2. PNEUMONIA
Definition: inflammation of the lung
parenchyma which may be primary or
secondary.
Lung parenchyma: respiratory bronchioles,
Alveolar duct, alveolar sacs and alveoli.
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
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
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
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.
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”.