Pneumonia (peds)

Background

- fever and tachypnea have high degree of sens but not specific

Causes

Common Causes

- viruses- rsv, influenza, parainflu, adeno, rhino, measles

- mycoplasma

- chlamydia- pneumoniae and trachomatis

- bacteria- strep, tb, staph, hflu, nontypable hflu

- measles and nontypable hflu common in undeveloped world

- c. pneumonia frequently recovered from asymptomatic subjects

Uncommon Causes

- viruses- varicella zoster, corona, entero, coxsackie, echo, cmv, ebv, mumps, hsv- newborns, hanta is animal exp,

- chlamydia psittaci

- coxiella

- bacteria- strep pyogenes, anaerobic mouth, hflu, pertussis, klebsiella, ecoli, listeria, nesseria, legionella, pseudomonas, tularremia, brucella, leptospira,

- Fungi- cocci, histo, blasto

Diagnosis

- cxr cannot differentiate between viral and bact pna (but lobar infiltrate more often bacterial)

WHO Criteria

1. Tachypnea

RR >50 (<1 yr old)

RR >40 (>1 yr old)

2. Retractions

Pneumonia: admit if <2 months, tx with azithromycin or clarithromycin after 3 months

Disposition

ADMIT

-< 3months

-SaO2 <91%

-severe dehydration

-moderate dehydration and unable to hydrate themselves orally after intravenous (IV) hydration

-moderate or severe respiratory distress

-failed outpatient antibiotic treatment, or

-unsafe to send home

Sources

Adapted from Donaldson, Pani