PNEUMONIA
ABDULLAH M. AL-OLAYAN
MBBS, SBP, ABP.
ASSISTANT PROFESSOR OF PEDIATRICS.
PEDIATRIC PULMONOLOGIST.
OBJECTIVES
① Recall the epidemiology and etiology of
community acquired pneumonia in
children.
② Discuss the clinical manifestations,
diagnosis and treatment of pneumonia.
③ Briefly discuss the aspiration pneumonias
in children.
DEFINITIONS
• Pneumonia is an infection of the lower respiratory
tract that involves the airways and parenchyma
with consolidation of the alveolar spaces.
• Lower respiratory tract infection is often used to
encompass bronchitis, bronchiolitis, pneumonia, or
any combination of the three.
• Pneumonitis is a general term for lung inflammation
that may or may not be associated with
consolidation.
DEFINITIONS
• Lobar pneumonia describes pneumonia localized to
one or more lobes of the lung.
• Bronchopneumonia refers to inflammation of the
lung that is centered in the bronchioles and leads
to the production of a mucopurulent exudate that
obstructs some of these small airways and causes
patchy consolidation of the adjacent lobules.
• Atypical pneumonia describes patterns typically
more diffuse or interstitial than lobar pneumonia.
EPIDEMIOLOGY
• Immunizations have had a great impact on the
incidence of pneumonia caused by :
① Pertussis.
② Diphtheria.
③ Measles.
④ Haemophilus influenza type b.
⑤ S. pneumoniae.
⑥ TB (BCG Vaccine).
EPIDEMIOLOGY
• Risk factors :
① Gastroesophageal reflux.
② Neurologic impairment (aspiration).
③ Immunocompromised states.
④ Anatomic abnormalities of the respiratory tract.
⑤ Residence in residential care facilities.
⑥ Hospitalization, especially in an intensive care unit.
CLINICAL MANIFESTATIONS
① Fever.
② Chills.
③ Tachypnea.
④ Cough.
⑤ Malaise.
⑥ Pleuritic chest pain.
⑦ Retractions.
CLINICAL MANIFESTATIONS
• Dullness to percussion may be due to lobar or
segmental infiltrates or pleural fluid.
• Auscultation may be normal in early or very focal
pneumonia, but the presence of localized crackles,
rhonchi, and wheezes may help one detect and
locate pneumonia.
• Physical examination findings cannot reliably
distinguish viral and bacterial pneumonias.
LABORATORY AND IMAGING
STUDIES
• In otherwise healthy children without lifethreatening disease, invasive procedures to obtain
lower respiratory tissue or secretions usually are not
indicated.
• (WBC) count with viral pneumonias is often normal
or mildly elevated, with a predominance of
lymphocytes, whereas with bacterial pneumonias
the WBC count is elevated with a predominance of
neutrophils.
LABORATORY AND IMAGING
STUDIES
• Blood cultures should be performed on hospitalized
children to attempt to diagnose a bacterial cause
of pneumonia.
• Blood cultures are positive in 10% to 20% of
bacterial pneumonia and are considered to be
confirmatory of the cause of pneumonia if positive
for a recognized respiratory pathogen.
LABORATORY AND IMAGING
STUDIES
• Viral respiratory pathogens can be diagnosed using
polymerase chain reaction (PCR) or rapid viral
antigen detection.
• CMV and enterovirus can be cultured from the
nasopharynx, urine, or bronchoalveolar lavage
fluid.
• M. pneumoniae can be confirmed by Mycoplasma
PCR.
LABORATORY AND IMAGING
STUDIES
• Frontal and lateral CXRs are required to localize disease
and adequately visualize retrocardiac infiltrates.
• they are not necessary to confirm the diagnosis in wellappearing outpatients.
• Decubitus views or ultrasound should be used to assess
size of pleural effusions and whether they are freely
mobile.
• (CT) is used to evaluate serious disease, pleural
abscesses, bronchiectasis, and effusion characteristics.
LABORATORY AND IMAGING
STUDIES
LABORATORY AND IMAGING
STUDIES
DIFFERENTIAL DIAGNOSIS
①Allergic pneumonitis.
②Asthma.
③Cystic fibrosis.
④Pulmonary edema.
TREATMENT
① Supportive.
② Specific treatment and depends on the degree of
illness, complications, and knowledge of the
infectious agent likely causing the pneumonia.
• Most cases of pneumonia in healthy children can
be managed on an outpatient basis.
TREATMENT
• Indications of Hospitalization :
Hypoxemia.
Inability to maintain adequate hydration.
Moderate to severe respiratory distress.
Infants under 6 months with suspected bacterial
pneumonia.
⑤ Concern exists about a family’s ability to care for
the child.
①
②
③
④
COMPLICATIONS AND
PROGNOSIS
1.
2.
3.
4.
5.
6.
7.
Parapneumonic effusion.
Empyema.
Pneumatocele.
Bronchiectasis.
Lung abscess.
Bronchiolitis obliterans(esp. with adenovirus).
Unilateral hyperlucent lung(Swyer-James
syndrome).
COMPLICATIONS AND
PROGNOSIS
• Most children recover from pneumonia rapidly and
completely, although radiographic abnormalities
may take 6 to 8 weeks to return to normal.
PREVENTION
• Annual influenza vaccine is recommended for all
children over 6 months of age.
• Universal childhood vaccination with conjugate
vaccines for H. influenzae type b and
S. pneumoniae has greatly diminished the
incidence of these pneumonias.
ASPIRATION PNEUMONIA
• Aspiration of material that is foreign to the lower
airway produces a varied clinical spectrum ranging
from an asymptomatic condition to acute lifethreatening events.
• Clinical Findings :
1. Fever.
2. Cough.
3. Respiratory distress.
4. Hypoxemia.
ASPIRATION PNEUMONIA
• Right side especially the right upper lobe in the
supine patient is commonly affected.
RISK FACTORS
TREATMENT
• Supportive treatment is the only recommended
therapy.
• Antimicrobial therapy for patients who are
acutely ill from aspiration pneumonia includes
coverage for gram-negative anaerobic organisms.
• Clindamycin is appropriate initial coverage.
REFERENCE