Pneumonia in Children

PNEUMONIA IN CHILDREN
Dr JD Kabamba
LECTURE OUTLINE
1. Introduction
2. Definition
3. Etiology
4. Epidemiology
5. Pathogenesis
6. History and Clinical features
7. Investigations
8. Complications
9. Management
10. Prevention
INTRODUCTION
Globally, pneumonia is a significant cause of morbidity and mortality in
children younger than 5 years throughout the world, particularly in
developing countries.
The introduction of immunisation ( Hib and Pneumococcal) has drastically
reduced the in the incidence and mortality due to pneumonia.
DEFINITION
Pneumonia is an inflammation of the parenchyma of the lungs.

Most cases of pneumonia are caused by microorganisms, but
there are several non-infectious causes, which include:
- Aspiration of food
- Gastric acid
- Foreign bodies
- Hydrocarbons
- Lipoid substances
- Hypersensitivity reactions
- Drug or radiation-induced pneumonitis.
ETIOLOGY
Causes of pneumonia in children can be classified by age-specific versus
pathogen-specific organisms
Neonates:
Early-Onset: 2-5 years
• Group B streptococci . Streptococcus pneumoniae
• Klebsiella pneumoniae . Hemophilus influenzae
• Escherichia coli . Respiratory viruses
• Listeria monocytogenes
Late onset: 5 years and above

• Streptococcus pneumoniae . S. pneumoniae
• Streptococcus pyogenes . Mycoplasma pneumoniae
• Staphylococcus aureus
S. Pneumoniae is still the most commonly identified organism in children of 5 years and above.
EPIDEMIOLOGY
An estimated 120 million cases of pneumonia occur annually worldwide,
resulting in1.3 millions deaths.
Children below the age of 2 years in the developing world, account for nearly
80% of paediatric deaths secondary to pneumonia.
The introduction of vaccines ( Hib and pneumococcal) has to a certain degree

reduce the risk of pneumonia in developing countries
PATHOGENESIS
Pneumonia is due to an invasion of the lower respiratory tract, below the larynx
by pathogens either by inhalation, aspiration, respiratory epithelium invasion or
hematogenous spread.
The infection breaches the anatomical barriers, humoral and cellular immunity
either by fomite/droplet spread ( mostly viral) or nasopharyngeal colonisation (
mostly bacterial). This leads to inflammation causing an exudative process, which
in turns impairs oxygenation.
There are 4 stages of lobar pneumonia:
1. Alveolar oedema and vascular congestion: within 24 hours
2. Red hepatisation: consolidation due to RBCs, neutrophils and desquamated
epithelial cells associated with fibrin deposits in the alveoli
3. Gray hepatisation: 2 -3 days later. Lung appear dark brown. There
accumulation of of hemosiderin and hemolysis of RBCs
4. Resolution: cellular infiltrate is resorbed and the pulmonary architecture is
restored.
HISTORY
• Duration of symptoms
• Exposures, travel,
• Sick contacts
• Baseline health of the child
• Chronic diseases
• Recurrent symptoms
• Immunisation history
• Maternal health
• Birth complications in neonates.
CLINICAL FEATURES
1. Symptoms:
 Cough
 Body hotness
 Fast and difficult breathing
 Feeding difficulty in infants
2. Signs:
 Tachypnoea
 Inter and sub-costal recessions
 Nasal flaring
 Cyanosis
 Sa O2 < 90% on room air
PHYSICAL EXAMINATION
Inspection
• ill-looking
• chills/rigors
• Inter and sub-costal recessions
• Nasal flaring
• cyanosis
Palpation
• decreased chest expansion or asymetry
• lymphadenopathy
• increased tactile fremitus
Percussion
• dull
• decreased diaphragmatic excursion
Auscultation
• bronchial breath sounds in periphery
• decreased air entry
• crepitations ( coarse crackles )
• bronchophony -voice heard abnormally clearly over consolidated lung
• egaphony - listen to patient's chest as they make "e" sound, if +'ve will hear an "a" sound
• whispering pectoriloquay - pt whispers "1, 2, 3, 4", if clear then extreme consolidation
RESPIRATORY RATES IN CHILDREN
INVESTIGATIONS
1. FBC + Acute phase reactants ( ESR and CRP)

2. CXR
3. Blood culture
4. Serology is being used to determine the presence of
mycoplasma, legionella, and chlamydia species.
Non homogenous opacity
in the right mid-zone
Homogenous opacity in
the right lower zone
TREATMENT
Treatment should be targeted to a specific pathogen that is

suspected based on information obtained from history and
physical exam.
1. Supportive and symptomatic management is key and
includes supplemental oxygen for hypoxia, antipyretics for
fever, and fluids for dehydration.
2. Specific antibiotics
3. Promote good nutrition + breastfeeding
COMPLICATIONS
1. Empyema: a collection of pus in the pleural cavity

2. Pleural effusion:build-up of excess fluid between the layers
of the pleura outside the lungs
3. Lung abscess
4. Necrotizing pneumonia*
5. Sepsis
PREVENTION
1. Avoid overcrowding
2. Immunisation:
– Pneumococcal conjugate (PCV)
– Haemophilus influenzae type b (Hib)
– Pertussis (whooping cough)
– Measles
3. Observe general hygiene
4. Breastfeeding during the first 6 months of life
5. Promote good nutrition
END

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PNEUMONIA IN CHILDREN

Pneumonia is an inflammation of the parenchyma of the lungs.

Late onset: 5 years and above

The introduction of vaccines ( Hib and pneumococcal) has to a certain degree

1. FBC + Acute phase reactants ( ESR and CRP)

Treatment should be targeted to a specific pathogen that is

1. Empyema: a collection of pus in the pleural cavity

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