UPPER RESPIRATORY
TRACT INFECTIONS.(URIs)
BRONCHIOLITIS.
PNEUMONIA.
Perpared by :
DR. SALMA ELGAZZAR
UPPER RESPIRATORY TRACT
INFECTIONS.(URIs)
Acute respiratory infections (ARIs) are classified as
upper respiratory tract infections (URIs) or lower
respiratory tract infections (LRIs).
 The upper respiratory tract consists of the airways
from the nostrils to the vocal cords in the larynx,
including the paranasal sinuses and the middle ear.
URIs are infections primarily affecting respiratory tract
structures above the larynx.
ETIOLOGY OF (URIs)
URIs are the most common infectious diseases. They
include rhinitis (common cold), sinusitis, ear
infections, acute pharyngitis or tonsillopharyngitis,
epiglottitis, and laryngitis.
Of which ear infections and pharyngitis cause the
more severe complications (deafness and acute
rheumatic fever, respectively).
The vast majority of URIs have a viral etiology. More
than 200 viruses can cause URIs.
The most important ones are Rhinoviruses.
 Rhinoviruses account for 25 to 30 percent of URIs;
(˃1/3 of cases).
Respiratory syncytial viruses (RSVs),
parainfluenza and influenza viruses, human
metapneumovirus, and adenoviruses for 25 to
35 percent.
 Corona viruses for 10 percent; and
unidentified viruses for the remainder .
Because most URIs are self-limiting, their
complications are more important than the
infections.
Acute viral infections predispose children to
bacterial infections of the sinuses and middle
ear ,and aspiration of infected secretions and
cells can result in LRIs.
ACUTE NASOPHARYNGITIS
Etiology:
There are more than 100 different varieties of rhinovirus, the
type of virus responsible for the greatest number of colds.
Other viruses that cause colds include enteroviruses
(echovirus and coxsackieviruses) and coronavirus.
Seasonal patterns :
Any time of year, although most colds occur during the fall and
winter months.
Transmission :
-direct contact .
-contact with the virus in the environment.
Colds are most contagious during the first two to four days.
PATHOGENESIS
CLINICAL PICTURE
The signs and symptoms of a cold usually begin one to two days after
exposure.
In young infant (more severe disease):
- Fever, irritability, sneezing.
- Nasal obstruction (snoring) + discharge.
- Difficult feeding.
- Congested ear drums.
- +/- vomiting , diarrhea.
In older children ( milder disease):
-
No Fever, or low grade fever, sneezing.
Body aches and headache.
Nasal obstruction , no respiratory distress.
Nasal discharge : thin→ thick → purulent +/- cough.
Mouth breathing → dry mouth and soreness.
DIFFERENTIAL DIAGNOSIS:
- Prodrome of viral infections ( as measles ,mumps ,poliomyelitis, etc).
- Allergic rhinitis:
• No fever
• Sneezing and itching.
• Pale mucous membrane.
• ↑Eosinophils in secretion.
• Discharge is watery, not purulent.
• Improves on antihistaminic.
COMPLICATIONS:
More in young infants.
I. Otitis media (in 25 % of young infants).
II. Sinusitis, mastoiditis, peritonsillar cellulitis , cervical adenitis.
III. Lower respiratory tract infection (laryngotracheobronchitis, bronchiolitis,
pneumonia).
IV. Triggers asthma in children with hyper-reactive airways.
TREATMENT
NO SPECIFIC TREATMENT
 Antibiotics DO NOT AFFECT THE COURSE and DO NOT REDUCE INCIDENCE
OF BACTERIAL COMPLICATIONS.
 Maintain good nutrition and fluid intake.
 Paracetamol or ibuprofen but avoid aspirin.
ASPIRIN + INFLUENZA INFECTION→ ↑ THE RISK OF REYE SYNDROME
 Relieve nasal obstruction :
Sterile saline, or phenylephrine ( 0.125-0.25 %) nasal drops administered 15
minutes before feeding and at bed time for not more than 5 days.
 Suction with a soft rubber bulb can help in clearing nasal obstruction in
young infants.
 Herbal and alternative treatments:
 Zinc, and herbal products such as echinacea.
 There is some evidence that prophylactic use of vitamin C may decrease the
duration of the common cold in children and adults.
ACUTE PHARYNGITIS
AND TONSILLOPHARYNGITIS
(SORE THROAT)
 Pharyngitis is redness, pain, and swelling of the throat
(pharynx).
 Tonsillitis is inflammation of the tonsils.
 The tonsils are a pair of tissue masses on either side
of the back of the throat.
 Children may have pharyngitis, tonsillitis, or both
(pharyngotonsillitis).
 Pharyngitis is part of most common URIs ,however ,in
the strict sense, acute pharyngitis refer to conditions
in which the principal involvement is in the throat.
AGE:
Peak incidence→ 4-7 years of age.
Uncommon before 1 year.
ETIOLOGY:
in children ˂ 2 years:
mostly viral (rhinovirus, adenovirus, coronavirus
,enterovirus)
in children ˃ 5 years:
Mostly bacterial, group Aβ hemolytic streptococci
(GABHS).
in school aged children and adolescents :
Mycoplasma.
CLINICAL PICTURE:
GENERAL SYMPTOMS AND SIGNS:
Fever, sore throat, dysphagia,
abdominal pain (due to mesenteric
adenitis ) ,vomiting ,throat erythema
(redness) ,palatine petechiae
,enlarged tonsils, exudates and
anterior cervical lymphadenopathy.
It is often impossible to distinguish clinically
between streptococcal and non-streptococcal
sore throat .
Streptococcal sore throat should be suspected if
there is:
Fever and/or sore throat and 2 of the following
signs:
1.Redness (congestion) of the throat.
2.White or yellow exudates on the throat and
tonsils.
3.Anterior cervical lymphadenopathy ( enlarged
and tender anterior cervical lymph nodes)
DIAGNOSIS OF GROUP AβHEMOLYTIC STREPTOCOCCI
The goal of specific diagnosis is to identify GABHS
infection to start prompt and adequate treatment
THROAT SWAB
↙
↘
IF +VE
IF -VE
etiology is β- hemolytic
do a throat culture
COMPLICATIONS OF STREPTOCOCCAL PHARYNGITIS
IMMEDIATE:
Sinusitis.
Otitis media.
Peritonsillar abscess.
Meningitis.
DELAYED:
Acute post-streptococcal glomerulonephritis.
Rheumatic fever.
TREATMENT OF ACUTE PHARYNGITIS
GENERAL MEASURES:
• Bed rest.
• Antipyretics e.g. paracetamol or ibuprofen for fever and pain.
• Gargels with warm saline.
• Cool blank liquids.
• Very soft foods.
SPECIFIC TREATMENT FOR BACTERIAL INFECTION:
• Penicillin is the drug of choice for β- hemolytic streptococci. It
can be given as IM procaine penicillin 400000 U /day for 10 days.
• Or single injection of 600000-1200000 U of long acting
benzathine penicillin.
• Erythromycin & azithromycin are acceptable alternative to
penicillin & can also treat mycoplasma.
CHRONIC TONSILLITIS
CLINICAL FEATURES:
• Recurrent or persistent sore throat.
• Recurrent or persistent obstruction to breathing in the form of snoring or
apnea during sleep ( usually due to associated enlarged adenoids).
• Offensive breath.
• Persistent hyperemia (congestion) of anterior pillars + enlarged cervical
lymph nodes.
IDEAL AGE FOR TONSILLECTOMY:
At the age of 5 years ( not before 2 years).
INDICATIONS OF TONSILLECTOMY:
• Repeated acute tonsillitis ( 4 or more culture-proved β-hemolytic
strept.tonsillitis /year).
• Chronic tonsillitis.
• Peritonsillar (quinsy)/ retrotonsillar abscess.
• Markedly hypertrophied tonsils→ chronic obstruction (especially if there is
sleep apnea).
Acute Ear Infection
• Acute ear infection occurs with up to 30 percent of
URIs.
• It may lead to perforated eardrums and chronic ear
discharge in later childhood and ultimately to hearing
impairment or deafness.
• Chronic ear infection following repeated episodes of
acute ear infection is common in developing
countries, affecting 2 to 6 percent of school-age
children.
• The associated hearing loss may be disabling and may
affect learning.
• Repeated ear infections may lead to mastoiditis,
which in turn may spread infection to the meninges.
RUPTURED EAR DRUM
MASTOIDITIS
BRONCHIOLITIS
INTRODUCTION :
• Bronchiolitis is a lower respiratory tract infection that occurs in
children younger than two years old.
• Usually caused by a virus → inflammation of the small airways
(bronchioles) .
• The inflammation partially or completely blocks the airways,
which causes wheezing .
• Bronchiolitis is a common cause of illness and is the leading
cause of hospitalization in infants and young children.
• Bronchiolitis can cause serious illness in some children(very
young Infants , born early, lung or heart disease).
ETIOLOGY
 Bronchiolitis is typically caused by a virus.
 Respiratory syncytial virus (RSV) is the most common cause in
˃ 50% of cases.
 Common in winter and early spring.
 First 2 years of life ( peak between 3-6 months), more in males
and in non breastfed.
 Children who are older than two years typically do not develop
bronchiolitis, but can be infected with RSV.
 RSV infection is common in children older than two years. It
usually causes symptoms similar to those of the common cold
or mild wheezing and at times the illness is significant enough
to require evaluation by a health care provider.
OTHERS:
Parainfluenza virus, adenovirus ,influenza virus, mycoplasma
PATHOGENESIS
 Acute infection → respiratory obstruction of the small airways.
 Viral invasion of the smaller radicles of the bronchial tree → edema+ accumulation
of mucus and cellular debris → bronchiolar obstruction.
VIRAL INVASION OF BRONCHIOLES
↓
BRONCHIOLAR OBSTRUCTION
↙
EDEMA
→
↘
ACCUMULATION OF MUCUS
CELLULAR DEBRIS
INCOMPLETE OBSTRUCTION
(BALL VALVE)
↓
EARLY AIR TRAPPING DURING
EXPIRATION
↓
OVER INFLATION
COMPLETE OBSTRUCTION
↓
ATELECTASIS
HYPOVENTILATION
IMPAIRED AIR EXCHANGE & HYPOXIA
HYPERCAPNEA
CLINICAL PICTURE
SYMPTOMS :
• History of exposure to an older person with minor respiratory distress.
• Mild upper respiratory tract infection (URTI) for 2-3 days.
• Followed by gradual onset of respiratory distress:
paroxysmal spasmodic cough, wheezes, dyspnea, irritability, feeding difficulty
due to tachypnea.
In mild cases symptoms resolve within 5-7 days .
In severe cases the course is more protracted.
SIGNS :
TACHYPNEA
RESPIRATORY DISTRESS
WHEEZES
HYPERINFLATION
INSPECTION:
-Fast ,shallow respiration. - R.R.60-80/minute.
-Flaring ala nasi. - Chest indrawing. -Intercostal retraction.
-Air hunger.
- Restlesness .
- Cyanosis.
AUSCULTATION:
↓air entry.
- Harsh vesicular breathing with prolonged expiration.
- Inspiratory and expiratory wheezes.
- Inspiratory widespread fine crackles.
PERCUSSION:
Hyper resonant note due to over inflated lungs.
DIAGNOSIS
Young infant with mild URI followed by :
Respiratory distress + wheezes+ over inflated chest
LAB FINDINGS:
The diagnosis of bronchiolitis is based upon a history and
physical examination. Blood tests and x-rays are not usually
necessary.
 Leukocytosis count normal or mild decrease.
 PO2, PCO2 and PH may be measured to assess the severity of
the disease.
 RSV may be demonstrated in nasopharyngeal secretions by
immunofluroscence or PCR
 Rising antibodty titre to RSV in serum.
X-ray finding
hyperinflated lungs.
In 30% scattered areas of opacity dt cosolidaton or atelectasis.
An X-ray of a child with RSV showing the typical bilateral perihilar fullness of
bronchiolitis.
DIFFERENTIAL DIAGNOSIS
•
•
•
•
•
Bronchial asthma.
Cystic fibrosis
Congestive heart failure
Bacterial bronchopneumonia
Organophosphrus poisoning.
COMPLICATIONS
•
•
•
Bacterial superinfection uncommon.
Cardiac failure rare
Death due to severe course
TREATMENT
• The healthcare provider must determine if the child's illness is severe or if
there is a risk of complications.
• In these cases, hospitalization is generally recommended to closely monitor
the child and provide intravenous fluids or supplemental oxygen.
• Approximately 3 percent of children with bronchiolitis will require
monitoring and treatment in a hospital.
Discharge to home:
• Most children who require hospitalization are well enough to return home
within three to four days. Children who require ventilator usually need to
stay in the hospital for four to eight days or longer before they are ready to
go home.
AT HOME
 There is no cure for bronchiolitis, so treatment is aimed at the
symptoms (eg, difficulty breathing, fever).
 Semi-sitting position (30-40 degrees) makes the infant more
comfortable.
 Fever control : acetaminophen ,Ibuprofen
 Nose drops or spray
 Encourage fluids
 Other therapies :
such as antibiotics, cough medicines, decongestants, and
sedatives, are not recommended.
 Monitoring at home involves observing the child periodically for
signs or symptoms of worsening ( increased rate of breathing,
worsening chest retractions, nasal flaring, cyanosis, a decreased
ability to feed or decreased urine output).
SUPPORTAIVE TREATMENT
 Semi-sitting position (30-40 degrees) makes the infant more comfortable.
 Oxygen:
• Cool humidified oxygen by nasal cannula, or by placing a face mask
over the nose and mouth. For infants, an oxygen head box (a clear
plastic box) may be used.
• If a child is severely ill and unable to breathe adequately on his or
her own, or if the child stops breathing, an endotracheal tube may
be inserted and connected to a ventilator that breathes for the
child at a regular rate.
• The use of an endotracheal tube and ventilator is a temporary
measure that is discontinued when the child improves.
 Fluids : parental + oral .
 In case of respiratory acidosis ,suitable I.V. fluids are given to adjust PH and
electrolytes.
 Avoid sedatives.
 Good nutrition
 Antiviral ( ribavarin) is given only to those with documented sever RSV
disease or high risk infants.it is given by continuous inhalation by aerosol
generator 10-12hr/day for 3-4 days.
DEFINATION
AND
EPIDEMIOLOGY
PNEUMONIA is a primary inflammation of lung parenchyma.
(WHO) estimates there are 156 million cases of pneumonia each year in children
younger than five years. Pneumonia affects more boys than girls.
Mortality:
The mortality rate in developed countries is low (<1 per 1000 per year). In developing
countries ,pneumonia is the number one killer of children in these societies
Seasonality :
Pneumonia is most common in winter and spring.
Medical conditions predispose to pneumonia and contribute to increasing severity:
●Congenital heart disease
●Bronchopulmonary dysplasia
●Cystic fibrosis
●Asthma
●Sickle cell disease
●Neuromuscular disorders, especially those associated with a depressed consciousness
●Some gastrointestinal disorders (eg, gastroesophageal reflux, tracheoesophageal
fistula)
●Congenital and acquired immunodeficiency disorders
ANATOMICAL TYPES OF PNEUMONIA
● Lobar pneumonia :
Involvement of a single lobe or segment of a lobe; this is the classic pattern
of S. pneumoniae pneumonia
●Bronchopneumonia :
Primary involvement of airways and surrounding interstitium; this pattern is
sometimes seen in Streptococcus pyogenes and Staphylococcus
aureus pneumonia
●Necrotizing pneumonia:
Associated with aspiration pneumonia and pneumonia resulting from S.
pneumoniae, S. pyogenes, and S. aureus)
●Caseating granuloma (as in tuberculosis pneumonia)
●Interstitial and peribronchiolar with secondary parenchymal infiltration :
This pattern typically occurs when a severe viral pneumonia is complicated by
bacterial pneumonia
ANATOMICAL TYPES OF PNEUMONIA
CLINICAL PICTURE
• Presenting features vary with age, infectious agent, and severity or stage of
the illness.
• Fever, cough (productive or non-productive), and difficulty breathing are
common presenting symptoms, often preceded by signs of a minor upper
respiratory tract infection.
• Chest or stomach pain.
• Decrease in appetite.
• Chills.
• Breathing fast or hard.
• Vomiting.
• Headache.
• Not feeling well.
CLINICAL PICTURE (CONTU.)
Examination
This includes assessment for:
Fever:
> 38.5o C is a feature of bacterial pneumonia
Oxygenation:
Cyanosis indicates severe illness.
Pulse oximetry identifies significant hypoxaemia (SaO2 <92% in air)
Respiratory rate:
Tachypnea is a useful indicator of pneumonia.
Rates defined by the WHO provide a 74% sensitivity for radiologically
defined pneumonia:
AGE
RESPIRATORY RATE
<2 months
>60 breaths/min
2–12 months
>50 breaths/min
>12 months
>40 breaths/min
CLINICAL PICTURE (CONTU.)
Work of breathing:
Chest recession, nasal flaring and grunting nasal flaring and grunting are most sensitive
in children aged <3 years.
Percussion and auscultation:
Examination findings consistent with radiographically confirmed pneumonia include :
●Crackles, also called rales or crepitations; in a systematic review, crackles were 3.5
times more frequent in infants with radiographic pneumonia than without .
●Findings consistent with consolidated lung parenchyma, including:
 Decreased breath sounds
 Bronchial breath sounds (louder than normal, with short inspiratory and long
expiratory phases, and higher-pitched during expiration), egophony (E to A
change)
 Bronchophony (the distinct transmission of sounds such as the syllables of
“ninety-nine”)
 Whispered pectoriloquy (transmission of whispered syllables)
 Tactile fremitus (eg, when the patient says “ninety-nine”) is increased
 Dullness to percussion
●Wheezing is more common in pneumonia caused by atypical bacteria and viruses than
bacteria .
●Findings suggestive of pleural effusion include chest pain with splinting, dullness to
percussion, distant breath sounds, and a pleural friction rub
Examination feature
General appearance (state of awareness, cyanosis)*
Possible significance
Most children with radiographically confirmed pneumonia appear ill
Vital signs
Temperature
Respiratory rate
Degree of respiratory distress
Fever may be the only sign of pneumonia in highly febrile young
children; however, it is variably present and nonspecific
¶
Tachypnea correlates with radiographically confirmed
pneumonia and hypoxemia
Absence of tachypnea helps to exclude pneumonia
Respiratory distress is more specific than fever or cough for
lower respiratory infection
Tachypnea
Hypoxemia
Predictive of pneumonia
Increased work of breathing:
Retractions
More common in children with pneumonia than without;
absence does not exclude pneumonia
Nasal flaring
More common in children with pneumonia than without;
absence does not exclude pneumonia
Grunting
Sign of severe disease and impending respiratory failure
Accessory muscle use
Sign of severe disease
Head bobbing
Sign of severe disease
Lung examination
Cough
Nonspecific finding of pneumonia
Auscultation
Findings suggestive of pneumonia include: crackles (rales,
crepitations), decreased breath sounds, bronchial breath
sounds, egophany, bronchophony, and whispered pectoriloquy
Wheezing more common in viral and atypical pneumonias
Tactile fremitus
Suggestive of parenchymal consolidation
Dullness to percussion
Suggestive of parenchymal consolidation or pleural effusion
Mental status
Altered mental status may be a sign of hypoxia
INVESTIGATIONS
Full blood count and acute phase reactants
 Total leukocyte and neutrophil count.
 C-reactive protein.
 ESR have poor sensitivity and specificity for distinguishing between viral and bacterial
pneumonia.
Microbiological investigations
Blood cultures:
The yield is low and a positive result takes 48–72 h. Positive in 10–15% of patients with
pneumococcal pneumonia.
Respiratory tract samples:
Sputum for culture is rarely available and samples are frequently contaminated.
Nasopharyngeal aspirate (NPA) for viral immunofluorescence assay or PCR is useful in
infants. Bronchoscopy or pleural fluid aspiration may provide samples.
Serology:
Paired serology 14 days apart is available for diagnosis of mycoplasma but treatment is
usually given on empirical grounds.
IMAGING
CXR:
The appearance of consolidation on CXR is reliable for the diagnosis of
pneumonia ,but CXR appearances are not reliable for distinguishing between
viral and bacterial infection as there is considerable overlap.
The CXR may
Appear normal early in the disease. However, as an approximate
guide:
Viral pneumonia:
Patchy perihilar infiltration, hyperinflation, atelectasis
Bacterial pneumonia:
Lobar consolidation (air bronchogram) occasionally with parapneumonic
effusion. Pneumatocoele and abscesses suggest staphylococcal pneumonia
Mycoplasma pneumonia:
Patchy, segmental consolidation with hilar lymphadenopathy.
Chest X-Ray showing patch of pneumonia
Image of chest x-ray displaying the interstitial pattern
seen in viral pneumonia. The interstitial pattern shows
fine lines radiating from the hila.
These chest X rays compare clear, healthy lungs with
the cloudy, inflamed lung tissue of pneumonia.
Right lower lobe consolidation in a patient with
bacterial pneumonia.
Anteroposterior radiograph from a child with a round
pneumonia.
x-ray view of mycoplasma pneumonia
Ultrasound:
This is most useful if a pleural effusion is suspected on CXR. It
can differentiate between clear fluid and fibrino-purulent
effusions
CT scan:
provides more detailed imaging of suspected abscess or empyema.
DIFFERENTIAL DIAGNOSIS
Although pneumonia is highly probable in a child with fever, tachypnea, cough, and
infiltrate(s) on chest radiograph, alternate diagnoses and coincident conditions must
be considered in children who fail to respond to therapy or have an unusual
presentation/course .
 Foreign body aspiration must be considered in young children. The aspiration event
may not have been witnessed.
 Other causes of tachypnea, with or without fever and cough, in infants and young
children include :
●Bronchiolitis .
●Heart failure
●Sepsis
●Metabolic acidosis .
These conditions usually can be distinguished from pneumonia by history,
examination, and laboratory tests or additional imaging may be necessary.
COMPLICATION
Most children with CAP improve without complications, but an
unexplained trend of increased complications of bacterial
pneumoniahas been seen worldwide.
 Treatment failure (antibiotic resistance)
 Lung abscess.
 Metatastic infection.
 Pleural infection (effusion or empyema).
 Pneumatoceles.
 Necrotizing pneumonia
 Hyponatraemia secondary to
inappropriate ADH secretion is common.
Pleural effusion or empyema
 Persistent or recurrent fever after 48 h treatment for pneumonia
should raise suspicion of a parapneumonic effusion or empyema .
 An AP or PA CXR and ultrasound should allow diagnosis and evaluation
of the nature of pleural fluid.
 A small unloculated effusion may resolve with IV antibiotics alone.
 A diagnostic pleural tap is usually unnecessary.
 A large loculated empyema with obvious pus and thickened pleura will
require drainage.
 Options include a pigtail chest drain with intrapleural fibrinolytics,
video-assisted thoracoscopic surgery (VATs) or early minithoracotomy
following chest CT scan.
Necrotizing pneumonia :
Necrotizing pneumonia, necrosis, and liquefaction of lung parenchyma, is a serious
complication of community-acquired pneumonia (CAP).
Necrotizing pneumonia usually follows pneumonia caused by particularly virulent
bacteria e.g S. pneumoniae (especially serotype 3 and serogroup 19) is the most
common cause of necrotizing pneumonia .
Necrotizing pneumonia also may occur with S. aureus and group A Streptococcus and
has been reported due to M. pneumoniae, Legionella, and Aspergillus.
Clinical manifestations of necrotizing pneumonia are similar to those of uncomplicated
pneumonia, but they are more severe .
Necrotizing pneumonia should be considered in a child with prolonged fever or septic
appearance .
The diagnosis can be confirmed by chest radiograph (which demonstrates a radiolucent
lesion) or contrast-enhanced computed tomography ,the findings on chest radiograph
may lag behind those of computed tomography .
Lung abscess
 Clinical manifestations of lung abscess are nonspecific and similar to those of
pneumonia
 They include fever, cough, dyspnea, chest pain, anorexia, hemoptysis, and
putrid breath.
 The diagnosis is suggested by a chest radiograph demonstrating a thickwalled cavity with an air-fluid level and confirmed by contrast-enhanced
computed tomography .
 The most common complication of lung abscess is intracavitary hemorrhage.
 This can cause hemoptysis or spillage of the abscess contents with spread of
infection to other areas of the lung .
 Other complications of lung abscess include empyema, bronchopleural
fistula, septicemia, cerebral abscess, and inappropriate secretion of
antidiuretic hormone
Anterior view of a chest radiograph in a patient with
thick-walled right lung abscess. The patient later
developed a brain abscess.
Pneumatocele :
Pneumatoceles are thin-walled, air-containing
cysts of the lungs.
They are classically associated with S. aureus,
but may occur with a variety of organisms .
Pneumatoceles frequently occur in association
with empyema .
In most cases, pneumatoceles involute
spontaneously, and long-term lung function is
normal .
However, on occasion, pneumatoceles result in
pneumothorax
Treatment
As viral and bacterial pneumonia are often difficult to distinguish treatment including use
of antibiotics is based on age and severity.
Treatment may include:
Oxygen: to maintain SaO2 >92%
Fluids: restrict to 80% maintenance .
Antipyretics
Antibiotics:
<5 years:
amoxicillin is first choice oral antibiotic, alternatives include co-amoxiclav and macrolides
>5 years:
a macrolide (erythromycin, clarithromycin or azithromycin) is the first choice oral
antibiotic as mycoplasma infection is more likely.
Oral antibiotics are safe and effective for many children with CAP, but in severe cases with
sepsis, consolidation with effusion, failed response or intolerance to oral antibiotics IV
treatment is indicated with a third-generation cephalosporin(e.g. cefuroxime) or
ampicillin.
A change to oral antibiotics can then be made if there is clear improvement.
Treatment duration is between 5 and 10 days depending on severity.
ASPIRATION PNEUMONIA
Causes:





Amniotic fluid or meconium (in newborns)
Foreign body.
Food.
Lipoid material.
Hydrocarbons→ kerosene pneumonia.
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