Pneumonia in childhood

Learning Objectives

By the end of this session, students are expected to be able to:

·       Define pneumonia

·       Identify the clinical features of pneumonia in paediatrics

·       Identify the causative organisms of pneumonia

·       Formulate the diagnosis of pneumonia in paediatrics

·       Identify treatment of pneumonia in paediatrics

·       Identify complications of pneumonia

Definition of Terms

·       Pneumonia: An infection of lower respiratory tract characterized by inflammation of the lung parenchyma with consolidation of alveoli

·       Causative organism depending on age:

o   Neonates < 1 month – group B streptococci, E. Coli, Klebsiella, Chlamydia trachomatis

o   Infants

§  Viruses: RSV, adenovirus, measles virus

§  HIV and AIDS-related: Lymphoid Interstitial Pneumonitis (LIP), Pneumocystis jiroveci Pneumonia (PCP/PJP)

§  Bacteria and fungi: Streptococci pneumoniae, Haemophilus influenza

o   Children 

§  Bacterial: Streptococcus pneumoniae, Hemophilus influenzae, Group A streptococci, Mycoplasma pneumoniae

§  HIV and AIDS-related: Lymphoid Interstitial Pneumonitis (LIP), Pneumocystis jiroveci Pneumonia (PCP/PJP)

§  Secondary pneumonia

Clinical Features of Pneumonia

·       Usually following a Upper Respiratory Tract Infection (UTRI) the patient develops worsening fever, cough or difficulty in breathing

·       Tachypnea (fast breathing) is a key sign

·       Tachycardia

·       Fever

·       Refusal to feeding

·       The classic signs of consolidation might be present but they are difficult to detect in infants, crepitations/crackles might be present

·       In bacterial pneumonia, pleural inflammation causing chest or abdominal pain and an effusion may develop

Diagnosis of Pneumonia

·       Based on clinical presentation

·       Chest X-ray

• Not needed if diagnosis is clear and the patient responds to treatment
• Needed in complications and treatment failure:

§  Effusion

§  Pneumatocele

§  Abscess, TB (to be considered)

·       Blood

• A full blood count (FBC) not needed, but repeated ESR and Hb show the progress of recovery
• Blood culture
• Repeated blood culture when sepsis is suspected

·       Mantoux Test

• If poor response to treatment always consider Tuberculosis (TB)
• Mantoux test is not very sensitive in active pulmonary Tuberculosis (TB)

·       Gastric/nasopharyngeal aspirate

o   For Acid-fast bacilli stain (AFB), preferred method to diagnose TB

o   One may also take this opportunity to do a Gram stain

Note: Young children are unable to produce sputum and definitive diagnosis of bacterial infection remains difficult. The following suggest bacterial pneumonia: polymorphonuclear leucocytosis, lobar consolidation and pleural effusion.

Activity: IMCI Part I Video Segment Instructions The tutor will show a short video segment entitled ‘Counting respiratory rate in a child with cough or difficult breathing’. Take notes of key issues during the video, note down any questions and ask for clarification during discussion.

Treatment of Pneumonia

·       Treatment of pneumonia depends on severity, causative organism and age of the patient.

Refer to Handout 4.1: Classification of the Severity of Pneumonia and Treatment

Complications of Pneumonia

·       Abscess formation

·       Pleural involvement:  pleural effusion or empyema

·       Lung collapse (atelectasis)

·       Pneumothorax

·       Bronchiectasis

·       Cardiac failure

·       Septicaemia

·       Meningitis