2009.
 In Regions VI,VII and VIII of the Philippines , the total number of children
under five years of age with pneumonia that have been seen and given treatment from
January to December 2012 were 89,221 and 85,923, respectively.

PCAP it may be caused by:

 Bacteria. The most common cause of bacterial pneumonia in the U.S. is

Streptococcus pneumoniae. This type of pneumonia can occur on its own or after
you've had a cold or the flu. It may affect one part (lobe) of the lung, a condition
called lobar pneumonia.

 Bacteria-like organisms. Mycoplasma pneumoniae also can cause pneumonia. It

typically produces milder symptoms than do other types of pneumonia. Walking
pneumonia is an informal name given to this type of pneumonia, which typically
isn't severe enough to require bed rest.

 Fungi. This type of pneumonia is most common in people with chronic health
problems or weakened immune systems, and in people who have inhaled large
doses of the organisms. The fungi that cause it can be found in soil or bird
droppings and vary depending upon geographic location.

 Viruses. Some of the viruses that cause colds and the flu can cause pneumonia.
Viruses are the most common cause of pneumonia in children younger than 5
years. Viral pneumonia is usually mild. But in some cases it can become very
serious
Major Risk factors for developing pneumonia are:

- A weakened immune system due to malnutrition or undernourishment

(especially in infants not exclusively breastfed), HIV and other pre-existing
illnesses such as measles.
- Environmental factors including indoor air pollution (cooking/heating with
wood, drug or other biomass fuels), living in crowded houses and parental
smoking.

There are many causes of Pneumonia, including bacteria, viruses, mycoplasmas, fungal
agents and protozoa. Pneumonia may also result from aspiration of food, fluids or
vomitus of from inhalation of toxic or caustic chemicals, smoke, dusts, or gasses.
Pneumonia may complicate immobility and chronic illnesses. Pneumonia often follows
influenza and together they rank as the 7th leading cause of death in the US.
Risk Factors:

- Being younger than 6 months of age

- Being born prematurely

- Birth defects, such as cleft palate

- Nervous system problems, such as seizures or cerebral palsy

- Heart or lung disease present at birth

- Weak immune system (this can occur due to cancer treatment or disease such
as HIV/AIDS)

- Recent surgery or trauma

Additional risk factors are dysphagia; exposure to air pollution; inhalation of noxious
substances’ aspiration of food, liquid or foreign or gastric material and residence in
institutional settings, where transmission of the disease is more likely.

Symptoms

The signs and symptoms of pneumonia vary from mild to severe, depending on
factors such as the type of germ causing the infection, and your age and overall health.
Mild signs and symptoms often are similar to those of a cold or flu, but they last longer.

Signs and symptoms of pneumonia may include:

 Chest pain when you breathe or cough

 Confusion or changes in mental awareness (in adults age 65 and older)

 Cough, which may produce phlegm

 Fatigue

 Fever, sweating and shaking chills

 Lower than normal body temperature (in adults older than age 65 and people with
weak immune systems)

 Nausea, vomiting or diarrhea

 Shortness of breath
Newborns and infants may not show any sign of the infection. Or they may vomit, have
a fever and cough, appear restless or tired and without energy, or have difficulty
breathing and eating.