Lower respiratory tract infection - Pneumonia and bronchiolitis

1. LOWER RESPIRATORYTRACTLOWER RESPIRATORYTRACT
INFECTION:INFECTION:
- PNEUMONIA- PNEUMONIA
- BRONCHIOLITIS- BRONCHIOLITIS
NURSYUHADA BINTI MD SAAD
082014100013
PEDIATRICS

2. PNEUMONIAPNEUMONIA
Consolidation of alveoli or infiltration of
interstitial tissue with inflammatory cells or
both

3. X-RAYX-RAY
NORMAL PNEUMONIA

4. • Classified
lobar pneumonia affect a
lobe or entire lung
bronchopneumonia consist
of multiple foci of suppurative
inflammation around
bronchioles
interstitial pneumonia
involves alveolar septa

6. LOBAR
PNEUMONIA
BRONCHOPNEUMONIA INTERSTITIAL
PNEUMONIA
AGE GROUP Any age group Infancy and old age Any age group
PREDISPOSING
FACTORS
High virulent
organism
• Congestive cardiac failure
• Disseminated malignancy
• Extension of pre-existing
bronchitis and bronchiolitis
• Malnutrition
• Alcoholism
• Underlying
debilitating
illnesses
ETIOLOGIC
AGENTS
Strep.
pneumoniae
• Staphylococci
• Streptococci
• Pneumococci
• H. influenza
• Pseudomonas aeruginosa
• Coliform bacteria
• Mycoplasma
pneumoniae
• Chlamydia
• Coxiella burnetti

7. LOBAR
PNEUMONIA
BRONCHOPNEUMONIA INTERSTITIAL
PNEUMONIA
DISTRIBUTION Consolidation of
large area of one
or whole lobe
Patchy consolidation of more
than one lobe of lung
Involvement of
patchy or whole
lobes unilaterally or
bilaterally
MICROSCOPIC
FEATURES
Inflammatory
exudate
Inflammatory exudate Composed of
lymphocytes,
virtually localised
within alveolar
walls

8. ETIOLOGYETIOLOGY
Bacteria
Viral
Atypical Organism
Fungi
Parasites
Others

9. AGE AGENTS
2 months Gram negative (Klebsiella, E. coli)
Gram positive (Pneumococci,
Staphylococci)
3 months and 3 year Strep. Pneumoniae, H. influenza,
Staphylococci
After 3 year Pneumococci, Staphylococci
BACTERIA

10. VIRUS FUNGI ATYPICAL
ORGANISM
PARASITE
• Respiratory
syncytial virus
• Influenza
• Parainfluenza
• Adenovirus
• Pneumocystis
jiroveci
• Histoplasmosis
• Coccidioidomycosis
• Chlamydia
• Mycoplasmosis
spp.
• Ascaris
OTHERS
• Aspiration of food
• Oily nose drops
• Liquid paraffin
• Kerosene poisoning

12. CLINICAL FEATURESCLINICAL FEATURES

13. LOBAR PNEUMONIA
PNEUMOCOCCAL PNEUMONIA

14. PNEUMOCOCCAL PNEUMONIAPNEUMOCOCCAL PNEUMONIA
PNEUMOCOCCAL
PNEUMONIA
• Infection due to Strep. Pneumoniae
• Transmitted by droplets
• Winter months
CLINICAL FEATURES Headache, chills, cough, high fever, pleuritic
chest pain, grunting, chest indrawing,
cyanosis, dysphagia
TREATMENT • Antibiotic therapy : penicillin, amoxycillin
• Oxygen

15. BRONCHOPNEUMONIA
STAPHYLOCOCCAL PNEUMONIA
HAEMOPHILUS PNEUMONIA
STREPTOCOCCAL PNEUMONIA

16. STAPHYLOCOCCALSTAPHYLOCOCCAL
PNEUMONIAPNEUMONIA
STAPHYLOCOCCAL
PNEUMONIA
• Occurs in infancy and childhood
CLINICAL MANIFESTATION Pyoderma or purulent disease, toxic and sick
looking, cyanosis, metastatic abscesses in
joints, bone, muscles, pericardium, liver
TREATMENT • Hospitalised and isolated
• Oxygen
• Intravenous fluids
• Antipyretics
• Antibiotic therapy
COMPLICATIONS Pneumatoceles, empyema, pyopneumothorax,
metastatic abscesses, pleural thickening

17. HAEMOPHILUS INFLUENZAHAEMOPHILUS INFLUENZA
HAEMOPHILUS INFLUENZA • Age between 3 months and 3
years associated bacteremia
• Begin in nasopharynx
CLINICAL FEATURES Moderate fever, dyspnea, grunting
respiratory, retraction of lower
intercostal spaces
COMPLICATION Bacteremia, pericarditis, empyema,
meningitis, polyarhritis
TREATMENT Ampicillin, cefotaxime

18. STREPTOCOCCAL PNEUMONIASTREPTOCOCCAL PNEUMONIA
STREPTOCOCCAL
PNEUMONIA
• Infection by group A beta hemolytic
streptococci (secondary to measles,
chickenpox, influenza, whooping
cough)
CLINICAL FEATURES Fever, chills, dyspnea, rapid respiration,
blood streaked sputum, cough, extreme
prostration
COMPLICATIONS Thin serosanguineous or purulent empyema,
bacteremia
TREATMENT • Antibiotic therapy: penicillin, amoxycillin
• Oxygen

19. INTERSTITIAL PNEUMONIA
PRIMARY ATYPICAL PNEUMONIA
CHLAMYDIA PNEUMONIA
VIRAL PNEUMONIA

20. PRIMARY ATYPICALPRIMARY ATYPICAL
PNEUMONIAPNEUMONIA
PRIMARY ATYPICAL
PNEUMONIA
• Etiology agent – mycoplasma
pneumoniae
• Transmitted by droplet
• Winter months
CLINICAL FEATURES Malaise, headache, fever, sore throat, myalgia,
cough, mild pharyngeal congestion, cervical
lymphadenopathy, few crepitations, hemolytic
anemia
TREATMENT Macrolide antibiotics
Tetracycline

21. CHLAMYDIA PNEUMONIACHLAMYDIA PNEUMONIA
 Affect young infants
 Clinical features:
◦ Spasmodic cough
◦ History of purulent conjunctivitis
VIRAL PNEUMONIAVIRAL PNEUMONIA
 Under 6 months – respiratory syncytial virus
 Other age – influenza, parainfluenza, adenovirus
 Involve bronchial tree or alveoli resulting interstitial
pneumonia
 Radiological: perihilar and peribronchial infiltrate

22. OTHERS

23. LOEFFLER SYNDROMELOEFFLER SYNDROME
Larvae of nematodes – enter portal circulation
– liver – through hepatic vein and vena cava –
into heart and lungs
In lungs – larvae penetrate capillaries – enter
alveoli – plug bronchi with mucus and
eosinophilic – allergic reaction
Clinical features: cough, low fever, feeling
unwell, scattered crepitations
Resemble miliary tuberculosis

24. INGESTION OF ALIPHATICINGESTION OF ALIPHATIC
HYDROCARBONSHYDROCARBONS
Kerosene
◦ Toxic effects on lungs and central nervous
system
◦ Poorly absorbed from gastrointestinal tract
◦ Milk and alcohol promotes absorption
Clinical features: cough, dyspnea, high
fever, vomiting, drowsiness
Treatment: gastric lavage avoided, keeps
on oxygen, routine of antibiotic and
corticosteroid

25. REFERENCESREFERENCES
GHAI Essential Pediatrics, Vinod K Paul &
Arvind Bagga, 8th
Edition, CBS Publisher &
Distributors Pvt Ltd
Textbook of Microbiology, Dir. Prof C P
Baveja, 4th
Edition, Arya Publications
Internet