BACTERIAL PNEUMONIA
 
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BACTERIAL PNEUMONIA

 

DEFINITION:

An acute or recurrent bacterial infection of the parenchyma of the lung causing cough, fever, and respiratory distress.

EPIDEMIOLOGY:

  • incidence: primary bacterial pneumonia is rare
  • age of onset:
    • depends upon etiology agent
  • risk factors:

    1. Primary Recurrent Pneumonia

    1. Chronic Underlying Illnesses

    • Decreased Mucociliary Clearance
      • CF, Ciliary Dyskinesia Syndrome
    • Immunodeficiencies
      • agammaglobulinemia, neutropenia
    • Congenital Disorders
      • cleft palate, congenital bronchiectasis, tracheoesophageal fistula

    2. Secondary Pneumonia

  • viral upper respiratory tract infections
  • iatrogenic
    • anesthesia, aspiration, trauma

PATHOGENESIS:

1. Pathogens

1. Gram Positive Cocci

  • Streptococcus - Pneumoniae, Groups A -> C
  • Staphylococcus

2. Gram Negative Bacilli

  • Haemophilus Influenzae
  • Klebsiella Pneumoniae
  • Pseudomonas Aeruginosa

2. Pathogenesis

  • for various reasons, the defense mechanisms of the lung are altered:

1. Viral URTI

  • virus alters:
    • properties of normal secretions
    • normal respiratory bacterial flora
    • inhibits phagocytosis
    • disrupts the normal epithelial layer of the lung

2. Chronic Underlying Illnesses

  • interfere with the lungs ability to clear infection
  • search for an underlying cause in a child who presents with recurrent pneumonias

CLINICAL FEATURES:

1. Prodrome

  • upper respiratory tract infection usually preceds by a few days

2. Pneumonia

  • varies with etiologic agent:
    • cough
    • crackles
    • dyspnea
    • respiratory distress
    • wheeze
    • chronic cough
  • respiratory features are often non-specific and few in infants and young children (anorexia, fever, lethargy, malaise)

3. Complications

  • abscesses
  • empyemas
  • pleural effusions
  • pneumatocele
  • pneumothorax
  • pyopneumothorax

INVESTIGATIONS:

1. Chest X-Ray

  • different patterns with different agents:
    • lobar or lobular
    • interstitial (bronchopneumonia)
  • complications

2. Microbiology

  • samples: sputum, throat swab, nasopharyngeal secretions, tracheal aspirate, bronchial washings, lung aspirate, pleural fluid
  • other samples: blood, CSF, urine
  • culture or rapid antigen detection

3. Serum

  • leukocytosis with left shift

MANAGEMENT:

1. Medical

  • antibiotic therapy
  • manage complications:
    • due to specific infective agent
    • respiratory
  • intubation/ventilation
  • treat underlying illness (i.e., CF)

 

 

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