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1、Topics,Respiratory disorders Respiratory infections Pneumonia,Topics Respiratory disorders,Respiratory Disorders,50% of consultation with general practitioners or acute illness in young children and a third of consultations in older children20-35% of acute pediatric admissions to hospital, some of w
2、hich are life-threateningAsthma is the most common chronic illness of childhoodCystic fibrosis is the most common inherited disorder in Caucasians causing chronic disease,Respiratory Disorders50% of co,Respiratory Infections,The most frequent infections of childhood: 6- 8/year Pathogens:viruses,bact
3、erial, other pathogens Host and environmental factors Classification of respiratory infections,Respiratory Infections The mos,Classification of Respiratory Infections,According to the level of the respiratory tree most involved: Upper respiratory tract infection Lower respiratory tract infection,Cla
4、ssification of Respiratory,Pneumonia,Enmei LiuChildrens Hospital, CMU,PneumoniaEnmei Liu,Case -1,C and a respiratory rate of 60 breaths/min. His chest is hyperinflated with marked intercoatal recession. On auscultation there are generalized fine crackles and wheezes.,Case -1,Question,Do you have any
5、 comments or what do you conclude anything from this case?,QuestionDo you have any commen,Case -1,Jack, age four months, is sent at home by his general practitioner because of two days of rapid, laboured breathing and poor feeding. He was born at 27 weeks gestation, birth weight 979g and was dischar
6、ged home at three months of age. On examination he was a C and a respiratory rate of 60 breaths/min. His chest is hyperinflated with marked intercoatal recession. On auscultation there are generalized fine crackles and wheezes.,Case -1,Question,What is pneumonia?,QuestionWhat is pneumonia?,Pneumonia
7、 is an inflammation of the parenchyma of the lungs.,Definition,Pneumonia is an inflammation o,Question,How about the prevalence of pneumonia?,QuestionHow about the prevalen,Pneumonia accounts for approximately 15% of all respiratory tract infections. Worldwide, about 3 million children die each year
8、 from pneumonia, with the majority of these deaths occurring in developing countries. Pneumonia remains the most common cause of morbidity in China.,Incidence,Pneumonia accounts for approx,Question,How to classify pneumonia in clinic?,QuestionHow to classify pneum,Anatomy Pathogens Severity Duration
9、 Onset site,Classification,AnatomyClassification,Bronchopneumonia Lobar or Lobular Pneumonia Interstitial Pneumonia,Based on anatomy or X-ray manifestation,BronchopneumoniaBased on anat,Based on etiology,Bacterial pneumonia Viral Pneumonia Mycoplasma Pneumonia Chlamydia Pneumonia,Based on etiology B
10、acterial pn,Acute Pneumonia Prolonged Pneumonia Chronic Pneumonia,Based on the process of pneumonia,Acute PneumoniaBased on the p,Mild Pneumonia Severe Pneumonia,Based on the severity of pneumonia,Mild PneumoniaBased on the se,Community Acquired Pneumonia (CAP) Hospital Acquired Pneumonia (HAP),Base
11、d on the onset site of pneumonia,Community Acquired Pneumonia,Bronchopneumonia,Bronchopneumonia,Question,Why are children likely have bronchopneumonia?,QuestionWhy are children likel,Characters of childhood airway anatomic structure and their respiratory physiology Immune function of childhood High
12、risk factors: premature baby, underlying disorders,呼吸系统疾病(英文)课件,Question,What cause bronchopneumonia?,QuestionWhat cause bronchopne, Bacteria: Streptococcus pneumoniae, Haemophilus influenzae Viruses Mycoplasma,Causes of Bronchopneumonia, Bacteria: Streptococcus pne,Pathology of Pneumonia,Pathology
13、of Pneumonia,Inflammaory exudate,Inflammaory exudate,Pathology of Pneumonia,Inflammaory exudateInflammaor,Question,What are the pathophysiology of pneumonia?,QuestionWhat are the pathophys,Pathogens,URTI,Bronchitis,Pneumonia,Inflammatory exudate,Obstruction of airway,Gas exchange abnormal,Ventilatio
14、n abnormal,hypoxemia,hypercapnia,toxinemia,tachypneacyanosis,rales,fever,cough,PathogensURTIBronchitisPneumon,Question,What are the signs and symptoms of pneumonia?,QuestionWhat are the signs and,The clinical signs and symptoms of pneumonia depend primarily on the age of the patient, the causative o
15、rganism, and the severity of the disease.,The clinical signs and symptom,Fever,Cough,Cyanosis,Tachypenea,Rales,FeverCoughCyanosisTachypeneaRa,out breathing in,With inspiration, the side of the nostrils flares outwards,Nasal Flaring,out breathing,With inspiration, the lower chest wall moves in,Lower
16、Chest Wall Indrawing,out breathing in,With inspiration, the lower ch,Fever,Cough,Cyanosis,Tachypenea,Rales,FeverCoughCyanosisTachypeneaRa,Classic findings of pneumonia that occur in adults and older children, such as fever,cough and rales, are often absent in infants and toddlers. Generally present
17、with nonspecific signs and symptoms including lethargy, irritability, poor feeding, vomiting. If it appear respiratory failure or other abnormality of other system-severe pneumonia.,Important Points,Classic findings of pneumonia,Complications,Empyema Pyopneumothorax Pneumatocele Lung abscesses Atele
18、ctasis,Complications Empyema,Laboratory Examination,White blood cell count and C-reaction protein Pathogens examination: 1)Sputum cultures 2)Blood cultures 3)Rapid screening tests for virus or bacterial Bronchoscopy Blood gas analysis: hypoxia and/or hypercapnia,Laboratory Examination White,Radiogra
19、ph Evaluation,Typical X-ray manifestation of bronchopneumonia is patchy infiltrates bilaterally Complication: lung abscesses, empyema, pyopneumothorax, pneumatocele, atelectasis CT,Radiograph Evaluation Typical,Normal chest X-ray,Normal chest X-ray,Patchy infiltrates,Patchy infiltrates,Lobar pneumon
20、ia of the right lower zone consolidation,Lobar pneumonia of the right l,lung abscesses,lung abscesses,pyopneumothorax,pyopneumothorax,Question,How to diagnosis pneumonia clinically?,QuestionHow to diagnosis pneum,According to the typical clinical manifestation of bronchopneumonia. According to X-ray
21、 manifestation Pay attention to the atypical manifestation of infants Evaluate the severity of pneumonia Find the etiology of pneumonia,According to the typical clin,Differential Diagnosis,Bronchitis Foreign Body Inspiration Tuberculosis,Differential Diagnosis Bronch,Question,How is pneumonia treate
22、d?,QuestionHow is pneumonia treat,Management,Supportive care Antimicrobials therapy Hospitalization in selected cases,Management Supportive care,Supportive Care Adolescents.,Respiratory care may range from oxygenation, bronchodilators for wheezing, humidification or mist, suctioning, and postural dr
23、ainage, intubation and mechanical ventilation. Hydration (sometimes intravenous) Control of fever Management of complications,Supportive Care Adolescents.,Antimicrobial Therapy Adolescents.,Organism,Antimicrobial,S. pneumoniae,Penicillin (if not resistant). third-generation cephalosporin e.g. cefota
24、ximeceftriaxone (if resistant to penicillin),H. influenzae,Azithromycin or Amoxicillin (if not resistant),Beta lactamase,Cefuroxime or third-generation cephalosporin (if beta lactamase and resistant),S. aureus,Methicillin (if not resistant) Vancomycin (if MRSA-methicillin resistant S. aureus) if pen
25、icillin allergy: vancomycin, clindamycin,Chlamydia,Azithromycin (other macrolides e.g erythromycin); alternative, sulfa drugs,Mycoplasma,Azithromycin (other macrolides); alternative, tetracycline (if older than 8 years),RSV,Ribavirin (optional),Influenza,Amantadine (if severe),Viruses,Antimicrobial
26、Therapy Adolesce,Organisms Causing Pneumonia and Empiric Therapy in Pediatric,Age GroupBacterialViralEmpi,Question,How about the clinical course of pneumonia ?,QuestionHow about the clinical,With treatment, pneumonia caused by bacteria can usually be cured in 1 or 2 weeks Pneumonia caused by a virus
27、 often lasts longer,Clinical Course Adolescents.,Clinical Course Adolescents.,Specific Pneumonias,Specific Pneumonias,Brochiolitis,Brochiolitis is the most common serious respiratory infection of infancy Two to three per cent of all infants are admitted to hospital with the disease each year during
28、annual winter epidemics. Ninety per cent are aged 1-9 months bronchiolitis is rare after one year old. Respiratory syncytial virus (RSV) is the pathogen in 75- 80% cases,Brochiolitis Brochiolitis is t,Clinical Features,Coryzal symptoms precede a dry cough and increasing breathlessness. Wheezing is o
29、ften but not always present. Feeding difficulties associated with increasing dyspnoea are often the reason for admission to hospital. Recurrent apnoea is a serious complication in infants in the first few months of life. Infants born prematurely who develop bronchopulmonary dysplasia and infants wit
30、h congenital heart disease are more severely affected. The finding on examination are characteristic: Sharp, dry cough Tachypnoea Subcostal and intercostals recession Hyperinflation of the chest,Clinical Features Coryzal s,Investigations,RSV can be identified rapidly using a fluorescent antibody tes
31、t on nasopharyngeal secretions. The chest X-ray shows hyperinflation of the lungs due to small airways obstruction and air trapping. Blood gas analysis, which is required in only the most severe cases, shows lowered arterial oxygen and raised CO2 tension,Investigations RSV can be ide,Hyperinflation
32、of the lungs with flattening of diaphragm,Hyperinflation of the lungs wi,Management,Is supportive. Humidified oxygen is delivered into a head- box Mist, antibiotics and steroids are not helpful Nebulised bronchodialators do not reduce the severity or duration of the illness The antiviral drug ribavi
33、rin only marginally shortens viral excretion and clinical symptoms, and should be considered only for infants with underlying cardiopulmonary disorders or immunodeficiency Fluids may need to be given by nasogastric tube or intravenously Mechanical ventilation is required in about 2% of infants admit
34、ted to hospital,Management Is supportive. Hu,Etiology： Respiratory syncytial virus (RSV) is the pathogen in 75-80% cases Clinical features: Age:3-6 monthSeasonWheezingX-ray Duration:7-10 daysManagement:,Bronchiolitis,Etiology： Respiratory syncytia,Staphylococcus aureus .,S. aureus is an uncommon but
35、 important cause of pneumonia that can occur in any age group. S. aureus is a rapidly progressive fulminant illness S. aureus pneumonia easily occurs complications. Blood cultures are positive in 20-30% of patients . The pleural effusions should be drained by thoracentesis or, if large, by a chest t
36、ube. Pneumatoceles are also common and are found in 45- 60% of patients with S. aureus pneumonia. Methicillin or vancomycin should be administered for 3-4weeks.,Staphylococcus aureus . S.,Mycoplasma Pneumonia,M pneumoniae is a common cause of symptomatic pneumonia in older children. Endemic and epid
37、emic infection can occur. The incubation period is long (2-3weeks), and the onset of symptoms is slow. Although the lung is the primary infection site, extrapulmonary complications sometimes occur.,Mycoplasma Pneumonia M pneumo,Clinical Features,Fever, cough, headache, and malaise are common symptom
38、s as the illness evolves. Rales are frequently present on chest examination, decreased breath sounds or dullness to percussion over the involved area may be present.,Clinical Features Fever, co,Laboratory findings,The total and differential white blood cell counts are usually normal. The cold hemagg
39、lutinin titier should be determined, because it may be elevated during the acute presentation. A titer of 1:64 or higher supports the diagnosis.,Laboratory findings The tota,Imaging,Chest x-rays usually demonstrate intersititial or bronchopneumonic infiltrates, frequently in the middle or lower lobe
40、s. Pleural effusions are extremely uncommon.,Imaging Chest x-rays usually d,Complications,Extrapulmonary involvement of the blood, CNS, skin, heart, or joints can occur Direct Coombs-positive autoimmune hemolytic anemia,Coagulation defects and thrombocytopenia can also occur A wide variety of skin r
41、ashes including erythema multiforma and Stevens-Johnson syndrome,Complications Extrapulmonary,Treatment,Antibiotic therapy with erythromycin for 7- 10 days usually shortens the course of illness. Supportive measures, including hydration, antipyretics, and bed rest, are helpful.,Treatment Antibiotic
42、therap,Chlamydial Pneumonia,Pulmonary disease due to C trachomatis usually evolves gradually as the infection descends the respiratory tract. Infants may appear quite well despite the presence of significant pulmonary illness. Appropriate age: 2-12 weeks Inclusion conjunctivitis, eosinophilia, and e
43、levated immunoglobulins can be seen.,Chlamydial Pneumonia Pulmonar,Clinical Features,About 50% of patients with chlamydial pneumonia have active inclusion conjunctivitis or a history of it Rhinopharyngitis with nasal discharge or otitis media may have occurred or may by currently present Cough is us
44、ually present. It can have a staccato character and resemble the cough of pertussis The infant is usually tachypenic. Scattered inspiraotrt rales are commonly heard, but wheezes rarely Significant fever suggests a different or additional diagnosis,Clinical Features About 50%,Laboratory findings,Alth
45、ough patients may frequently be hypoxemic, CO2 retention is not common. Peripheral blood eosinphilia has been observed in about 75% of patients. Serum immunloglobulins are usually abnormal. IgM is virtually always elevated, IgG is high in many, and IgA is less frequently abnormal. C trachomatis can
46、usually be identified in nasopharyngeal washings using fluorescent antibody or culture techniques.,Laboratory findings Although,Imaging,Chest x-rays usually reveal diffuse interstitial and patchy alveolar infiltrates, peribronchial thickening, or focal consolidation. A small pleural reaction can be
47、present . Despite the usual absence of wheezes, hyperexpansion is commonly present.,Imaging Chest x-rays usually r,Treatment,Erythromycin or sulfisoxazole therapy should be administered for 14 days. Oxygen therapy may be required for prolonged periods in some patients.,Treatment Erythromycin or s,Su
48、mmary,Pneumonia in pediatric patients encompasses a wide spectrum of etiologies and illness from mild to severe and life threatening. Therapy should include an antibiotic if a bacteria or atypical bacteria (chlamydia or mycoplasma) is suspected. No antibiotics are necessary for viral pneumonia. Supp
49、ortive therapy also includes fever control, maintenance of hydration and respiratory care . Close follow-up is necessary in order to detect any secondary bacterial infection or the development of complications.,Summary Pneumonia in pediat,Key Issues,Etiology of pneumonia Pathophysiology of pneumonia
50、 Clinical feature of pneumonia Diagnosis and differential diagnosis of pneumonia Management of pneumonia Several special pneumonias,Key Issues Etiology of pneum,Case -2,History: A 9-week old female infant come to see doctor with a 3 week history of rhinorrhea and a 2 week history of cough. The cough
