Pneumonia

• Pneumonia is an inflammation of the

paranchyma of the lung
• the various clinical pneumonia are often
classified by their anatomic distribution
 lobar
 lobular
 interstitial
 bronchopneumonia
conti
• By the agent that cause
 viral
 bacterial
 aspiration
• Certain lesion are commonly produced by
specific causative agent
Example
Pneumococcus produces an inflammatory
mucosal lesion and alveolar exudates usually
without destruction of mucosal cells or extensive
involvement of interstitial tissue.
• The gross lesion is a consolidation of all parts of
a lob or lobular variety, or of scattered lobules
the broncho-pneumonic variety
• Pneumocccal pneumonia characteristically
assumes a lobar pattern in alder children and
young adults, but lobar consolidation is less
typical in young children.
• In contrast, viral agents, H.influenza and certain
strains of viridance group of streptococcusi
invade or destroy the mucus membrane and may
produce principally bronchiolitis and
peribronchiolitis and interstitial lesion
• Both staphylococcus and klebsiella tend to
destroy tissue and to produce multiple small
abscesses
Etiology
• The age of the child and the presence or absence
of underlying disease, determine the etiology of
bacterial pneumonia.
• Bacterial pneumonia presenting in the first 2
days of life is generally acquired in utero or
intrapartum- group B streptococci, listeria
monocytogenes, H,influenza, gram negative
enteric bacilli
conti
• After neonatal period- strep, pneumonia,
H,influenza type b, staphylococcus aureus,
group A streptococci
• Children older than 4-5yr- streptococcal-
pneumonia, mycoplasma pneumonia
Pathogenesis
• The respiratory tract bellow the vocal cord is
sterile, micro organism, are excluded from the
tracheobronchial tree by nonspecific host
defenses, including the blanket of mucus
covering the mucosal epithelium, ciliary
transport activity, and the cough reflex
• Secretory IgA antibody
• Within lung parenchyma by the lymphatic
channels and macrophages that line the terminal
bronchioles and alveoli
conti
• By systemic humeral and cell mediated immune
mechanism, including passively acquired
maternal antibody
• The transmission is person to person via close
personal contact or via airborne spread
• Colonization of the URT with pathogenic
bacteria is relatively common
• The prevalence of carriage of pneumococci,
H,influenza, type b or meningococci in
approximately 40%, 10% and 2% respectively
conti
• Pneumonia results from aspiration of
pathogenic bacteria in the LRT
• The process may be aided by concurrent viral
infection, particularly with RSV, measles, and
influenza virus
• Acute viral infection serves to disrupt the normal
anatomic and physiological barriers of the
respiratory tract mucosa and may briefly
suppress the activity of phagocytic leukocytes in
the airway and lungs
conti
• Less common, bacterial spread in the lung
hematogenously from distant focus
Clinical feature
• Older children and adolescent present-
Fever, chilliness, headache, dyspnea,
productive cough, chest pain, abdominal
pain and nausea or vomiting, circumoral
cyanosis,
Retraction, nasal flaring, dullness,
diminished tactile and vocal fremitus, BBS,
and rales
• Young infants
present with non specific symptoms of
fever, lethargy, poor feeding, respiratory
distress (grunting, nasal flaring, IC, SC,
Supra clavicular)
Dullness, BBS and rales
Displacement of the diaphragm,
abdominal distention, nuchial rigidity with
out meningeal infection
Complication
1. Parapneumonic effusion
 Transudate few WBC, low protein and
PH > 7.2
 Exudate (empyma) WBC> 15,000/cm, protein
more than 3.o gm/l, PH <7.2
 Staph-aureus, Hinfluenza and strep pneumonia
 Continous fever, chestpain, dyspnea,
tachycardia, dullnes and diminished breath sound
 X- ray lateral ducubitus
• RX antibiotic
drainage pleural fluid- needle aspiration for
empyema requires insertion of one or more
thoracotomy tube
2. Pneumatocel cx of 40% staphylococcus
pneumonia
 Asymptomatic , except when rupture into
pleural space, causing a pneumothorax or pyo
pneumothorax
 Most persist for 2-3 months and resolve
spontaneously
3. Lung abscess
 Dependent segment of the lung- the
posterior segment of the right upper lobe
 Anaerobic bacteria play a prominent role
 Sx fever cough, tachypnea, and fetid breath
oder
 X ray focal infiltrate surrounding a cavity
that contain an air fluid level, in 10% of pts have
more than one cavity
• Rx
3-4 wks course of penicillin G
Metronidazole or clindomcin
Diagnosis
• Chest x ray
• Presence of lobar consolidation, pleural effusion,
suggestive of bacterial infection
• Pneumatocel and abscess cavities are diagnostic
• Culture from blood or pleural fliud
treatment
• Depends on the severity of the illness and
presence or absence of underlying chronic
disease
• Antibiotics and maintenance of oxygenation is
the main stay of treatment of bacterial
pneumonia
• Pneumococcal pneumonia penicillin G
100,000units/kg, cefotaxim 150 mg/kg/24hr,
 Ceftriaxon 75mg/kg/24hr
Vancomycin 40mg/kg/24hr in case of penicillin
resistance
• Group A streptococcal pneumonia
Penicillin G 100,000 unit/kg/24hr
Stapylococcal pneumonia
semisyntetic ,penicilinase-resistant penicillin
naficillin 200mg/kg/24hr
• Haemophilus influenza pneumonia
Ceftriaxon 75mg/kg/24hr, cefotaxim
150mg/kg/24hr
Strain is sensitive ampicillin 100mg/kg/24hr
References
1. Nelson text book of pediatrics 20th dition
2. Principles and practice of pediatrics
by Frank A. Oski
3. International child health care, a practical
manual for hospitals worldwide
Child advocacy international
by David Southall, Brian Coulter, Christian
Ronald, Sue Nicholson, Simon Park