Childhood Pneumonia

Question 1

What are the causes for decreased incidence of pneumonia?

Answer 1

Antibiotics, vaccine, hygiene

Question 2

What are the vaccines available that prevent pneumonia?

Answer 2

Pneumococcus, H. Influenza, Influenza

Question 3

What percentage of Bedouin and Jewish children respectively visit the hospital with alveolar pneumonia during their first 5 years of life?

Answer 3

8.3/5.4%

Question 4

What are the most common bacterial pathogens causing pneumonia?

Answer 4

1. Pneumococcus (59%), 2. Staph, 3. H. Influenza (14%, usually type B), 4. Mycoplasma (11%, most common in children over 5), 5. Chlamydia (6% under 4, 35% in older children)

Question 5

What are the most common viral causes of pneumonia?

Answer 5

1. RSV (bigger problem for

Question 6

What proportion of lower respiratory infections in children are RSV positive? Of these, how many are pneumonia?

Answer 6

1/3, almost 1/2

Question 7

What is the risk of neonates for pneumonia hospitalization compared to term babies with RSV?

Answer 7

6x

Question 8

What variables can distinguish viral from bacterial pneumonia?

Answer 8

Abdominal pain more common in pure pneumococcus (uncommon overall), wheezing more common with RSV (/rhinovirus), normal oscultation in pneumococcus, ESR, CRP, procalcitonin higher in alveolar (pneumococcus),

Question 9

Definition of Alveolar Pneumonia

Answer 9

A dense opacity that may be a fluffy consolidation of a portion of the lobe or of the entire lung, often containing air bronchogram and sometimes associated with pleural effusion. Generally accepted as bacterial (pneumococcus). Lobar is a subtype.

Question 10

Definition of non-alveolar/interstitial pneumonia

Answer 10

The presence of other infiltrate as defined above in the absence of a pleural effusion. Linear and patchy densities minor patchy infiltrates (interstitial infiltrate) in a lacy pattern involving both lungs, featuring peribronchial thickening and multiple areas of atelectasis. Generally accepted as viral. Less conclusive.

Question 11

What mortality rate for untreated pneumonia in children under 1 year?

Answer 11

50%

Question 12

What is the ideal length of a pneumonia course of antibiotics?

Answer 12

3-5 days in developing countries, 7-10 days in developed populations

Question 13

What is the WHO recommendation for pneumonia definition for diagnosis?

Answer 13

Increased respiratory rate

Question 14

WHO treatment recommendation of oral CAP

Answer 14

3-5 days of oral amoxicillin

Question 15

What are the Soroka diagnostic criteria for pneumonia?

Answer 15

Fever>38.5 • WBC>15,000 • Chest X ray • CRP • Age 3-59 months.

Question 16

How much does the pneumococcus vaccine reduce pneumonia?

Answer 16

20% viral reduction, 20-40% alveolar reduction