This document provides an outline and overview of a seminar presentation on pneumonia. It discusses the epidemiology, pathophysiology, etiology, classification, clinical manifestations, laboratory/diagnostic investigations, treatment approaches, and complications of pneumonia. Pneumonia remains a common cause of severe sepsis and a leading infectious cause of death. Treatment involves antibiotics targeting the likely causative pathogens, with choices dependent on patient age, location of infection (community-acquired, hospital-acquired, ventilator-associated), and risk of drug-resistant organisms. Patient education on prevention, symptom management, and completing antibiotic courses is also emphasized.

1. Seminar presentation on
pneumonia
Presented by
ferhan mahamud
felmata abdi
hanan muktar
endisar abdela

2. Out line
• Introduction
• epidemiology
• pathophysiology
• etiology
• Classification and risk factors
• clinical manifestations
• Laboratory and other investigations
• Treatment

3. Introduction
•Pneumonia:
• is acute infection and inflammation
of the lung tissue caused by various
bacterial species, viruses, fungi or
parasites.

4. Epidemiology
• Pneumonia remains:
• one of the most common causes of severe sepsis and
• leading infectious cause of death in children and
adults
• a mortality rate as high as 50% depending on the
severity of illness
• It occurs in persons of all ages, although the clinical
manifestations are most severe in the very young,
and elderly,

5. Etiology
• lung Infections( by impairing alveormacrophage and
mucociliary clearance)
• Aspiration of gastric contents
• Malnutrition, lack of immunization
•
• • Rickets, preceding upper respiratory tract infection
•
• • Exposure to cigarette smokes, indoor air pollution
•
• • Immunosuppression ( HIV, cancer, alcohol dependence,)
•Any alteration of the normal lung microbiome by infection or.
disease can lead to pneumonia

6. Causative pathogen vary according to
age and patient conditions
• Neonates: group B streptococcus, Klebsiella, E.coli,
Chlamydia and S. aureus
•
• • Children <5 years: streptococcus pneumonia
. - (Pneumococcus), Haemophilus
influenzae,
• less frequently: S. aureus, M. Pneumoniae, viruses (
influenza, measles)
•
• • Children and adult >5 years: most commonly
S.pneumoniae, followed by atypical bacteria, e.g.

7. • Pneumonia in pt with cytic fibrosis is caused by
- S. aureus in infancy and p. aeruginosa •
, in older pt.
• Pneumonia in immunocompromised child is
caused by : pneumocystis ( in HIV infected)

8. Pathophysiology
• Pneumonia results from the proliferation of microbial
pathogens at the alveolar level and the host's
response to those pathogens
• Respiratory pathogens enter the lower respiratory
• tract by one of three routes:
• 1) direct inhalation of infectious droplets
• 2) aspiration of oropharyngeal contents or
• 3) hematogenous spread from another infection site

9. Classification of pneumonia
• According to environment :
1) CAP : pneumonia developing outside the
hospital or <48 hour after hospital
admission
risk factor : DM,asplenia, pulmonary disease
2) HAP : pneumonia developing >48 hours
after hospital admission
risk factor : witnessed aspiration, COPD , MDR risk such as
MRSA and MDR pseudomonas if IV antibiotic use within 90
days
3) VAP : pneumonia developing >48 hours
after endotracheal intubation
risk factor: acute replacement therapy preceding VAP or
5+ day of hospitalization preceding VAP

10. • 2) According to the causative
organisms
• a, Bacterial
b, virus
c, parasite
d, fungal

12. Virus

13. Parasite : ascaris and strongloides species

14. 3) According to Infection
There are two major types:
• Bronchopneumonia: involves both the lung
parenchyma and the bronchi.
It is common in children and the elderly.
• Lobar pneumonia: involves one or more lobes
of the lung. It is common in young people

15. Clinical manifestations
• Pneumonia:
• • Cough
• • Fast breathing
• • But no signs for severe pneumonia
• Severe pneumonia:
•Cough or difficult breathing
•Lower chest indrawing,
•Nasal flaring,
•Grunting in young infants.
•Fast breathing( 2 -12 month : >/ =50 bpm, 1-5yr >/=
40bpm
• abnormal breath sounds may. also be present

16. Clinical manifestations of
atypical pneumonia
• − Fever, Tiredness (fatigue), headache
•
• − Skin rash, ( malaise) general feeling of sickness
•
• − Cough, dry to phlegmy ear infections
•
• − sinus infection, sore throat
•
• − Wheezing in children who have an airway problem
such as asthma

17. Lab and other investigations
• The decision to treat a child who has pneumonia is usually
made clinically
•
• • Chest X ray and for looking complications,
Eg. Dense lobar or segmented infiltrates
• Sputum: For Gram stain, Ziehl-Neelsen (ZN) stain, ..
culture for AFB
•
• • Blood: Complete blood count
• Leukocytes with predominance of polymorphonuuclear cell
•

18. Treatment Approach of
pneumonia
• Gaol of treatment
Primary goals are
Eradication of the offending organism and
subsequent complete clinical cure
secondary goals are
minimization of the unintended consequence
Of therapy and
minimizing costs through outpatient and oral therapy
when the patient’s severity of illness and clinical
considerations permit

19. Non pharmacological treatment
• Frequent monitoring of all the vital signs in order
to detect complications early and to monitor
response to therapy, for all patients.
• Give attention to fluid and nutritional
replacements as required.
• Administer Oxygen via nasal

20. Treatment Of pneumonia
• Severe Pneumonia in an Infant (up
to 2 months):
•
Ampicilin is 50mg/kg IV
BID for neonates<14days old
, QID for those > 14 days,
In severely ill infants Ceftriaxone 100 mg/kg IV once
daily
Continue treatment for at least 7 days

21. Management of infant (up to 2month
• Admit, keep baby warm
•
• • Prevent hypo glycaemia by breastfeeding/giving
expressed breast milk/NGT
•
• • If child is lethargic, do not give oral feeds. Use IV.
fluids with care
•
• • Give oxygen to keep SpO2 >94%

22. Pneumonia in a child of 2 month-5yr
For non sever
_First-line
Amoxicillin, 25 mg/kg every 12hourss P.O for 5 days
- Alternatives
Azithromycin, 10mg/kg/24 P.O., once daily for 3
days mainly when patients have afebrile
pneumonia syndrome.
- Reassess child for progress after 3 days

23. Pneumonia in child of 2 Month-5year
for sever
Antipyretic : Paracetamol, 10-15mg /kg P.O., up to. . .
4-6 times a day for the relief of high fever
Alternatives: Ibuprofen, 5 – 10mg/kg/dose every 6 – .
8hr P.O. (max. 40mg/kg/24hours
• first-line
Benzyl penicillin, 50,000units/kg/24hours IV QID for at least 3 days
N.B. When the child improves switch to oral
Amoxicillin: 25 mg/kg/24 hours 3 times a day.
The total course of treatment is 5-7day

24. • If the child doesn’t improve within 48 hours, switch to
ceftriaxone 80mg/Kg/24 hours IM/IV BID for 5 days
• If staphylococcus is suspected (empyema
pneumatocele at X ray),
give gentamicin 5 mg/kg once daily plus
Cloxacillin 50 mg/kg IV every 6-hour
•
• Zinc supplementation in children <5years with severe
peumonia

25. For atypical pneumonia
Azithromycin, 10mg/kg P.O., on day 1, 5mg/kg on
day 2-5,
• for children <6 months of age
10mg/kg/day for 5 days

26. Treatment for HAP and VAP
• Patients at lower risk of drug resistant
organisms, ie those with:
No IV antibiotics within previous 3 months,
no structural lung damage( COPD,lung fibrosis),
few or no co-morbidities, and
Not known MRSA carriers
− Ceftazidime 75 mg/kg/day IV
( into 2 divided doses per day) AND Gentamicin 3 –
5 mg/kg/day IV (given once daily) for 7 days

27. • Patients at higher risk of drug resistant
organisms, ie those with:
history of IV antibiotic use within previous 3 months,
structural lung damage (Bronchiectasis, COPD,lung
fibrosis),
prior co-morbidities and known MRSA carrier
•
• − Piperacillin-Tazobactam 100 mg/kg IV q 8 hours for
7 day

28. Aspiration pneumonia
• Non-pharmacologic
•
• Give oxygen if SpO2 < 90% with nasal prongs and
• monitor through pulse oximetry for those in respiratory
distress via nasal cannula
• Gentle suction of thick secretions from upper airway
•
• Pharmacologic
•
• - Ceftriaxone 80mg/Kg/24 hours IM/IV + Metrondazole
7.5mg/kg every 8 hours
• - Refer the patient for possible removal

29. Management for complication
• Pleural effusion and empyema:
_Non-pharmacologic : Chest tubes (tube thoracostomy)
Insert chest tubes immediately after a complicated
parapneumonic pleural effusion or empyema thoracis is diagnosed.
• The key to resolution involves prompt drainage of
pleural fluid because delay leads to the formation of loculated
pleural fluid.
treat with : macrolide( azithromycin) plus ceftriaxon

30. Common side effect of
Medication
• Aminoglycoside (gentamicin):
- nephrotoxicity
- ototoxicity
• Cephalosporins(ceftriaxon,ceftazidin, cefepime):
- Hypersensitivity ,
- Diarrhoea and Pain at injection site
• penicillin ( ampiciline,amoxicillin) :
Hypersensitivity
•vancomycin: Redman syndrome, nephrotoxicity and
Hypotension and fever

31. Evaluation of Therapeutic Outcomes
• Progress should be noted in the first 2 days and
progression to complete resolution whithin 5 to 7
days
•Serum procalcitonin concentrations in combination
with clinical response criteria can be used in the
decision to discontinue antibiotic therapy

32. Patient education
• Limite Infection spread by :
- covering mouth , nose when coughing and sneezes
- wearing mask in public
- whashing hand frequently
• to complete the prescribed antibiotic course
• to drink plenty of water to liquefy and mobilize secretion
• educate about vaccination such as
- Polyvalent polysaccharide vaccines for prevent two of the
leading causes of bacterial pneumonia,
S.pneumoniae and
H. influenzae type b

33. Reference
• STG for general hospital in Ethiopia 4th
edition 2020
• Nelson textbook of pediatric 21 edition