More Related Content
What's hot
What's hot (20)
Similar to Pneumonia
Similar to Pneumonia (20)
More from Rashi773374
More from Rashi773374 (19)
Recently uploaded
Recently uploaded (20)
Pneumonia
- 1. PNUEMONIA IN CHILDREN Presented by: Dr. Jyoti Kaushik M.D.IstYear P.G.Deptt. Of Bala roga R.G.G.P.G.Ayu.College
- 2. INTRODUCTION • Pneumonia is defined as an acute inflammation of the lower respiratory tract that involves the airways and lung parenchyma with consolidation of the alveolar spaces. • Pneumonia can be classified anatomically as lobar or lobular, bronchopneumonia and interstitial pneumonia. • Pathologically there is consolidation of alveoli or infiltration of the interstitial tissue with inflammatory cell or both.
- 3. SOME DEFINITIONS Lobar pneumonia Broncho pneumonia Interstitial pneumonia describes “typical” pneumonia localized to one or more lobes of lung in which the affected lobe or lobes are completely consolidated. is primarily a spreading inflammation of the terminal bronchioles and their related alveoli and causes patchy consolidation of the adjacent lobules. refers to inflammation of interstitium, which is composed of the wall of the alveoli, the alveolar sacs and ducts, and the bronchioles.
- 5. ETIOLOGY Infectious causes AGE GROUP ETIOLOGY 0-3 months Gram ngative enteribacteriacae Enterococci Chlamydia trachomatis Haemophilus influenzae Streptococcus pneumoniae 3month-5year Streptococcus pneumoniae Viruses Haemophilus influenzae Staphylococcus Mycoplasma pneumoniae >5 year Streptococcus pneumoniae Mycoplasma pneumoniae Viruses Staphylococcus
- 6. Cont. Noninfectious causes include: • Aspiration of food • Foreign bodies • Hydrocarbons, and lipid substances • Hypersensitivity reactions • Drug or radiation induced pneumonitis.
- 7. SIGNS AND SYMPTOMS •Cough •Fever • Chest pain. Tachypnea. Difficult noisy respiration • Retractions. •Signs of consolidation. • Crepitations, wheezing. • Cyanosis. • Abdominal pain. •Vomitting •Diarrhoea
- 8. DIFFERENTIATION B/W BACTERIAL & VIRAL PNEUMONIA Features Bacterial pneumonia Viral pneumonia Onset acute gradual course progressive Self limiting Temperature +++ +- Toximia +++ - Dyspnea ++ +(infants) URTI - + Auscultation crepts Rhonchi/wheeze ++ +- +- ++ Radiological Confluent infiltrates Diffuse infiltrates Hyperinflation +- +(RSV infection) Pleural involvement + - Pneumatocele + - WBC count elevated(>20000/ mm3) with a predominance of neutrophils often normal(<20000/mm3) or mildly elevated, with a predominance of lymphocytes.
- 9. DIAGNOSIS • Chest X-ray confirms pneumonia and pleural effusion or empyema- lobar consolidation is typically in pneumococcal causes - Viral pneumonia- hyperinflation with bilateral interstitial infiltrates. • Bronchoscopy, USG, CT scan in malformation or tumors • WBC in viral pneumonia are normal or <20000/mm3 with lymphocyte rises; in bacterial WBC>20,000/mm3 with neutrophils rises. • Atypical pneumonia: a higher WBC, ESR and C- reactive protein. • DNA, RNA, antibodies tests for the rapid detection of viruses.
- 10. DIFFERNTIAL DIAGNOSIS • Bronchitis • Bronchial asthma • Pulmonary tuberculosis • Pleural effusion • Empyema
- 11. D/Dx Pneumonia Bronchitis Asthma Pleural Effusion Empyema Movement of chest wall Reduced on affected side Normal or symmetrically diminished symmetrically diminished Reduced & absent Reduced & absent Percussion note Dull Normal Normal Stony dull Stony dull Breath sounds High pitched bronchial Vesicular with prolonged expiration Vesicular with prolonged expiration Diminished or absent Absent (occasionally bronchial) Vocal resonance Increased Normal Normal or reduced Reduced or absent (occasionally increased) Absent or reduced Added sounds Fine crepitations early ,coarse crepitations later Rhonchi , some coarse crepitations Rhonchi, mainly expiratory and high pitched Pleural rub Pleural rub Temp High grade & mild fever Mild fever none High fever High grade fever
- 12. TREATMENT Treatment of suspected bacterial pneumonia is based on the presumptive cause and the clinical appearance of the child. For mildly ill children who do not require hospitalization amoxycillin is recommended . ANTIBIOTICS: • Penicillins and betalactams: Amoxycillin • Cephalosporines- Cefuroxime, Ceftriaxon. • Quinolones-Ciprofloxacin, Levofloxacin, Gatifloxacin- more effective in Gram-ve bacteria. • In atypical pneumonia – macrolides: Clarithromycin,Azithromycin (7.5-15mg/kg/day) • Aminoglycosides- dosage according to age, weight and kidney function (Gentamicin,Netilimycin). • In viral pneumonia treatment withhold antibiotics.
- 13. SUPPORTIVE TREATMENT • good hydration, cough remedies, antipyretics, oxygen in the central cyanosis. • For children with wheeze- rapid acting bronchodilator(Salbutamol.) • Drainage with tube in empyema, fibrinolytic therapy: urokinase, streptokinase. • Indications for hospitalization: age <6month, persistent fever, worse signs, severe respiratory distress, toxic appearance, no response to antibiotic.
- 14. Complications • Pleural effusion • Empyema • Pneumothorax • Pericarditis • Sepsis • Meningitis • Arthritis • Respiratory failure • Lung abcess.
- 15. PREVENTION OF PNEUMONIA • Immunization against H. influenzae type b. • Influenza vaccine. • Heptavalent pneumococcal conjugate vaccine. • Health education of the community. • Messages for mothers to recognize the signs of pneumonia.
- 17. Name : Aditya Sex : male Age : 1 year Father’s Name : Ajay kumar Informant : Mother Address :VPO-Bagh ,Teh -Ladbadhol Distt.-Mandi IPD No. : 5833 Date of Admission : 31/12/17 Date of Discharge : 5/01/18
- 18. Chief Complaints : Cough since 4 days. Fever since 4 days Difficult Noisy breathing since 2 day Not taking feeds since 2 days Vomiting 2 episodes at morning H/O Present illness : According to pt.’s mother he was quite asymptomatic 4days back then next day he suddenly developed cough with fever . On enquiry She told that cough was dry in nature, fever was continous, high grade in nature and was not associated with chills and rigor.Mother gave him medications for it.but baby did not get relief. On further enquiry she told that cough became associated with noisy breathing after 2 days.He was having breathlessness so he refused to feed.Baby vomitted two times this morning. Mother told that vomitting material contains food particles. With all these complaints mother brought the baby to the hospital & got admitted in the IPD of Balrog deptt.
- 19. H/O Past illnesss : H/O Recurent infection Antenatal History : No H/o Infection,Irradiation & any teratogenic toxic drug intake Natal History : NVD Cry : Immediate cry Postnatal History : No H/O feeding difficulty No H/O neonatal jaundice.
- 20. Developmental history : All the milestones attained at normal time Immunization history :properly done As per national immunization schdule. Personal history : Appetite : decreased Thirst : Normal Urine : once/day Stool : Not passed since 24 hours Family History: Father : Healthy Mother : Healthy
- 21. Socioeconomic history : • House : Pakka, well ventilated • Surroundings : Clean • Source of water : Tap water • Status : middle class General Physical Examination : General appearance : ill looking • Built : Normal • Nutrition : well nourished • Height : 72cm • Wt : 9 kg • Head : B/L symmetrical • Eyes : N • Nose : N
- 22. • Oral cavity : Normal hygiene • Teeth : N • Tongue : coated • Throat : N • Lips : dry • Neck : No swelling • Lymphadenopathy : Absent • Skin : Warm and dry • Hairs : N • Nails : N • Spine : N • Extremities : N Vitals : HR:130/min, Temp:100⁰ F, RR:50/min
- 23. Systemic examination : Respiratory system Inspection: • Breathing :Bronchial • Intercostal recession :Present • Scar mark :Absent Palpation: • Temp :Raised • Tenderness :Absent Percussion: • Dullness over Rt side in lower zone
- 24. Auscultation: • Breathing sound :Bronchial • Air entry :Diminished in right side • Added sounds :B/L Crepitations present • Vocal resonance :increased right side Other System : Clinically NAD Differtial Diagnosis: • Bronchial asthma • Bronchitis • Tuberculosis
- 25. Positive Findings : • High grade fever • B/L Crepts • Difficulty in breathing • Refusal to feed Provisional Diagnosis: Acute Pneumonia
- 26. Treatment Given : 1st day Keep baby warm • Free flow warm and humidified oxygen @4-5 lt/min for 3hrs After that RR came in normal range then 02 discontinued and then following treatment cont. for 7 days • Give plenty of fluids • Inj. Cefoprox 375mg I.V. BD • Inj. Netspan 25 mg I.V. BD • Syp. Brozedex LS kid 4 ml BD • Syp. Crocin / marimol 6 ml 8 hourly • novin nasal drops 2 drops B/N BD (for 3 days) • Solvin cold AF 1ml tid
- 27. Ayurvedic approach • Keep the baby warm • Home made decoction of tulsi, adrakh, loung , elaychi. • Balchaturbhadra churna 250 mg Tankan bhasma 125 mg Godanti bhasma 125 mg Sfatika bhasma 60 mg Shankha bhasma 60 mg 1×3 ē Madhu • Adliv drop : 1 ml BD
- 28. THANKS