Paediatrics: Pneumonia

Question 1

Define

Answer 1

Pneumonia is simply an infection of the lung tissue. It causes inflammation of the lung tissue and sputum filling the airways and alveoli.

Question 2

What can cause a pneumonia?

Answer 2

It can be caused by a bacteria, virus or atypical bacteria such as mycoplasma.

Question 3

Presentation

Answer 3

Cough (typically wet and productive)
High fever (> 38.5ºC)
Tachypnoea
Tachycardia
Increased work of breathing
Lethargy
Delirium (acute confusion associated with infection)

Question 4

Signs of sepsis secondary to the pneumonia

Answer 4

There may be a derangement in basic observations. These can indicate sepsis secondary to the pneumonia:

Tachypnoea (raised respiratory rate)
Tachycardia (raised heart rate)
Hypoxia (low oxygen)
Hypotension (shock)
Fever
Confusion

Question 5

Characterised chest signs of pneumonia

Answer 5

Bronchial breath sounds. These are harsh breath sounds that are equally loud on inspiration and expiration. These are 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 6

Bacterial causes of pneumonia

Answer 6

Streptococcus pneumonia is most common

Question 7

Viral causes

Answer 7

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

Question 8

Investigations

Answer 8

A chest xray is the investigation of choice for diagnosing pneumonia. It is not routinely required, but can be useful if there is diagnostic doubt or in severe or complicated cases.

Sending sputum cultures and throat swabs for bacterial cultures and viral PCR can establish the causative organism and guide treatment. All patients with sepsis should have blood cultures.

Question 9

Management

Answer 9

Amoxicillin is often used first line.

Adding a macrolide (erythromycin, clarithromycin or azithromycin) will cover atypical pneumonia.

Macrolides can be used as monotherapy in patients with a penicillin allergy.

IV antibiotics can be used when there is sepsis or a problem with intestinal absorption.

Oxygen is used as required to maintain saturations above 92%.