Pneumonia is an infection of the lower respiratory tract that involves the airways and parenchyma with consolidation of the alveolar spaces Banadir Hospital Pediatric Departments

1. Pneumonia in children
Dr. Abdulkadir Keynaan
MBBS/MPH
Pediatric residence
Banadir Hospital
Pediatric department
Keynan1443@gmail.com

2. OUTLINE
✓ Definition
✓ Pathogenesis
✓ Classification
✓ Aetiology
✓ Predisposing factors
✓ Clinical features
✓ Investigations
✓ Treatment
✓ Complications
✓ Prevents

3.  Pneumonia is an infection of the lower respiratory tract
that involves the airways and parenchyma with
consolidation of the alveolar spaces. The term lower
respiratory tract infection is often used to encompass
bronchitis , bronchiolitis , or pneumonia or any
combination of the three, which may be difficult to
distinguish clinically.

4. Defense mechanism of the lung
 Lower airways and secretions are sterile as a result of a
multifactorial system.
 The cough reflex that expels foreign substance out of the airway
tract
 The cilia on epithelial surfaces move particles upward toward
the throat, where they are swallowed or expectorated.
 Polymorphonuclear neutrophils and tissue macrophages ingest
and kill microorganisms
 IgA secretion into the upper airway fluid protects against
invasive infections and facilitates viral neutralization.

5. Pathogenesis
❖Pneumonia results from:
✓ Aspiration
✓Contiguous spread of virulent agents from upper airway
✓Secondary infection when there is disruption of protective
mechanism
✓Haematogenous spread

7. Classification
Multilobar
pneumonia
Anatomical classification
Lobar or lobular
pneumonia
Interstitial
pneumonia
Bronchopneumoni
a

8. Classification
BESED ON THE DURATION OF SYMTOMS
Persistence pneumonia Recurrent pneumonia
-Persistence of symptoms and
X-ray abnormalities for more
than four weeks
- Two episodes of pneumonia in
one year or more than three
episodes at any time with X-ray
clearance between two episodes
of illness

9. Classification
Infective
BESED ON THE AETOLOGYCAL FACTOR
Non-infective
- Pneumonia occurs as a result of
invasion of lungs due to micro-
organisms
- Chemical. Pneumonia is
referred to as pneumonitis when
the cause is non-infective .

10. Classification
BESED ON THE IMMINITY
Secondary pneumonia
Primary Pneumonia
- It is caused by organisms of
high virulence and it’s affect
those with good immunity
- This occurs with organisms of
low virulence. Either the
immunity of host is diminished
or some predisposing factors is
present , such as aspiration

11. Classification
Community Acquire
pneumonia
BESED ON THE SOURCE OF INFECTION
Hospital Acquire
pneumonia
Opportunistic
pneumonia
-caused by organisms
present outside the
hospital who have not
been hospitalized with in
14 days.
-caused by organisms
present in the hospital .
- It occurs after at least
48 -72 hours of being
admitted in hospital
-is seen in children with
decreased immunity

12. AETIOLOGY
 The causative organism can be:
1: Infective 2: Non-infective

13. INFECTIVE PNEUMONIA
INFECTIVE PNEUMONIA AETIOLOGICAL AGENTS
Bacterial pneumonia Streptococcus pneumonia
Haemophilus influenzae
Staphylococcus aureus
Pseudomonas aeruginosa
Atypical pneumonia Chlamydia
Mycoplasma
legionella
Viral pneumonia Respiratory syncytial virus
Parainfluenza virus
Influenza virus
Rhinovirus
Adenovirus

14. Common organism causing Pneumonia various Age Group
Organisms Neonates 1 month to 5 year Above 5 years
Bacteria Group B
Streptococcus
E. Coli
Klebsiella
Listeria
S. Aureus
S. Pneumonia
S. aureus
H. Influenzae
Group A
streptococcus
Klebsiella
Pseudomonas
M. tuberculosis
S. Pneumonia
S. aureus
H. Influenzae
M. tuberculosis
Viruses CMV
Herpes
CMV
RSV
Influenza virus
Adenovirus
Influenza virus
Varicella
Atypical
Organisms
Chlamydia
trachomatis
Mycoplasma Mycoplasma
Legionella
Chlamydia

15. Differences b/w Bacterial and Viral
Features Bacterial pneumonia Viral pneumonia
Onset Abrupt Gradual
Epidemic Not seen Common
Associated conditions Infection at other sites,
septicemia
Associated with URI
coryza
Fever Height grade My be absent
Toxemia Common Absent
Respiratory Distress Common Common in infant
Lung sign Crackles ++ Wheeze ++
X-ray chest Confluent infiltrates Diffuse in peripheral areas
Pleural involvement May be seem Not Common
Prognosis Complication such as
Empyema
Pneumatocela
Septicemia may be seen
Sell-limiting, usually
resolves in about a week.
Hyperinflation seen in
RSV infection

16. PREDISPOSING FACTORS
HOST FACTORS
Age : below 6 month
Neonatal factors: preterm and babies
low birth weight
Congenital Defect ( may predisposing
aspiration) cleft palate and Tracheo-
Oesophageal fistula
Nutritional factors: PEM, Vitamin A
deficiency( severe), Iron deficiency
anemia, Zink deficiency and so on
Systemic Factors
Immunosuppressed states
Iatrogenic : Anesthesia
ENVIROMENTAL FACTORS
Overcrowding
Indoor air pollution
Passive smoking

17. CLINICAL FEATURES
❖SYMTOMS
✓ Fever
✓ Cough
✓ Poor feeding , irritability and excessive crying
✓ Fast and difficult breathing
✓Chest pain
✓Abdominal pain

18. Cont…
❖SIGNS
✓ Tachypnoea
✓Chest retraction
✓Grunting and Stridor
✓Nasal flaring
✓Cyanosis
✓Dullness on percussion
✓Diminished breath sounds, wheeze and crackles on
Auscultation

19. CLASSIFFY COUGH OR DIFFICULT BREATHING:

20. Differential Diagnosis
➢Asthma
➢Bronchiolitis
➢Inhaled foreign body
➢Pulmonary TB
➢ Bronchitis

21. INVESTIGATIONS
 Chest Radiography
 * Lobar pneumonia : homogenous opacity in one or more lobes ( usually
bacterial
 *Bronchopneumonia: scattered opacities in both lungs (viral or bacterial)
 * Insterstitial pneumonia : scattered bilateral perihilar pulmonary infiltrate,
 hyperinflation, and atelectasis (usually viral in origin)
 * In complicated cases, repeat chest radiograph 6 weeks later to verify
resolution.

23. Cont…
 CBC
 ESR
 CRP
 Blood culture
 Maria smear if there is fever?
Acute phase reactants : leucocytosis with
predominant granulocytes , ESR and
positive C-reactive protein suggest bacterial rather
than viral pneumonia.

24. TREATMENT
CLASSIFICATIO
N
CILINICAL
FEATURES
TREATMENT PLACE OF
TREATMENT
No pneumonia Cough
No fast breating
No chest
indrowing
Feeding well
Treat like URI.
No antibiotics
Ask the mother
to observe .
Treat underlying
condition.
Treat fever
Home
Pneumonia Cough
No chest
indrowing
Able to drink
Fast breathing
Amoxicillin 25-
50mg/kg
Home/health
care centre
Reassess after
two days

25. Cont…
CLASSIFICATIO
N
CILINICAL
FEATURES
TREATMENT PLACE OF
TREATMENT
Severe
Pneumonia
Lower chest indrowing
present
Able to drink
Fast breathing
Other signs may be
present – Nasal
flaring, grunting and
cyanosis
Antibiotics:
Ampicillin ing
500mg/5ml+
Gentamycin ing
80mg/2ml
Penicillin G 5 mega
Admit in hospital
Assess once a daily
Very severe
pneumonia
Not able to drink
Cyanosis
Stridor in clam child
Severe respiratory
distress, grunting
Lethargy /Excessive
drowsiness
Antibiotics:
Ceftriaxon ing
1g/10m
+
Gentamycin ing
80mg/2m
Oxygen therapy
Admit in Hospital
Assess twice a
daily

26. COMPLICATIONS
● The result of
❖ direct spread in the thoracic cavity:
pleural effusion, empyema, pneumothorax, pericarditis
❖ Hematologic spread: sepsis, meningitis, arthritis,
osteomyelitis

27. PREVENTION OF PNEUMONIA
● Immunization against H. influenzae type b
● Influenza vaccine
● Heptavalent pneumococcal conjugate vaccine
● Health education of the community
● Messages for mothers to recognize the signs of pneumonia

28. Case 1
6 month old has been admitted to the pediatric ward
because of difficulty in breathing, cough and refusal of
breastfeeding
O/E: sick, dyspnic, RR:64/min
chest: nasal flaring, lower chest wall indrawing,
wheezy.
What is your differential diagnosis?
What are the common pathogens that causes this
condition?
How do you manage this condition?

29. Case 2
Ahmed is 6 years old have been treated with pneumonia
2 weeks ago with oral amoxicillin, but the mother
reported that there is no improvement up to now.
O/E: Alert child, afebrile
RR: 48/min, chest retraction, crepitation &
wheezy
What is your diff. diagnosis?
What are the suspected causative organism?
How do you manage?

31. Reafference:
❖IMCIN
❖Clinical Paediatrics History taking and case
discussion