Community acquired pneumonia - Ref. Nelson, WHO, Clinical books etc...

1. COMMUNITY ACQUIRED
PNEUMONIA (CAP)
in
children
DR.M.SUCINDAR
ASST. PROF
DEPT. OF PEDIATRICS
SLIMS

2. CONTENTS
DEFINITIONS
ETIOLOGY
RISK FACTORS
PATHOPHYSIOLOGY
MANAGEMENT
COMPLICATIONS
PREVENTION

3. DEFINITIONS
Pneumonia is defined as a
inflammation of lung parenchyma.
CAP is defined as presence of
signs and symptoms of
pneumonia in a previously
healthy child caused by an
infection that has been
acquired outside of the
hospital.

4. ETIOLOGY
Bacterias:
Streptococcus pneumoniae (most common)
Haemophilus influenzae type b (Hib)
Staphylococcus aureus
Group B Streptococcus
E.Coli
Klebsiella.
Viruses:
Respiratory syncytial virus (RSV)
Influenza virus.
Atypical organisms:
Mycoplasma
Chlamydia.
Fungi:
Pneumocystis jiroveci.

5. RISK FACTORS
Definite risk factors
Malnutrition (weight-for-age z-
score < –2)
Low birth weight (≤ 2500 g)
Non-exclusive breastfeeding (during the
first 4 months of life)
Lack of measles immunization (within the
first 12 months of life)
Indoor air pollution
Crowding.
Likely risk factors
Parental smoking
Zinc deficiency
Mother’s experience as a caregiver
Concomitant diseases (e.g. diarrhoea, heart
disease, asthma)
Possible risk factors
Mother’s education
Day-care attendance
Rainfall (humidity)
High altitude (cold air)
Vitamin A deficiency

6. PATHOPHYSIOLOGY
Increased bacterial virulence.
Decreased host defense.
FOUR STAGES:
CONGESTION – 1 d – Vasodilatation & Congestion.
RED HEPATIZATION – 2 d – Exudation & RBC’s.
GREY HEPATIZATION – 4 d – Neutrophils &
Macrophages.
RESOLUTION – 8 d – few macrophages, normal.

7. MANAGEMENT
CLINICAL FEATURES
INVESTIGATIONS
TREATMENT

8. CLINICAL FEATURES
SYMPTOMS:
Cough
Fever
Difficult in breathing
Chest pain
Feeding difficulty – Severe.
Drowsiness or Restlessness – Severe.
Convulsions – Severe.
Abdominal pain, vomiting.
SIGNS:
Tachypnea
Chest retractions
Diminished Breath sounds
Crackles
Wheeze
SpO2 < 90%, Cyanosis – Severe.

10. INVESTIGATIONS
Investigations Bacterial Pneumonia Viral Pneumonia
WBC count 15,000 – 40,000/mm3
Neutrophils
< 20,000/mm3
Lymphocytes
CRP Positive Negative
X Ray Chest Lobar Consolidation Patchy Consolidation
Isolation of
organism
Cultures from blood, sputum,
pleural fluid
DNA or RNA test from
respiratory secretions

11. BACTERIAL PNEUMONIA

12. VIRAL PNEUMONIA

13. WHO CLASSIFICATION (LATEST)

14. PNEUMONIA
FAST BREATHING:
< 2 months:
RR >= 60 b/min
◦2 – 12 months:
RR >= 50 b/min
◦1 – 5 years:
RR >= 40 b/min
CHEST INDRAWING:
Lower chest wall indrawing (subcostal
retractions)
Intercostal, Suprasternal retractions.
Nasal flaring.

15. CHILD AGED 2 MONTHS UPTO 5 YEARS
SIGNS
FAST BREATHING
CHEST INDRAWING
NOT ABLE TO DRINK
PERSISTENT VOMITING
LETHARGIC or CONVULSIONS
STRIDOR IN A CALM CHILD
SEVERE MALNUTRITION
CLASSIFY AS PNEUMONIA SEVERE PNEUMONIA
TREATMENT Advise mother to give home care.
Give an antibiotic.
Treat fever, if present.
Treat wheezing, if present.
Advise mother to return with child
in 2 days for reassessment or
earlier if the child is getting
worse.
Refer URGENTLY to hospital.
Give first dose of an antibiotic.
Treat fever, if present.
Treat wheezing, if present
(if referral is not feasible, treat
with an antibiotic and follow
closely).

16. S.NO CATEGORIES ANTIBIOTICS
1. Pneumonia Oral Amoxycillin 40 mg/kg/dose twice daily for 5 days
(for 3 days in low HIV prevalence areas).
2. Severe Pneumonia 1st
line – Ampicillin 50 mg/kg/dose (or Benzyl Pencillin
50,000 U/kg/dose) IM/IV every 6 hrs for at least 5
days + Gentamicin 7.5 mg/kg IM/IV once a day for at
least 5 days.
2nd
line – Ceftriaxone 75 – 100 mg/kg/day in two
divided doses IV for at least 5 days.
Supportive measures – O2, IVF, Paracetamol etc…

17. COMPLICATIONS
PULMONARY:
Pleural effusion
Empyema
Abscess
Bronchopleural fistula
Necrotizing pneumonia
Acute respiratory distress syndrome.
EXTRA PULMONARY:
Meningitis
Arthritis
osteomyelitis
Pericarditis
Endocarditis
Sepsis
Hemolytic uremic syndrome.

18. PREVENTION

19. THANK YOU