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PNEUMONIA IN CHILDREN
dr.Rodman Tarigan,SpA.,MKes
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HISTORY OF THE TERM
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1603 : The frst record or using this word in English
language
Until 1822: pneumonia =pneumonitis
ince 1!60s : attempts to distinguish these two terms
"#EU$%#&' : in(ammator) conditions *inecti+e condition,
"#EU$%#&T&: in(ammator) conditions *non inecti+e,
- not consistentl) applied- anomalies
*i.e: rheumatic pneumonia and rheumatic pneumonitis
/oth are associated with +aricella inection,
TE E"&'T% &E'E descri/ed /) ""%4'TE*5th centur) 4, and called 7"E&"#EU$%#&'
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pneumonia inecti+e condition
pneumonitis non-inecti+e condition*such as radiation-induced lung
in9ur),
This distinction is not consistent
#ow :
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DEFINITION
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#o single defnition o pneumonia: thereis contro+ers) on how /est to defne it
efnitions ma) depend upon:
the use the) are putthe o/9ecti+es
(I.e. health-care worker in the feld in developingcountry may dier rom that employed in clinical studyin a developed country)
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' clinical illness defned in terms othe clinical s)mtoms and signs andit course
"#EU$%#&'
Two typical clinical defnition :ronchopneumonia:
e!rile illness" cough" respiratory distress" rale onphysical e#amination" chest $-ray evidence o
locali%ed or geneli%ed patchy infltrate
;o/ar pneumonia:&imilar to !ronchopneumonia e#ept that physical
e#amination and chest $-ray indicate lo!ar
consolidation
#%TE: in man) de+eloping countries
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Lower lobe pneumonia
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% E>&T&%#
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4ountries limited health-care aciliti
"#EU$%#&' a e/rile illness with tach)pn
- The gold standard or the diagnosis o pneumonia inan am!ulatory setting in developing countries
- This !oard defnition results in the inclusion opatients who do not have pneumonia !ut othercondition" i.e. asthma and systemic inection
- ' sensitivity or pneumonia
- rom * pneumonia detected !y +, criteria *- have severe pneumonia" and pro!a!ly have
-
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E"&E$&%;%?
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>E4T&%# %> ;%E E"&'T% T'4T = ;&including croup /ronchiolitis pneumonia mostcommon pro/lem(/ illmesses0' children less than 1 years o age)
$ost o these episodes are "#EU$%#&'
&n de+eloping countries "#EU$%#&' occurs 2-10
times more re@uentl) in children and isresponsi/le or
a @uarter o all death in underf+e children
(The incidence o 2cute respiratory tract inections3
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a5ow !irth weight!6ormal !irth weight
'nnual incidence opneumonia per 100'ge *)ears,"lace
e+eloped countr) 7hapel ,ill" 8&2 &eattle" 8&2
e+eloping cou/tr) 9angkok" Thailand adchiorii" India ilgit" ;akistan enny ?+. @ ;A>I2T4 'B1C 'B:1/-D1)
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& >'4T%:- low !irth weight
- poor nutrition (general and vitamin 2defciency)
- nasopharingeal carrage o pathogens"- enviromental actors
h l i
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"lace
e+eloped countr) ote!org"&weden 6orth +ales" 8=
6e!raska" 8&2 6orth 7arolina" 8&2 Eirginia" 8&2
e+eloping cou/tr) 9asse" am!ia
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ETIOLOGY
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- The etiologi very with the age, immunologyc status,some
enviromental conditions
'. >E4T&%# (viral" !acterial" mycoplasma"chlamydia"
parasites" ungi" myco!acterium"ricketsia) Hiruses account or the ma9orit) o cases*H
adeno+irus parain(uenGa and in(uenGa+irus,
2. #%#->E4T&%# (ood aspiration" oreign !ody"drugs" radiation" etc)
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-Factors increase the risk of bacterial pneumoniaconginetal anatomic defectsdeficits in immun function (by drug or diseasede!elopmental and genetic disease
(trac"eoesop"ageal fistula# cystic fibrosis# etcaspiration of a foreign bodygastroesop"ageal reflu$mec"anical !entilationprolonged "opitali%ation
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3 month- B )earsA 3 month"athogen
Streptococcus pneumoniaeHirusesEnteric /acilli
?roup streptococciChlamydia trachomatisStaphylococcus aureusHaemophilus infuenzaeGrup A strreptococci
Mycoplasma pneumoniaeChlamidia pneumoniae
IIIIII
I
-II
IIII
III
J B )ears
IIIIIIIII
IIIIIIIII-
-
IIIIII
-
III
IIIII
III +er) re@uentK II moderatel) re@uentK I rareK - a/
>re@uenc) o pathogens in communit)-ac@uiredchildhood pneumonia in de+eloped countries
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CLINICAL MANIFESTATION
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T)pical eatures o /acterial +iral and m)coplasmapneumonia in children
Hiralacterial
'geeason%nset>e+er
Tach)pnea4ough'ssosiated s)mptoms
"h)sical fndings
;euLoc)tosisadiographic fndings
"leural eMusion
$)coplasma
'n)inter'/ruptigh
4ommon"roducti+e$ild cor)Ga'/dominal painE+idence o consolidation
>ew cracLles4ommon4onsolidation
4ommon
'n)interHaria/leHaria/le
4ommon#onproducti+e4or)Ga
Haria/le
Haria/leilateral diMuse infltratesare*adeno+irus,
B-1B )ears'll )ear&nsidious;ow grade
Uncommon#onproducti+eullous m)ringit"har)ngitis>ine cracLleseeGing
UncommonHaria/le
mall in 10-20F
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RADIOGRAPHIC EXAMINATION
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Remain the diagnostic mainstay in
childhoodpneumonia, support the clinicalimpression
and dening extent the disease
Posteroanterior and lateral view o !"rayshould #e made
Pneumomatoceles and pleural eusions reuently assosiated with !taphyloccocal
pneumonia
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DIAGNOSISDIAGNOSIS
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MANAGEMENT
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COMPLICATIONS
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)* Empyema
+* Lung abscess
,* Pneumot"ora$
* Pericarditis
.* Pneumatocele
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