Pneumonia (peds)

Background

fever and tachypnea have high degree of sens but not specific

Causes

Common Causes

1. viruses- rsv, influenza, parainflu, adeno, rhino, measles
2. mycoplasma
3. chlamydia- pneumoniae and trachomatis
4. bacteria- strep, tb, staph, hflu, nontypable hflu
5. measles and nontypable hflu common in undeveloped world
6. c. pneumonia frequently recovered from asymptomatic subjects

Uncommon Causes

1. viruses- varicella zoster, corona, entero, coxsackie, echo, cmv, ebv, mumps, hsv- newborns, hanta is animal exp,
2. chlamydia psittaci
3. coxiella
4. bacteria- strep pyogenes, anaerobic mouth, hflu, pertussis, klebsiella, ecoli, listeria, nesseria, legionella, pseudomonas, tularremia, brucella, leptospira,
5. Fungi- cocci, histo, blasto

Diagnosis

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

WHO Criteria

1. Tachypnea
   1. RR >50 (<1 yr old)
   2. RR >40 (>1 yr old)
2. Retractions

Treatment

tx with azithromycin or clarithromycin after 3 months

Disposition

ADMIT

1. <3months old
2. SaO2 <91%
3. severe dehydration
4. moderate dehydration and unable to hydrate themselves orally after intravenous (IV) hydration
5. moderate or severe respiratory distress
6. failed outpatient antibiotic treatment, or
7. unsafe to send home

Sources

Adapted from Donaldson, Pani