Pneumonia

Question 1

Causes of pneuomnia

Answer 1

• 50% cases no aetiological agent found
• Viruses common younger children
• Bacteria common older children
• Newborn
  
  • _​_group B strep
  • Gram -ve enterococci
• Infants and young children
  
  • _​_RSV
  • Streptococcus pneumoniae
  • H. influenzae
  • Bordella pertussis
  • Chlamydia trachomatis
  • Staphylococcus aureus- rare but serious
• >5 yrs
  
  • ​Mycoplasma pneumoniae
  • Streptococcus pneumoniae
  • Chlamydia pneumoniae
• At all ages mycoplasma tuberculosis should be considered

Question 2

Natural history of pneumonia

Answer 2

• Preceding URTI
• Fever
• Difficulty breathing
• +/- cough, lethargy, poor feeding and ‘unwell child’
• Localised chest/ abdo/ neck pain ? pleural irritation ? bacterial infection
• Small proportion are associated with pleural effusion
  
  • blunting of costophrenic angle on CXR
  • empyema development
  • fibrin strands–> septations (difficult drainage)

Question 3

Clinical features of pneumonia

Answer 3

• Preceding URTI
• Fever
• Difficulty breathing
• +/- cough, lethargy, poor feeding and ‘unwell child’
• Localised chest/ abdo/ neck pain ? pleural irritation ? bacterial infection
• Examination:
  
  • ​tachypnoea
  • nasal flaring
  • chest indrawing
  • end-inspiratory coarse crackles
  • dullness on percussion (consolidated area)
  • decreased breath sounds
  • bronchial breathing over affected area
  • Low O2 sats
    *

Question 4

Treatment of pneumonia

Answer 4

• Admission w/
  
  • sats < 93%
  • severe tachypnoea
  • difficulty breathing/ grunting/ apnoea
  • diffuculty feeding
• O2
• Analgesia
• IV fluids
• Abx
  
  • childs age, severity and appearence on CXR
  • Newborns: broad-spectrum IV antibiotics
  • Older infants: amoxicillin (PO) + co-amoxiclav(complicated/ unresposive)
  • > 5 yo: amoxicillin or macrolide- erythromycin (PO)
• Drainage if emphysema
  
  • chest drain
  • fibrinolytic agent into intrapleural space urokinase
  • surgical decortication

Question 5

Advice to parents child with pneumonia

Answer 5

• FU generally not required in simple consolidation on CXR
• If CXR shows lobar collape, atelectasis or empyema repeat CXR 4-6 weeks
• Virtually all make full reocvery incl. those w/ empyema