Pulmonology Book

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Pneumonia in ChildrenAka: Pediatric Pneumonia

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  1. See Also
    1. Pneumonia
  2. Causes
    1. See Pneumonia Causes in Children
  3. History
    1. Age suggests cause and management
    2. Immunizations deficient
      1. Streptococcus Pneumoniae
      2. Haemophilus Influenzae
      3. Pertussis
    3. Recent hospitalizations
      1. Nosocomial Pneumonia
    4. Day care attendance
      1. Viral Pneumonia
    5. Contagious contacts
      1. Viral Pneumonia
      2. Mycoplasma pneumonia
      3. Tuberculosis
    6. Travel
      1. Influenza
      2. Severe Acute Respiratory Syndrome (Asia)
      3. Fungal Infection
        1. Blastomycosis
        2. Coccidioidomycosis (Southwestern U.S.)
        3. Histoplasmosis (Ohio and Mississippi River Valleys)
    7. Recent antibiotics
      1. Consider Antibiotic Resistance (e.g. PRP)
    8. Comorbid conditions
      1. Cardiopulmonary disease (e.g. Cystic Fibrosis)
      2. Immunodeficiency (e.g. Asplenic)
      3. Neuromuscular Disease
    9. Possible Ingestion
      1. Foreign Body Aspiration
      2. Toxin Ingestion
  4. Symptoms
    1. Respiratory symptoms (see signs below)
    2. Lethargy
    3. Irritability
    4. Decreased oral intake
    5. Dehydration (e.g. decreased urine output)
    6. Vomiting
    7. Diarrhea
    8. Abdominal Pain
  5. Signs
    1. Pneumonia unlikely without fever and Tachypnea
    2. Findings highly suggestive of Pneumonia
      1. Fever
        1. More commonly >101.3 F in Bacterial Pneumonia
      2. Cyanosis
      3. Respiratory distress (one or more of the following)
        1. Tachypnea
        2. Cough
        3. Nasal flaring
        4. Intercostal retractions
        5. Rales
        6. Decreased breath sounds
  6. Differential Diagnosis
    1. See Pneumonia
    2. Evaluate for alternative upper respiratory diagnosis
      1. Otitis Media
      2. Rhinorrhea
      3. Nasal Polyps
      4. Pharyngitis
  7. Labs
    1. Tests that are helpful
      1. Rapid viral antigens (e.g. Influenza Immunoassay)
      2. Oxygen Saturation (if respiratory distress)
    2. Tests helpful in severe cases (low yield if moderate)
      1. Gram Stain
      2. Blood Culture
    3. Tests possibly useful in retrospect (identify outbreak)
      1. Mycoplasma pneumoniae titer
      2. Chlamydia pneumoniae titer
    4. Tests which are usually not helpful for diagnosis
      1. Complete Blood Count (CBC)
      2. C-Reactive Protein (CRP)
      3. Erythrocyte Sedimentation Rate (ESR)
  8. Radiology: Chest XRay
    1. Indications
      1. Unclear diagnosis
      2. Prolonged Pneumonia or not responding to antibiotics
      3. Pneumonia complications
    2. Findings
      1. Chest XRay does not differentiate virus from bacteria
      2. Lobar consolidation
        1. More common in Bacterial Pneumonia
        2. May be seen in viral pneumona
      3. Interstitial Infiltrates
        1. More common in Viral Pneumonia
        2. May be seen in Bacterial Pneumonia
  9. Management
    1. See Pneumonia Management in Children
  10. Prevention: Immunization: Primary Series
    1. Rubeola
    2. Varicella Zoster Virus
    3. Pertussis
    4. Haemophilus Influenzae
    5. Pneumococcal Conjugate Vaccine (Prevnar)
    6. Influenza Vaccine
  11. References
    1. McIntosh (2002) N Engl J Med 346:429
    2. Nelson (2000) Pediatr Infect Dis 19:251
    3. Ostapchuk (2004) Am Fam Physician 70(5):899

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