Pneumonia Flashcards
How many children does Pneumonia kill worldwide per year
How many kids get Pneumonia
1 million kid die
156 million get pneumonia per year
Biggest killer of kids <5yrs in the world ( after the neonatal period)
In Australia 2nd leading cause of death <5y age grp after the neonatal period. ( leading cause is injury0
<5year old worldwide pneumonia acconts for what proportion of death
1 : 6. Childhood deaths from pneumonia
Prevention of pneumonia
Vaccination Breast feeding Reducing smoking exposure Avoid environmental toxins Good hygiene HIV prevention and treatment
Which vaccination prevent pneumonia (4)
HIB. Pneumvax measles pertussis
ATSI children are more prone to pneumococcal Pneumonia
True 3x increased risk
So they have a different vaccination schedule
3x Prevanar13 and then 4th at 12 months and then PPV23 15years
Pneumonia often starts with an URTI. T/F
TRUE
SIGNS OF PNEUMONIA 2 KEY ONES
FEVER >38 C
TACHYPONEA at rest
Cough may be absent later sign
Where do you listen for the lingue or right ML in the lung
Axial last
Features suggestive of mycoplasma pneumonia
More common in school age children
Assoc symptoms. Headache /rash
Mycoplasma m/o has no cell wall
Wheeze /creptitations bilaterally
CXR bilateral worse than clinical presentation diffuse changes Bronchopneumonia
Diagnosis serology /cultures
Treatment Roxithromycin/azithromycin/ EES. Macrolide antibiotics
What things should you consider in TB with ? Pneumonia
Visiting an endemic region
Close Relative with active TB
Travel
With a history of travel what chest infections should you consider
Measles TB fungi
Risk factors for pneumonia
Premature infant Smoke exposure Low SES Chronic lung disease Chronic heart disease CF, Cilary dysfunction, Immunological def congenital or acquired Abnormal swallow or cough reflex. ( neuromuscular)
Pneumonia severity assessment
Mild oxygen sat normal (>92%) Normal color Temp <38.5 No or mild resp distress Normal heart rate Normal capillary refill
Severe Pneumonia Hypoxia ( O2 <92%) Cyanosis Mod-severe resp distress Difficulty breathing Temp>38.5 Altered mental status Or they have pneumonia with sepsis ( raised HR/LOW BP/cap refill slow)OR pneumonia with eye a
Pneumonia is a clinical diagnosis don’t need tests but which ones would you consider
MICRO Sputum c/s Viral NPA culture nad Pcr PNA pertussis Blood cultures?sepsis Mycoplasma/chlamydia
CXR not necessary in mild P CRP not necessary does not dd viral/bacterial FBC may aid dd viral/bacterial TB Histoplasmosis birds/bats
Who do you admit with Pneumonia
Severe pneumonia
People not getting better with mild
Children <12/12 of age
What are the DD of pneumonia (6)
Heart failure Bronchiolitis Sepsis Inhaled FB Metabolic acidosis Asthma exacerbation with viral induced illness
CXR in pneumonia when
Severe pneumonia
?CCF
Complications eg pl effusion
Management of mild pneumonia
Oxygen if necessary
Oral antibiotics amoxicillin 25-30mg /kg tds
IV benzepenicillin 60mg/kg QID
Mycoplasma macrolides roxithromycin 4mg /kg bd
Severe pneumonia treatment
Oxygen
Antibiotics
Fluids ( watch avoid SIADH)
Antibiotics 3rd generation cephalosporin 50mg/kg
Add in clindomycin 10mg/kg iv tds toxin clover staph strep
Add Azithromycin atypical
Add Vancomycin MRSA
A positive NPA viral rules out bacterial cause for pneumonia T/F
False 50% can have an associated bacterial infection
Bacterial pneumonia
Usually a lobar Pneumonia Pneumococcus/ S. Aurueus/ H Influenza common m/o Treat with an antibiotics for 7-10 days Complications pl effusion Emphysema Necrotising P Abscess Should respond to antibiotics in 48hours if does not consider addition of 3rd generation cephalosporin ( cephtriaxone 50mg /kg)if not responding to the antibiotics
Pneumococcus Pneumonia features
Normally use amoxicillin/ penicillin Vaccination reduces the incidence Normal kids prevenar13 x3 At risk eg ATSI 4th prevenar 13 at 12/12 And PPV23 at 15years
Staph aureus Pneumonia
If SEVERE Pneumonia always cover add in clindomycin good for toxins and if ?MRSA vancomycin
Viral pneumonia
Common viruses are RSV paraInfluenza Influenza A/B
Adenovirus. Usually from URT
Symptoms coryza, fever, coug
Signs are bilateral wheezing cracked recession reduced Oxygen stat
APONEA in infants
CXR hyperinflation diffuse patchy
NPA
Treatment is conservative management
But 50% have co infection so watch for need for antibiotics
Rare complication Bronchiolitis obliterans adenovirus
Or Bronchiectasis
Pneumonia in infants/neonates
Group B strep
Seen in prolonged rom, chorioamniocentesis prem labor
Associated with rapid deterioration in neonates
CXR shows diffuse / focal
Treatment iv ampicillin and gentamicin
Chlamydia Pneumonia first 3months of life 50% conjunctivitis Pneumonia 10-20% Dx conjunctival inclusion body /NPA culture /serology Treatment erythromycin 14/7 Chlamydia
Complications of pneumonia (8)
SIADH Pl effusion Empyma Necrotising P Lung abscess Resp failure ARDS Sepsis Bronchiectasis
Pleural effusion
Common complication of pneumonia Assoc with chest pain / dysponea Dull to percussion Decreased breath sounds Ix CXR/USS ( volume estimate type watery or thick/fibrous) Treatment Small conservative watch and antibiotics Large /resp distress. Drain
SIADH
Can be a complication of pneumonia
HypoNa+ and fluid retention
Treatment is fluid restrict 2/3 and very carefully replace Na+
Empyma
Extension of a pl effusion
Pus in the intrapl space
Consider this if fever >48hours despite proper antibiotics
Diagnosis CXR /USS fibrous strands thick
Treatment is antibiotics
Chest drain ( if very thick ?use urokinase to thin it down)
Aspiration ( likely to reaccumulate)
VATS surgical drainage
Monitor inflammatory markers
If pleural fluid is drained send for micro and cytology
Micro bacterial C/S
STAIN AFB
Step pneumonia Ag test
16SPCR
Cytology
Raised lymphocytes?malignacy /TB
Necrotising pneumonia
Rare/sever/sepsis
Often have a pl effusion
Abscess +/- broncholpleural fistula
Good prognosis if managed correctly
S. Aureus/ S pneumonia/ mycoplasma
Diagnosis CXR /CTscan ( esp if surgery being considered )
Treatment is prolonged antibiotics IV / +/- chest tube/ +/- surgery
Lung abscess
Can be part of necrotising pneumonia
Cavitation inflmatatory lesion
Can be caused by inadequate treatment of a lobar pneumonia
Can be assoc with an aspiration ( FB/Vomit)
CXR thick walled lesion with an air filled level
Pneumatocoele
Air filled /thin walled sac
Associated with Staph Aureus
Risk of broncholpleual fistula / pneumothorax
Associated with empyma
