OBJECTIVES

• DEFINITION OF PNEUMONIA
• TO REVIEW THE ETIOLOGY AND PATHOGENESIS OF PNEUMONIA
• TO KNOW THE DIASNOSTIC AIDS THAT ARE INITIALLY REQUESTED
• TO KNOW THE TREATMENT TO USE WITH REGARDS TO THE ETIOLOGIC AGENT
• HOW CAN A PNEUMONIA BE PREVENTED
PNEUMONIA
• IS THE INFLAMMATION OF THE PARENCHYMA OF THE LUNGS
• MOST CASES OF PNEUMONIA ARE CAUSED BY MICROORGANISM
• IS A SUBSTANTIAL CAUSE OF MORBIDITY AND MORTALITY IN CHILDHOOD THROUGHOUT THE WORLD.
• LEADING CAUSE OF DEATH GLOBALLY AMONG CHILDREN YOUNGER THAN 5 YEARS OLD
• IN DEVELOPING COUNTRIES, THE INTRODUCTION OF MEASLES VACCINE HAS GREATLY REDUCED THE
INCIDENCE OF MEASLES-RELATED PNEUMONIA DEATHS.
• NON INFECTIOUS CAUSES – ASPIRATION OF FOOD OR GASTRIC ACID; FOREIGN BODIES; HYDROCARBONS;
LIPID SUBSTANCES; HYPERSENSITIVITY REACTIONS AND DRUG OR RADIATION INDUCED PNEUMONITIS
SPECIFIC RISK FACTORS:
• LUNG DISEASE
• ANATOMIC PROBLEMS
• GASTROESOPHAGEAL REFLUX DISEASE WITH ASPIRATION
• NEUROLOGIC DISORDERS THAT INTERFERE WITH PROTECTION OF THE AIRWAY OR COMPROMISE
CLEARING OF THE AIRWAY
• DISEASES THAT ALTER THE IMMUNE SYSTEM, SUCH AS UMMUNODEFICIENCY DISEASES OR
HEMOGLOBINOPATHIES
ETIOLOGY
• MOST INFECTIOUS CASES ARE CAUSED BY FOLLOWING
• BACTERIAL: S. PNEUMONIA, GROUP B STREP, M. PNEUMONIAE, CHLAMYDOPHILA PNEUMONIA AND
CHLAMYDIA TRACHOMATIS
• VIRAL: RESPIRATORY SYNCYTIAL VIRUS, PARAINFLUENZA VIRUS 1-3, INFLUENZA A&B, ADENOVIRUS AND
HUMAN METAPNEUMOVIRUS

• VIRAL : PEAK ATTACK IS BETWEEN 2-3 YEARS OLD

• S. PNEUMONIA, M. PNEUMONIAE : OLDER THAN 5 YEARS OLD
CLINICAL MANIFESTATIONS
• URTI (COUGH, RHINITIS) • LETHARGY
• FEVER (BACTERIA CAUSE HIGH FEVER THAN VIRUS) • DIMINISHED APPETITE
• TACHYPNEA • ABDOMINAL PAIN
• INCREASE CYANOSIS AND FATIGUE IN INFANTS • LIVER MAY SEEM ENLARGED
• ADULTS AND OLDER CHILDREN TYPICALLY BEGINS • CRACKLES AND WHEEZING
SUDDENLY WITH A SHAKING CHILL FOLLOWED BY A
HIGH FEVER, COUGH , AND CHEST PAIN
• TACHYPNEA IS THE MOST CONSISTENT CLINICAL MANIFESTATION
• INCREASED WORKING BREATHING ACCOMPANIED BY INTERCOSTAL RETRACTIONS, NASAL FLARING AND
USE ACCESSORY MUSCLES
PREDICTORS OF CAP IN PATIENT WITH
COUGH

• AGES 3-5 : TACHYPNEA AND OR CHEST INDRAWING

• AGES 5-12 : FEVER, TACHYPNEA AND CRACKLES
• >12 : FEVER, TACHYPNEA, TACHYCARDIA ATLEAST 1 ABNORMAL CHEST FINDINGS RHONCHI, CRACKLES,
WHEEZES, DECREASE BREATH SOUNDS
• THE LOWER RESPIRATORY TRACT IS NORMALLY KEPT STERILE BY PHYSIOLOGIC DEFENSE MECHANISM,
INCLUDING MUCOCILIARY CLEARANCE.
• THE SECRETORY IMMUNOGLOBULIN A, AND CLEARING THE AIRWAY BY COUGHING
• IMMUNOLOGIC DEFENSE MECHANISMS OF THE LUNG THAT LIMIT INVASION BY PATHOGENIC ORGANISMS
INCLUDE MACROPHAGES THAT ARE PRESENT IN ALVEOLI AND BRONCHIOLES.
WHO SHALL BE CONSIDERED AS HAVING
COMMUNITY
•
ACQUIRED PNEUMONIA?
1. THE PRESENCE OF PNEUMONIA MAY BE CONSIDERED EVEN WITHOUT A CHEST RADIOGRAPH IN A PATIENT
PRESENTING WITH COUGH AND/OR RESPIRATORY DIFFICULTY THE FOLLOWING PREDICTORS OF RADIOGRAPHIC
PNEUMONIA:
• AT THE EMERGENCY ROOM AS THE SITE OF CARE:
• TACHYPNEA IN A PATIENT AGED 3MONTHS TO 5 YEARS
• FEVER AT ANY AGE
• OXYGEN SATURATION LESS THAN OR EQUAL TO 92% AT ROOM AIR AT ANY AGE ABSENCE OF ANY CO-EXISITING ILLNESS.

• AT THE OUT PATIENT CLINIC AS THE SITE OF CARE

• TACHYPNEA IN A PATIEN AGED 3MONTHS TO 5 YEARS
• FEVER AT ANY AGE
• 2. THE PRESENCE OF PNEUMONIA SHOULD BE DETERMINED USING A CHEST RADIOGRAPH IN A PATIENT
PRESENTING WITH
• COUGH AND/OR RESPIRATORY DIFFICULTY IN THE FOLLOWING SITUATIONS:
• PRESENCE OF DEHYDRATION AGED 3 MONTHS TO 5 YEARS
• PRESENCE OF SEVERE MALNUTRITION AGED LESS THAN 7 YEARS

• HIGH GRADE FEVER AND LEUKOCYTOSIS AGED 3-24 MONTHS WITHOUT RESIPIRATORY SYMPTOMS
WHO WILL REQUIRE ADMISSION?
PARAMETERS TO BE EVALUATED WHEN
CONSIDERING ADMISSION:
• 1. HOST FACTORS: • 2. EXTERNAL FACTORS:
• ABILITY TO FEED • A COMPLIANT CAREGIVER

• AGE • ABILITY TO FOLLOW UP

• SIGNS OF RESPIRATORY FAILURE

• PULMONARY COMPLICATIONS
• RESPIRATORY RATE
• STATE OF DEHYDRATION
• PRESENCE OF COMORBID FACTORS
• GRUNTING AND APNEA
• ARE MANIFESTATIONS OF ACUTE RESPIRATORY FAILURE REQUIRING ADMISSION TO CRICITICAL CARE UNIT
• CYANOSIS AND HEAD BOBBING
• INABILITY TO CRY, HEAD NODDING AND A RESPIRATORY RATE OF >60/MIN WERE BEST PREDICTORS OF
HYPOXEMIA
WHAT DIASNOSTIC AIDS INITIALLY
REQUESTED?
• PCAP - A & PCAP-B
• NO DIASNOSTIC AIDS ARE INITIALLY REQUESTED
• WHO IS BEING MANAGED IN AN AMBULATORY
SETTING
• PCAP C & D:
• CHEST X RAY – PA LATERAL
• WBC COUNT
• CULTURE AND SENSITIVITY OF
• BLOOD, PLEURAL FLUID, SPUTUM
ANTIBIOTIC RECOMMENDATION
• 1. FOR PATIENT CLASSIFIED AS EITHER PCAP-A OR B IS
• BEYOND 2 YEARS OF AGE
• HAVING HIGH FEVER WITHOUT WHEEZE
• 2. FOR A PATIENT CLASSIFIED AS PCAP-C AND IS
• BEYOND 2 YEARS OF AGE
• HAVING A HIGH GRADE WITHOUT WHEEZE
• HAVING ALVEOLAR CONSOLIDATION IN CXR
• WBC COUNT >15,000
WHAT EMPIRIC TREATMENT SHOULD BE
CONSIDERED IF A BACTERIAL ETIOLOGY IS
CONSIDERED?
• FOR A PATIENT WHO HAS BEEN CLASSIFIED AS PCAP-A OR B WITHOUT PREVIOUS ANTIBIOTIC
• AMOXICILLIN IS THE DRUG OF CHOICE
• AZITHROMYCIN
• CLARITHROMYCIN : GIVEN TO THOSE PATIENTS WITH KNOWN HYPERSENSITIVITY TO AMOXICILLIN
• FOR PCAP-C WITHOUT PREVIOUS ANTIBIOTIC, REQUIRING HOSPITALIZATION
• A. HAS COMPLETED THE PRIMARY IMMUNIZATION AGAINST H.INFLUENZA TYPE B, PENICILLIN G,
ADMINISTERED AS MONOTHERAPY IS THE DRUG OF CHOICE
• B. HAS NOT COMPLETED THE PRIMARY IMMUNIZATION OF IMMUNIZATION STATUS UNKNOWN AGAINST H.
INFLUENZA TYPE B, AMPICILLIN IS THE DRUG OF CHOICE.
WHAT TREATMENT SHOULD BE INITIALLY
GIVEN IF A VIRAL ETIOLOGY IS
CONSIDERED?
• 1. OSELTAMIVIR: THE DRUG OF CHOICE FOR LABORATORY CONFIRMED OR CLINICALLY SUSPECTED CASES
OF INFLUENZA.
A PATIENT BE CONSIDERED AS RESPONDING
TO THE CURRENT ANTIBIOTIC WHEN
• DECREASE IN RESPIRATORY SIGNS AND OR DEFERVESCENSE WITHIN 72 HOURS AFTER INITIATION OF
ANTIBIOTIC
• IF AN INPATIENT CLASSIFIED AS PCAP C IS NOT RESPONDING TO THE CURRENT ANTIBIOTIC WITHIN 72
HOURS CONSIDER ANY OF THE FOLLOWING:
• CO EXISTING ILLNESS
• CONDITIONS SIMULATING PNEUMONIA
HOW CAN PNEUMONIA BE PREVENTED?
• VACCINE AGAINST:
• 1. STREPTOCOCCUS PNEUMONIA
• INFLUENZA
• DIPHTHERIA, PERTUSSIS, RUBEOLA, VARICELLA, HAEMOPHILUS INFLUENZA TYPE B
• MICRONUTRIENT
• ELEMENTAL ZINC FOR AGES 2-59 MONTHS TO BE GIVEN FOR 4-6 MONTHS
• VITAMIN D3 SUPPLEMENTATION
• VITAMIN A SHOULD NOT BE GIVEN TO PREVENT PNEUMONIA
THANK YOU.!