Ira Shah
Pneumonia - Introduction
Pneumonia is infection of the lungs. Other lower respiratory tract infections seen in children are croup (laryngotracheobronchitis), bronchitis, and bronchiolitis.

Pneumonia results from direct inflammation of the lung tissue. Most commonly, it is the result of infections (bacterial, viral or fungal), but it can occur as a result of chemical injury (gastric acid/ aspiration of food/ hydrocarbon and lipoid pneumonia/ radiation induced pneumonia). The causative agent may reach the lung via the blood stream or from direct inhalation

The incidence of pneumonia in developing countries in children less than 5 years old is almost 30% with a high mortality rate.

Newborns:group B Streptococcus (GBS), respiratory syncytial virus (RSV).

Viruses: parainfluenza viruses, influenza virus, adenovirus, and respiratory syncytial virus (RSV). cytomegalovirus

Atypical organisms: Chlamydia trachomatis, Ureaplasma urealyticum, and Pneumocystis carinii (PCP). PCP is especially seen in children with immunodeficiencies.

Bacterial: B. pertussis, Streptococcus pneumoniae, Haemophilus influenzae, Haemophilus influenzae, mycobacterial tuberculosis.

Young children:
Viruses: parainfluenza viruses, influenza virus, adenovirus, and respiratory syncytial virus (RSV).

Atypical organisms: Mycoplasma pneumoniae.

Bacterial: Pneumococcus, mycobacterial tuberculosis.

Older children and adolescents:
Atypical organisms: Mycoplasma pneumoniae, Chlamydia trachomatis.

Bacterial: Pneumococcus, B. pertussis, mycobacterial tuberculosis.

Other rare causes of pneumonia:
Histoplasma capsulatum: It is found in nitrate rich soil from bird droppings and decaying wood. It is usually acquired as a result of inhalation of spores. The infection is usually asymptomatic; however, in infants and young children it may cause respiratory distress and hypoxemia.
Cryptococcus neoformans: is a common among pigeon breeders, seen in immunocompromised patients.
In older children, pneumonia may complicate common varicella infections

Neonates: Refusal of feeds, lethargy. Tachypnea, grunting, retractions, cyanosis.

Infants: Cough, fever, Refusal of feeds, lethargy.Tachypnea, grunting, retractions, cyanosis, wheezing, noisy breathing.

Preschoolers: cough, post tussive vomiting, fever, chest pain, abdominal pain.In severe cases: Tachypnea, grunting, retractions, cyanosis,

Older Children: fever, cough, chest pain, dyspnea. Pharyngitis and otalgia/otitis are other common symptoms.

The pathognomic sign of pneumonia is the presence of crackles (also called as crepitations). Localized crepitations in a febrile child without underlying lung disease is pneumonia until proven otherwise. However, not all children with pneumonia have crepitations. Decreased breath sounds with dull note on percussion and presence of bronchial breathing are also suggestive of pneumonia.

- Most children with uncomplicated pneumonia recover without sequelae. Persistent effusions and empyemas are the most common serious complications of bacterial pneumonia.
- Pulmonary abscess
- Respiratory distress
- Sepsis
- Pneumatoceles especially with staphylococcal infections

In children who have recurrent or chronic symptoms, further testing including skin testing to identify fungal pathogens, sweat chloride estimation to identify Cystic fibrosis, titers against rare organisms, and bronchoscopy may be required.

The prognosis for most forms of pneumonia is excellent.
- Most cases of viral pneumonia resolve without treatment; common bacterial pathogens and atypical organisms respond to antimicrobial therapy.
- The prognosis for varicella pneumonia is somewhat more guarded.
- Staphylococcal pneumonia, although rare, can be very serious despite treatment.
- Immunocompromised children, those with underlying lung disease, and neonates are at high risk for severe sequelae.
- Some forms of viral pneumonia, particularly adenoviral disease, tend to cause bronchiolitis obliterans and hyperlucent lung syndrome.

Pneumonia Pneumonia 01/02/2001
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