Community acquired pneumonia(CAP) in children: Causes, Symptoms, Diagnosis & Treatments
Community acquired pneumonia is a leading cause of death in children under five in developing countries and accounts for 29% of all deaths worldwide for children under five years of age. The incidence of pneumonia is ten times higher in developing countries than in developed countries. Between 1939 and 1996 in the United States, children's pneumonia mortality declined by 97%. Haemophilus influenza type b (Hib) has been one of the major causes of bacterial pneumonia, but it has been reduced by the introduction of vaccines, which is thought to have decreased with the expansion of medical insurance for antibiotics, vaccines and children.
Causes
Most cases of pneumonia are caused by microbial infections, but food, gastric acid, foreign body aspiration, and hypersensitivity reactions are the noninfective causes. It is difficult to find the cause of pneumonia in individual patients. First, lung tissue biopsy is so invasive that it is rarely performed. 2) Sputum does not show the cause of lower respiratory tract infection. In children between 3 and 4 years of age, Streptococcus pneumoniae is the most common bacterial pathogen, and Mycoplasma pneumoniae and Chlamydophila pneumoniae are the most common causes of children over 5 years of age.
In children younger than 5 years, viral pathogens are an important cause of lower respiratory tract infections. Unlike Mosaic bronchitis, where Peak incidence is the first year of life, viral pneumonia has the highest incidence between 2 and 3 years of age, followed by a gradual decrease in incidence. Influenza virus and respiratory syncytial virus (RSV) are important pathogens of viral pneumonia. Other viruses include parainfluenza virus, adenovirus, rhinovirus, and human metapneumovirus.
Pathogenesis is also a little different depending on the cause microorganism. In the case of viral pneumonia, infection spreads along the airway, leading to direct injury of the respiratory epithelium, swelling, abnormal secretions, and cellular debris, resulting in airway obstruction. In the case of bacterial pneumonia, respiratory tract organism occurs when colonizing the organs and also by direct seeding of lung tissue after bactermia. M. pneumoniae attaches to the respiratory epithelium, inhibiting the ciliary action and inducing cellular destruction and inflammatory response of the submucosa.
Symptoms
In pneumonia, rhinitis and cough are associated with upper respiratory tract infection in a few days. Viral pneumonia has a fever and usually tachypnea. If you have a stethoscope, you can hear crackle or wheezing. Bacterial pneumonia is followed by high fever, cough, and chest pain after chills. Splinting appears in many children with pnuemonia to minimize pleuritic pain and improve ventilation. I can see that the children are lying on one side and putting their knees up to the chest.
Diagnosis
A definitive diagnosis of viral pneumonia is to isolate the virus from the respiratory secretion or to detect the viral genome or antigen. Bacterial infection can be a definitive diagnosis when isolation of bacteria from blood, pleural fluid, and lungs. Sputum culture has little diagnostic value. About 50% of patients with M. pneumonia infection have cold agglutinin at> 1:64 titer of blood.
Treatments
Amoxicillin is recommended for children who are mildly sick without requiring hospitalization. Children from neighborhoods with high rates of penicillin-resistant pneumococci prescribe high dose amoxicillin (80-90 mg / kg / 24hrs). Other treatments include cefuroxime axetil and amoxicillin / clavulanate. Macrolide antibiotics such as azithromycin are recommended for children with M. pneumoniae or C. pneumonia infection. Drugs such as respiratory quinolone can be considered in adolescents. Viral pneumonia may be suspected withholding antibiotics for a short time, but coexisting bacterial pathogens are also found in patients with a viral infection of 30%. Therefore, bacterial infection should also be suspected if the patient's clinical status deteriorates when antibiotics therapy is stopped.
In this patient, Tamiflu is being prescribed because it is treated with ubacilin (sulbactam + ampicillin) and KlaricidZithromax on the day of admission and is influenza B positive. Mycoplasma antibody test is negative and will be performed again. I use various antipyretics for fever control and continue to encourage percussion.
Causes
Most cases of pneumonia are caused by microbial infections, but food, gastric acid, foreign body aspiration, and hypersensitivity reactions are the noninfective causes. It is difficult to find the cause of pneumonia in individual patients. First, lung tissue biopsy is so invasive that it is rarely performed. 2) Sputum does not show the cause of lower respiratory tract infection. In children between 3 and 4 years of age, Streptococcus pneumoniae is the most common bacterial pathogen, and Mycoplasma pneumoniae and Chlamydophila pneumoniae are the most common causes of children over 5 years of age.
In children younger than 5 years, viral pathogens are an important cause of lower respiratory tract infections. Unlike Mosaic bronchitis, where Peak incidence is the first year of life, viral pneumonia has the highest incidence between 2 and 3 years of age, followed by a gradual decrease in incidence. Influenza virus and respiratory syncytial virus (RSV) are important pathogens of viral pneumonia. Other viruses include parainfluenza virus, adenovirus, rhinovirus, and human metapneumovirus.
Pathogenesis is also a little different depending on the cause microorganism. In the case of viral pneumonia, infection spreads along the airway, leading to direct injury of the respiratory epithelium, swelling, abnormal secretions, and cellular debris, resulting in airway obstruction. In the case of bacterial pneumonia, respiratory tract organism occurs when colonizing the organs and also by direct seeding of lung tissue after bactermia. M. pneumoniae attaches to the respiratory epithelium, inhibiting the ciliary action and inducing cellular destruction and inflammatory response of the submucosa.
Symptoms
In pneumonia, rhinitis and cough are associated with upper respiratory tract infection in a few days. Viral pneumonia has a fever and usually tachypnea. If you have a stethoscope, you can hear crackle or wheezing. Bacterial pneumonia is followed by high fever, cough, and chest pain after chills. Splinting appears in many children with pnuemonia to minimize pleuritic pain and improve ventilation. I can see that the children are lying on one side and putting their knees up to the chest.
Diagnosis
A definitive diagnosis of viral pneumonia is to isolate the virus from the respiratory secretion or to detect the viral genome or antigen. Bacterial infection can be a definitive diagnosis when isolation of bacteria from blood, pleural fluid, and lungs. Sputum culture has little diagnostic value. About 50% of patients with M. pneumonia infection have cold agglutinin at> 1:64 titer of blood.
Treatments
Amoxicillin is recommended for children who are mildly sick without requiring hospitalization. Children from neighborhoods with high rates of penicillin-resistant pneumococci prescribe high dose amoxicillin (80-90 mg / kg / 24hrs). Other treatments include cefuroxime axetil and amoxicillin / clavulanate. Macrolide antibiotics such as azithromycin are recommended for children with M. pneumoniae or C. pneumonia infection. Drugs such as respiratory quinolone can be considered in adolescents. Viral pneumonia may be suspected withholding antibiotics for a short time, but coexisting bacterial pathogens are also found in patients with a viral infection of 30%. Therefore, bacterial infection should also be suspected if the patient's clinical status deteriorates when antibiotics therapy is stopped.
In this patient, Tamiflu is being prescribed because it is treated with ubacilin (sulbactam + ampicillin) and KlaricidZithromax on the day of admission and is influenza B positive. Mycoplasma antibody test is negative and will be performed again. I use various antipyretics for fever control and continue to encourage percussion.
