Community acquired pneumonia is a common illness in children worldwide. Children under 5 years old have the highest risk, and the most common causes are respiratory viruses and Streptococcus pneumoniae. Clinical features do not reliably distinguish between viral and bacterial pneumonia. Treatment involves antibiotics, with amoxicillin as first-line therapy. Complications include empyema, which presents with prolonged fever and evidence of pleural effusion. Hospitalization is required for severe cases or lack of response to outpatient treatment.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
What is bronchiolitis and its definition, the age group, signs and symptoms and clinical presentation The clinical practice guidelines, how to diagnosis, clinical criteria, what are the severity degrees and How to assess the severity, what are the investigations that may be needed, Is there any diagnostic test, what is the prognosis
What is the management,
Definition of neonatal sepsis,type of neonatal sepsis ,early onset neonatal sepsis,late onset neonatal sepsis,Pathophysiology of neonatal sepsis,,sign and symptoms of neonatal sepsis, diagnosis of neonatal sepsis,management of neonatal sepsis, antibiotic used for neonatal sepsis,prevention of neonatal sepsis, prognosis of neonatal sepsis ,and A summary
Hi Guys,
This presentation talks about Tuberculosis diagnosed in mother in the antenatal period, its treatment, implications on mother and fetus, the various protocols available currently regarding the neonatal management . Special focus being in major issues like breastmilk feeding, BCG, AKT prophylaxis, mother-child isolation.
Hope you find it useful.
P.S. - Please checkout my youtube channel - 'NEONATOHUB' & Facebook page 'Neonatohub' for lectures on neonatology.
Covid19 and pregnancy: There are case reports of preterm birth in women with COVID-19 but it is unclear whether the preterm birth was always iatrogenic, or whether some were spontaneous.
As per ICMR Guidelines Pregnant women do not appear more likely to contract the infection than the general population. However, pregnancy itself alters the body’s immune system and response to viral infections in general, which can occasionally be related to more severe symptoms and this will be the same for COVID-19. Reported cases of COVID-19 pneumonia in pregnancy are milder and with good recovery.Pregnant women with heart disease are at highest risk (congenital or acquired). In other types of coronavirus infection (SARS, MERS), the risks to the mother appear to increase in particular during the last trimester of pregnancy. There are case reports of preterm birth in women with COVID-19 but it is unclear whether the preterm birth was always iatrogenic, or whether some were spontaneous.The coronavirus epidemic increases the risk of perinatal anxiety and depression, as well as domestic violence. It is critically important that support for women and families is strengthened as far as possible; that women are asked about mental health at every contact. A small study of nine pregnant women in Wuhan, China, with confirmed COVID-19 found no evidence of the virus in their breast milk, cord blood or amniotic fluid. According to WHO, pregnant women
do not appear to be at higher risk of severe disease.
Furthermore, WHO reports that currently there is no known difference between the clinical manifestations of COVID-19 in pregnant and non-pregnant women of reproductive age
ACOG is advising caution based on the impact of other respiratory illnesses (including influenza/ SARS outbreak of 2002–2003), stating that “pregnant women should be considered an at-risk population for COVID-19
India has the largest burden of tuberculosis. The disease is gradually extending its storm into the paediatric age group, the manifest in which is severe and tortous. So a preventive approach is always better than a curative approach
Bacteriological profile of childhood sepsis at a tertiary health centre in so...QUESTJOURNAL
Introduction: Sepsis is a leading cause of morbidity and mortality in children worldwide, even more so in developing countries. Knowledge of common pathogens and their antibiotic susceptibility pattern is useful for guiding initial treatment while awaiting blood culture results. Objective:To determine the major causative organisms and their antibiotic sensitivity pattern of childhood sepsis at the Niger Delta University TeachingHospital (NDUTH), with the aim of revising existing treatment protocols. Methods: Within a 2 year period (1st January 2014 to 31st December 2015) blood culture results of children with clinical suspicion of sepsis were retrospectively studied. Results:During the study period, 116 (12.11%) of the 958 children admitted into the Children Emergency Ward had blood culture tests. Thirty one (26.72%) had positive blood cultures.Eighteen (58.06%) of the organisms were gram positive while thirteen (41.93%) were gram negative. The predominant organism was Staphylococcus aureus in 16 (51.61%) followed by Klebsiella pneumoniae in 5 (16.13%) patients. The bacterial isolates demonstrated the highest sensitivity to the quinolones. Conclusion:There is need for periodic surveillance of the causative organisms and antibiotic susceptibility pattern of childhood sepsis to guide effective management of patients.
Đa số chúng ta thường gặp những ca viêm xoang ở người lớn nhưng điều đó không có nghĩa là không xuất hiện ở trẻ em. Bệnh viêm xoang ở trẻ nhỏ thường gặp ở trẻ từ 6 tuổi trở xuống, cơ địa gầy gò ốm yếu, sức đề kháng kém, cơ địa dễ mắc bệnh viêm mũi và viêm mũi dị ứng bẩm sinh… Vậy cha mẹ cần làm gì khi con mình có trong những trường hợp trên? Hãy cùng Venus Global tìm hiểu một số liệu pháp chữa viêm xoang ở trẻ nhỏ ngay sau đây.
Nguồn: Trích https://venusglobal.com.vn/chua-viem-xoang-cho-tre-em/
#viêm_xoang_ở_trẻ_nhỏ
#chữa_viêm_xoang_cho_trẻ_em
#cách_chữa_viêm_xoang_cho_trẻ_em
#chữa_bệnh_viêm_xoang_cho_trẻ_em
#viêm_xoang_mãn_tính_tuổi_trẻ
Kathryn Maitland describes the challenges faced with oxygen therapy as an emergency intervention in critical illness in African children.
Where Kathryn works, in East Africa, there is no access to intensive care. Caring for critically ill children is all done in the Emergency Department.
70% of the global burden of disease and deaths from pneumonia occurs in Southeast Asia and Sub-Saharan Africa. The WHO has published guidelines as to what classifies as pneumonia, severe pneumonia, and very severe pneumonia.
These classifications rely on clinical signs. However, Kathryn in her research has discovered that these classifications are rarely correlated with the actual underlying disease process.
Clinical signs are non-specific for the diagnosis of pneumonia. Oxygen is recommended for severe and very severe pneumonia.
This has led to calls to prioritise oxygen delivery in African hospitals. However, it has not led to change from a health department or funding viewpoint.
There are also oxygen delivery practicalities to consider. Often there is only one source of oxygen on a ward (if at all) with patients clustered around it.
The production of Oxygen may only happen in a few places.
Poor cylinder quality leads to leaks and therefore, low supply.
Concentrators are useful however they need regular servicing. They also rely on power, and in a region that experiences regular power outages, this can be problematic. When the power goes off, there is no oxygen available.
Kathryn asks – do all children actually need oxygen? There is still however a hidden burden of hypoxia.
Outside of Africa, Kathryn discusses the current state of equipoise on oxygen therapy.
Moreover, oxygen can be harmful if given inappropriately. This leads to concerns more broadly on the harms of oxygen therapy.
Kathryn concludes her talk by looking to the future. She discusses ongoing research and the implications for future practice in resource poor settings, and indeed the world.
Similar to Community acquired pneumonia in children (1) (20)
definition of malnutrition, the definition of protein-energy malnutrition , the etiology 0f protein-energy malnutrition, the pathophysiology of malnutrition, features of marasmus, features of kwashiorkor, vitamins and micronutrient deficiencies, signs of micronutrients deficiency, diagnosis, management of malnutrition,prognosis of malnutrition ,prevention of malnutrition
Definition of erythema infectiosum, the causative factor, clinical presentation, the three stages of rash, the slipped cheek, the sequences of the rash, the diagnosis of the fifth disease, the differential diagnosis of fifth disease, the treatment of erythema infectiosum, the prognosis of fifth disease , congenital erythema infectiosum, the complications of fifth disease , Human parvovirus B19
What is kingella kingae bacterium,features of K. kingae,Species of Kingella,epidemiology of k. kingae,Proposed pathogenesis of K. kingae infections,Transmission of k. kingae ,Pathegenesis of k. kingae,diagnosis ,NAAT for k.kingae ,treatment of k.kingae,prevension ,osteomyelitis due to k,kingae.endocarditis due to k.kingae,Septic Arthritis due to k. kingae,Spondylodiscitis due to k. kingae, prevention of k. kingae infection
What is congenital nephrotic syndrome ,what is the definition of congenital nephrotic syndrome,what is the inheritance,what are the responsible genes ,what are the types of congenital nephrotic syndrome,what is the presentation ,diagnosis ,and treatment of congenital nephrotic syndrome, primary type and secondary type of congenital nephrotic syndrome
What is nonalcoholic fatty liver disease, what is the prevalence among children ,the definition of NAFLD,What are the relationship between obesity and over weight with the development of NAFLD,what are the sequences ,what is NASH,Who are at risk , How to diagnosis NAFLD what is the differential diagnosis ,what is the treatment
#what is listeriosis #,listeria monocytoges ,#what is the mode of transmission,#food-born infection ,#vertical infection ,#early and late onset ,#meningitis و#Sepsis ;#Early vs.Late onset neonatal listeriosis ,diagnosis of neonatal listeriosis ,treatment of neonatal listeriosis ,prevention of neonatal listeriosis
What is achondroplasia, definition , etiology ,types of dwarfism , genetic background,clinical presentations ,history and clinical examination , differential diagnosis ,diagnostic tests ,radiological findings ,CT scan and MRI , Medical care and role of growth hormone ,Surgical care and consultation,
What is your knowledge regarding electrical burn in children,types of electrical burns in children.,characteristic features of each type ,minor electrical burn , high -voltage electrical burn ,lightning electrical burn what are the clinical presentations and management ,cardiac complication of electrical burn,neurological complication of electrical burn , cutaneous and oral complication ,masculoskeletal complication and ocular and renal complications
definition what is FPIES, what it defers from other food allergy, what are the signs and symptoms ,what are the different types of food allergy ,how to diagnose FPIES ,what are the oral food challenge (OFC) ,what is the treatment , the prognosis of FPIES
What is influenza ,ethology ,types ,presentations signs and symptoms ,epidemic influenza ,laboratory investigations , management , the WHO guidelines in dealing with cases and contact
What is Fifth disease, what is erythema infectiosum What is the causative factor, pathophysiology ,clinical presentation ,diagnosis ,laboratory investigations ,treatment , precautions and prognosis ,
حساسية الجلد ماهي فوائد الجلد ماهي الحساسية ماهي انواع حساسية الجلد ماهي العوامل التي تؤدي لحدوث الحساسية ماهي انواع الحساسية ماهي اعراض الحساسية ماهي طرق الوقاية من الحساسية ماهو علاج الحساسية
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
NVBDCP.pptx Nation vector borne disease control program
Community acquired pneumonia in children (1)
1. Community acquired
pneumonia in children
Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Departments
Khorfakkan Hospital
Sharjah ,UAE
saadsalani@yahoo.com
2. Community acquired pneumonia (CAP)
:Definition
• A clinical diagnosis of pneumonia caused by a
community acquired infection in a previously
healthy child
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 2
3. Introduction
• Around 14.4 per 10 000 children aged over 5
years and 33.8 per 10 000 under 5 years are
diagnosed with CAP annually in European
hospitals (1.2).
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 3
1. Clark JE, Hammal D, Hampton F, Spencer D, Parker L. Epidemiology of community-
acquired pneumonia in children seen in hospital. Epidemiol Infect 2007;356:262-9.
2. Senstad AC, 2.Surén P, Brauteset L, Eriksson JR, Høiby EA, Wathne KO. Community-
acquired pneumonia (CAP) in children in Oslo, Norway. Acta Paediatr 2009;356:332-6.
4. Introduction (Cont.)
• CAP is more common in the developing world,
estimated at 0.28 episodes per child per year and
accounting for 95% of all cases
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 4
Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. WHO Child Health Epidemiology
Reference Group. Global estimate of the incidence of clinical pneumonia among children
under five years of age. Bull World Health Organ 2004;356:895-903
5. Risk factors
• < 5 years old are at greatest risk (In otherwise healthy children)
• Boys have a higher incidence across all ages.
• Other risk factors include:
Prematurity, Immunodeficiency, Chronic respiratory
disease, Neurodisability
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 5
6. Facts
• Clinical and radiological features do not reliably
distinguish between viral and bacterial etiology
• Obtaining cultures from the lower respiratory tract
of young children is tricky
• More specific but invasive investigations such as
pleural aspiration are infrequently indicated and
reserved for severe cases
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 6
7. Facts (Cont.)
• Blood cultures are rarely performed in patients
managed in the community, and hospitalized
patients demonstrate a poor yield
• Nasopharyngeal secretions are easily obtainable, and
the application of more sensitive techniques such as
polymerase chain reaction (PCR) has resulted in
pathogen identification in 65-83% of reported cases
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 7
Thomson A, Harris M. Community-acquired pneumonia in children: what’s new? Thorax 2011;356:927-8.
8. Etiology: Respiratory viruses
• Respiratory viruses are common, particularly in infants,
accounting for 30-67% of hospitalised cases.
• Respiratory syncytial virus accounts for 30% of viral etiology.
• Other viruses include parainfluenza, influenza, and
human metapneumovirus.
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 8
Cevey-Macherel M, Galetto-Lacour A, Gervaix A, et al. Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines.
Eur J Pediatr 2009;356:1429-36.
9. Etiology: bacterial causes
• Streptococcus pneumoniae is the commonest
bacterial cause across all ages, accounting for 30-
40% of cases.
• Other bacterial causes include: group A
streptococcus and, in infants, group B streptococcus
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 9
Cevey-Macherel M, Galetto-Lacour A, Gervaix A, et al. Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines.
Eur J Pediatr 2009;356:1429-36.
10. Community acquired pneumonia (CAP) :
Etiology by age group
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 10
1-3 months
Common
• Streptococcus pneumoniae
• Chlamydia pneumoniae
• Respiratory viruses
• Enterovirus
11. Community acquired pneumonia (CAP) :
Etiology by age group (Cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 11
1-3 months
Less common
• Group A streptococcus
• Group B streptococcus
• Haemophilus influenzae
12. Community acquired pneumonia (CAP)
Etiology by age group (Cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 12
1-3 months
Rare
• Mycobacterium spp
• Varicella zoster virus
13. Community acquired pneumonia (CAP)
Etiology by age group (Cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 13
< 5 years
Common
• Streptococcus pneumoniae
• Respiratory viruses
14. Community acquired pneumonia (CAP)
Etiology by age group (Cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 14
<5 years
Less common
• Mycoplasma pneumoniae
• Group A streptococcus
• Haemophilus influenzae
• Staphylococcus aureus
15. Community acquired pneumonia (CAP)
Etiology by age group (Cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 15
<5 years
Rare
• Moraxella
• Mycobacterium spp
16. Community acquired pneumonia (CAP)
Etiology by age group (Cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 16
≥ 5 years
Common
• Streptococcus pneumoniae
• Mycoplasma pneumoniae
• Respiratory viruses
17. Community acquired pneumonia (CAP)
Etiology by age group (Cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 17
≥ 5 years
Less common
• Staphylococcus aureus
• Chlamydia pneumoniae
• Mycobacterium spp
18. Community acquired pneumonia (CAP)
Etiology by age group (Cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 18
≥ 5 years
Rare
Group A streptococcus
19. Community acquired pneumonia (CAP)
Etiology by age group (Cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 19
Immunocompromised (all ages)
Common
As with age group plus
Fungi ,Burkholderia , Pseudomonas, and mycobacterium spp
20. CAP assessment
• It is difficult to distinguish clinically between bacterial
and viral aetiologies.
• Consider bacterial pneumonia in children presenting
with persistent or recurrent fever ≥38.5°C over the
preceding 24-48 hours with chest wall recession and
tachypnea
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 20
21. CAP assessment (Cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 21
• Assess the likelihood and severity of CAP by :
Fever Breathlessness
Tachypnea Chest wall recession
Cough Chest pain
Respiratory rate and dyspnea are useful measures
of severity and predict oxygen requirement
22. Assessment in the community
• Focus the examination on defining severity and
identify children with underlying conditions who are
at increased risk.
• Hypoxemia increases mortality risk, and oxygen
saturations <95% in room air are a key indicator for
hospital assessment
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 22
23. Assessment in hospital
• All children require pulse oximetry.
• Level of C reactive protein is not useful to differentiate viral and
bacterial causes, but it can guide investigation and management of
CAP complicated by effusions, empyema, or necrosis.
• Urinary pneumococcal antigen detection has a high sensitivity but
very low specificity. If it is available, consider using it as a negative
predictor.
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 23
Charkaluk M-L, Kalach N, Mvogo H, et al. Assessment of a rapid urinary antigen detection by an immunochromatographic test for diagnosis of
pneumococcal infection in children. Diagn Microbiol Infect Dis 2006;356:89-94
24. Assessment in hospital (cont.)
• Avoid routine chest radiography in children requiring hospital
admission
• Radiographic appearance correlates poorly with clinical signs
and outcome
• Consider radiography:
In severe cases
Where complications such as effusion or empyema are suspected
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 24
25. British Thoracic Society recommended
investigations for complicated or severe
community acquired pneumonia (CAP)
• Bloods (full blood count, urea and electrolytes, C
reactive protein, blood culture, anti-streptolysin O
titre, serology for viruses, Mycoplasma pneumoniae
and Chlamydia pneumoniae, atypical CAP screen)
• Nasopharyngeal secretions and swabs for viral PCR or
immunofluorescence detection
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 25
26. British Thoracic Society recommended
investigations for complicated or severe
community acquired pneumonia (CAP) (Cont.)
• Chest x ray to assess for effusion or empyema
• Consider pleural fluid for :
Microscopy, culture (including tuberculosis)
Pneumococcal antigen for PCR
Biochemistry
Cytology (if aspiration required)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 26
29. Chest X-rays of a CAP patient before (left) and after treatment
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 29
https://en.wikipedia.org/wiki/Community-acquired_pneumonia
30. Gram stain showing Streptococcus pneumoniae
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 30
https://emedicine.medscape.com/article/234240-overview
31. British Thoracic Society criteria for referral
to paediatric intensive care
•Indications for referral:
Development of respiratory failure
requiring assisted ventilation
Pneumonia complicated by septicaemia
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 31
32. British Thoracic Society criteria for referral
to paediatric intensive care (cont.)
• Clinical features:
Failure to maintain oxygen saturations >92% with FiO2 60%
Clinical features of shock
Increasing respiratory and heart rates with severe respiratory
distress and exhaustion, with or without raised pCO2
Recurrent apnoea or slow irregular breathing
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 32
33. Red flag features for community
acquired pneumonia (CAP)
• History of underlying comorbidities, including:
Bronchopulmonary dysplasia
Disorders of mucus clearance (such as cystic fibrosis)
Congenital heart disease
Immunodeficiency
Severe cerebral palsy
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 33
34. Red flag features for community
acquired pneumonia (CAP) (cont.)
• Relevant medical history :
History of severe pneumonia (inpatient
stay requiring oxygen, paediatric intensive
care admission, complications of CAP
(such as lung abscess, effusion, empyema)
Recurrent pneumonia
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 34
35. CAP management
• Children with clinical features consistent with CAP
require antibiotics .
• CAP in a fully vaccinated child less than 2 years old (who
has received the pneumococcal vaccine) with mild
symptoms is unlikely to be bacterial, and antibiotics are
not required unless symptoms become more severe.
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 35
36. British Thoracic Society recommendations for
antibiotic selection in community acquired
pneumonia (CAP)
• Preferred route of administration
Oral antibiotics are safe and effective for children even with severe
CAP
Use intravenous antibiotics in children who:
– Are unable to tolerate oral fluids (such as because of vomiting) or
– Have signs of septicaemia or complicated pneumonia
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 36
37. British Thoracic Society recommendations for
antibiotic selection in community acquired
pneumonia (CAP) (cont.)
• Which antibiotic?
Amoxicillin is first line therapy (use macrolides as first line in
penicillin allergy)
Macrolides can be added at any age if :
o There is no response to first line therapy
o Mycoplasma or Chlamydia pneumoniae are suspected
o Disease is severe
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 37
38. British Thoracic Society recommendations for
antibiotic selection in community acquired
pneumonia (CAP) (cont.)
• Which antibiotic? (Cont.)
Co- amoxiclav is recommended for pneumonia associated with
influenza
Intravenous antibiotic treatment with amoxicillin, co-amoxiclav,
cefuroxime, cefotaxime, or ceftriaxone is recommended for
severe pneumonia
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 38
39. Supportive therapies and advice for care
givers
• Advice on signs of deterioration, dehydration, and complications
• Ask the parents or carers to seek further advice if fever persists
or symptoms deteriorate despite 48 hours of antibiotic treatment
• In secondary care, children with oxygen saturations <92% in
room air require supplemental oxygen to maintain >95%
saturation
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 39
40. Supportive therapies and advice for care
givers
• Oxygen can be administered via face mask, nasal cannulae, or head
box .
• Nasogastric feeds can maintain hydration, but if they are not
tolerated because of vomiting or severe illness, intravenous fluid
replacement may be required, with daily electrolyte monitoring for
sodium depletion or syndrome of inappropriate antidiuretic
hormone secretion.
• There is no any benefit from physiotherapy on radiological
resolution, length of hospital stay, or symptom improvement
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 40
41. CAP complications
Empyema
• Is the most common complication
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 41
Risk factors
• Age >3 years
• Recent varicella infection
42. Empyema (cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 42
Signs and symptoms
Fever >7 days Evidence of effusion:
- Decreased chest expansion
- Dull percussion
- Reduced or absent breath sounds
± Cyanosis
Pleuritic chest pain
Severe CAP symptoms
No response to 48 hours
antibiotics
44. Empyema (cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 44
Treatment
• Referral to tertiary centre
• High dose IV antibiotics
± Thoracentesis or decortication
± Fibrinolytic therapy
• Oral antibiotics for further 1-4 weeks
45. CAP complications (Cont.)
• Necrotising pneumonia
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 45
Risk factors
• Congenital lung abnormalities
• Bronchiectasis
• Immunodeficiency
• Neurological disorders
• Staphylococcal aureus with PVL toxin
PVL = Panton-Valentin leucocidin
46. Necrotising pneumonia (cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 46
Signs and symptoms
Insidious onset Productive foul smelling sputum
Persistent fever Weight loss
Night sweats Pleuritic chest pain
48. Necrotising pneumonia (cont.)
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 48
Treatment
• Referral to tertiary centre
• High dose IV antibiotics (2-3 week course)
• Prolonged oral antibiotic course ± Surgical
intervention
49. CAP complications (Cont.)
Other complications include:
• Systemic sepsis
• Haemolytic uremic syndrome
• Bronchiectasis following severe or complicated CAP
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 49
50. Measurements to reduce CAP incidence
The schedule of giving the following vaccines is hoping to reduce CAP
incidence:
• Pneumococcal conjugate vaccine (PCV) at 2, 4, and 12 months old.
• Haemophilus influenzae type B (Hib) vaccination is given at 2, 3, and 4
months with a booster at 1 year.
• An annual influenza vaccine is given to children between 2 and 8
years old every September, including children in school years 1, 2,
and 3.
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 50
51. Measurements to reduce CAP incidence
(cont.)
Additional pneumococcal, and in some cases influenza, vaccination is
provided for high risk children with:
• asplenia or splenic dysfunction
• cochlear implants (due to the meningitis risk)
• chronic disease
• complement disorders
• immunosuppression.
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 51
52. Conclusion
Pneumonia can be diagnosed clinically when
there are signs of a lower respiratory tract
infection and wheezing syndromes have been
ruled out.
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 52
53. Conclusion
Blood tests and microbiological investigations
are NOT recommended for routine use in the
diagnosis and management of CAP.
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 53
54. Conclusion
CXR does not need to be performed in those
with mild disease who will be managed as
an outpatient.
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 54
55. Conclusion
• Respiratory viruses are common,
particularly in infants, accounting
for 30-67% of hospitalised cases
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 55
56. Conclusion
Streptococcus pneumoniae is the commonest
bacterial cause across all ages, accounting for
30-40% of cases.
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 56
57. Conclusion
• < 5 years old are at greatest risk
(In otherwise healthy children)
• Boys have a higher incidence across all ages.
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 57
58. Conclusion
For non-severe pneumonia, high dose
oral amoxicillin is recommended even
for inpatient use. IV benzylpenicillin
can be considered if patient is not
tolerating oral intake and not vomiting.
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 58
59. Conclusion
Empyema and necrotizing pneumonia
are the most serious complications of
Community acquired pneumonia
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 59
60. Conclusion
To reduce the CAP incidence ,the following
vaccines have been given :
• Pneumococcal conjugate vaccine (PCV)
• Haemophilus influenzae type B (Hib)
vaccination
• An annual influenza vaccine
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 60
61. References
• Thomson A, Harris M. Community-acquired pneumonia in children: what’s new? Thorax 2011;356:927-8
• Clark JE. Determining the microbiological cause of a chest infection. Arch Dis Child 2015;356:193-7.
• Clark JE, Hammal D, Hampton F, Spencer D, Parker L. Epidemiology of community-acquired pneumonia in children seen in hospital. Epidemiol
Infect 2007;356:262-9.
• Senstad AC, 2.Surén P, Brauteset L, Eriksson JR, Høiby EA, Wathne KO. Community-acquired pneumonia (CAP) in children in Oslo, Norway. Acta
Paediatr 2009;356:332-6.
• Cevey-Macherel M, Galetto-Lacour A, Gervaix A, et al. Etiology of community-acquired pneumonia in hospitalized children based on WHO
clinical guidelines. Eur J Pediatr 2009;356:1429-36
• Charkaluk M-L, Kalach N, Mvogo H, et al. Assessment of a rapid urinary antigen detection by an immunochromatographic test for diagnosis of
pneumococcal infection in children. Diagn Microbiol Infect Dis 2006;356:89-94
• https://www.scribd.com/document/358621252/Basic-Concepts-on-Communityacquired-Bacterial-Pneumonia-in-Pediatrics
• https://en.wikipedia.org/wiki/Community-acquired_pneumonia
• https://www.rch.org.au/clinicalguide/
2/5/2019Commuinity acquired pneumonia in children Prof.Dr.Saad S Al Ani 61