Pediatric Pneumonia

Definition: Pneumonia
Inflammation & Infection of the Lung Tissue: Visceral Pleura, Connective Tissue, Airways, & Alveoli

Special Etiologies: Pneumonia
Aspiration, Immunocompromise, and Sickle Cell Disease

Etiology: Pneumonia
Viral, Bacterial, Fungal, & Rickettsiae

Common Causes: Neonatal Pneumonia
Group B Strep (MOST COMMON), E. coli, HSV, CMV, K. Pneumoniae, S. Pneumoniae, Listeria, UREAPLASMA Urealyticum, Candida

Febrile PNA Causes: Infants 1-4 mos
RSV (MOST COMMON), Other Viruses, S. Pneumonia, & nontypable H. influenza

Afebrile PNA Causes: Infants 1-4 mos
Chlamydia trachomatis, Mycoplasma hominis & CMV

Etiology: Chlamydial Pneumonia
Chlamydia trachomatis from mom’s Vaginal Secretions

Epidemiology: Chlamydial PNA
Up to 30% of Exposed Infants will Develop PNA

Symptoms: Chlamydial Pneumonia
Hx of CONJUNCTIVITIS, Afebrile, STATACCO Cough, Bilateral Rales

CBC: Chlamydial Pneumonia
Normal WBC w/ High Eosinophils

Treatment: Chlamydial Pneumonia
Erythromycin

PNA Causes: 4-mos – 5 years
VIRAL (RSV, parainfluenza, etc), S. pneumoniae, nontypable H. influenzae, S. aureus, Group A strep, & Mycoplasma

Pneumonia Causes: > 5 years
S. pneumoniae, Mycoplasma, Influenza, Adenovirus, C. pneumoniae, Nontypable H. influenzae

Symptoms: Pneumonia
Fever, Cough, Anorexia, Fatigue, Tachypnea, Restractions, Nasal Flaring, Grunting, Chest Pain & Abdominal Pain

Physical Findings: Pneumonia
Fever, Hypoxemia, Tachypneic, Respiratory Distress, Asymmetric Fremitus, (+) Egophony, Fewer Breath Sounds, Crackles, Dull Percussion, & TART

Features: Viral Pneumonia
Gradual Onset, Prominent URTI Symptoms, Low Grade Fever, Diffuse Crackles/Rales

CBC: Viral Pneumonia
Normal WBC w/ Slight RIGHT Shift

CXR: Viral Pneumonia
Streaky/Patchy Infiltration BILATERALLY

Features: Bacterial Pneumonia
Acute Onset, Mild-No URTI Symptoms, HIGH Fever, Ill/Toxic Appearance, Localized Crackles/lung Findings

CBC: Bacterial Pneumonia
Elevated WBC with LEFT Shift

CXR: Bacterial Pneumonia
Lobar/Segmental Infiltrate/Consolidation

Features: Atypical Pneumonia
Refers to Mycoplasma OR Chlamydia; Usually in OLDER Children

Symptoms: Atypical Pneumonia
Fever, Malaise, Myalgia, Sore Throat, Gradually Worsening, Nonproductive Cough

Differentials: Pneumonia
Bronchiolitis, Asthma (if wheezing), Foreign Body Aspiration, CHF

Diagnosis: Pneumonia
History & Physical Exam!

Radiographic Confirmation: Pneumonia
Don’t attempt in healthy children w/ outpatient or mild uncomplicated Cases

Confirmation Modalities: Pneumonia Diagnosis
CBC/Blood Culture, Sputum Culture, Nasopharyngeal Swab, Mycoplasma Serology (thoracentesis if pleural effusion) Open Lung Biopsy & Culture

When to Admit: Pneumonia
Hypoxemia needing O2, Dehydration, Respiratory Distress, Toxic Appearance, Underlying Conditions that put patient at risk, Failure of Outpatient Management

Treatment: Pneumonia in Neonate <1 mos
IV Ampicillin & Gentamicin

Treatment: Pneumonia in 1-4 month old
May Require Hospitalization if Bacterial; CEFUROXIME, CEFOTAXIME, or CEFTRIAXONE

Treatment: Pneumonia in 4mos-5 years
Amoxicillin (can give IM dose of Ceftriaxone before starting oral meds)

Treatment: Pneumonia >5 years
Amoxicillin OR (Azythromycin for Atypical)

Treatment: Influenza + Pneumonia
Oseltamivir (Tamiflu_

Prevention: Pneumonia
HANDWASHING! Vaccines: HiB, PCV13, and Influenza Vaccine

Vaccine: HiB
Haemophilus influenziae type B vaccine

Vaccine: PVC 13
Pneumococcal Conjugate Vaccine

Prognosis: Pneumonia
Most kids recover w/o Complications, No Repeat Imaging Necessary

Abnormal CXR: Pneumonia
May Lag 6-8 weeks even though infection is no longer there/has resolved

Understand the definition and epidemiology of bronchiolitis and pneumonia Bronchiolitis Inflammation of the bronchioles (small airways) More specifically, it is a syndrome that occurs in children

Pneumonia Acute infection of lung tissue with possible impairment of gas exchange Classified in three ways: Origin etiology Anatomical location Type WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample …

Patho -Streptococcus pneumoniae -most commonly found organism -60-75% of adults -Haemophilus influenzae, moraxella catarrhali -common in patients with underlying lung disease -Staphylococcus aureus -common in influenza-associated pneumonia -Mycoplasma pneumoniae Goals of Treatment -Return to baseline respiratory status -Improvement in 48-72 …

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