pneumonia in children & lung abscess

8/9/2019 Pneumonia in Children & Lung Abscess

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PNEUMONIA IN CHILDREN

dr.Rodman Tarigan,SpA.,MKes


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HISTORY OF THE TERM


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1603 : The frst record or using this word in English

language

Until 1822: pneumonia =pneumonitis

ince 1!60s : attempts to distinguish these two terms

"#EU$%#&' : in(ammator) conditions *inecti+e condition,

"#EU$%#&T&: in(ammator) conditions *non inecti+e,

- not consistentl) applied- anomalies

*i.e: rheumatic pneumonia and rheumatic pneumonitis

/oth are associated with +aricella inection,

TE E"&'T% &E'E descri/ed /) ""%4'TE*5th centur) 4, and called 7"E&"#EU$%#&'


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pneumonia inecti+e condition

pneumonitis non-inecti+e condition*such as radiation-induced lung

in9ur),

This distinction is not consistent

#ow :


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DEFINITION


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#o single defnition o pneumonia: thereis contro+ers) on how /est to defne it

efnitions ma) depend upon:

the use the) are putthe o/9ecti+es

(I.e. health-care worker in the feld in developingcountry may dier rom that employed in clinical studyin a developed country)


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' clinical illness defned in terms othe clinical s)mtoms and signs andit course

"#EU$%#&'

Two typical clinical defnition :ronchopneumonia:

e!rile illness" cough" respiratory distress" rale onphysical e#amination" chest $-ray evidence o

locali%ed or geneli%ed patchy infltrate

;o/ar pneumonia:&imilar to !ronchopneumonia e#ept that physical

e#amination and chest $-ray indicate lo!ar

consolidation

#%TE: in man) de+eloping countries


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Lower lobe pneumonia


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% E>&T&%#


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4ountries limited health-care aciliti

"#EU$%#&' a e/rile illness with tach)pn

- The gold standard or the diagnosis o pneumonia inan am!ulatory setting in developing countries

- This !oard defnition results in the inclusion opatients who do not have pneumonia !ut othercondition" i.e. asthma and systemic inection

- ' sensitivity or pneumonia

- rom * pneumonia detected !y +, criteria *- have severe pneumonia" and pro!a!ly have

-


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E"&E$&%;%?


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>E4T&%# %> ;%E E"&'T% T'4T = ;&including croup /ronchiolitis pneumonia mostcommon pro/lem(/ illmesses0' children less than 1 years o age)

$ost o these episodes are "#EU$%#&'

&n de+eloping countries "#EU$%#&' occurs 2-10

times more re@uentl) in children and isresponsi/le or

a @uarter o all death in underf+e children

(The incidence o 2cute respiratory tract inections3


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a5ow !irth weight!6ormal !irth weight

'nnual incidence opneumonia per 100'ge *)ears,"lace

e+eloped countr) 7hapel ,ill" 8&2 &eattle" 8&2

e+eloping cou/tr) 9angkok" Thailand adchiorii" India ilgit" ;akistan enny ?+. @ ;A>I2T4 'B1C 'B:1/-D1)


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& >'4T%:- low !irth weight

- poor nutrition (general and vitamin 2defciency)

- nasopharingeal carrage o pathogens"- enviromental actors

h l i


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"lace

e+eloped countr) ote!org"&weden 6orth +ales" 8=

6e!raska" 8&2 6orth 7arolina" 8&2 Eirginia" 8&2

e+eloping cou/tr) 9asse" am!ia


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ETIOLOGY


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- The etiologi very with the age, immunologyc status,some

enviromental conditions

'. >E4T&%# (viral" !acterial" mycoplasma"chlamydia"

parasites" ungi" myco!acterium"ricketsia) Hiruses account or the ma9orit) o cases*H

adeno+irus parain(uenGa and in(uenGa+irus,

2. #%#->E4T&%# (ood aspiration" oreign !ody"drugs" radiation" etc)


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-Factors increase the risk of bacterial pneumoniaconginetal anatomic defectsdeficits in immun function (by drug or diseasede!elopmental and genetic disease

(trac"eoesop"ageal fistula# cystic fibrosis# etcaspiration of a foreign bodygastroesop"ageal reflu$mec"anical !entilationprolonged "opitali%ation


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3 month- B )earsA 3 month"athogen

Streptococcus pneumoniaeHirusesEnteric /acilli

?roup streptococciChlamydia trachomatisStaphylococcus aureusHaemophilus infuenzaeGrup A strreptococci

Mycoplasma pneumoniaeChlamidia pneumoniae

IIIIII

I

-II

IIII

III

J B )ears

IIIIIIIII

IIIIIIIII-

-

IIIIII

-

III

IIIII

III +er) re@uentK II moderatel) re@uentK I rareK - a/

>re@uenc) o pathogens in communit)-ac@uiredchildhood pneumonia in de+eloped countries


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CLINICAL MANIFESTATION


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T)pical eatures o /acterial +iral and m)coplasmapneumonia in children

Hiralacterial

'geeason%nset>e+er

Tach)pnea4ough'ssosiated s)mptoms

"h)sical fndings

;euLoc)tosisadiographic fndings

"leural eMusion

$)coplasma

'n)inter'/ruptigh

4ommon"roducti+e$ild cor)Ga'/dominal painE+idence o consolidation

>ew cracLles4ommon4onsolidation

4ommon

'n)interHaria/leHaria/le

4ommon#onproducti+e4or)Ga

Haria/le

Haria/leilateral diMuse infltratesare*adeno+irus,

B-1B )ears'll )ear&nsidious;ow grade

Uncommon#onproducti+eullous m)ringit"har)ngitis>ine cracLleseeGing

UncommonHaria/le

mall in 10-20F


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RADIOGRAPHIC EXAMINATION


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Remain the diagnostic mainstay in

childhoodpneumonia, support the clinicalimpression

and dening extent the disease

Posteroanterior and lateral view o !"rayshould #e made

Pneumomatoceles and pleural eusions reuently assosiated with !taphyloccocal

pneumonia


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DIAGNOSISDIAGNOSIS


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MANAGEMENT


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COMPLICATIONS


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)* Empyema

+* Lung abscess

,* Pneumot"ora$

* Pericarditis

.* Pneumatocele


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pneumonia in children & lung abscess

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