Description
Pneumonia in children is often caused by viral or bacterial infections, leading to inflammation of the lungs. Symptoms may include cough, fever, rapid breathing, and chest pain. Diagnosis typically involves physical examination, chest X-ray, and sometimes blood tests or other imaging studies. Treatment may include antibiotics for bacterial pneumonia, supportive care such as rest, fluids, and fever management, and in severe cases, hospitalization for oxygen therapy and close monitoring. Vaccination against common pathogens like Streptococcus pneumoniae and Haemophilus influenzae type b can help prevent pneumonia in children.
Summary Listen
- Pneumonia is a significant cause of morbidity and mortality in children, often stemming from viral agents that can become secondarily infected. Anatomically, the infection affects the lungs, potentially involving the pleura, leading to conditions like pleural effusion or empyema. Pneumonia can impact multiple systems, leading to sequelae like cognitive impairment, hearing loss, cardiac issues, and kidney disease.
- The pathogenesis of pneumonia involves the alveoli being filled with fluid due to inflammation, replacing normal air. Radiological features of pneumonia include dense opacity, air bronchograms, and increased broncho-vascular markings on X-rays. Conditions presenting with acute onset breathing difficulties in children, such as asthma, bronchitis, or foreign bodies, should be differentiated from pneumonia.
- The body's defenses against pneumonia involve cough reflex, mucosal clearance, macrophages, and secretary IgA. Viral pneumonia involves lymphocytes destroying virus-infected cells, while bacterial pneumonia involves neutrophils combating bacteria. Pneumonia is defined as lung infection impacting the air sacs, interfering with oxygen and carbon dioxide exchange.
- WHO classifies pneumonia based on severity: cough and cold (no pneumonia), fast breathing and chest in-drawing (pneumonia), and general danger signs, lethargy, severe respiratory distress, and cyanosis (severe pneumonia). Bacterial pneumonias have different patterns depending on the pathogen, ranging from local edema with Streptococcus pneumoniae to confluent bronchopneumonia with Staphylococcus aureus.
- Etiological agents of pneumonia vary by age group. Neonates are more prone to bacterial infections like Group B Streptococcus and E. coli, while older infants and children are susceptible to viral infections like RSV and bacteria like Streptococcus pneumoniae and Mycoplasma pneumoniae. Viral pneumonia can spread from upper to lower respiratory tract, causing epithelial damage and airway blockage, whereas bacterial spread can be local or hematogenous.
- Clinical features of pneumonia include persistent fever, chest recession, and increased respiratory rate. Neonates may present atypically with apnea, grunting, or rapid clinical deterioration. Diagnosis involves CBC, chest X-ray, and consideration of cold agglutinins for Mycoplasma pneumoniae. Differential diagnoses include bronchiolitis, foreign body aspiration, and congestive heart failure.
- Management of pneumonia includes antibiotics like amoxicillin for OPD cases, and macrolides for atypical pneumonia. Hospitalized patients receive supportive care like oxygen, hydration, and antipyretics, along with specific antibiotics determined by culture and sensitivity. Treatment duration varies from 10-14 days for lobar pneumonia to 3-4 weeks for Staphylococcus pneumonia.
- Complications of pneumonia include pleural effusion, lung abscess, pneumothorax, empyema, sepsis, and meningitis. Hospitalization is indicated for hypoxia, dehydration, high-risk factors like immunodeficiency, and lack of response to oral antibiotics. Discharge criteria include resolution of respiratory distress, normal oxygen saturation, and parental understanding of warning signs.
- Prevention of pneumonia involves vaccination against Hib, pneumococcal, measles, influenza, and other diseases. Maintaining clean hygiene, sanitation, and a smokeless house are also important. Aspiration pneumonia, particularly from kerosene ingestion, requires specific management including oxygen therapy, IV fluids, and antibiotics, while avoiding induced vomiting and gastric lavage.
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