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Inflammation of the parenchyma of the lungs Most cases are caused by microorganisms Noninfectious causes: aspiration of food or gastric acid, foreign bodies, hydrocarbons, and lipoid substances, hypersensitivity reactions, and drug- or radiation-induced pneumonitis
Estimated 146- 159 million new episodes per year in developing countries. Cause approximately 4 million deaths among children worldwide Incidence in developed countries 0.026 episodes per child-year Incidence in developing countries 0.280 episodes per child-year
Remains to be a major cause of morbidity and mortality among Filipino patients Ranked 3rd in the 10 leading causes of morbidity in 2000 and mortality in 1997 in all age groups H. influenzae type b was an important cause of bacterial pneumonia in young children but has become uncommon with the routine use of effective vaccines.
Streptococcus pneumoniae (Pneumococcus):
most common bacterial pathogen
Chlamydia pneumoniae Mycoplasma pneumoniae Group A Streptococcus Staphylococcus aureus
Developing countries: S. pneumoniae, H.
influenzae, S. aureus Children with HIV: M. tuberculosis, atypical mycobacterium, Salmonella, E.coli, P. jirovecii
Viral pneumonia: Influenza virus and RSV are the common pathogens; Parainfluenza viruses, Adenoviruses, Rhinoviruses, Metapneumovirus
Neonates (<1 month): Group B Strep, E.
coli, other gram (-) bacilli, S. pneumoniae, H. influenzae
Febrile pneumonia: RSV, other respiratory viruses,
3-12 months: RSV, other respiratory
S. pneumoniae, H. influenzae Afebrile pneumonia: C. trachomatis, M. hominis, U. urealyticum, Cytomegalovirus
viruses, S. pneumoniae, H. influenzae, C. trachomatis, M. pneumoniae, Group A streptococcus
2-5 yrs: Respiratory viruses, S. pneumoniae,
H. influenzae, C. trachomatis, M. pneumoniae, Chlamidophyla pneumoniae, S. aureus, group A Streptococcus 5-18 yrs: M. pneumoniae, S. pneumoniae, C. pneumoniae, H. infleunzae, influenza virus, adenovirus, RSV
Viral pneumonia: spread of infection along the airways, accompanied by direct injury of the respiratory epithelium, resulting in airway obstruction from swelling, abnormal secretions, and cellular debris Bacterial infection: varies according to the invading organism
Bacterial pneumonia M. pneumoniae- attaches to respiratory epithelium, inhibits ciliary action, and leads to cellular destruction and an inflammatory response in the submucosa. S. pneumoniae- produces local edema that aids in the proliferation of organisms and their spread to adjacent portions of the lungs.
Group A streptococcus- infection of lower
respiratory tract results in more diffuse infection with interstitial pneumonia
Bacterial pneumonia S. aureus- manifests in confluent bronchopneumonia, which is often unilateral and characterized by the presence of extensive areas of hemorrhagic necrosis and irregular areas of cavitation of the lung parenchyma, resulting in pneumatoceles, empyema, or at times, bronchopulmonary fistulas.
Recurrent Pneumonia- 2 or more episodes in a single year or 3 or more episodes ever, with radiographic clearing between occurrences. Slowly resolving pneumonia- persistence of symptoms or radiographic abnormalities beyond the expected time course.
Often preceded by several days of symptoms of URTI Viral pneumonia: Fever is usually present; temp. generally lower than in bacterial pneumonia Tachypnea is the most consistent clinical manifestation of pneumonia Crackles and wheezing Bacterial pneumonia in adolescents and older children: shaking chill followed by a high fever; circumoral cyanosis; splinting on affected side
Predictors Of CAP in a patient with cough: 1.) For ages 3 mo. to 5 yrs. are tachypnea and/or chest indrawing 2.) For ages 5 to 12 yrs are fever, tachypnea, and crackles 3.) Beyond 12 years are the presence of the following features: a. fever, tachypnea, and tachycardia, and; b. at least 1 abnormal chest findings of diminished breath sounds, rhonchi, crackles or wheezes.
VARIABLES Co-morbid Illness Compliant caregiver Ability to follow-up Presence of DHN Ability to feed Age
PCAP A (Minimal Risk) None yes Possible None Able >11 mos
PCAP B ( Low Risk) Present yes Possible Mild Able >11 mos
PCAP C (Moderate Risk) Present no Not possible Moderate Unable <11 mos
PCAP D (High Risk) Present no Not possible Severe Unable <11 mos
Respiratory rate 2-12 mos 1-5 yrs > 5 yrs
>/= 50/min >/= 40/min >/= 30/min
> 50/min > 40/min > 30/min
> 60/min > 50/min > 35/min
> 70/min > 50/min > 35/min
PCAP A (Minimal Risk)
PCAP B ( Low Risk)
PCAP C (Moderate Risk)
PCAP D (High Risk)
Signs of Respiratory failure Retraction Head bobbing Cyanosis Grunting Apnea Sensorium Complications (effusion, pneumothorax) ACTION PLAN
None None None None None Awake
None None None None None Awake
Intercostal/ subcostal Present Present None None Irritable Present
Supraclavicular/ Intercostal/ subcostal Present Present Present Present Lethargic/stuporous/co matose Present
OPD Follow-up at end of treatment
OPD Follow up after 3 days
Admit to regular ward
Admit to a critical care unit Refer to a specialist