Pneumonia is an inflammatory lung condition primarily affecting alveoli, causing significant mortality in children under five, particularly in developing countries. It can be classified by lung tissue involvement, source, and severity, with various infectious and non-infectious causes, and is marked by symptoms like fever and respiratory distress. Treatment includes counseling, supportive care, and specific therapies depending on the causative agent, with prevention emphasizing vaccination and pollution control.

1. Pneumonia
Dr. Md. Saddam Hossain
MBBS (PMC,DU)
Bangladesh
Phone No.: +8801770980080

2. Pneumonia
Definition :
Pneumonia is an inflammatory condition of the lung affecting primarily the
microscopic air sacs known as alveoli.

3. Epidemiology:
• Pneumonia causes 28–34% of all deaths in those under five years of
age of which 95% occur in the developing world.
• Countries with the greatest burden of disease include:
India (43 million)
China (21 million)
Pakistan (10 million).

4. Types of Pneumonia :
1. According to involvement of lung tissue :
a. Bronchopneumonia
b. Lobar Pneumonia
2. According to source:
a. Community acquired Pneumonia
b. Nosocomial Pneumonia
c. Pneumonia in special situation (aspiration pneumonia, opportunistic pneumonia)
3. According to severity (IMCI) :
a. Severe Pneumonia or very severe disease
b. Pneumonia
c. no pneumonia

5. Risk Factors for Pneumonia of pediatric age group:
1. Preterm baby
2. Malnutrition
3. cystic fibrosis
4. asthma
5. Diabetes
6. heart failure
7. weak immune system.

6. Causes of Pneumonia:
A. Infectious:
1. Bacteria:
Streptococcus pneumonia (50%)
Haemophilus influenza(20%)
Chlamydophila pneumoniae (13%)
Mycoplasma pneumoniae (2%)
Staphylococcus aureus
Moraxella catarrhalis
Legionella pneumophila
Gram-negative bacilli
Chlamydia psittaci
Coxiella burnetti
Pseudomonas aeruginosa

7. 2. Viruses:
rhinoviruses
coronaviruses
influenza virus
respiratory syncytial virus (RSV)
adenovirus, and parainfluenza
Herpes simplex virus
3. Fungi:
Histoplasma capsulatum
blastomyces
Cryptococcus neoformans
Pneumocystis jiroveci (pneumocystis pneumonia),
Coccidioides immitis

8. 4. Parasites:
Toxoplasma gondii
Strongyloides stercoralis
Ascaris lumbricoides, and
Plasmodium malariae

9. B. Non-infectious:
Idiopathic interstitial pneumonia
diffuse alveolar damage,
organizing pneumonia,
nonspecific interstitial pneumonia,
lymphocytic interstitial pneumonia,
desquamative interstitial pneumonia,
respiratory bronchiolitis interstitial lung
usual interstitial pneumonia.

10. Organisms causing Pneumonia in different age group :
Age Organisms
Neonatal period • E. coli
• K pneumonia
• Group B streptococcus
After neonatal
period
• S. pneumoniae
• H. influenzae type B
• S. aureus
• viruses
Beyond 5 years • Mycoplasma
• Chlamydia

11. Clinical Features:
Symptoms:
Fever
Cough
Respiratory distress
Signs:
Fast breating
Chest indrawing
Features of hypoxemia : low SpO2, cyanosis, head nodding

12. Fast breating:
0 to 2 months: Respiratory rate> 60/min
2 months to 12 months: RR > 50/min
1 year to 5 year : RR > 40/min

13. Investigations
Name of investigations Probable Findings
1. X-Ray chest In CONSOLIDATION: Homogenous radio-opacity in any area of the lung field.
In Bronchopneumonia: Patchy opacities are seen in different areas of lung field.
2. Complete blood counts Polymorphonuclear leukocytosis
ESR: high
3. Blood CS May show growth of organisms

14. Treatment
1. Counselling
2. Supportive Treatment :
Oxygen therapy: if Cyanosis or SpO2 less than 92%
Paracetamol for fever
Salbutamol for wheeze
Clear nose with normal saline drop
soothe the throat, relieve cough with a safe remedy(warm water, tulsi leaf
juice, lemon tea)

15. 3. Specific Treatment :
a. Bacterial:
Severe Pneumonia:
Hospitalization
Parenteral Ampicillin/ Amoxicillin
Pneumonia:
Oral Amoxicillin
Other antibiotics: Cloxacillin, Ceftriaxone

16. b. Viral:
Influenza A : rimantadine or amantadine
Influenza A or B: oseltamivir, zanamivir or peramivir
C. Aspiration Pneumonia:
Clindamycin
Beta lactam
Metronidazole
Aminoglycosides

17. Prevention of Pneumonia:
1. Vaccinations
2. Medications
3. Others: prevention of air pollution, avoiding of passive smoking of
children

18. Complications if untreated or maltreated:
Pleural effusion
Empyema
Lung abscess
Pneumothorax
Heart Failure
Septicemia
Dissemination to other organs: meninges, bones, joints etc.

19. Pneumonia in IMCI: