15.3.1 Breathing Difficulty In Children : Upper Resp Tract Flashcards
Clinical importance of Pneumonia
- Pneumonia is the single greatest cause of death in children worldwide .
- Each year, 2 million children younger than 5 years die of pneumonia, representing 20% of all deaths in children within this age group .
- 155 million cases of pneumonia occur in children every year worldwide
- In many children with LRTI, diagnostic testing may identify 2 or 3 pathogens, including combinations of both viruses and bacteria, making it difficult to determine the significance of any single pathogen
CAP
Def
Common organism
Community acquired pneumonia
Def:
- CAP can be defined as acute infection (of less than 14 days’ duration), acquired in the community, of the lower respiratory tract leading to cough or difficult breathing, tachypnoea or chest-wall indrawing
- Most of cases of pneumonia is CAP
- CAP accounts for between 30% and 40% of hospital admissions, with associated case fatality rates of between 15% and 28%.
- Mixed bacterial and viral infections may occur in 30 - 40% of cases of childhood CAP.
Organism
- S.pneumoniae as the most common documented bacterial pathogen, occurring in 4%–44% of all children
- Viral etiologies of CAP have been documented in up to 80% of children younger than 2 years; in contrast, older children, 10–16 years, who had both clinical and radiographic evidence of pneumonia, documented a much lower percentage of viral pathogens
- RSV is consistently the most frequently detected, representing up to 40%of identified pathogens in those younger than 2 years, but rarely identified in older children with CAP.
- Epidemiologic investigations of hospitalized children with CAP document that 2%–33% are simultaneously infected by 2 or more viruses
Define Hospital acquired pneumonia
- 24-48 hrs after being admitted to hospital get infection with pneumonia
- Complicated by underlying conditions
- different than CAP organisms (antibiotic resistant!)
Define ventilator acquired pneumonia
- If on ventilator; few days later raised infec markers and pneumonia symptoms
- different than CAP organisms (antibiotic resistant!)
Define simple pneumonia
- either bronchopneumonia (primary involvement of airways and surrounding interstitium), or lobar pneumonia involving a single lobe.
Define complicated pneumonia
defined as a pulmonary parenchymal infection complicated by parapneumonic effusions, multilobar disease, abscesses or cavities, necrotizing pneumonia, empyema, pneumothorax or bronchopleural fistula
CAP
Causes
Slide 9
Bacteria
- Strep pneumonia (declined in past years because of injection)
- Haemophilus influenza (disappeared because of vac)
- Stap Aureus (Became more prevalent; more complications {emphyema})
- TB (not acute pneumonia; but pneumonia signs)
Atypical bac
- Mycoplasma pneumonia (school age, hostels)
Viruses
- RSV (young age)
- human metaoneumonia
- parainfluenza virus types 1 & 3
- adenovirus
- Influenza A & B
- Rhinovirus
- measles
- Covid
CAP
Etiology (why is age important?)
Different organism
<3months
– Gram negative organisms – Group B streptococcus
– Staphylococcus aureus
– Haemophilus influenzae
– Other atypical
• chlamydia, ureoplasma
3months-5years
– Streptococcus pneumoniae
– Haemophilus influenzae
– Staphylococcus aureus
>5years
– Streptococcus pneumoniae
– Mycoplasma pneumoniae
– Staphylococcus aureus
Mycoplasma
Atypical pneumonia caused by Mycoplasmais characteristically slowly progressing, with malaise, sore throat,low-grade fever, and cough developing over 3–5 days
Causes of CAP in HIV positive children
Slide 13
- immunosupressed
- most NB cause of death in children <6 months
Bac
- non-typical salmonella
- klebsiella pneumonia
- streptococcus milleri
- E. coli
Viral
Indications for hospital admission in CAP
- all children younger that 2 months
Children older than 2 months with:
- Impaired level of consciousness
- inability to drink or eat
- cyanosis
Impact of HIV infec on clinical diagnosis of CAP
- Clinical signs of CAP are similar in HIV-infected and HIV uninfected children.
- However, pneumonia resulting from opportunistic pathogens should also be considered in HIV infected children.
- Of these, PCP is the most common and serious infection among infants, occurring commonly at 6 weeks - 6 months of age.
- PCP is frequently (20 - 40%) the initial presenting feature of AIDS in HIV- infected children not taking co-trimoxazole prophylaxis.
- Although PCP may present with a tetrad of features comprising tachypnoea, dyspnoea, fever and cough, these are not specific for pneumonia caused by P. jiroveci.
- Hypoxia may be prominent and rapidly progressive.
- Other stigmata of AIDS such as hepatosplenomegaly and generalised lymphadenopathy are not always present and adventitious sounds in the chest may be absent despite clinical signs of severe respiratory distress.
Risk for types of pneumonia according to age
- < 2 months risk of gram negative infection
- > 5 years have more infection with Mycoplasma pneumoniae
What can determine your immune status
Congenital immundefiency
– T-cell defiency
– B-cell deficiency
Acquired immundefiency
– HIV
– Malnutrition
– Cancer patient
Complications of pneumonia
- Empyema
- Lung abscess
- Necrotising pneumonia
Slide 44
Metastatic
- Meningitis
- CNS abscess
- pericarditis
- endocarditis
- osteomyelitis
- septic arthritis
