Beruflich Dokumente
Kultur Dokumente
140 120 100 80 60 40 20 0 1-5 6-11 12-23 Age in Months 24-35 36-50
Distribution of 12.2 million deaths among children less than 5 years old in all developing countries, 1993
Other (33.1%)
Malnutrition (29%)
Lack of immunization
Young age
Vitamin A deficiency
Low birth weight
Pneumonia
Classifications
Anatomical classification
Etiological classification
Etiology of Pneumonia
(Shann,1986):
Bacterial etiology
Streptococcus pneumoniae Hemophilus influenzae Staphylococcus aureus Streptococcus group A B Klebsiella pneumoniae Pseudomonas aeruginosa Chlamydia spp Mycoplasma pneumoniae
BACTERIA ISOLATED FROM LUNG ASPIRATES IN 370 UNTREATED CHILDREN WITH PNEUMONIA
%
50
40
30
20
10
S Pneumoniae
H Influenzae
S Aureus
Characteristic features
S pneumoniae
mucosal
Staphylococcus, Klebsiella
destruction
Chest Indrawing
(subcostal retraction)
Sign/Symptom
Tachypnea (+) Chest indrawing (+) Tachypnea (+) Chest indrawing (-) Tachypnea (-) Chest indrawing (-)
Management
Refer
Pneumonia
Antibiotic
No antibiotic
Bronchopneumonia Early stages of acute bronchopneumonia. Abundant inflammatory cells fill the alveolar spaces. The alveolar capillaries are distended and engorged.
Bronchopneumonia Acute bronchopneumonia. The alveolar spaces contain abundant PMNs and an inflammatory infiltrate rich in fibrin.
Acute Bronchopneumonia Acute bronchopneumonia; the alveolar spaces are full and distended with PMNs and a proteinaceous exudate. Only the alveolar septa allow identification of the tissue as lung.
Radiographic patterns
1. Diffuse alveolar and interstitial pneumonia (perivascular and interalveolar changes) 2. Bronchopneumonia (inflammation of airways and parenchyma) 3. Lobar pneumonia (consolidation in a whole lobe) 4. Nodular, cavity or abscess lesions (esp.in immunocompromised patients)
O2 3 L/min without O2
(PaCO2
52,4 % 100 %
Ventilatory insufficiency
< 35 mmHg)
> 45 mmHg )
87,5 %
4.8 %
Ventilatory failure
(PaCO2
Metabolic Acidosis
poor
Management
Severe Pneumonia Hospitalization Antibiotic administration
Amphycillin Chloramphenicol
or Gentamycin
Complications
Bronchiolitis
Bronchioles Clinical
inflammation
Predominantly
(2 6 months)
Difficult
Bronchiolitis
Etiology Predominantly RSV (Respiratory Syncytial Virus), adenovirus etc. Diagnosis Etiological diagnosis Microbiologic examination Clinical diagnosis Signs and symptoms Age Resource of infection
Bronchiolitis
Clinical Manifestations cough, cold, fever, fast breathing, retraction, wheezing, irritable, vomitus, poor intake Physical Examinations tachypnea, tachycardia, retraction, expiration >, wheezing, fever, pharyngitis, conjunctivitis, otitis media.
Bronchiolitis
Radiologic examination
diffuse hyperinflation
flat
Bronchiolitis
Management
Supportive
Severe
disease hospitalization intra venous fluid drip oxygen (antibiotics) Bronchodilator: controversial Corticosteroid: controversial
Bronchiolitis
Bronchiolitis