Pneumonia
Lesson Objectives
By the end of this lesson, learners should be able to:
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Define pneumonia and recognize its common causes in children.
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Identify viral and bacterial etiologies, including high-risk pathogens in HIV-infected children.
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Recognize the clinical signs and symptoms of pneumonia in infants and children.
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Classify pneumonia severity according to WHO criteria.
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Determine indications for hospital admission.
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Identify relevant investigations and interpret results.
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Apply appropriate management including oxygen therapy, IV fluids, and antibiotics.
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Adjust therapy according to age, severity, HIV status, and response to treatment.
Description
Pneumonia is inflammation of the lung parenchyma. Both bacteria and viruses are important causes. In HIV-infected children, bacterial causes predominate.
Common bacterial causes: Streptococcus pneumoniae, Haemophilus influenzae, Staphylococcus aureus, Mycoplasma pneumoniae.
Common viral causes: Respiratory syncytial virus, adenovirus, cytomegalovirus, influenza, parainfluenza, herpes, human metapneumovirus, measles.
Signs and Symptoms
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Fever >38°C
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Cough
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Difficulty breathing
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Increased respiratory rate (>60/min in infants; >50/min in older children)
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Severe chest indrawing
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Reduced consciousness
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Severe acute malnutrition
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Seizures
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Vomiting and poor feeding
Cut-offs for Fast Breathing
| Age | Fast Breathing Cut-off |
|---|---|
| <2 months | ≥60 breaths/min |
| 2–12 months | ≥50 breaths/min |
| 12 months–5 years | ≥40 breaths/min |
WHO Classification of Pneumonia
| Category | Characteristics |
|---|---|
| No Pneumonia | No signs of pneumonia |
| Pneumonia | Immunocompetent child ≥2 months; tachypnoea (RR>50 in 2–12 months; RR>40 in 1–5 yrs); lower chest indrawing |
| Severe Pneumonia / Very Severe | Infants <2 months with danger signs; lower chest indrawing; RR>60; HIV-exposed/infected infants; malnourished children |
Indications for Admission
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Cyanosis, SpO2 <92%
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Increased respiratory rate
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Subcostal recession
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Intermittent apnoea or grunting in infants
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Poor feeding
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Convulsions
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Restlessness or agitation
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Signs of dehydration
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Unconsciousness or lethargy
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Capillary refill time >3 seconds
Investigations
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Chest X-ray
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Full blood count (FBC), erythrocyte sedimentation rate (ESR)
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Urea, electrolytes
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Blood culture
Treatment
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Oxygen via nasal cannula or mask
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IV fluids if required: <2/3 of requirements (risk of SIADH in hypoxic children)
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Antipyretics and analgesics as indicated
Antibiotic Therapy
| Drugs | Age / Indication |
|---|---|
| 1st Line | |
| Amoxicillin | 40–80 mg/kg/day in 3 divided doses |
| Co-Amoxiclav | 45 mg/kg/day (amoxicillin component) every 8 hours |
| Benzylpenicillin + Gentamicin | 0–3 months: 50,000 IU/kg/dose every 6h + Gentamicin 7.5 mg/kg once daily or 3.75 mg/kg 12h |
| >3 months: same dosing as above | |
| 2nd Line | Ceftriaxone 50–80 mg/kg/day IV or Cefotaxime 50 mg/kg 8 hourly IV |
| Severe pneumonia / Staph suspected | Add IV Cloxacillin 12.5–25 mg/kg every 6 hours |
| HIV-exposed / non-responders | Consider high-dose IV/PO cotrimoxazole 20 mg/kg/day (trimethoprim component) |
| Macrolides | Consider in school-aged children or adolescents not responding to first-line treatment |
| Erythromycin (oral) | 1–2 yrs: 125 mg 6h; 2–8 yrs: 250 mg 6h; 8–18 yrs: 250–500 mg 6h |
| Azithromycin (oral) | 6 months–2 yrs: 10 mg/kg once daily; 3–7 yrs: 200 mg once daily; 8–11 yrs: 300 mg once daily; 12–14 yrs: 400 mg; >14 yrs: 500 mg once daily |