incidence, cllinical features, CBIMCI classification, management of pneumonia at health post level identifcation of important complications and immediate referral

1. Pneumonia

2. Pneumonia
 Inflammation of lung
parenchyma
 Significant cause of mortality
in < 5yr children
 About 4 million deaths world
wide per yr

3. Classification
 Anatomical
 Lobar pneumonia
 Bronchopneumonia
 Interstitial pneumonia

4.  Etiological
 Viral
 RSV, Influenza, parainfluenza, adeno virus
 Bacterial
 Streptococcus pneumoniae
 Staphylococcus aureus
 Haemophilous influenzae
 Mycoplasma pneumoniae
 Kleibsella pneumoniae
 E. coli
 Pseudomonas

5.  Fungal
 Aspiration pneumonia
 Hypersensitivity pneumonitis

6. 0-3 months Gram Negative
St pyogenes
Chlamydia
Viruses
3mo-5yrs Str pneumoniae
H Influenzae
Staph aureus
Viruses
Mycoplasma pneum
>5 yrs Str pneumoniae
Staph aureus
Viruses
Mycoplasma pneum
St pyogenes
Age related Pathogens involved in Community
Acquired Pneumonia

7. Risk factors
 Underlying lung disease
 Asthma, cystic fibrosis
 Anatomic problems
 Tracheoesophageal fistula
 Immunodeficiency
 PEM
 Lack of breast feeding
 LBW
 Overcrowding

8. Clinical features
 Prodromal symptoms URTI
 Rhinorrhoea, sneeze, cough
 Fever
 Fast breathing
 Noisy breathing
 Chest indrawing
 Cyanosis
 Chest pain
 Feeding difficulties
 Lethargy

9. On examination
 Varying degree of resp. distress
 Tachypnea
 Chest
 Chest movement
 Breath sound
 Bronchial breath sound
 Crepts
 Wheeze

10. TACHYPNEA –
Most consistent clinical sign of pneumonia

11. Investigations

12. Investigation
 CXR
 Viral
 B/l interstitial infiltrates
 Peribronchial cuffing

13.  Bacterial
 Lobar homogeneous opacity
 Inhomogeneous opacities
 Pneumatocoeles

14. Lobar consolidation

16. Homogeneous
opacity with
air bronchogram

17. Inhomogeneous
opacities

19.  Cell count
 Leucocytosis
 Blood C/s
 Positive 10-30%
 Isolation from respiratory tract secretion

20. ARI control program CBIMCI
GUIDELINE
 launched to decrease U5MR
 Later merged into IMCI
 For age group 2mon-5yr
1.NO PNEUMONIA:
 ONLY cough or cold
 No fast breathing/ chest indrawing
 No signs of danger features
TREATMENT:
home treatment
councel the mother for danger signs
 No need of antibiotics
 Keep the baby warm
 Frequent feeding

21. 2. PNEUMONIA
 Tachypnea:
 No chest indrawing/ danger signs
 Cough and cold
Age Respiratory rate
60 or more< 2 months
2 months upto 12 mo 50 or more
12 months upto 5 years 40 or more
WHO recommends using these Respiratory rate cutoffs to
diagnose pneumonia at the community level
RR should be counted for full 60 secs.

22.  Treatment:
 OPD basis
Keep the patient warm,
frequent feeding,
management of fever with antipyretics
 Oral Cotrimoxazole for 5 days
 F/U in 2 days
 Counsel about danger signs

23.  VERY SEVERE PNEUMONIA
 Chest indrawing
 Stridor in calm child
 Danger signs:
 Lethargy/ unconscious
 Seizure
 Unable to feed
 Cyanosis

24. Indications for admission to hospital
 Marked tachypnea
 difficulty in breathing
 marked chest indrawing
 intermittent apnea, grunting
 not feeding/ dehydrated
 family not able to provide appropriate
observation or supervision.
 Failure of OPD treatment

25.  TREATMENT:
 Requires hospitalization
Supportive therapy
 O2 supplement
 Adequate hydration
 Bronchodiator
 Antipyretics
 Proper nutrition
Specific management
 Parenteral antibiotics
 Cryst. Penicillin + Chloramphenicol

26. Specific management
 Parenteral antibiotic
 Empirically
 Cefuroxime
 3rd generation cephalosporin
 Ampicillin + chloramphenicol
 Cryst. penicillin + chloramphenicol
 Add cloxacillin or vancomycin
 If staph suspected

27. Complications
 Local
 Pleural effusion
 Empyema
 Pneumothorax
 Lung abscess
 Systemic
 Sepsis
 Menigitis
 Septic arthritis
 Osteomyelitis

28.  Thank you