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RESPIRATORY
INFECTIONS
Pneumonia
Bronchiolitis
Acute Respiratory Infections (ARI)
120
100
80
60
40
20
0
1-5 6-11 12-23 24-35 36-50
Ag e i n M on t h s
Distribution of 12.2 million deaths among children less
than 5 years old in all developing countries, 1993
ARI/Malaria (1.6%)
Malaria (6.2)
ARI (26.9%)
Malnutrition
(29%)
Other (33.1%)
ARI/Measles (5.2%)
Measles (2.4%)
Diarrhoea/measles
(1.9%)
Diarrhoea (22.8%)
RISK FACTORS FOR PNEUMONIA
OR DEATH FROM ARI
Malnutrition, poor
breast feeding
practices
Lack of immunization Vitamin A deficiency
17 / an hour
1 / four minutes
Pneumonia is a no 1 killer for infants
(Balita)
Pneumonia
Classifications
Anatomical classification
Lobar pneumonia
Lobular pneumonia
Intertitial pneumonia
Bronchopneumonia
Etiological classification
Bacterial pneumonia
Viral pneumonia
Mycoplasma pneumonia
Aspiration pneumonia
Mycotic pneumonia
Etiology of Pneumonia
Streptococcus pneumoniae
Hemophilus influenzae
Staphylococcus aureus
Streptococcus group A B
Klebsiella pneumoniae
Pseudomonas aeruginosa
Chlamydia spp
Mycoplasma pneumoniae
BACTERIA ISOLATED FROM LUNG ASPIRATES
IN 370 UNTREATED CHILDREN WITH PNEUMONIA
%
50
40
30
20
10
0
S Pneumoniae H Influenzae S Aureus
Characteristic features
S pneumoniae
mucosal inflammation lesion
alveolar exudates
frequently lobar pneumonia)
H influenzae, S viridans, Virus
invasion and destruction of mucous membrane
Staphylococcus, Klebsiella
destruction of tissues multiple abscesses
Simple Clinical Signs of Pneumonia
(WHO)
Respiratory thresholds
Age Breaths/minute
< 2 months 60
2 - 12 months 50
1 - 5 years 40
Chest Indrawing
(subcostal retraction)
Pathology and Pathogenesis
Bacteriae peripheral lung tissues
tissues reaction oedematous
Red Hepatization Stadium
alveoli consist of : leucocyte, fibrine,erythrocyte,
bacteria
Grey Hepatization Stadium
fibrine deposition, phagocytosis
Resolution Stadium
neutrophil degeneration, loose of fibrine,
bacterial phagocytosis
Bronchopneumonia
Early stages of acute bronchopneumonia. Abundant inflammatory cells fill the
alveolar spaces. The alveolar capillaries are distended and engorged.
Bronchopneumonia
Acute bronchopneumonia. The alveolar spaces contain abundant PMNs and an
inflammatory infiltrate rich in fibrin.
Acute Bronchopneumonia
Acute bronchopneumonia; the alveolar spaces are full and distended with
PMNs and a proteinaceous exudate. Only the alveolar septa allow identification
of the tissue as lung.
Blood Gas Analysis & Acid Base Balance
Bronchioles inflammation
Clinical syndromes:
fast breathing, retractions, wheezing
Predominantly < 2 years of age
(2 6 months)
Difficult to differentiate with pneumonia
Definition
Etiology
.........................
...........bronchiolitis
Etiology
Predominantly RSV (Respiratory Syncytial
Virus), adenovirus etc.
Diagnosis
Etiological diagnosis
Microbiologic examination
Clinical diagnosis
Signs and symptoms
Age
Resource of infection
............bronchiolitis
Clinical Manifestations
cough, cold, fever,fast breathing, retraction,
wheezing, irritable, vomitus, poor intake
Physical Examinations
tachypnea, tachycardia, retraction,
expiration >, wheezing, fever,pharyngitis,
conjunctivitis, otitis media.
Bronchiolitis
Radiologic examination
diffuse hyperinflation
flat diaphragm,
subcostal >
retrosternal space >
peribronchial infiltrates
pleural effusion (rare)
Bronchiolitis
Management
Supportive
Severe disease
hospitalization
intra venous fluid drip
oxygen (antibiotics)
Bronchodilator: controversial
Corticosteroid: controversial
Bronchiolitis