Pneumonia (peds): Difference between revisions

(Text replacement - "== " to "==")
No edit summary
(8 intermediate revisions by 3 users not shown)
Line 1: Line 1:
==Background ==
==Background==
*Most common site of infection in neonates
*Most common site of infection in neonates


Line 7: Line 7:
**[[Gram-negative bacilli]]
**[[Gram-negative bacilli]]
**[[Listeria monocytogenes]]
**[[Listeria monocytogenes]]
*1mo-3mo
*1-3 months
**[[Streptococcus pneumoniae]]  
**[[Streptococcus pneumoniae]]  
**[[Chlamydia trachomatis]]     
**[[Chlamydia trachomatis]]     
Line 13: Line 13:
**[[Bordetella pertussis]]   
**[[Bordetella pertussis]]   
**[[Staphylococcus aureus]]
**[[Staphylococcus aureus]]
*3mo-5yr
*3 months-5 years
**[[S. pneumoniae]]   
**[[S. pneumoniae]]   
**[[S. aureus]]   
**[[S. aureus]]   
Line 20: Line 20:
**[[C. trachomatis]]   
**[[C. trachomatis]]   
**[[Mycoplasma pneumoniae]]   
**[[Mycoplasma pneumoniae]]   
*5–18 y
*5–18 years
**[[M. pneumoniae]]   
**[[M. pneumoniae]]   
**[[S. pneumoniae]]   
**[[S. pneumoniae]]   
Line 36: Line 36:
{{Pediatric fever DDX}}
{{Pediatric fever DDX}}


==Diagnosis ==
==Evaluation==
*Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
*Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
*Imaging
*Imaging
**CXR is not the gold standard!
**[[CXR]] is not the gold standard!
**Cannot differentiate between viral and bact (but lobar infiltrate more often bacterial)
**Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
**Consider for:
**Consider for:
***Age 0-3mo (part of w/u for sepsis)
***Age 0-3mo (as part of sepsis work up)
***<5yr w/ temp >102.2, WBC >20K and no clear source of infection
***<5yr with temperature >102.2, WBC >20K and no clear source of infection
***Ambiguous clinical findings
***Ambiguous clinical findings
***PNA that is prolonged or not responsive to abx
***Pneumonia that is prolonged or not responsive to antibiotics
*Consider rapid assays for RSV, influenza
*Consider rapid assays for RSV, [[influenza]]
*Blood/nasal culture are low yield
*Blood/nasal culture are low yield


Line 55: Line 55:
''All Children less than 2 months should be hospitalized<ref>AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011</ref>''
''All Children less than 2 months should be hospitalized<ref>AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011</ref>''
===Consider Admission For===
===Consider Admission For===
*Age: 2-3 months old
*Age: <2-3 months old
*History of severe or relevant congenital disorders
*History of severe or relevant congenital disorders
*Immune suppression (HIV, SCD, malignancy)
*Immune suppression (HIV, SCD, malignancy)
*Toxic appearance/respiratory distress
*Toxic appearance/respiratory distress
*SpO2 <90-93%
*SpO2 <90-93%
*Vomiting/dehydration
*Unstable social environment


==See Also==
==See Also==

Revision as of 17:49, 19 April 2018

Background

  • Most common site of infection in neonates

Bugs by Age Group

Clinical Features

Fever and tachypnea are sensitive but not specific

  • Fever
  • Cough
    • Productive cough is rarely seen before late childhood

Differential Diagnosis

Pediatric fever

Evaluation

  • Absence of tachypnea, respiratory distress, and rales/decreased breath sounds rules-out with 100% sensitivity
  • Imaging
    • CXR is not the gold standard!
    • Cannot differentiate between viral and bacterial (but lobar infiltrate more often bacterial)
    • Consider for:
      • Age 0-3mo (as part of sepsis work up)
      • <5yr with temperature >102.2, WBC >20K and no clear source of infection
      • Ambiguous clinical findings
      • Pneumonia that is prolonged or not responsive to antibiotics
  • Consider rapid assays for RSV, influenza
  • Blood/nasal culture are low yield

Treatment[1]

Newborn

1-3 Month

>3mo - 18 years

Disposition

All Children less than 2 months should be hospitalized[9]

Consider Admission For

  • Age: <2-3 months old
  • History of severe or relevant congenital disorders
  • Immune suppression (HIV, SCD, malignancy)
  • Toxic appearance/respiratory distress
  • SpO2 <90-93%
  • Vomiting/dehydration
  • Unstable social environment

See Also

References

  1. Sanford Guide to Antimicrobial Therapy 2014
  2. Sanford Guide to Antimicrobial Therapy 2014
  3. Sanford Guide to Antimicrobial Therapy 2014
  4. Sanford Guide to Antimicrobial Therapy 2014
  5. Sanford Guide to Antimicrobial Therapy 2014
  6. Sanford Guide to Antimicrobial Therapy 2014
  7. Sanford Guide to Antimicrobial Therapy 2014
  8. Sanford Guide to Antimicrobial Therapy 2014
  9. AAP. Management of Communty-Acquired Pneumonia in Infants and Children Older than 3 Months of Age. Pediatrics. Vol 128 No 6 December 1, 2011