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This is the first line of treatment in bronchopneumonia. Along with the above treatment additionally proper food supplementation, hydration by giving adequate water, vegetable juices made up of carrot, and spinach can be given. Pneumococcal vactionation is advised in children. Related Topics

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Etiology
Pneumonia can be caused by a myriad of microorganisms. Clinical suspicion of a particular offending agent is derived from clues obtained during the history and physical examination. While virtually any microorganism can lead to pneumonia, specific bacterial, viral, fungal, and mycobacterial infections are most common in previously healthy children. The age of infection, exposure history, risk factors for unusual pathogens, and immunization history all provide clues to the infecting agent. In a prospective multicenter study of 154 hospitalized children with acute community-acquired pneumonia (CAP) in whom a comprehensive search for an etiology was sought, a pathogen was identified in 79% of children. Pyogenic bacteria accounted for 60% of cases, of which 73% were due to Streptococcus pneumoniae, while the atypical bacteria Mycoplasma pneumoniae and Chlamydophila pneumoniae were detected in 14% and 9%, respectively. Viruses were documented in 45% of children. Notably, 23% of the children had concurrent acute viral and bacterial disease. In the study, preschool-aged children had as many episodes of atypical bacterial lower respiratory infections as older children. Multivariable analyses revealed that high temperature (38.4°C) within 72 hours after admission and the presence of pleural effusion were significantly associated with bacterial pneumonia.[4] Specific etiologic agents vary based on age groups (ie, newborns, young infants, infants and toddlers, 5-year-olds, school-aged children and young adolescents, older adolescents).

Newborns
In newborns (age 0-30 d), organisms responsible for infectious pneumonia typically mirror those responsible for early onset neonatal sepsis. This is not surprising in view of the role that maternal

when the impact of intrapartum chemoprophylaxis in reducing neonatal and maternal infection by this organism became evident. However. and baseline increased oxygen requirements. and Pneumocystis carinii. via aspiration of organisms present in the birth canal. may cause pneumonia in the first 24 hours of life. S pneumoniae is . although most infants are asymptomatic during the first 24 hours and develop pneumonia only after the first 2 weeks of life. or by postnatal contact with other people or contaminated equipment. E coli has become the most common bacterial isolate among VLBW infants (1500 g or less) since that time. Listeria monocytogenes.[5] Other potential bacterial organisms include the following:     Nontypeable Haemophilus influenzae (NTHi) Other gram-negative bacilli Enterococci Staphylococcus aureus Some organisms acquired perinatally may not cause illness until later in infancy. or gram-negative rods (eg. usually as a result of colonization of the mother's vagina and cervix by the organism. The clinical presentation usually involves other organ systems as well. C trachomatis organisms are presumably transmitted at birth during passage through an infected birth canal. Infections with group B Streptococcus. making premature infants (who may not have benefited from sufficient transfer of transplacental immunoglobulin [Ig] G]) especially vulnerable to lower-tract disease. such as CMV. Young infants In the young infant (aged 1-3 mo). These pathogens can be acquired in utero. Group B streptococci infections are most often transmitted to the fetus in utero. S aureus. Mycoplasma hominis. most bacterial pneumonia in this age group is community acquired and involves S pneumoniae. fewer functional alveoli. Escherichia coli. In addition.genitourinary and gastrointestinal tract flora play in both processes. Risk factors for infection include older siblings. Agents of chronic congenital infection. U urealyticum. group daycare. Group B Streptococcus (GBS) was the most common bacterial isolate in most locales from the late 1960s to the late 1990s. with associated hyperreactive airways. and nontypeable H influenzae. CMV. Newborns may also be affected by the bacteria and viruses that commonly cause infections in older infants and children. continued concern about the perinatally acquired pathogens mentioned above remains. Klebsiella pneumoniae) are common causes of bacterial pneumonia. Toxoplasma gondii. The transfer of maternal antibodies is important in protecting newborns and young infants from such infections. Community-acquired viral infections occur in newborns. Treponema pallidum (the cause of pneumonia alba). including Chlamydia trachomatis. and others. premature infants may have chronic lung disease of prematurity. and lack of immunization. although less commonly than in older infants. The most commonly isolated virus is respiratory syncytial virus (RSV).

and types 1 and 2 occur in the fall. Among other potential atypical bacterial pathogens. 2. and preschool-aged children Viruses remain the most common cause of pneumonia in this age group. S pneumoniae is by far the most common bacterial cause of pneumonia. Bacterial infections in this age group are seen on a regular basis. and P carinii are described. and coronavirus. Parainfluenza type 3 infection occurs in the spring. Infants.[7. and human metapneumovirus (hMPV). parainfluenza viruses. 9. Of these. rhinovirus.[6] At this age. Most lower respiratory tract disease in young infants occurs during the respiratory virus season and is viral in origin.[11] RSV is the most common viral pathogen. toddlers. CMV. A recent addition to this list is hMPV. although herd immunity gained from widespread immunization of the population has been broadly protective. The most common viral agents include RSV. Among hospitalized children with bacterial pneumonia. U urealyticum. adenovirus. although S aureus is notorious for such complications. but nonvaccine types remain problematic. parapneumonic effusions.by far the most common bacterial pathogen in this age group. The herpesviruses (HSV. Infection with any of these pyogenic bacteria may be complicated by lung abscess. RSV infection occurs in the winter and early spring. U urealyticum and U parvum have been recovered from endotracheal aspirates shortly after birth in very low birth weight (VLBW) infants and have been variably associated with various adverse pulmonary outcomes. particularly in children with impaired immune systems. Influenza occurs in the winter. including bronchopulmonary dysplasia (BPD). which causes an illness similar to RSV and may be responsible for one third to one half of nonRSV bronchiolitis. Tsolia et al identified a viral infection among 65% of hospitalized children with community-acquired pneumonia. S . enterovirus. and empyema. and CMV) may rarely cause pneumonia. infants are incompletely immunized and remain at higher risk for H influenzae type B and pneumococcal disease. 10] Whether these organisms are causal or simply a marker of increased risk is unclear. followed by parainfluenza types 1. influenza virus. Other viruses that cause pneumonia less frequently in infants and young children include adenovirus. C trachomatis. Bordetella pertussis infection leads to pneumonia in as many as 20% of infected infants (as a complication of the whooping cough infection). particularly in the patient with clinical bronchiolitis. and 3 and influenza A or B. Atypical organisms may rarely cause infection in infants. It is important to note that the current conjugate pneumococcal vaccine provides protection against 13 common pneumococcal types. 8. VZV. accounting for approximately 90% of all lower respiratory tract infections.

. most notably the Ohio and Mississippi River valleys. 11. 13] Other agents to consider include H influenzae type B (HiB) (very uncommon in immunized children[14] ).[4. opportunistic infections with organisms such as Aspergillus species. in previously healthy individuals. In immunosuppressed individuals. but it is unusual in other immunocompetent individuals. Histoplasma capsulatum. 12. Other pyogenic bacterial pathogens to consider include S aureus and S pyogenes. the diagnosis must be considered in immunocompromised children. In this age group. 15] Children in homeless shelters and group homes and those with household contacts are at particular risk. usually caused by S pneumoniae. Cryptococcus neoformans is a common infection among pigeon breeders. Atypical pneumonia caused by C pneumoniae can present with identical signs and symptoms. is found in certain geographic locations. and S aureus. Pulmonary infections caused by dimorphic fungi are also seen in this age group. Children younger than 5 years. Mycoplasma accounts for 14-35% of pneumonia hospitalizations in this age group. Similarly.pneumoniae accounts for 21-44% of disease. is an unusual cause of pneumonia that occurs in people who work with and handle birds. which. usually with S pneumoniae or S aureus. the most common is acute pneumonia. School-aged children and young adolescents M pneumoniae is the most frequent cause of pneumonia among older children and adolescents. As with histoplasmosis. Blastomyces dermatitides. blastomycosis is acquired by inhalation of spores. and CMV can occur. or those with frequent ear infections are at increased risk for invasive pneumococcal disease and infection with resistant pneumococcal strains. Chlamydophila pneumoniae also causes pneumonia. children enrolled in daycare. Older adolescents M pneumoniae is the most common cause of community-acquired pneumonia during the teenage and young adult years. most often resolves without treatment. C psittaci. which is found in nitrate-rich soil. pyogenic bacterial pneumonia remains a concern. Chicken coops and other bird roosts and decaying wood are often-cited sources. Pneumocystis jirovecii. Evidence suggests that breastfeeding has a protective effect against invasive pneumococcal infection. Viral pneumonia remains common in this age group. The related organism.[4. is usually acquired as a result of inhalation of spores. Bacterial pneumonia caused by S pneumoniae is also seen. Although 3 distinct forms of infection exist. S pyogenes. another dimorphic fungus. Influenza pneumonia is a particular concern because ongoing infection with this virus predisposes to the development of bacterial superinfection.

gastrointestinal motility. swallowing abnormalities. Patients with underlying hematologic malignancies are at the highest risk. fungus. Additionally. Fungal pneumonia. Inhalation of certain chemicals or smoke may cause pulmonary inflammation. or other related fungi. with or without aerobes. and it is important to remember that children with TB usually do not present with symptoms until 1-6 months after primary infection. Patients with sickle cell disease have problems with their complement system as well as functional asplenia. Virtually any bacteria. whether secondary to HIV infection/AIDS. Children with cystic fibrosis are especially prone to develop infections with S aureus. or who has traveled to a TB-endemic area of the world needs to be fully evaluated for the possibility of tuberculosis. or a gastrostomy tube. have prolonged neutropenia. and other multidrug-resistant organisms. P jirovecii pneumonia (PCP) is common in the most severely compromised children and can lead to respiratory failure and death in those who are profoundly immunocompromised. or chemotherapy for a malignancy. Pseudomonas aeruginosa. occur in immunocompromised patients who undergo prolonged hospitalization. Not all pneumonia is caused by infectious agents. particularly when a bacterial infection follows. In addition. aspiration pneumonia is more common in children with neurologic impairment. M pneumoniae is also a common agent of pneumonia is this group of patients. or even parasite can invade and infect the lungs if the immune system is sufficiently impaired. TB pneumonia in children warrants special mention. It can occur in any age group. Immunocompromised children Some children who are immunocompromised. Zygomycetes. an immune disorder.Viral pneumonias are common in this age group are usually mild and self-limited. Any child with pneumonia who has a history of TB exposure. virus. Children who have severe gastroesophageal reflux (GERD) may develop chemical pneumonitis secondary to recurrent aspiration. Carefully obtained samples for appropriate microbiologic testing are paramount in such patients so that therapy can be optimized. caused by Aspergillus. the agent of Legionnaires disease. CMV poses a great risk to immunocompromised patients. . Legionella pneumophila. Oral anaerobic flora. can also cause pneumonia. are at risk for pneumonias with opportunistic agents. Adenovirus infections can be severe in these children as well. and/or have received broad-spectrum antibiotics. is the most common etiologic agent. leading to bronchiolitis obliterans or hyperlucent lung syndrome. which predisposes them to infection with encapsulated organisms such as S pneumoniae and H influenzae type B. although it is uncommon in the pediatric age group. but influenza pneumonia can be severe or protracted. Burkholderia cepacia.

[20] This equates to an annual incidence of 150.28 episodes per child-year. In a large community-based study conducted by Denny and Clyde. . and 1 case per 100 children aged 9-15 years. the second highest rates of influenzaassociated hospitalizations in the United States were in children younger than 5 years. bronchopneumonia occurs in 0. The WHO Child Health Epidemiology Reference Group estimated the median global incidence of clinical pneumonia to be 0. Approximately 150 million new cases of pneumonia occur annually among children younger than 5 years worldwide. respectively. although it is more common in younger children. particularly children in homeless shelters and group homes and those with household contacts.[4. 11.026 episodes per child-year. In school-aged children and adolescents. of which 11-20 million (7-13%) are severe enough to require hospital admission. and age group.[20] and a study conducted in the United Kingdom showed that 59% of deaths from pertussis are associated with pneumonia. the annual incidence rate of pneumonia was 4 cases per 100 children in the preschool-aged group.[18] Although the overall rate of pneumonia has decreased in the United States with the use of the 7-valent vaccine. 15] and mycobacterial pneumonia has recently been noted with increasing frequency in some inner-city areas.8-2% of all pertussis cases and 16-20% of hospitalized cases. In a randomized double-blind trial.[16] Thompson et al reported that. International statistics Pneumonia and other lower respiratory tract infections are the leading cause of death worldwide. Ninety-five percent of all episodes of clinical pneumonia in young children worldwide occur in developing countries. The new vaccine includes serotypes that have become associated with complicated or antibiotic-resistant disease (19A and 6A.[19] With the use of the 13-valent conjugated pneumococcal polysaccharide vaccine. for example). the overall rates of pneumonia are anticipated to drop further.[16] A WHO Child Health Epidemiology Reference Group publication cited the incidence of communityacquired pneumonia among children younger than 5 years in developed countries as approximately 0.7 million new cases. discharge type. M pneumoniae accounts for 14-35% of pneumonia hospitalizations in this age group. after elderly persons.[17] The investigators evaluated annual influenza-associated hospitalizations by hospital discharge category. Pneumonia accounts for 13% of all infectious illnesses in infants younger than 2 years. the rate of empyema and complicated pneumonia has increased. accounting for approximately 10-20 million hospitalizations. 2 cases per 100 children aged 5-9 years. the heptavalent pneumococcal vaccine reduced the incidence of clinically diagnosed and radiographically diagnosed pneumonia among children younger than 5 years by 4% and 20%.Epidemiology United States statistics Pneumonia can occur at any age.

pneumonia remains a significant cause of morbidity in industrialized nations. and acute chest syndrome occurs in 15-43% of patients with sickle cell disease. Although most fatalities occur in developing countries. including bronchiolitis obliterans and necrotizing bronchiolitis. such as chronic lung disease of prematurity. With neonatal pneumonia.Prognosis Overall. many hosts develop long-lasting or permanent pulmonary changes that affect lung function. those with underlying lung disease. although rare. Significant sequelae occur with adenoviral disease. Mortality The United Nations Children's Fund (UNICEF) estimates that 3 million children die worldwide from pneumonia each year. common bacterial pathogens and atypical organisms respond to antimicrobial therapy (see Treatment and Management). Morbidity Although viral pneumonias are common in school-aged children and adolescents and are usually mild and self-limited. Individuals with sickle cell disease not only have problems with their complement system. and they are also susceptible to various comorbidities. Bronchopneumonia occurs in 0. and neonates are at high risk for severe sequelae. The prognosis for varicella pneumonia is somewhat more guarded. even in children with pneumonia that has been complicated by empyema or lung abscess.8-2% of all pertussis cases and 16-20% of hospitalized cases. which predisposes them to infection with encapsulated organisms such as S pneumoniae and H influenzae type B. the prognosis is good. and susceptibility to later infections. can be very serious despite treatment. If TB is not treated during the early stages of infection. even if the infection is eradicated. Most cases of viral pneumonia resolve without treatment. Staphylococcal pneumonia. Infants and postpubertal adolescents with TB pneumonia are at increased risk of disease progression. the survival rate of these patients is much lower than in those with pneumonia that is attributed to other causes. these deaths almost exclusively occur in children with underlying conditions. approximately 25% of children younger than 15 years develop extrapulmonary disease. Long-term alteration of pulmonary function is rare. . these pneumonias are occasionally severe and can rapidly progress to respiratory failure. and immunosuppression. congenital heart disease. Immunocompromised children. but they also have functional asplenia. Patients placed on a protocol-driven pneumonia clinical pathway are more likely to have favorable outcomes. Cryptococcosis may occur in as many as 5-10% of patients with AIDS. Morbidity and mortality from RSV and other viral infections is higher among premature infants and infants with underlying lung disease. the quality of life. either as a primary manifestation of viral infection or as a consequence of subsequent bacterial infection.

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