🔸
🔸 it is an acute inflammation of lung parenchyma
🔸 Most cases of pneumonia are caused by microorganisms,
Non-infectious caused include;aspiration of food or gastric acids, foreign bodies, hydrocarbons and
🔸
lipoid substances,hypersensitivity reactions and drugs or radiation induced pneumonia
Is a substantial cause of morbidity and mortality in childhood (particularly among children < 5yrs of
age)
Factors contributing to high morbidity and mortality of acute LRI include;
1. Vit A deficiency
2.PEM
3. Anemia
4. Lack of breast feeding
5. LBW
6. Childhood infectious diseases
7. Poor socioeconomic status
It is a viral disease 8. Immunodeficiency
-Respiratory syncytial virus (RSV) is responsible for >50% for cases
Other agents include; parainfluenza, adenovirus, mycoplasma, human metapneumovirus There is no evidence of a bacterial
cause for bronchiolitis
🔸 viral pathogens are prominent causes of lower respiratory tract infections in infants and children <5yrs of age
-It is more common between 2m-2yr with peak of 6m More common in male, in those who have not been breast-fed and in
those who live in crowded condition definition: 🔸
with the highest frequency between 2-3yrs, decreasing slowly thereafter.
🔸 Influenza and Respiratory syncytial virus(RSV) are the major pathogens, especially in children <3yrs of age
-Older family members are a common source of infection,they may only experience minor respiratory symptoms
-Acute bronchiolitis is characterized by bronchiolar obstruction with edema, mucus and cellular debris
🔸 Other viruses that cause pneumonia, parainfluenza, adenovirus, rhinovirus and metapneumo virus
Most bacterial pneumonia are preceded by viral infection which disturb the defense mechanisms of the
-Resistance inthe small air passage is increased during both inspiration and exhalation, but because the radius of an airway
is smaller during expiration, the resultant respiratory
🔸
respiratory tract and of the lungs
Streptococcus pneumonia is the most common bacterial pathogen followed by chlamydia pneumonia
and mycoplasma pneumonia.
obstruction leads to early airtrapping and overinflation
-If obstruction becomes complete, there will be resorption of trapping distal air, and the child will develop atelectasis.
Classification;
•Etiologic Bacterial:
Viral
Mycoplasma
Fungal etc. s
Clinical manifestation; •Anatomic:
🔹
🔹 Usually preceded by expose to an older contact with a minor respiratory syndrome within the previous"week Lobar pneumonia
Bronchopneumonia
🔹
🔹
The infant first develops a mild upperrespiratory tract infection with sneezing and clear rhinorrhea
There is diminished appetite and fever 38.5-39c Interstitial pneumonia which is inflammation of the interstitium (the walls of alveoli, the alveolar sac and duct, and
the bronchioles)
🔹
🔹
Gradually respiratory distress ensues, with paroxysmal wheezy cough, dyspnea and irritability
The infant is tachypnic which may interfere with feeding
🔹 There is systemic complaints, such as diarrhea or vomiting
Apnea may be.more prominent than wheezing early in the course of the disease, particularly
🔹
with very yoing infant
🔹 The physical exam is characterized most predominant by wheezing
Definition;
Pneumonia localized to one lobe or segment of lobe ofthe lung, which is completely
🔹 Tachypnea, nasal flaring and retractions
Auscultation may reveal fine crackles or overt wheeze, with prolongation of the expiratory
phase of breathing
consolidated.
EtiolOgy;
uaalds pue JaN!l 4109 f0 uonedled 1!wuad keu s6unl ayt fo uolelfu!Jad/H O Acute bronchiolitis: commonly caused by streptococcus pneumonia
Incidence;- common in preschool and schoolaged children and in adults
-More common in children 4-10yra of ages
-Occurs sporadically, more frequently in winter months.
clinical manifestation;
Diagnosis;
Clinically
🔶 In children and adolescents: almost typical manifestation
1.A brief, mild URTI followed by abrupt onset of;
White blood cell and differential count are usually normal 2. High grade fever and shacking chills
Chest radiography reveals hyperinflated lungs with patchy atelectasis Viral testing (usually rapid 3. Drowsiness, intermittent restlessness and may also delirium
immunofluorescence polymerase chain reaction or Yiral culture) is helpful if the diagnosis is uncertain or for 4. Cough, dry, unproductive, hacking (initially), as resolution occurs may become productive. Diagnosis;
epidemiological purposes 5. Chest pain (pleural pain: sharp and severe,the child is splinting the affected side. It may
refer to the abdomen, neck or shoulder. 🔸
Clinically
Chest x-ray:
Treatment;
Admission requires in 3-5% of patients
6.Rapid respiration, expiratory grunt,nasal flaring, retractions and may be circumoral
cyanosis 🔸
homogenous , well-marked opacity of one lobe or segment without medistenal shift
Peripheral blood:
Indications
7.Classical signs of consolidation,localized dullness, increased fremitus, bronchial breathing
and fine rales.
8. Transient pleural fraction rub may be detected.
🔸
leukocytosis (15000-40000) with neutrophilia
Isolation of pneumococci by culture from blood, pleural fluid or tracheal aspiration.
Prognosis; 1) <6mo of age
-Infants with acute bronchiolitis are at highestrisk for further respiratory compromise in the first 2) Sleeping rate >60/mint Lobar pneumonia 9. Abdominal pain is common in lower lobe pneumonia, abdominal distension (due to gastric
Complication;
3.) Inability of oral feeding dilation or ileus) may be prominent
48-72hr. after onset of cough and dyspnea Pleural effusion/ empyema
4.) High grade fever and irritability 10. Neck stiffness/ meningism (may be observed with right upper lobe pneumonia)
-The case fatality rate is <1% with death attributable to apnea, uncompensated respiratory acidosi Lung abscess
or severe dehydration 5.) The occurrence of apnea and cyanosis
6.)Underlying chronic heart or lung diseases 🔶 in infants:
the above typical manifestations are rarely observed.
Septicemia
Metastatic infection: otitis media, sinusitis, meningitis
7.)Non-compliant family
Prevention; 1. A prodrome of URTI for few days, with decrease appetite
-Reduction in the severity and incidence of a cute bronchiolitis due to RSV is possible through the The main stay of treatment is supportive 2. A abrupt onset of fever, restless, apprehension and signs of respiratory distress and
administration of pooled hyperimmune RSV intravenous immunoglobulin and palivizumab •Cool humidified oxygen retractions
-palivizumab (RSV vacccne) is recommended for infants<2yrs of age with chronic lung disease or prematurity •Comfortable position with head and chestelevated at a 30degree angle with neck extended 3. Gastrointestinal disturbances (vomiting, diarrhea, abdominal distension) are frequent.
Pneumonia
prematurity •Nil orally(becauserisk ofaspiration increased in infant) and maintained with parenteral fluid 4. Auscultation findings are misleading.
-Meticulous hand washing is the best measure to prevent nosocomial transmission •Frequent suctioning of nasal and oral secretion
•Nebulized epinephrine may be more effective than B-agonist
•Corticosteroid can beused in bronchiolitis butare not recommended in previously healthy infants with RSV Treatment;
•Ribavirin,anantiviral agent administered by aerosol,has beenused forinfantswith CHD or chronic lung disease the majority of patients can be treated at home
•Antibiotics have no value unless there is secondary bacterial pneumonia *Admission indications:
-Young infants
- Respiratory distress (RR>40/min, dyspnea, cyanosis)
- Complicated cases (pleurl effusion/empyema)
pneumonia caused by staph. Aureus is a serious and rapidly progressive infection
unless recognized early and treated appropriately is associated with prolonged 🔸
-Underlying chronic lung or heart disease.
symptomatic : -rest -oxygen -iv fluid - analegsic and antipyretics
🔹
morbidity and high mortality.
🔸 Antibiotic:
🔹
🔹
Affects most commonly the infants, 30% are <3m of age and 70% are<1yr
Boys are affected more commonly than girls
It is often unilateral or more prominent in one side than the other(65% involved
penicillin-G is the drug of choice: 100000 U/kg/day(IV/IM)
-Alternatives;
the right side) cefatoxime 150mg/kg/day
Ceftriaxone 75mg/kg/day
Predisposing factors; Vancomycin 40mg/kg/day
1.Staph skin infection; patient or family member
2. Infectious diseases of childhood, e.g. pertussis, measles, chickenpox ……
3. Recent hospitalization
4. Debilitating conditions; severe PEM, cystic fibrosis, malignancies It accounts for >50% of cases
5. Hypogammaglobulinemia and immunosuppressive therapy More common during the winter months
Clinical manifestation;
-It is often preceded by several days of symptoms of an upper respiratory tract infection typically
clinical manifestation; rhinitis and cough
History of URTI for few days, then abrupt onset of; High fever and toxic appearance -Fever is usually present but is generally low
Complications; -Cough and evidence of RD;tachycardia, grunting, nasal flaring, retraction -Tachypnea is the most consistent clinical manifestation of pneumonia
1. Empyema, pyopneumothorax Severe dyspnea and hock-like state may be seen -Increased work of breathing accompanied by intercostal, subcostal and suprasternal retraction,
2. Septicemia and paralytic ileus -GIT disturbance; anorexia, vomiting, diarrhea, and abdominal distension nasal flaring and use of accessory muscle is common
3. CCF and anemia -Alternating lethargic and irritability state -By auscultation of chest: crackles and wheezing
4. Circulatory collapse (shock)
5. Metastatic septic lesions; pericarditis,
Early finding: diminish breathing sounds, scattered rales and rhonchi
With the development of effusion, empyema, or pyopneumothorax, decrease movements of
Staphylococcal pneumonia; -Family history of viral respiratory infections.
osteomyelitis and meningitis affected side, dullness on percussion, and marked decrease of breathing sound and fremitus
Rapid progression of symptoms and signs is typical Viral pneumonia; Diagnosis;
The severity of symptoms is greater than the physical findings The peripheral white blood cell can
be normal or elevated but is usually
not higher than 20000/mm3 with
Diagnosis;
🔹
lymphocyte predominance
Clinical: suggestive features Chest radiograph
-Age: neonate or infant hyperinflation with bilateral interstitial infiltration and peribronchial cuffing
-History of; staph pyoderma or other predisposing factors
-Evidence of effusion, empyema, Pyopneumothorax •is a diffuse inflammation of the parenchyma involving multiple lobes or segments of lobes in one The definitive diagnosis _
🔹
-Rapid progression of symptoms and signs
Paraclinical:
Chest x-ray; frequent chest x-ray exam is essential
or both lungs.
•lt is common in infants and small children and in an older children who has some chronic condition
by isolation of a virus or detection of the viral genome or antigen in respiratory
tract secretions.
such as; CHD, PEM, cystic fibrosis
🔹
Rapid change in x-ray finding is characteristic
🔹 Early finding;non-specifc br. Pneumonia(diffuse patchy infiltration)
Within hours;-the infiltrate become patchy and limited in extent, or may become;
Etiology;
Br.pneumonia is caused by a wide variety of organisms (viral, bacterial, mycoplasma and others)
Treatment;
Supportive
Up to 30% of patients with viral
-dense and homogenous and involve an entire lobe or hemithorax pneumonia may have coexisting
-pneumatoceles of various sizes are commom bacterial pathogens.
-pleural effusion or empyema is noted in most of the patients
-pyopneumothorax occurs in about 25% of cases
therightlung alone is involved in about 65%,bilateral involvement <20% of cases Is an inflammation of the lungs, beginning in the bronchioles, producing an exudates
Leukocytosis (15000-20000mm3) with neutrophil predominant and moderate anemia that obstructs these small airways and cause patchy consolidation of the adjacent
Gram stain and culture for, blood, pleural fluid, skin lesion…. lobules. Complication;
Clinical manifestation;
Bronchopneumonia -It is often preceded by several days of symptoms of an upper respiratory tract
infectionHigh grade fever
🔹
Complications of pneumonia are usually the result of
Direct spread of bacterial infection within the thoracic
Cavity;
-Increased in cough intensity, may be productive or followed by vomiting pleural effusion
-Irritability, poor sleep, poor feeding, vomiting, diarrhea and abdominal distension Empyema
-Rapid breathing, dyspnea, retraction, expiratory grunt and nasal flaring
-By exam;
early in the course of illness, diminished breath sounds, scattered crackles and
🔹
pericarditis
Pyopneumothorax and rarely lung abscess
Bacteremia and hematologic spread
by fatema okoff rhonchi are commonly heard over the affected lung field.
•With the development of increasing consolidation or complications of Pneumonia
Meningitis
Supportive arthritis
such as osteomyelitis
effusion, empyema, or pyopneumothorax, dullness on percussion and breath sound
may be diminish Diffuse crepitation and rhonchi
Diagnosis;
Elevated WBC count (15000-
40000) and a predominance of
granulocytes
Chest radiograph ---- diffuse
patchy consolidation involving
one or both lungs
•Definitive diagnosis is isolationof an organism from the blood,
pleural fluid or lung.
Bacterial pneumonia; Treatment;
Supportive treatment -rest -oxygen -IV fluid -nutritional support
🔹 For mildly ill children who do not need hospitalization, amoxicillin is
recommended( dose 80-90mg/kg/day in communities with a high percentage
of penicillin-resistant pneumococci)
Alternative therapeutic:
cefuroxime or amoxicillin-clavulanate For school aged children and in those
in whom infection with mycoplasma pneumonia or chlamydia is suggested a
macrolide antibiotic such as azithromycin is an appropriat choice.
🔹 Moderate to severe pneumonia;
&Admission indications
1. Age <4m
2. Respiratory distress (tachypnea, retraction, cyanosis……)
3. Inability to take oral fluids and drugs
4. Consolidation in more than one lobe
5.Empyema, pneumatoceles
6. Underlying CHD or severe anemia
🔹ampicillin+
Antibiotic therapy
Neonates:
gentamycin +- cloxacillin IV Alternatives; ceftriaxone
(75mg/kg/day 2DD) or cefuroxime 50-100mg/kg/day 3DD IM/ IV)
+gentamycin (5mg/kg/day 2-3 DD IM/iV)
🔹 infants:
<6m ampicillin(100-150mg/kg/day 4DD)
+cloxacillin (100-200mg/kg/day 4DD) V
>6m ampicillin inj IV
🔹
G
Children 1-5yr: ampicillin/ amoxicillin(50-100mg/kg/day 3DD)/ penicillin-
🔹 Older children penicillin-G inj
🔷
Erythromycin (40-50mg/kg/day 4DD oral) if mycoplasma is suspected
“Typically, a patient with uncomplicated community-acquired bacterial
pneumonia responds to therapy with improvement in clinical symptoms
within 48-96hr. of initiation of antibiotics.
🔸 it is an acute inflammation of lung parenchyma
🔸 Most cases of pneumonia are caused by microorganisms,
Non-infectious caused include;aspiration of food or gastric acids, foreign bodies, hydrocarbons and
🔸
lipoid substances,hypersensitivity reactions and drugs or radiation induced pneumonia
Is a substantial cause of morbidity and mortality in childhood (particularly among children < 5yrs of
age)
Factors contributing to high morbidity and mortality of acute LRI include;
1. Vit A deficiency
2.PEM
3. Anemia
4. Lack of breast feeding
5. LBW
6. Childhood infectious diseases
7. Poor socioeconomic status
It is a viral disease 8. Immunodeficiency
-Respiratory syncytial virus (RSV) is responsible for >50% for cases
Other agents include; parainfluenza, adenovirus, mycoplasma, human metapneumovirus There is no evidence of a bacterial
cause for bronchiolitis
🔸 viral pathogens are prominent causes of lower respiratory tract infections in infants and children <5yrs of age
-It is more common between 2m-2yr with peak of 6m More common in male, in those who have not been breast-fed and in
those who live in crowded condition definition: 🔸
with the highest frequency between 2-3yrs, decreasing slowly thereafter.
🔸 Influenza and Respiratory syncytial virus(RSV) are the major pathogens, especially in children <3yrs of age
-Older family members are a common source of infection,they may only experience minor respiratory symptoms
-Acute bronchiolitis is characterized by bronchiolar obstruction with edema, mucus and cellular debris
🔸 Other viruses that cause pneumonia, parainfluenza, adenovirus, rhinovirus and metapneumo virus
Most bacterial pneumonia are preceded by viral infection which disturb the defense mechanisms of the
-Resistance inthe small air passage is increased during both inspiration and exhalation, but because the radius of an airway
is smaller during expiration, the resultant respiratory
🔸
respiratory tract and of the lungs
Streptococcus pneumonia is the most common bacterial pathogen followed by chlamydia pneumonia
and mycoplasma pneumonia.
obstruction leads to early airtrapping and overinflation
-If obstruction becomes complete, there will be resorption of trapping distal air, and the child will develop atelectasis.
Classification;
•Etiologic Bacterial:
Viral
Mycoplasma
Fungal etc. s
Clinical manifestation; •Anatomic:
🔹
🔹 Usually preceded by expose to an older contact with a minor respiratory syndrome within the previous"week Lobar pneumonia
Bronchopneumonia
🔹
🔹
The infant first develops a mild upperrespiratory tract infection with sneezing and clear rhinorrhea
There is diminished appetite and fever 38.5-39c Interstitial pneumonia which is inflammation of the interstitium (the walls of alveoli, the alveolar sac and duct, and
the bronchioles)
🔹
🔹
Gradually respiratory distress ensues, with paroxysmal wheezy cough, dyspnea and irritability
The infant is tachypnic which may interfere with feeding
🔹 There is systemic complaints, such as diarrhea or vomiting
Apnea may be.more prominent than wheezing early in the course of the disease, particularly
🔹
with very yoing infant
🔹 The physical exam is characterized most predominant by wheezing
Definition;
Pneumonia localized to one lobe or segment of lobe ofthe lung, which is completely
🔹 Tachypnea, nasal flaring and retractions
Auscultation may reveal fine crackles or overt wheeze, with prolongation of the expiratory
phase of breathing
consolidated.
EtiolOgy;
uaalds pue JaN!l 4109 f0 uonedled 1!wuad keu s6unl ayt fo uolelfu!Jad/H O Acute bronchiolitis: commonly caused by streptococcus pneumonia
Incidence;- common in preschool and schoolaged children and in adults
-More common in children 4-10yra of ages
-Occurs sporadically, more frequently in winter months.
clinical manifestation;
Diagnosis;
Clinically
🔶 In children and adolescents: almost typical manifestation
1.A brief, mild URTI followed by abrupt onset of;
White blood cell and differential count are usually normal 2. High grade fever and shacking chills
Chest radiography reveals hyperinflated lungs with patchy atelectasis Viral testing (usually rapid 3. Drowsiness, intermittent restlessness and may also delirium
immunofluorescence polymerase chain reaction or Yiral culture) is helpful if the diagnosis is uncertain or for 4. Cough, dry, unproductive, hacking (initially), as resolution occurs may become productive. Diagnosis;
epidemiological purposes 5. Chest pain (pleural pain: sharp and severe,the child is splinting the affected side. It may
refer to the abdomen, neck or shoulder. 🔸
Clinically
Chest x-ray:
Treatment;
Admission requires in 3-5% of patients
6.Rapid respiration, expiratory grunt,nasal flaring, retractions and may be circumoral
cyanosis 🔸
homogenous , well-marked opacity of one lobe or segment without medistenal shift
Peripheral blood:
Indications
7.Classical signs of consolidation,localized dullness, increased fremitus, bronchial breathing
and fine rales.
8. Transient pleural fraction rub may be detected.
🔸
leukocytosis (15000-40000) with neutrophilia
Isolation of pneumococci by culture from blood, pleural fluid or tracheal aspiration.
Prognosis; 1) <6mo of age
-Infants with acute bronchiolitis are at highestrisk for further respiratory compromise in the first 2) Sleeping rate >60/mint Lobar pneumonia 9. Abdominal pain is common in lower lobe pneumonia, abdominal distension (due to gastric
Complication;
3.) Inability of oral feeding dilation or ileus) may be prominent
48-72hr. after onset of cough and dyspnea Pleural effusion/ empyema
4.) High grade fever and irritability 10. Neck stiffness/ meningism (may be observed with right upper lobe pneumonia)
-The case fatality rate is <1% with death attributable to apnea, uncompensated respiratory acidosi Lung abscess
or severe dehydration 5.) The occurrence of apnea and cyanosis
6.)Underlying chronic heart or lung diseases 🔶 in infants:
the above typical manifestations are rarely observed.
Septicemia
Metastatic infection: otitis media, sinusitis, meningitis
7.)Non-compliant family
Prevention; 1. A prodrome of URTI for few days, with decrease appetite
-Reduction in the severity and incidence of a cute bronchiolitis due to RSV is possible through the The main stay of treatment is supportive 2. A abrupt onset of fever, restless, apprehension and signs of respiratory distress and
administration of pooled hyperimmune RSV intravenous immunoglobulin and palivizumab •Cool humidified oxygen retractions
-palivizumab (RSV vacccne) is recommended for infants<2yrs of age with chronic lung disease or prematurity •Comfortable position with head and chestelevated at a 30degree angle with neck extended 3. Gastrointestinal disturbances (vomiting, diarrhea, abdominal distension) are frequent.
Pneumonia
prematurity •Nil orally(becauserisk ofaspiration increased in infant) and maintained with parenteral fluid 4. Auscultation findings are misleading.
-Meticulous hand washing is the best measure to prevent nosocomial transmission •Frequent suctioning of nasal and oral secretion
•Nebulized epinephrine may be more effective than B-agonist
•Corticosteroid can beused in bronchiolitis butare not recommended in previously healthy infants with RSV Treatment;
•Ribavirin,anantiviral agent administered by aerosol,has beenused forinfantswith CHD or chronic lung disease the majority of patients can be treated at home
•Antibiotics have no value unless there is secondary bacterial pneumonia *Admission indications:
-Young infants
- Respiratory distress (RR>40/min, dyspnea, cyanosis)
- Complicated cases (pleurl effusion/empyema)
pneumonia caused by staph. Aureus is a serious and rapidly progressive infection
unless recognized early and treated appropriately is associated with prolonged 🔸
-Underlying chronic lung or heart disease.
symptomatic : -rest -oxygen -iv fluid - analegsic and antipyretics
🔹
morbidity and high mortality.
🔸 Antibiotic:
🔹
🔹
Affects most commonly the infants, 30% are <3m of age and 70% are<1yr
Boys are affected more commonly than girls
It is often unilateral or more prominent in one side than the other(65% involved
penicillin-G is the drug of choice: 100000 U/kg/day(IV/IM)
-Alternatives;
the right side) cefatoxime 150mg/kg/day
Ceftriaxone 75mg/kg/day
Predisposing factors; Vancomycin 40mg/kg/day
1.Staph skin infection; patient or family member
2. Infectious diseases of childhood, e.g. pertussis, measles, chickenpox ……
3. Recent hospitalization
4. Debilitating conditions; severe PEM, cystic fibrosis, malignancies It accounts for >50% of cases
5. Hypogammaglobulinemia and immunosuppressive therapy More common during the winter months
Clinical manifestation;
-It is often preceded by several days of symptoms of an upper respiratory tract infection typically
clinical manifestation; rhinitis and cough
History of URTI for few days, then abrupt onset of; High fever and toxic appearance -Fever is usually present but is generally low
Complications; -Cough and evidence of RD;tachycardia, grunting, nasal flaring, retraction -Tachypnea is the most consistent clinical manifestation of pneumonia
1. Empyema, pyopneumothorax Severe dyspnea and hock-like state may be seen -Increased work of breathing accompanied by intercostal, subcostal and suprasternal retraction,
2. Septicemia and paralytic ileus -GIT disturbance; anorexia, vomiting, diarrhea, and abdominal distension nasal flaring and use of accessory muscle is common
3. CCF and anemia -Alternating lethargic and irritability state -By auscultation of chest: crackles and wheezing
4. Circulatory collapse (shock)
5. Metastatic septic lesions; pericarditis,
Early finding: diminish breathing sounds, scattered rales and rhonchi
With the development of effusion, empyema, or pyopneumothorax, decrease movements of
Staphylococcal pneumonia; -Family history of viral respiratory infections.
osteomyelitis and meningitis affected side, dullness on percussion, and marked decrease of breathing sound and fremitus
Rapid progression of symptoms and signs is typical Viral pneumonia; Diagnosis;
The severity of symptoms is greater than the physical findings The peripheral white blood cell can
be normal or elevated but is usually
not higher than 20000/mm3 with
Diagnosis;
🔹
lymphocyte predominance
Clinical: suggestive features Chest radiograph
-Age: neonate or infant hyperinflation with bilateral interstitial infiltration and peribronchial cuffing
-History of; staph pyoderma or other predisposing factors
-Evidence of effusion, empyema, Pyopneumothorax •is a diffuse inflammation of the parenchyma involving multiple lobes or segments of lobes in one The definitive diagnosis _
🔹
-Rapid progression of symptoms and signs
Paraclinical:
Chest x-ray; frequent chest x-ray exam is essential
or both lungs.
•lt is common in infants and small children and in an older children who has some chronic condition
by isolation of a virus or detection of the viral genome or antigen in respiratory
tract secretions.
such as; CHD, PEM, cystic fibrosis
🔹
Rapid change in x-ray finding is characteristic
🔹 Early finding;non-specifc br. Pneumonia(diffuse patchy infiltration)
Within hours;-the infiltrate become patchy and limited in extent, or may become;
Etiology;
Br.pneumonia is caused by a wide variety of organisms (viral, bacterial, mycoplasma and others)
Treatment;
Supportive
Up to 30% of patients with viral
-dense and homogenous and involve an entire lobe or hemithorax pneumonia may have coexisting
-pneumatoceles of various sizes are commom bacterial pathogens.
-pleural effusion or empyema is noted in most of the patients
-pyopneumothorax occurs in about 25% of cases
therightlung alone is involved in about 65%,bilateral involvement <20% of cases Is an inflammation of the lungs, beginning in the bronchioles, producing an exudates
Leukocytosis (15000-20000mm3) with neutrophil predominant and moderate anemia that obstructs these small airways and cause patchy consolidation of the adjacent
Gram stain and culture for, blood, pleural fluid, skin lesion…. lobules. Complication;
Clinical manifestation;
Bronchopneumonia -It is often preceded by several days of symptoms of an upper respiratory tract
infectionHigh grade fever
🔹
Complications of pneumonia are usually the result of
Direct spread of bacterial infection within the thoracic
Cavity;
-Increased in cough intensity, may be productive or followed by vomiting pleural effusion
-Irritability, poor sleep, poor feeding, vomiting, diarrhea and abdominal distension Empyema
-Rapid breathing, dyspnea, retraction, expiratory grunt and nasal flaring
-By exam;
early in the course of illness, diminished breath sounds, scattered crackles and
🔹
pericarditis
Pyopneumothorax and rarely lung abscess
Bacteremia and hematologic spread
by fatema okoff rhonchi are commonly heard over the affected lung field.
•With the development of increasing consolidation or complications of Pneumonia
Meningitis
Supportive arthritis
such as osteomyelitis
effusion, empyema, or pyopneumothorax, dullness on percussion and breath sound
may be diminish Diffuse crepitation and rhonchi
Diagnosis;
Elevated WBC count (15000-
40000) and a predominance of
granulocytes
Chest radiograph ---- diffuse
patchy consolidation involving
one or both lungs
•Definitive diagnosis is isolationof an organism from the blood,
pleural fluid or lung.
Bacterial pneumonia; Treatment;
Supportive treatment -rest -oxygen -IV fluid -nutritional support
🔹 For mildly ill children who do not need hospitalization, amoxicillin is
recommended( dose 80-90mg/kg/day in communities with a high percentage
of penicillin-resistant pneumococci)
Alternative therapeutic:
cefuroxime or amoxicillin-clavulanate For school aged children and in those
in whom infection with mycoplasma pneumonia or chlamydia is suggested a
macrolide antibiotic such as azithromycin is an appropriat choice.
🔹 Moderate to severe pneumonia;
&Admission indications
1. Age <4m
2. Respiratory distress (tachypnea, retraction, cyanosis……)
3. Inability to take oral fluids and drugs
4. Consolidation in more than one lobe
5.Empyema, pneumatoceles
6. Underlying CHD or severe anemia
🔹ampicillin+
Antibiotic therapy
Neonates:
gentamycin +- cloxacillin IV Alternatives; ceftriaxone
(75mg/kg/day 2DD) or cefuroxime 50-100mg/kg/day 3DD IM/ IV)
+gentamycin (5mg/kg/day 2-3 DD IM/iV)
🔹 infants:
<6m ampicillin(100-150mg/kg/day 4DD)
+cloxacillin (100-200mg/kg/day 4DD) V
>6m ampicillin inj IV
🔹
G
Children 1-5yr: ampicillin/ amoxicillin(50-100mg/kg/day 3DD)/ penicillin-
🔹 Older children penicillin-G inj
🔷
Erythromycin (40-50mg/kg/day 4DD oral) if mycoplasma is suspected
“Typically, a patient with uncomplicated community-acquired bacterial
pneumonia responds to therapy with improvement in clinical symptoms
within 48-96hr. of initiation of antibiotics.
