pneumonia Flashcards
(23 cards)
What is the single largest cause of death in children worldwide?
Pneumonia
What is pneumonia?
Lower respiratory tract infection associated with fever, respiratory symptoms, and parenchymal involvement as evidenced by physical exam findings or infiltrates on CXR
What is walking pneumonia?
School-aged children and young adults with clinical and radiographic evidence of PNA but with mild enough symptoms that do not interfere with normal activity
What organism is responsible for walking pneumonia?
Mycoplasma pneumoniae
What is the definition for hospital-acquired pneumonia?
A pneumonia that develops in a hospitalized child within 48 hours after admission
What are common causes of bacterial pneumonia in neonates (0-3 months)?
Group B strep
Gram-negative bacteria
Maternal flora
What is the most common bacterial cause of pneumonia in children >1 week old?
Streptococcus pneumoniae
Pneumonia secondary to atypical organisms (e.g., Mycoplasma, Chlamydophila) is more common in what age group?
School-aged children (>5 years)
What bug should be considered in cases of complicated PNA with empyema and necrosis?
CA-MRSA
How does early onset pneumonia present in neonates?
Respiratory distress at or soon after birth (within first 3 DOL) + nonspecific sx (lethargy, apnea, tachycardia, poor perfusion)
Infection acquired from mother
What causes late-onset pneumonia in a newborn?
Occurs after birth during hospitalization or after discharge
Either nosocomial acquired or due to colonization of contaminated equipment
How does pneumococcal pneumonia typically present?
Lobar pneumonia
Fever, nonproductive cough, tachypnea, decreased breath sounds over affected lobe
Wheezing in a child older than 5 years is more likely associated with what type of pneumonias?
Viral or atypical bacterial PNA (Mycoplasma, Chlamydia)
Why does normal CXR NOT rule out pneumonia if there is high suspicion for it?
- XR findings lag behind clinical picture
- Dehydrated children may not have infiltrate initiallyl
- Hard to differentiate atelectasis from PNA on one-view
What is Lemierre syndrome?
Jugular vein suppurative thrombophlebitis
Caused by Fusobacterium that infects carotid sheath and spreads to lung and mediastinum
More common in adolescents and young adults
Outpatient treatment for preschool child with CAP?
Amoxicillin-clavulanate (Augmentin)
Outpatient treatment for school-aged child or teen with suspected atypical pneumonia?
Consider macrolide like azithromycin
Empiric antibiotic treatment for hospitalized children with CAP?
Ampicillin (covers strep pneumo) OR
Ampicillin-sulbactam (Unasyn: also covers Hib, M. catarrhalis, MSSA)
Ceftriaxone (or other 3rd gen ceph like cefotaxime) if not fully immunized, high rates of pneumo penicillin resistance, or severe/complicated cases
Add macrolide if suspecting atypical PNA
Add vanc, linezolid, or clindamycin if suspecting MRSA
Duration of antibiotics for uncomplicated pneumonia?
7-10 days
Duration of antibiotics for complicated pneumonia?
4 weeks total OR
2 weeks after defervescence and clinical improvement
When is necrotizing pneumonia suspected?
Translucent lesion is seen on CXR in a child with prolonged fever or septic appearance
Dx confirmed with CT with contrast
Most often caused by pneumococci or S. aureus
How long does cough persist after CAP?
From several weeks to up to 4 months post CAP
For 3-4 months post viral PNA or pertussis
May have dyspnea on exertion for 2-3 months
What are the most sensitive clinical signs of pneumonia?
Fever and tachypnea, especially after the first 3 days of illness
