PNEUMONIA

TENGKU PUTRI CAMELIA

CLASSIFICATION
ANATOMICAL
DURATION & SYMPTOMS
AETIOLOGICAL FACTORS
IMMUNITY
SOURCE OF INFECTION
 CLASSIFICATION
ANATOMICAL DURATION OF AETIOLOGICAL
SYMPTOMS FACTORS
• Lobar or lobular • Persistent • Infective
Replacement of Persistence of Invasion of lung due to
alveolar air with symptoms & Xray microorganism
cellular exudates abnormalities >4weeks • Non infective
• Interstitial • Recurrent chemical
affects the tissue that 2 episodes -1 year OR
surrounds alveoli >3 episodes any time
Bronchopneumonia with X ray clearance
Spreading between 2 episodes of
inflammation of illness
terminal bronchioles
 IMMUNITY SOURCE OF INFECTION
• Primary • Community acquired
Caused by organism with Caused by organism
high virulence present in community of
• Secondary children that not
Organism with low hospitalized recently
virulence (immunity of • Hospital acquired
host Organism present at
diminished/predisposing hospital. =>48-72 hrs of
factor) hospital admission
• Opportunistic
Children with decreased
immunity
 Age
Congenital anomalies (cleft
palate/trachea oesophageal fistula)
Immunity status
Underlying lung disease (S. Aureus,
H.Influenzae, P. aeruginosa)
h/o exposure to infection
 CLINICAL FEATURES
SYMPTOMS SIGNS
• Onset may be insidious • Tachypnoea, dyspnoea
starting with high fever • Lower chest and intercostal
spaces retraction
• Cough • Consolidation in lobar
• Chest pain pneumonia
• Abdominal pain • Grunting respiration
• Poor feeding • Nasal flaring
• Irritability • Cyanosis
• Dullness on percussion
• Excessive sleepiness • Diminished breath sound,
wheeze, crackles on auscultation
PNEUMOCOCCAL PNEUMONIA

• Transmitted by droplets, common in winter

• Predisposing factor : overcrowding & reduced host resistance
• Incubation period : 1-3 days
PATHOGENESIS
Scattered area of
Bacteria multiply Inflammatory consolidation Lobar/lobular
in alveoli exudate that coalesce distribution
around bronchi
SYMPTOMS SIGNS
• Onset abrupt • Grunting (severe)
• Headache, chills, • Chest indrawing
cough, high fever • Cyanosis
• Cough initially dry but • Air entry diminished
may a/w thick rusty • Crepitation and
sputum bronchial breathing
• Chest pain referred to over areas of
shoulder/abdomen consolidation
• Fast breathing • Bronchophony and
• Difficulty in feeding whispering
pectoriloquy
DIAGNOSIS
• History, examination, X ray findings of lobar
consolidation, leukocytosis
• Sputum examined by gram staining and
culture
• Blood culture may be positive in 5-10% cases

TREATMENT
• Penicillin G 5000 IU/kg/day IV or IM in
divided doses for 7 days
• Therapy with IV cefotaxime, ceftriaxone or
coamoxiclav
 • Occurs in infancy and childhood

After some time, pneumonic lesions suppurate resulting

in broncho alveolar destruction

Multiple micro abscess formed which erode bronchial

wall and discharge their contents in the bronchi
• May cause purulent
pericarditis
Air enters abscess cavity during inspiration • Empyema <2y/o nearly
always staphylococcal
Formation of pneumatoceles aetiology
TREATMENT
• Fever-antipyretic and hydration (IV fluid)
• Oxygen administered (relief dyspnoea and cyanosis)
• Antibiotic therapy (penicillin G, coamoxiclav, cloxacillin or
ceftriaxone). If does not respond, vancomycin, teicoplanin
or linezolid used. Prolonged therapy (2-6 weeks)

COMPLICATIONS
• Empyema & pyopnemothorax – intercostal drainage under
water seal or low pressure aspiration
• Metastatic abscesses – surgical drainage
• Significant pleural thickening – decortication by open
thoracotomy or thoracoscopic surgery
Reference
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PNEUMONIA
MEEA ARISSA BINTI MOHD NOH
150385
 HAEMOPHILUS PNEUMONIA
• H. Influenza infections occur between 3 months and 3 years old.
• Infections begin in nasopharynx and spreads locally or through blood.
• Present with moderate fever, dyspnea, grunting and retraction of lower intercostal
spaces.
• Complications : bacteremia, pericarditis, empyema, meningitis and polyarthritis.
• Best treated with parenteral ampicillin (100mg/kg/day) and coamoxiclav.
• Cefotaxime (100mg/kg/day) and ceftriaxone (50-75mg/kg/day) are satisfactory
agents for therapy.
 STREPTOCOCCAL PNEUMONIA
• Streptococcal infection by group A beta hemolytic streptococci may follow measles,
varicella, influenza or pertussis.
• Onset is abrupt with fever, chills, cough, dyspnea, rapid respiration and blood streaked
sputum.
• Radiograph shows interstitial pneumonia with segmental involvement, diffuse
peribronchial densities or an effusion, which needs to be distinguished with primary
atypical pneumonia.
• CBC: neutrophilic leukocytosis.
• Penicillin G 50,000 to 100,000 IU/kg body weight, daily in divided doses for 7-10 days.
 PRIMARY ATYPICAL PNEUMONIA
• Etiological agent : mycoplasma pneumoniae, chlamydia and legionella spp.
• Disease transmitted by droplet infection and uncommon below 4 years of age.
• Incubation period is 12-14 days and onset may be insidious or abrupt.
• Initial symptoms: malaise, headache, fever, sore throat, myalgia and cough.
• Physical signs: mild pharyngeal congestion, cervical lymphadenopathy and a few crepitations.
• Xray: infiltrates one lobe, poorly defined hazy or fluffy exudates radiate from hilar region (occasionally
with enlarged hilar lymph node and pleural effusion)
• Acute stage: IgM antibody by ELISA and IgG antibodies after 1 week.
• Treat with macrolide antibiotics ( erythromycin, azithromycin, clarithromycin) or tetracycline for 7-10
days.
 PNEUMONIA DUE TO GRAM
NEGATIVE ORGANISM
• E.coli, Klebsiella and Pseudomonas affect small children <2 months old, children
with malnutrition and poor immunity.
• Onset of illness is gradual and assumes serious proportions.
• Radiograph: multiple area of consolidation; those with E.coli or Klebsiella
pneumoniae may have pneumatoceles.
• Treatment: IV cefotaxime or ceftriaxone (75-100mg/kg/day) with or without an
aminoglycoside for 10-14 days.
• Pseudomonas infection: ceftazidime is drug of choice
 VIRAL PNEUMONIA
• Respiratory syncytial virus is chief cause for children under 6 months of age.
• At other age, parainfluenza, influenza and adenoviruses are common
presenting with extensive interstitial pneumonia.
• Clinical sign of consolidation are absent.
• Radiological sign: perihilar and peribronchial infiltrates.
 ALIPHATIC HYDROCARBON
ASSOCIATED PNEUMONIA
• Kerosene exerts its toxic effects on lungs and CNS.
• Since kerosene has low viscosity and low surface tension, it diffuse quickly from
pharynx into the lungs.
• Features: cough, dyspnea, high fever, vomiting, drowsiness, and coma.
• Xray: ill defined homogenous or patchy opacities, and may resemble miliary
mottling.
• Treatment: removal from exposure, protection of airway and treatment of
hypoxemia.
 LOEFFLER SYNDROME
• Larvae of many nematodes enter portal circulation and pass through hepatic
vein and IVC into the heart and lungs.
• In the lungs, larvae penetrate the capillaries, enter the alveoli, and block
bronchi with mucus and eosinophilic material.
• Clinical features: cough, low fever and scattered crepitations.
• Radiograph: pulmonary infiltrates of varying sizes that superficially resemble
miliary TB.
REFERENCES