2. Definition
 Pneumonia is an inflammation of the
pulmonary parenchyma
 Most caused by microorganisms,
noninfectious causes include aspiration of
food or gastric acid, foreign bodies,
hydrocarbons, and lipoid substances,
hypersensitivity reactions, and drug- or
radiation-induced pneumonitis

3.  classified as community-acquired, hospital-
acquired, or ventilator-associated
-40–80% of children with community-
acquired pneumonia.
-Streptococcus pneumoniae (pneumococcus)
is the most common bacterial pathogen

4. Epidemiology
 Pneumonia is substantial cause of
morbidity and mortality in childhood
(particularly among children <5 yr of age)
 Estimated approximately 4 million deaths
children among worldwide

5. Global distribution of deaths among children under age
5, by cause, 2010

6. Organisms of pneumonia
 bacterial or viral cause of pneumonia can be
identified in 40–80% of children with
community-acquired pneumonia.
Streptococcus pneumoniae (pneumococcus)
is the most common bacterial pathogen,
followed by Chlamydia pneumoniae and
Mycoplasma pneumoniae

7. Leading Etiologic Agents of Pneumonia Infants
and Children
S.aureus
S.aureus

8. Pathophysiology
 Virusairbornedropletsmouth or
noselungsvirus incaded cells lining
airway and alveoli cell death(protective
process) immune system responds  more
lung damage  fluid leak into alveoli(due to
WBC,lymphocytes activate)  interrupts
normal transportation of oxygen

9.  Bacterial invasion triggers the
immune system to send neutrophils kill
the offending organisms, and also release
cytokines  fever, chills, and fatigue

10. Types of pneumonia
 Classify by clinically:
 Lobar pneumonia-infection that only
involves a single lobe, or section.
 Bronchopneumonia - affects the lungs in
patches around the tubes (bronchi or
bronchioles)

11. Clinical features
 Fever
 Dyspnoea
 Cough （ productive or non-productive ）
 Lethargy
 Poor feeding

13. Physial examination
 Tachypnoea,nasal flaring and chest indrawing
 Consolidation with dullness on percussion
 End –inspiratory respiratory coarse carckles
over the effeted area
 Decreased breath sounds and bronchial
breathing

14. Assessment of severity of
pneumonia
 The predictve value of respiratory rate for the
diagnosis of pneumonia
 Tachypnoea is defined as follows :
 < 2 months age: > 60 /min
 2- 12 months age: > 50 /min
 12 months – 5 years age: > 40 /min

15. Assessment the severity of
pneumonia
AGE < 2months AGE>2 months – 5yrs old
Severa pneumonia Mild pneumonia
severe chest indrawing fast breathing
or fast breathing
Severe pneumonia
Very severe pneumonia chest indrawing
not feeding
convulsion Very severe pneumonia
abnormally sleepy or difficult to not able to drink
wake convulsions
fever/low body temperature drowsiness
hypopnoea with slow irregular malnutrition
breathing

16. Investigations
 Chest X-ray
 White blood cell count
 Blood culture
 Pleural fluid analysis
 Serology
 Nasopharyngeal aspirate

18. Chest X-ray

19. Investigations
 elevated WBC count in the range of 15,000-
40,000/mm and a predominance of
granulocytes
 erythrocyte sedimentation rate (ESR)
 C–reactive protein (CRP)
 anti-streptolysin O (ASO) titer useful in the
diagnosis of group A streptococcal
pneumonia

20. Viral pneumonia
 several days of symptoms of an upper
respiratory tract infection eg: rhinitis and
cough
 Fever, lower than in bacterial pneumonia
 Tachypnea
 intercostal, subcostal, and suprasternal
retractions, nasal flaring, and use of
accessory muscles
 cyanosis

22. Investigations
 Reliable DNA or RNA tests for the rapid
detection of RSV
 PCR test
 seroconversion in an IgG assay

23. Myocoplasma pneumonia
 Headaches and malasia
 precede the chest symptoms by 1-5 days
 Cough may not obvious
 chest may be scanty

24.  chest X-ray - one lobe is involved but
sometimes may shadowing in both lungs
 frequently no correlation between the X-ray
appearances and the clinical state of the
patient.

26. Investigation
 Serology :
 acute phase serumtitre > 1:160 or paired
samples taken 2-4 weeks apart showing a
4 fold rise is a good indicator of Mycoplasma
pneumoniae infection
 This test should be considered for children
aged five years or older

27. Management
 Assessment of oxygenation
 The best objective measurement of hypoxia
is by pulse oximetry which avoids the need
for arterial blood gases. It is a good indicator
of the severity of pneumonia

28. Criteria for
hospitalization
 community acquired pneumonia can be
treated at home
 it is crucial to identify indicators of severity in
children who may need admission.
 Failure to recognise the severity of
pneumonia may lead to death.

29. The following indicators can be used as a
guide for admission:
 children aged 3 months and below, whatever the
severity of pneumonia.
 fever ( more than 38.5 ⁰C ), refusal to feed and
vomiting
 fast breathing with or without cyanosis
 associated systemic manifestation
 failure of previous antibiotic therapy
 recurrent pneumonia
 severe underlying disorder ( i.e. immunodefi
ciency )

30. Antibiotics Bacterial pathogens of
children and the recommended antimicrobial agents to
be used:
Pathogen Antimicrobial agent
Beta-lactam susceptible
Streptococcus pneumonia penicillin, cephalosporins
Haemophilus influenzae type b ampicillin, chloramphenicol, cephalosporins
Staphylococcus aureus cloxacillin
Group A Streptococcus penicillin, cephalosporin
Mycoplasma pneumoniae macrolides , e.g. erythromycin, azithromycin
Chlamydia pneumoniae macrolides , e.g. erythromycin, azithromycin
Bordetella pertussis macrolides , e.g. erythromycin, azithromycin

31. Children with severe pneumonia, the following
antibiotics are recommended:
Suggested antimicrobial agents for inpatient
treatment of pneumonia
1st line beta-lactam drugs : benzylpenicillin, amoxycillin, ampicillin,
amoxycillin-clavulanate
2nd line cephalosporins : cefotaxime, cefuroxime, ceftazidime
3rd line carbapenem: imipenam
Others aminoglycosides: gentamicin, amikacin

32. • second line antibiotics need to be considered when :
- there are no signs of recovery
- patients remain toxic and ill with spiking
temperature for 48 - 72 hours
• a macrolide antibiotic is used if Mycoplasma or
Chlamydia are the causative agents
• a child admitied to hospital with severe community
acquired pneumonia must receive parenteral
antibiotics. As a rule, in severe cases of pneumonia,
combination therapy using a second or third
generation cephalosporins and macrolide should be
given.

33. Supportive treatment
 Fluids
 Oxygen
 Temperature control
 Chest physiotherapy

34. Complications of pneumonia
 Pleural effusion
 Empyema
 Pericarditis
 Lung abscess
 Respiratory failure
 Meningitis
 Suppurative arthritis
 Osteomyelitis

35. Org Strep Staph Mycoplasm RSV HIV(PCP
Comparism of common organisms causing
a )
pneumonia incom
Commonest PaedIv drugs users or
population
-acq with cental
venous catheters Any age
Age 3mth -childhood Noenatal-- >5yrs <3mths
infancy high
fever,
Clinical Broncho in young Fever Headaches, upper
respiratory breathless
Feature child Tachypnea Malaise, ness and
Lobar/consolidation Cyanosis Chest tract
infection, dry cough
in older Extremely ill symptoms.
Fever,tachyp
F,Rusty sputum nea diffuse
Haemoptysis bilateral
Pleuritic pain alveolar
O/E- and
interstitial
shadowin
Inv- CXR multi lobar Not Infiltr ate g perihilar
consolidati on, correlate In affect- regions
cavitation, with clinical ed area spread out
pneumatocoel state in a
es butterfly
pattern
Tx 1st line Iv flucloxacillin Erythromycin, HAART
2nd line (200mg/kg/d) Clarithromycin

36. The End