Pneumonia

 What is Pneumonia?

DEFINITION 

Pneumonia: is an infection of the lung parenchyma 

WHO: recommends diagnosis of pneumonia when children under 5 have acute on set cough with tachypnea 

Pathologist: is an infection of the alveoli distal airways 

Types Of Pneumonia

Bronchopneumonia: involves both the lung parenchyma and the bronchi its common in children and elderly 

Lobarpneu: in volves one or more lobes of the lung its common in young people 

Classification Of Pneumonia

1: community acquired pneumonia [CAP]:pt who have been hospital for other reasons for less than 48hrs before the development of respiratory symptoms 

2: hospital [HAP]: pt who have been hospitalized for at least 2days >48hrs 

3: ventilator [VAP]: pt contracting pneumonia >48hrs after the institution 

                       - endotracheal intubation 

                       - mechanical ventilation 

Causes Of Pneumonia

◆causes Neonates 

◆group B streptococcus

◆Klebsiella 

◆E coli 

◆Chlamydia and s.aureus 

Pneumonia Of Children Under 5 Years 

Pneumococcus 

H influenza

s.aureus 

Virus 

Children>5yrs and adults the most cause is pneumonia followed by atypical bacteria e.g. mycoplasma pneumonia, viruses 

Risk Factors

◆Malnutrition

◆Lack immunization 

◆Preceding URTI 

◆Exposure to cigarette smokes indoor airpollution 

◆Immunosuppression [HIV,cancer]

◆measles 

Clinical Features

◆Sym Severe pneumonia is:                     

◆Cough or difficult breathing 

◆Lower chest drawing 

◆Nasal flaring 

◆Grunting 

◆SIC/ IC RETRACTION 

◆Sym pneumonia 

◆Cough

◆Fast breathing

◆But no signs for S PNEU

◆Sym no pneumonia 

◆Cough 

◆Common cold no sing for S pneu/pneumonia 

Investigations

◆Pneumonia is usually made clinically 

◆Chest Xray 

◆Sputum for gram stain 

◆Culture for AFB 

◆CBC

Managements

Non pharmacologic

Admit 

Keep baby warm 

Prevent hypoglycaemia by breastfeeding/giving expressed breast milk/NGT 

If child is lethargic do not give oral feeds use IV fluids with care 

Give oxygen to keep SpO2>94%

Non pharmacologic

◆Anti biotics 

◆Ampicillin is 50mg/kg IV QID for meningitis 150mg/kg BID 14dys

◆Gentamicin5mg/kgIV once daily 

In severly ill infants ceftriaxone100mg/kgIV 

◆Benzyl penicillin 50,000units/kg/24hrsIV QID for at least 3days 

When is PO 

◆PCM 10-15mg/kg

◆Ibuprofen 5-10mg/kg qid/tid

◆Amoxicillin 30-50mg/kgbid

◆Azithromycin 10mg/kg/24 

Complications

Acute respiratory distress syndrome [ARDS]

Lung abscesses

Respiratory failure 

Sepsis  

Aspiration pneumonia 

Is a complication of pulmonary aspiration 

Clinical features

Chest pian ,fever,SOB,wheezing,fatigue,blue discoloration in P/E decrease flow of air,rapid heart rate and cracklingsound in lungs 

Risk factor 

Impaired consciousness

Lung disease seizure,stroke,swallowing dysfunction [GERD]

Diagnosis

chest Xray ,blood test, sputum tests,pulseoximetry,plural fluild culture  

Mgmt.

Spo2<90%

Ceft 80mg/kg/24hrs or metrondazol7.5mg/kg tid