2.5 Pneumonia

Question 1

PNEUMONIA: Presentation / Signs?

Answer 1

• Cough (typically wet and productive)
• Tachypnoea (raised respiratory rate)
• Tachycardia (raised heart rate)
• Hypoxia (low oxygen)
• Hypotension (shock)
• Fever
• Confusion

Question 2

Pneumonia chest findings?

Answer 2

CHEST FINDINGS:

• BRONCHIAL breath sounds (harsh sounds, equally loud on inspiration and expiration; caused by consolidation of the lung tissue around the airway)
• Focal coarse crackles caused by air passing through sputum similar to using a straw to blow into a drink.
• Dullness to percussion due to lung tissue collapse and/or consolidation.

Question 3

Bacterial causes of pneumonia?

Answer 3

• STREPTOCOCCUS PNEUMONIA is most common
• GROUP A STREP (e.g. Streptococcus pyogenes)
• GROUP B STREP occurs in pre-vaccinated infants, often contracted during birth as it often colonises the vagina.
• STAPHYLOCOCCUS AUREUS causes typical chest xray findings of pneumatocoeles (round air filled cavities) and consolidations in multiple lobes.
• HAEMOPHILUS INFLUENZA particularly affects pre-vaccinated or unvaccinated children.
• MYCOPLASMA pneumonia, an atypical bacteria with extra-pulmonary manifestations (e.g. erythema multiforme).

Question 4

Viral causes of pneumonia?

Answer 4

• Respiratory syncytial virus (RSV) is most common viral
• Parainfluenza virus
• Influenza virus

Question 5

7 possible investigations in pneumonia?

Answer 5

CXR is not required but is Ix of choice if there is doubt.

Causative organism: sputum cultures, throat swab, bacterial cultures, viral PCR

Sepsis: blood cultures

Unwell: capillary blood gas for resp metabolic acidosis / lactate

Question 6

Management of pneumonia?

Answer 6

AMOXICILLIN

add MACROLIDE (erythromycin, clarithromycin, azithromycin) to cover atypical or monotherapy in pen allergy.

IV if sepsis or problem with gut absorption.

O2 to keep sats above 92%

Question 7

What could be wrong if child has recurrent lower resp tract infections? What investigations?

Answer 7

Consider underlying lung or immune system pathology.

Hx: reflux, aspiration, neurological disease, heart disease, asthma, cystic fibrosis, primary ciliary diskinesia, immune deficiency.

Ix:

• FBC
• CXR (structural abnormal, scarring etc)
• serum immunoglobulins and class (selective antibody deficiency)
• test immunoglobulin to previous vaccines eg pneumococcus or haemophilus –> unable to convert IgM to IgG –> “immunoglobulin class switch recombination deficiency”
• sweat test (CF)
• HIV if mums status is unknown or positive