Pneumonia is an inflammation of the parenchyma of the lungs. Most cases of pneumonia are cause by microorganisms.

Non infectious causes are aspiration of blood or gastric acid; foreign bodies; hydrocarbons; lipoid substances; hypersensitivity reactions and drug or radiation induced pneumonitis. The specific risk factors are lung disease, anatomic problems, gastroesophageal reflux disease with aspiration, neurologic disorders that infere with protection of the airway or compromise clearing of the airway, and diseases that alter the immune system, such as immunodeficiency diseases or hemoglobinopathies. Etiology Viral pneumonia peak attack is between two to three years old. S. pneumonia, M. pneumonia peak is older than 5 year old, other bacterial causes includes: groups A strep, S. pyogenes, Staph aureus, H. influenza type B. Clinical Manifestation Viral and bacterial pneumonias are most often preceded by several days of symptoms of an upper respiratory tract infection, typically rhinitis and cough. In viral pneumonia, temperature is generally lower than bacterial. Tachypnea is the most consistent clinical manifestation. Increased working breathing accompanied by intercostal retractions, nasal flaring, and use of accessory muscles. Bacterial pneumonia in older children typically begins suddenly with shaking chill followed by high fever, cough, and chest pain. Predictors of CAP in a Patient With Cough 1. Ages 3 to 5 years old tachypnea and.or chest indrawing 2. Ages 5 to 12 years old fever, tachypnea and crackles 3. > 12 years old fever, tachypnea, tachycardia at least 1 abnormal chest findings, ronchi, crackles, wheezes, decreased breath sounds Reliable indicators either tachypnea and/or chest indrawing among infants and preschool children. Tachypnea is still the best predictor. Age specific criteria for tachypnea: 2 to 12 months 50 breaths/min 1 to 5 years old 40 breaths/min > 5 years old 30 breaths/min

Patients with CAP are 2 to 3 times more likely to have the following signs and symptoms: nasal flaring, grunting, tachypnea, rales and pallor.