Pneumonia
PNEUMONIA
Pneumonia is an infectious disease affecting lung parenchyma. It is a respiratory disease caused by inflammation of the lung parenchyma caused by viruses, bacteria or irritants introduced into the lungs through hematogenous spread or by inhalation. It's one of the most leading cause of death in children under 5 years of age. It's classified into community acquired , Hospital acquired , Ventilator associated pneumonia.
Epidemiology :
Pneumonia globally very serious problem killing 1000s of people world wide. Though well developed countries with new technologies it does not reduce it's affect on people because of life styles of human beings and MDR (multidrug resistance) pathogens , high virulence capacity of the microbes.
Etiology:
Common pathogens that cause Pneumonia are the following
Pneumonia is an infectious disease affecting lung parenchyma. It is a respiratory disease caused by inflammation of the lung parenchyma caused by viruses, bacteria or irritants introduced into the lungs through hematogenous spread or by inhalation. It's one of the most leading cause of death in children under 5 years of age. It's classified into community acquired , Hospital acquired , Ventilator associated pneumonia.
Epidemiology :
Pneumonia globally very serious problem killing 1000s of people world wide. Though well developed countries with new technologies it does not reduce it's affect on people because of life styles of human beings and MDR (multidrug resistance) pathogens , high virulence capacity of the microbes.
Etiology:
Common pathogens that cause Pneumonia are the following
Clinical manifestations :
Cough is the most common complaint, it may be productive or nonproductive. Tachypnea most specific and consistent sign and they use accessory muscles for respiration in common. Patients frequently febrile in nature. nearly 20% have nausea , vomiting etc GI symptoms. Crackles can be appreciate on auscultation.
Pathophysiology:
Risk Factors:
- Multilobular infiltrates
- Severe hypoxemia (arterial saturation <90%)
- Severe acidosis (pH <7.30 ; Normal pH 7.40 )
- Mental confusion
- Severe tachypnea (>30 breaths/min)
- Hypoalbuminemia
- NeutropeniaThrombocytopenia
- Hyponatremia
- Hypoglycemia
- Lung diseases such as emphysema
- Smoking
- Immunosuppresion diseases
Gram stain and culture of sputum
Blood cultures
Urinary antigen test
PCR
Serology
Biomarkers
Treatment:
WHO recommendations to pneumonia
Recommendation 1:
Children with fast breathing pneumonia with no chest indrawing or general danger sign should be treated with oral amoxicillin: at least 40mg/kg/dose twice daily (80mg/kg/day) for five days. In areas with low HIV prevalence, give amoxicillin for three days.
Children with fast-breathing pneumonia who fail on first-line treatment with amoxicillin should have the option of referral to a facility where there is appropriate second-line treatment.
Recommendation 2:
Children age 2–59 months with chest indrawing pneumonia should be treated with oral amoxicillin: at least 40mg/kg/dose twice daily for five days.
Recommendation 3:
Children aged 2–59 months with severe pneumonia should be treated with parenteral ampicillin (or penicillin) and gentamicin as a first-line treatment.
— Ampicillin: 50 mg/kg, or benzyl penicillin: 50 000 units per kg IM/IV every 6 hours for at least five days
— Gentamicin: 7.5 mg/kg IM/IV once a day for at least five days
Ceftriaxone should be used as a second-line treatment in children with severe pneumonia having failed on the first-line treatment.
Recommendation 4:
Ampicillin (or penicillin when ampicillin is not available) plus gentamicin or ceftriaxone are recommended as a first-line antibiotic regimen for HIV-infected and -exposed infants and for children under 5 years of age with chest indrawing pneumonia or severe pneumonia.
For HIV-infected and -exposed infants and for children with chest indrawing pneumonia or severe pneumonia, who do not respond to treatment with ampicillin or penicillin plus gentamicin, ceftriaxone alone is recommended for use as second-line treatment.
Recommendation 5:
Empiric cotrimoxazole treatment for suspected Pneumocystis jirovecii (previously Pneumocystis
carinii) pneumonia (PCP) is recommended as an additional treatment for HIV-infected and -exposed infants aged from 2 months up to 1 year with chest indrawing or severe pneumonia.
Empirical cotrimoxazole treatment for Pneumocystis jirovecii pneumonia (PCP) is not recommended for HIV-infected and -exposed children over 1 year of age with chest indrawing or severe pneumonia.
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