Pediatric Pneumonia - CRASH! Medical Review Series

Summary

This talk focuses on pediatric pneumonia, discussing common pathogens by age group and their diagnostic and management differences. Pneumonia is the leading cause of children's deaths worldwide, with 158 million cases annually. In underdeveloped countries, the death rate is 2,000 times higher than in the US. The presentation varies by age, with viruses like RSV predominant in young children, and bacteria like Streptococcus pneumoniae more common in older children. Diagnosis involves symptoms, physical exam, and chest X-rays, with treatment ranging from supportive care for viral pneumonia to antibiotics for bacterial cases.

Takeaways

• 🌐 Pneumonia is the leading cause of death in children worldwide, causing 29% of all pediatric deaths globally.
• 👶 In underdeveloped countries, the death rate from pneumonia is 2,000 times higher than in the US.
• 🦠 Common pathogens vary by age group, with viruses like RSV and parainfluenza being predominant in young children.
• 👶🏻 Newborns are primarily affected by Group B Strep, gram-negatives, and Listeria, with Listeria affecting the very young and the elderly.
• 🧬 Viral pneumonia is more common in young children, presenting with low-grade fever and upper respiratory symptoms.
• 🦠 Bacterial pneumonia presents more severely with high fever, chills, chest pain, and a toxic appearance.
• 🔍 Diagnosis involves physical examination, CBC with differential, blood cultures, nasopharyngeal swabs, and chest X-rays.
• 🏥 Hospitalization is considered for young children, those with respiratory distress, dehydration, multiple lobar involvement, or toxic appearance.
• 💊 Treatment for viral pneumonia is supportive, while bacterial pneumonia is treated with antibiotics like amoxicillin.
• 📈 About 30% of children with viral pneumonia may develop a coexisting bacterial infection.
• 📊 Chest X-rays help differentiate between viral and bacterial pneumonia, with viral showing a more generalized pattern and bacterial showing consolidated areas.

Q & A

What is the leading cause of death in children worldwide?

Pneumonia is the leading cause of death in children worldwide, accounting for 29% of pediatric deaths globally.

How does the death rate from pneumonia in underdeveloped countries compare to that in the US?

The death rate from pneumonia in underdeveloped countries is 2,000 times higher than that of children in the US.

What are the common pathogens that cause pneumonia in children under three months of age?

In children under three months of age, common pathogens include viruses such as RSV and parainfluenza, as well as pneumococcal pneumonia, strep pneumonia, and staph aureus.

What are the typical symptoms of pneumonia in newborns and very young infants?

Newborns and very young infants may not show typical symptoms of pneumonia and can be silent before suddenly decompensating.

How can you differentiate between viral and bacterial pneumonia based on symptoms?

Viral pneumonia often presents with low-grade fever and upper respiratory tract symptoms, while bacterial pneumonia presents with high-grade fever, chills, more severe cough, and a more toxic appearance.

What is the significance of dullness to percussion in diagnosing pneumonia?

Dullness to percussion on a chest exam can indicate the area affected by bacterial pneumonia, as it tends to consolidate in one area, unlike viral pneumonia which is more generalized.

What are the common pathogens that cause pneumonia in children aged four months to four years?

In children aged four months to four years, viruses are the most common cause of pneumonia, with possibilities of strep pneumonia and mycoplasma being less common.

Why is it important to get both AP and lateral views of the chest x-ray when diagnosing pneumonia?

Both AP and lateral views of the chest x-ray provide better diagnostic clues, helping to differentiate between viral and bacterial pneumonia based on the patterns of lung involvement.

What are the indications for hospitalizing a child with pneumonia?

Indications for hospitalizing a child with pneumonia include very young age, respiratory distress, dehydration, multiple lobar involvement, toxic appearance, immunocompromised state, no response to oral antibiotics, and social or care issues.

How is mycoplasma pneumonia typically treated?

Mycoplasma pneumonia is typically treated with azithromycin (Z-pack) or erythromycin. In cases of allergy or intolerance to these drugs, respiratory fluoroquinolones may be used.