Pneumonia is a leading cause of death due to infectious diseases in under 5 age group. Here is a presentation made by me. Excerpts are taken from Nelson Textbook of Pediatrics, Osmosis.org and IAP Guidelines on Community Acquired Pneumonia (CAP). It includes Slides, screen Shots available on net and Videos on Youtube.

1. Dr. Punit Tripathi 18.12.2023
Community Acquired
Pneumonia

2. Community-Acquired Pneumonia -
Acute Infection of lung parenchyma in previously healthy child,
acquired outside of the hospital settings, and not hospitalised
with in 14 days prior to onset of symptoms.
This excludes children with immunodeficiency, severe
malnutrition and post measles state.

4. Pneumonia - Infection of lower respiratory tract
that involves the airways and parenchyma with
consolidation of the alveolar spaces.
Lower Respiratory Tract Infection - bronchitis,
bronchiolitis, pneumonia or any combination of
the three.
Pneumonitis - lung inflammation that may or
may not be associated with consolidation.

5. Lobar Pneumonia - one or more lobes are affected
and completely consolidated.
Bronchopneumonia - inflammation of the lung that
is centred in the bronchioles and causes patchy
consolidation of adjacent lobules.
Interstitial Pneumonitis - inflammation of the
interstitium (walls of alveoli, alveolar sacs, alveolar
ducts and bronchioles). Characteristic of acute viral
Pneumonitis, but may also be a chronic process.

6. Pneumonia is cause of 33% mortality due to
infectious causes in under 5 children
worldwide.
Mortality has reduced after immunization for
HiB, Measles, Pertusis, Pneumococcous, S.
Pneumoniae, BCG.
Epidemiology

7. Risk Factors for LRTI
. GERD
. Low Birth Weight, Prematurity
. Vitamin Deficiency
. Lack of Breastfeeding
. Passive Smoking
. Over crowding
. Outdoor or Indoor air pollution
. Family H/o Bronchitis
. Neurological Impairment (Aspiration)
. Immunocompromised State
. Anatomical Abnormalities of Respiratory Tract
. Residents of Handicapped children care facility
. Poor economic statutes of family
. Hospitalisation, especially in ICU, Requiring Invasive Procedures

12. • Aspiration
Food or gastric acid
Foreign bodies
Hydrocarbons
Lipoid substances
Hypersensitivity reactions
Drug or radiation induced pneumonia
Non-infectious Causes of
Pneumonia

13. Indications for Admission or Referral
• Age <3 months
• SpO2 <92%
• Marked tachypnoea (eg. 20 BPM
above the cutoff of that age
• Severe Malnutrition, not feeding/
dehydrated
• Intermittent apnoea and grunting
• Failure of OPD Treatment

16. • CAP is a clinical Dx and no investigations
are required in OPD Settings.
Initial Investigations in hospitalised patients -
CBC, Blood Culture, CXR, Inflammatory Markers (CRP, Procal),
Molecular Methods (RT-PCR, BioFire)
To assess Response of treatment - CRP, CBC,
Procal.
Mycoplasma - ELISA for antibody detection (better that Cold
Agglutinins IgM)
Investigations

17. • Blood C/s - to Dx a bacterial cause of
pneumonia.
Urine - Ag for L. pneumophila
PCR - Pneumolysin based PCR test for
pneumococcous
CMV and Enterovirus - can be cultured from
nasopharynx, Urine, BAL.
TB - Sputum, GA - AFB staining, C/S
Pleural Fluid - empyema, Pleural Effussion
Chest X-ray

18. Indications for Chest X-Ray
• Tachypnoea
• Nasal flaring
• Retractions
• Grunting
• Rales
• Decreased breath sounds
• Respiratory distress

20. The need to establish an etiology for
pneumonia is greater for patients who
are -
Needing hospitalisation
Immunocompromised pt
H/o recurrent pneumonia
Pneumonia Unresponsive to empirical therapy
For these pts, Bronchoscopy with BAL and
Brush mucosal biopsy, Needle Aspiration
of lung, and open lung biopsy.

25. Indications of Macrolides in CAP
• In an HiB and PCV immunised child -
1. If no response to first line therapy
2. Suppurative complications of CAP are absent
• Persistence of the following
1. Low grade fever
2. Cough
3. Few clinical signs
4. CXR - B/L perihilar streaky infiltrates
• Extrapulmonary Manifestations not suggestive of Staph aureus or
no response to anti-staphylococcal antibiotics
(Extrapulmonary Manifestations of Staph Aureus - deep abscesses,
osteomyelitis, endocarditis, phlebitis, mastitis and meningitis)

26. • Pleural Effusion
Empyema
Parapneumonic Effusion
Lung Abscess
Pneumothorax
Pneumatocoele
Delayed Resolution
Respiratory Failure
Metastatic Septic Lesions
Activation of Latent TB
Complications

27. • Immunization
Zinc, VIT. A Supplementation
RSV Infection - Palivizumab
Reduce the length of mechanical ventilation
Hand Washing
Hospital Staff with Respiratory illnesses or who
are carriers of certain organisms (eg. MRSA)
should use mask or be assigned to to non-
patient care duties.
Prevention