Pneumonia

Question 1

Bacterial aetiologies of pneumonia

Answer 1

Streptococcus pneumoniae most common

Group A strep (Strep. progenies)

Group B strep in pre-vaccinated infants

Staph. aureus

Haemophilus influenzae (pre-vaccinated/unvaccinated children)

Mycoplasma pneumoniae (atypical, can affect pre-school children)

Question 2

Viral aetiologies of pneumonia

Answer 2

RSV most common

Parainfluenza

Influenza

Question 3

Clinical features of pneumonia

Answer 3

Cough (typically wet and productive)

High fever (>38)

Tachypnoea

Tachycardia

Increased work of breathing

Lethargy

Delirium

Question 4

Pneumonia chest signs

Answer 4

Bronchial breath sounds (harsh breath sounds equally loud on inspiration and expiration, caused by consolidation of the lung tissue around airway)

Focal coarse cracklescaused by air passing through sputum

Dullness to percussiondue to lung tissue collapse and/or consolidation

Question 5

Pneumonia investigations

Answer 5

Sputum cultures, throat swabs for bacterial culture & viral PCR can establish causative organism and guide treatment

All patients with sepsis should have blood cultures

CXR - not routinely used but can be used if in diagnostic doubt/severe cases

Question 6

Management of pneumonia

Answer 6

Antibiotics in accordance with local guidelines

Amoxicillin first-line for all children with pneumonia

Macrolides (erythromycin, clarithromycin or azithromycin) may be added if there is no response to first line therapy

Macrolides should be used if mycoplasma or chlamydia is suspected

In pneumonia associated with influenza, co-amoxiclav is recommended

IV antibioticscan be used when there is sepsis or a problem with intestinal absorption

Oxygen to maintain sats above 92%