Pneumonia

Question 1

Pneumonia - background

Answer 1

1. Definition = infection of lower respiratory tract and lung parenchyma that leads to consolidation
2. Viruses account for 15-35% of CAP in childhood; in up to 60% of cases, a pathogen is not found

Common infecting bacterial agents by age:

3. Neonates = GBS, E. coli, Klebsiella
4. Infants = Streptococcus pneumoniae, Chlamydia
5. School age = Streptococcus pneumoniae, Staphylococcus aureus, Mycoplasma pneumoniae

Question 2

Pneumonia - RF

Answer 2

1. Congenital lung cysts
2. Chronic lung disease
3. Immunodeficiency
4. Cystic fibrosis
5. Sickle cell disease

Question 3

Pneumonia - symptoms

Answer 3

1. Dyspnoea
2. Fever
3. Malaise
4. Pleuritic chest pain - often present. If pneumonia involves the apices, neck pain may be present and can be confused with neck stiffness of menignism. If diaphragmatic pleural surface is involved, pain can be referred to the abdomen or shoulder tip
5. Cough - may be dry or moist, but not always present. Sputum production generally in older children (>7y)

Question 4

Pneumonia - signs

Answer 4

1. Tachypnoea and respiratory distress
2. Dullness to percussion
3. On auscultation, localised crackles + bronchial breathing
4. Cyanosis is rare, but low levels of oxygen saturation are common

5.*Of the signs above, tachypnoea is the most consistent and reliable, and may be the only sign pointing to this dx.

What is the relevance of lethargy/conscious state?

Complications = pleural effusion, pneumothorax

Question 5

Pneumonia - ix

Answer 5

1. CXR - most reliable ix to confirm dx of pneumonia. Repeat X-ray to establish resolution of pneumonia (preferably 4-6wks after acute illness has settled down)
2. Blood cultures if clinically indicated (but bacteraemia not common in bacterial pneumonia)
3. Nasal aspirate + PCR if dx unclear or viral etiology suspected
4. Sputum culture - often difficult to obtain sputum and of limited usefulness due to contamination by upper airway bacteria
5. Pleural fluid (aspirated sample) - when there is a significant pleural effusion

Question 6

Pneumonia - mx (overview)

Answer 6

1. Admit to hospital if (4)

Question 7

Pneumonia - mx (abx)

Answer 7

1. Birth to 5y mild disease
   - Amoxycillin 25mg/kg up to 1g orally, TDS 5d
2. > 5y M. pneumonia (or other atypical pathogen
   - Doxycycline (child 5y severe disease
   - Cefotaxime 50mg/kg up to 1g IV TDS or ceftriaxone 50mg/kg up to 1g IV daily, plus flucloxacillin 50mg/kg up to 2g IV QID (plus azithromycin 10mg/kg up to 500mg IV daily if atypical pathogen suspected)