Pneumonia

Dr. Md. Saddam HossainMBBS (PMC,DU)

Bangladesh

Phone No.: +8801770980080

PneumoniaDefinition : Pneumonia is an inflammatory condition of the lung affecting primarily the microscopic air sacs known as alveoli.

Epidemiology:

• Pneumonia causes 28–34% of all deaths in those under five years of age of which 95% occur in the developing world.

• Countries with the greatest burden of disease include: India (43 million) China (21 million) Pakistan (10 million).

Types of Pneumonia :

1. According to involvement of lung tissue : a. Bronchopneumonia b. Lobar Pneumonia2. According to source: a. Community acquired Pneumonia b. Nosocomial Pneumonia c. Pneumonia in special situation (aspiration pneumonia, opportunistic pneumonia)3. According to severity (IMCI) : a. Severe Pneumonia or very severe disease b. Pneumonia c. no pneumonia

Risk Factors for Pneumonia of pediatric age group:1. Preterm baby2. Malnutrition 3. cystic fibrosis 4. asthma 5. Diabetes 6. heart failure 7. weak immune system.

Causes of Pneumonia:

A. Infectious:

1. Bacteria: Streptococcus pneumonia (50%) Haemophilus influenza(20%) Chlamydophila pneumoniae (13%) Mycoplasma pneumoniae (2%) Staphylococcus aureus Moraxella catarrhalis Legionella pneumophila Gram-negative bacilli Chlamydia psittaci Coxiella burnetti Pseudomonas aeruginosa

2. Viruses: rhinoviruses coronaviruses influenza virus respiratory syncytial virus (RSV) adenovirus, and parainfluenza Herpes simplex virus3. Fungi: Histoplasma capsulatum blastomyces Cryptococcus neoformans Pneumocystis jiroveci (pneumocystis pneumonia), Coccidioides immitis

4. Parasites: Toxoplasma gondii Strongyloides stercoralis Ascaris lumbricoides, and Plasmodium malariae

B. Non-infectious:

Idiopathic interstitial pneumonia diffuse alveolar damage, organizing pneumonia, nonspecific interstitial pneumonia, lymphocytic interstitial pneumonia, desquamative interstitial pneumonia, respiratory bronchiolitis interstitial lung usual interstitial pneumonia.

Organisms causing Pneumonia in different age group :

Age Organisms

Neonatal period • E. coli• K pneumonia• Group B streptococcus

After neonatal period

• S. pneumoniae• H. influenzae type B• S. aureus• viruses

Beyond 5 years • Mycoplasma• Chlamydia

Clinical Features:

Symptoms: Fever Cough Respiratory distress

Signs: Fast breating Chest indrawing Features of hypoxemia : low SpO2, cyanosis, head nodding

Fast breating: 0 to 2 months: Respiratory rate> 60/min 2 months to 12 months: RR > 50/min 1 year to 5 year : RR > 40/min

InvestigationsName of investigations Probable Findings

1. X-Ray chest In CONSOLIDATION: Homogenous radio-opacity in any area of the lung field.In Bronchopneumonia: Patchy opacities are seen in different areas of lung field.

2. Complete blood counts Polymorphonuclear leukocytosisESR: high

3. Blood CS May show growth of organisms

Treatment

1. Counselling2. Supportive Treatment : Oxygen therapy: if Cyanosis or SpO2 less than 92% Paracetamol for fever Salbutamol for wheeze Clear nose with normal saline drop soothe the throat, relieve cough with a safe remedy(warm water, tulsi leaf juice, lemon tea)

3. Specific Treatment :

a. Bacterial: Severe Pneumonia: Hospitalization Parenteral Ampicillin/ Amoxicillin Pneumonia: Oral Amoxicillin

Other antibiotics: Cloxacillin, Ceftriaxone

b. Viral: Influenza A : rimantadine or amantadine Influenza A or B: oseltamivir, zanamivir or peramivir

C. Aspiration Pneumonia: Clindamycin Beta lactam Metronidazole Aminoglycosides

Prevention of Pneumonia:

1. Vaccinations2. Medications3. Others: prevention of air pollution, avoiding of passive smoking of children

Complications if untreated or maltreated: Pleural effusion Empyema Lung abscess Pneumothorax Heart Failure Septicemia Dissemination to other organs: meninges, bones, joints etc.

Pneumonia in IMCI: