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PNEUMONIA
‫وترتیب‬ ‫تهیه‬
:
‫هللا‬ ‫داکترصفی‬
(
‫سلیمانخیل‬
)
‫داخله‬ ‫متخصص‬
‫اطفال‬
PNEUMONIA
 Definition: inflammation of the lung
parenchyma which may be primary or
secondary.
 Lung parenchyma: respiratory bronchioles,
 Alveolar duct, alveolar sacs and alveoli.
Bacterial -Streptococcus pneumoniae
(Pneumococcus)
- Staphylococcus
- H. influenzae
- Klebsiella
- H. pertussis,
- M. tuberculosis, E.coli
Classification
I. Etiologic Classification:
Influenza, measles, RSV
Chickenpox, adenovirus
Mycoplasma Mycoplasma pneumonia
Fungal
coccidomycosis
histoplasmosis,
blastomycosis
Classification
Pneumonia by safiullah
Pneumonia by safiullah
Etiology
• Viral pneumonia 40% of cases
• Bacterial in over tow-thirds of the
cases
• klebsiella, E.coli, pneumococci
and staphylococci
0-2m
• S.pneumonia, staphylococci
and H.influenza
3m-3y
• Pneumococci and
staphylococci
After 3y
 Persistent pneumonia, or chronic non
resolving pneumonia in which
radiologic findings persist for over
one month.
 Recurrent pneumonia is defined as 2
or more episodes in a single yr or 3 or
more episodes ever, with radiographic
clearing between occurrences.
 Pneumonitis is an inflammation of the
lungs caused by chemical or radiation
therapy but not with infectious agents.
Pneumococcal pneumonia
 accounts for 90% of bacterial pneumonias
in childhood.
 It causes lobar pneumonia.
 The onset is abrupt with cough & fever
 May develop pleuritic chest pain
Staphylococcal pneumonia
 Risk factors: measles ,influenza,
malnutrition ,cystic fibrosis, diabetes.
 manifests in confluent bronchopneumonia.
 which is often unilateral .
 irregular areas of cavitation resulting in
pneumatoceles, empyema.
 Follows URTI,Pyoderma
 Toxic & sick looking , Progression is rapied
Predisposing factors for chronic
pneumonia
 Immunodeficiency (PEM & HIV)
 Congenital respiratory
malformations(TEF & GERD)
 Congenital heart disease (VSD)
 Defective clearance of airway secretions
( Cystic fibrosis)
 Chronic pulmonary diseases
(Tuberculosis, Bronchiectasis & Asthma
Risk factor for pneumonia
 Low birth weight
 Malnutrition
 Vitamin A deficiency
 Lack of breast feeding
 Passive smoking
 Large family size
 Young age
 Air pollution
Clinical Features
 high fever
 chills
 cough
 respiratory distress
 Nasal flaring
 grunting expiration
 Chest indrawing
 cyanosis.
Clinical Features
 Rarely may present with acute abdomen
this referred pain from pleura
 Apical pneumonia may be with
meningismus and convulsion and CSF is
always clear
WHO clinical classification
• Cough
• Cold
No
pneumonia
• Fast breathing
Pneumonia
• Chest indrawing
Sever
pneumonia
• Cyanosis
• Sever chest indrawing
• Inability to feed
Very sever
pneumonia
WHO clinical classification
Revised WHO classification
• No fast breathing
• No indicator for
pneumonia
Cough or
cold
• Fast breathing
• Chest indrawing
Normal saturation,
feeding well
Pneumonia
(With or
without chest
indrawing)
• Chest indrawing,unable
to drink, convulsion,
• lethargy,unconscious,
• cyanosis
Sever
pneumonia
 Consolidation ( movements of affected
side ) (vocal fremitus and resonance,
dullness)
 Crepitations denote beginning of resolution.
 Bronchopneumonia: tachypnea, harsh
breath sounds and diffuse crepitations spread
all over both lungs.
 1°C rise 2 to 3 breaths per minute
 In debilitated children, despite the presence
of pneumonia, signs and symptoms may
not be as classical as described above.
The diagnosis of pneumonia in such cases
is often made following detailed
examination and a chest radiograph.
 Of the various types, staphylococcal
pneumonia carries the worst prognosis.
Predisposing factors for
staphylococcal pneumonia
 Infectious diseases of childhood such as
measles and chickenpox
 Staphylococcal infections elsewhere in the
body, e.g. skin (furunculosis), throat, etc.
 Debilitating illnesses, e.g. advanced
(PEM), cystic fibrosis, malignancies, etc.
 Hypogammaglobulinemia
 Immunosuppressive therapy
Complications
 Pleural effusion
or emphysema
 Collapse
 Pneumatocele
 Lung abscess,
 Bronchiectasis
 Subcutaneous emphysema
 Metastatic spread: Meningitis, septic
arthritis, osteomyelitis, etc.
Diagnosis
 clinical suspicion
 Chest X-ray
 Bronchopneumonia(diffuse patchy consolidation)
 lobar pneumonia (consolidation)
 staphylococcal pneumonia(pneumatocele, pleural
effusion, pyopneumothorax)
Pneumonia by safiullah
Pneumonia by safiullah
Bronchopneumonia
Interstitial pneumonia
-First 24 hours
-Dehydration
-Elderly
-Neutropenia
-Pneumocystis carinii
Normal Chest X Ray in Pneumonia
Typical pneumonia Atypical pneumonia
acute subacute,
fever,chills subfebril fever
productive cough non productive cough
pleural pain nonrespiratory symptoms
physical signs ( + ) physical signs ( - )
lobar consolidation non-lobar infiltration
Agents
S. pneumoniae M.pneumonia
H. Influenzae C.pneumoniae
Gr(-)aerop bacillus
Recurrent pneumonia suspicion
of the following :
 Abnormalities of antibody production such
as agammaglobulinemia
 Cystic fibrosis (CF) & Foreign body
 Cleft palate & Deficient gag reflex
 Congenital bronchiectasis
 Immotile cilia syndrome
 Tracheoesophageal fistula
 Abnormalities of polymorphonuclear
leukocytes & Neutropenia
WHO Treatment
 Pneumonia: amoxcillin 40 mg/kg/ dose
twice daily for 5 days.
 severe pneumonia: These patients
require admission, supportive care and
treatment with IV penicillin or ampicillin
and gentarnicin for at least 5 days. IV
ceftriaxone may be used as second-line
treatment.
Treatment
Antibiotics in
Community-acquired
Pneumonia
Penicillin is the choice for
pneumococcal pneumonia
(Streptococcus pneumonia)
(for 7-14days) which is usual
in >1Y 1 year
Amoxicillin 40mg/kg/d for7d
In case of staphylococcal pneumonia
cloxacillin plus ampicillin or Ceftriaxone is the
best choice.
If not improvement within 48h
vancomycin.
Duration of therapy in uncomplicated 2wks
In empyema & pneumoathorax 4-6 wks
 For H. influenza, ampicillin alone or a
combination of penicillin plus
chloramphenicol is recommended.
 ampicillin plus chloramphenicol or
ceftriaxone must be incorporated in the initial
therapy of H. influenzae B pneumonia.
 For Klebsiella, a combination of penicillin
plus kanamycin or gentamicin is the therapy
of choice
 For Pseudomonas pneumonia,
ceftazidime or piperacillin-tazobactam .
 Pneumocystis carinii pneumonia (interstitial
plasma cell pneumonia) needs to be
treated with cotrimoxazole in very high
doses (20 mg/kg/day with reference to
trimethoprim).
 Thrush pneumonia (pulmonary candidiasis)
responds well to only amphotericin B or 5-
fluorocytosine.
 Tuberculous pneumonia requires
antituberculous therapy (ATT)
 Viral pneumonia responds to ribavirin
aerosolization in case of respiratory
syncytial virus (RSV)
 amanta-dine (rimantidine) in case of
influenza A isolates.
 Loeffler pneumonia (Loeffler syndrome)
resulting from larva pass through lung
during the life cycle of nematodes is purely
symptomatic. Diethylcarbamazine for
 Primary atypical pneumonia resulting from
Mycoplasma pneumoniae is treated with
erythromycin or tetracyclines in case of
grown-up children.
 For aspiration pneumonia, use of
prophylactic antibiotics is usually
recommended.
Gram negative bacilli: aminoglycosides.
Anaerobes: Metronidazole and clindamycin
General Measures
 Good nursing care
 Bed rest & Oxygen
 Suction to remove secretions from
tracheobronchial tree
 Symptomatic treatment for cough,
restlessness,fever and pain
 Adequate fluid and dietary intake
 Treatment of congestive cardiac failure, if
present.
 Physiotherapy: Breathing exercise during
recovery are of value.
 Surgical intervention in complications like
empyema or tension pneumothorax,
(common in staphylococcal pneumonia)
 Prognosis is generally good following
appropriate treatment “in time”.

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Pneumonia by safiullah

  • 2. PNEUMONIA  Definition: inflammation of the lung parenchyma which may be primary or secondary.  Lung parenchyma: respiratory bronchioles,  Alveolar duct, alveolar sacs and alveoli.
  • 3. Bacterial -Streptococcus pneumoniae (Pneumococcus) - Staphylococcus - H. influenzae - Klebsiella - H. pertussis, - M. tuberculosis, E.coli Classification I. Etiologic Classification:
  • 4. Influenza, measles, RSV Chickenpox, adenovirus Mycoplasma Mycoplasma pneumonia Fungal coccidomycosis histoplasmosis, blastomycosis Classification
  • 7. Etiology • Viral pneumonia 40% of cases • Bacterial in over tow-thirds of the cases • klebsiella, E.coli, pneumococci and staphylococci 0-2m • S.pneumonia, staphylococci and H.influenza 3m-3y • Pneumococci and staphylococci After 3y
  • 8.  Persistent pneumonia, or chronic non resolving pneumonia in which radiologic findings persist for over one month.  Recurrent pneumonia is defined as 2 or more episodes in a single yr or 3 or more episodes ever, with radiographic clearing between occurrences.  Pneumonitis is an inflammation of the lungs caused by chemical or radiation therapy but not with infectious agents.
  • 9. Pneumococcal pneumonia  accounts for 90% of bacterial pneumonias in childhood.  It causes lobar pneumonia.  The onset is abrupt with cough & fever  May develop pleuritic chest pain
  • 10. Staphylococcal pneumonia  Risk factors: measles ,influenza, malnutrition ,cystic fibrosis, diabetes.  manifests in confluent bronchopneumonia.  which is often unilateral .  irregular areas of cavitation resulting in pneumatoceles, empyema.  Follows URTI,Pyoderma  Toxic & sick looking , Progression is rapied
  • 11. Predisposing factors for chronic pneumonia  Immunodeficiency (PEM & HIV)  Congenital respiratory malformations(TEF & GERD)  Congenital heart disease (VSD)  Defective clearance of airway secretions ( Cystic fibrosis)  Chronic pulmonary diseases (Tuberculosis, Bronchiectasis & Asthma
  • 12. Risk factor for pneumonia  Low birth weight  Malnutrition  Vitamin A deficiency  Lack of breast feeding  Passive smoking  Large family size  Young age  Air pollution
  • 13. Clinical Features  high fever  chills  cough  respiratory distress  Nasal flaring  grunting expiration  Chest indrawing  cyanosis.
  • 14. Clinical Features  Rarely may present with acute abdomen this referred pain from pleura  Apical pneumonia may be with meningismus and convulsion and CSF is always clear
  • 15. WHO clinical classification • Cough • Cold No pneumonia • Fast breathing Pneumonia • Chest indrawing Sever pneumonia
  • 16. • Cyanosis • Sever chest indrawing • Inability to feed Very sever pneumonia WHO clinical classification
  • 17. Revised WHO classification • No fast breathing • No indicator for pneumonia Cough or cold • Fast breathing • Chest indrawing Normal saturation, feeding well Pneumonia (With or without chest indrawing) • Chest indrawing,unable to drink, convulsion, • lethargy,unconscious, • cyanosis Sever pneumonia
  • 18.  Consolidation ( movements of affected side ) (vocal fremitus and resonance, dullness)  Crepitations denote beginning of resolution.  Bronchopneumonia: tachypnea, harsh breath sounds and diffuse crepitations spread all over both lungs.  1°C rise 2 to 3 breaths per minute
  • 19.  In debilitated children, despite the presence of pneumonia, signs and symptoms may not be as classical as described above. The diagnosis of pneumonia in such cases is often made following detailed examination and a chest radiograph.  Of the various types, staphylococcal pneumonia carries the worst prognosis.
  • 20. Predisposing factors for staphylococcal pneumonia  Infectious diseases of childhood such as measles and chickenpox  Staphylococcal infections elsewhere in the body, e.g. skin (furunculosis), throat, etc.  Debilitating illnesses, e.g. advanced (PEM), cystic fibrosis, malignancies, etc.  Hypogammaglobulinemia  Immunosuppressive therapy
  • 21. Complications  Pleural effusion or emphysema  Collapse  Pneumatocele  Lung abscess,  Bronchiectasis  Subcutaneous emphysema  Metastatic spread: Meningitis, septic arthritis, osteomyelitis, etc.
  • 22. Diagnosis  clinical suspicion  Chest X-ray  Bronchopneumonia(diffuse patchy consolidation)  lobar pneumonia (consolidation)  staphylococcal pneumonia(pneumatocele, pleural effusion, pyopneumothorax)
  • 27. -First 24 hours -Dehydration -Elderly -Neutropenia -Pneumocystis carinii Normal Chest X Ray in Pneumonia
  • 28. Typical pneumonia Atypical pneumonia acute subacute, fever,chills subfebril fever productive cough non productive cough pleural pain nonrespiratory symptoms physical signs ( + ) physical signs ( - ) lobar consolidation non-lobar infiltration Agents S. pneumoniae M.pneumonia H. Influenzae C.pneumoniae Gr(-)aerop bacillus
  • 29. Recurrent pneumonia suspicion of the following :  Abnormalities of antibody production such as agammaglobulinemia  Cystic fibrosis (CF) & Foreign body  Cleft palate & Deficient gag reflex  Congenital bronchiectasis  Immotile cilia syndrome  Tracheoesophageal fistula  Abnormalities of polymorphonuclear leukocytes & Neutropenia
  • 30. WHO Treatment  Pneumonia: amoxcillin 40 mg/kg/ dose twice daily for 5 days.  severe pneumonia: These patients require admission, supportive care and treatment with IV penicillin or ampicillin and gentarnicin for at least 5 days. IV ceftriaxone may be used as second-line treatment.
  • 31. Treatment Antibiotics in Community-acquired Pneumonia Penicillin is the choice for pneumococcal pneumonia (Streptococcus pneumonia) (for 7-14days) which is usual in >1Y 1 year Amoxicillin 40mg/kg/d for7d
  • 32. In case of staphylococcal pneumonia cloxacillin plus ampicillin or Ceftriaxone is the best choice. If not improvement within 48h vancomycin. Duration of therapy in uncomplicated 2wks In empyema & pneumoathorax 4-6 wks
  • 33.  For H. influenza, ampicillin alone or a combination of penicillin plus chloramphenicol is recommended.  ampicillin plus chloramphenicol or ceftriaxone must be incorporated in the initial therapy of H. influenzae B pneumonia.  For Klebsiella, a combination of penicillin plus kanamycin or gentamicin is the therapy of choice
  • 34.  For Pseudomonas pneumonia, ceftazidime or piperacillin-tazobactam .  Pneumocystis carinii pneumonia (interstitial plasma cell pneumonia) needs to be treated with cotrimoxazole in very high doses (20 mg/kg/day with reference to trimethoprim).  Thrush pneumonia (pulmonary candidiasis) responds well to only amphotericin B or 5- fluorocytosine.
  • 35.  Tuberculous pneumonia requires antituberculous therapy (ATT)  Viral pneumonia responds to ribavirin aerosolization in case of respiratory syncytial virus (RSV)  amanta-dine (rimantidine) in case of influenza A isolates.  Loeffler pneumonia (Loeffler syndrome) resulting from larva pass through lung during the life cycle of nematodes is purely symptomatic. Diethylcarbamazine for
  • 36.  Primary atypical pneumonia resulting from Mycoplasma pneumoniae is treated with erythromycin or tetracyclines in case of grown-up children.  For aspiration pneumonia, use of prophylactic antibiotics is usually recommended. Gram negative bacilli: aminoglycosides. Anaerobes: Metronidazole and clindamycin
  • 37. General Measures  Good nursing care  Bed rest & Oxygen  Suction to remove secretions from tracheobronchial tree  Symptomatic treatment for cough, restlessness,fever and pain  Adequate fluid and dietary intake  Treatment of congestive cardiac failure, if present.
  • 38.  Physiotherapy: Breathing exercise during recovery are of value.  Surgical intervention in complications like empyema or tension pneumothorax, (common in staphylococcal pneumonia)  Prognosis is generally good following appropriate treatment “in time”.