Pneumonia 24

pneumonia
Professor Baha Diaa Moohee Alosy,

Departments of Pediatrics- Collage of
Medicine. University of Tikrit –IRAQ.
FICMSP ,AAP
Objectives
• identify the approach of

pneumonia
• Identify clinical manifestation
of pneumonia
• Know the treatment for
pneumonia
Epidemiology
Incidence :
30–40 cases per 1000 children per year in the UK;
a GP will see, on average, 1-2 cases per year.
Prevalence :
Every year, pneumonia contributes to 750,000 –
1.2 million neonatal deaths worldwide:
• (60% due to S. pneumoniae/H. influenzae)
• H. influenzae infection is now quite rare
amongst UK children due to immunization.
Definition & Etiology
There is no hard and fast definition of lower respiratory

tract infection (LRTI), that is universally adopted.
Essentially, it is inflammation of the airways/pulmonary
tissue, due to viral or bacterial infection, below the
level of the larynx.
Viral causes
Influenza A
Respiratory Syncytial Virus (RSV)
Human Metapneumovirus 4
Varicella-Zoster Virus (VZV - Chickenpox)
Adenovirus
Para-influenza virus
Bacterial Agents
 Streptococcus pneumoniae
 Hemophilus Influenzae
 Staphylococcus aureus
M
 Klebsiella pneumoniae
 Enterobacteria e.g. E. coli
 Anaerobes
Atypical Agents
 Mycoplasma pneumoniae
 Legionella pneumophila
 Chlamydia sp.
 Coxiella burnetii
Clinical Picture
• Presentation Acute febrile illness, possibly

preceded by typical viral URTI.
• Symptoms :
1. Cough
2. Breathlessness ( preventing feeding)
3. Irritability
4. Sleeplessness
5. Chest or abdominal pain in older patients
 Audible wheezing is rare in LRTI, but can occur
Physical Signs
 Capillary blood oxygen saturation <95%

 Intercostal and supra-sternal recession
 Flushing
 Tachypnea
 High fever over 38.5 c
 Nasal flaring in children under 1 yr of age
 Dullness to percussion over zones of pneumonia
consolidation.
 Cyanosis in advanced cases.
Differential Diagnosis
• Asthma
• Bronchiolitis (a form of LRTI)
• Inhaled foreign body
• Pneumothorax
• Cardiac dyspnoea
• Pneumonitis of other cause e.g.
extrinsic allergic alveolitis
Investigations
• Chest radiography if fever and tachypnea, oxygen

saturation to monitor condition.
• In hospital consider capillary or arterial blood gases.
• Culture of sputum or nasopharyngeal discharge/aspirate
may be used in hospital but has little to add in primary
care.
• Blood cultures if evidence of septicemia.
• Blood urea and electrolytes
Management
• Admission for children under 5 years with

fever and breathlessness is mandatory.
• Older children can be managed with close
observation at home if not distressed
• Physiotherapy has no place in treatment of
uncomplicated pneumonia in children without
pre-existing respiratory disease.
Essential Measures
• Oxygen,
• IV fluids if unable to feed,
• Respiratory support in severe cases
• Cough medicines are not indicated and may be used if
cough interferes with feeding or sleep. Honey with
lemon may be helpful.
• Antihistamines are dangerous in young children & should
be avoided.
Medications
• Antipyretics (avoid aspirin in young children

due to danger of Reye's syndrome).
• Antibiotic treatment for bacterial
pneumonias.
• Pneumonia or LRTI following URTI is likely to
be viral and will not respond to antibiotic
therapy. However, it is difficult to
distinguish between viral and bacterial
infection and young children can
deteriorate rapidly. so consider antibiotic
therapy depending on presentation and the
clinical judgment of the concerned child.
Antibiotics
• Streptococcal pneumonia is treated with oral

penicillin V, or synthetic penicillin such as
amoxicillin as first line drugs.
• Recent research indicates that children with
non-severe pneumonia on amoxicillin for 3 days
do as well as those who receive it for 5 days
• If a child is genuinely allergic to penicillin,
consider using a macrolide or quinolone.
• Cephalosporin often cross-react with penicillin.
Antibiotics/2
• For Hemophilus influenzae cephalosporins or

Amoxicillin/Calvulenic acid combination are
useful.
• For Staph pneumonia cloxacillin and
flucloxacillin are used and in severe cases
parenteral vancomycin is required.
• Injectable antibiotics are indicated in severe
cases
Complications
 Bacterial invasion of the lung tissue can cause:

• pneumonic consolidation,
• septicemia,
• empyema,
• lung abscess(esp. S. Aureus)
• pleural effusion.
• Mycoplasma P. can cause hemolysis
• Rarely, respiratory failure, hypoxia and death.
Prevention
• It is achieved with pneumococcal vaccine and

influenza vaccine
• Stop indoor smoking. Smoking at home or
school is a major risk factor.
• Zinc supplementation reduces the incidence of
pneumonia by over 40% in malnourished
children.

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pneumonia

Professor Baha Diaa Moohee Alosy,

• identify the approach of

There is no hard and fast definition of lower respiratory

• Presentation Acute febrile illness, possibly

 Capillary blood oxygen saturation <95%

• Chest radiography if fever and tachypnea, oxygen

• Admission for children under 5 years with

• Antipyretics (avoid aspirin in young children

• Streptococcal pneumonia is treated with oral

• For Hemophilus influenzae cephalosporins or

 Bacterial invasion of the lung tissue can cause:

• It is achieved with pneumococcal vaccine and

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