CHILDREN WITH SEVERE PNEUMONIA - PowerPoint PPT Presentation

Loading...

PPT – CHILDREN WITH SEVERE PNEUMONIA PowerPoint presentation | free to download - id: 47ba31-MDlhO



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

CHILDREN WITH SEVERE PNEUMONIA

Description:

CHILDREN WITH SEVERE PNEUMONIA Piyarat Suntarattiwong * * * * * HISTORY A 3-month-old girl Present with 2 days of fever, cough and dyspnea Two birds died a week ago ... – PowerPoint PPT presentation

Number of Views:439
Avg rating:3.0/5.0
Slides: 19
Provided by: pent175
Learn more at: http://www.pidst.net
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: CHILDREN WITH SEVERE PNEUMONIA


1
CHILDREN WITH SEVERE PNEUMONIA
  • Piyarat Suntarattiwong

2
HISTORY
  • A 3-month-old girl
  • Present with 2 days of fever, cough and dyspnea
  • Two birds died a week ago

3
EXAMINATION
  • BT 38.0oC, RR 50/min,
  • PR 140/min
  • Dyspnea, tachypnea
  • Lung crepitation wheezing both lungs,
    prolonged expiratory phase

4
DIFFERENTIAL DIAGNOSIS?
  • A. Acute bronchiolitis
  • B. Viral pneunonia
  • C. Influenza pneumonia
  • D. Avian influenza pneumonia
  • E. Bacterial pneumonia
  • F. Pertussis
  • G. Chlamydia trachomatis pneumonia
  • H. Others

5
Differentiation of bacterial and viral pneumonia
Bacterial features
Viral features
  • ??????
  • ??? gt 38.5OC
  • ????????? gt 50 ?????/????
  • ???????????
  • ??????????????????? wheeze (?????? mycoplasma)
  • ????? consolidation
  • ??????????????????????
  • ??? lt 38.5 OC
  • ?????????????????????????????
  • ??????????????
  • ??????????? wheeze
  • ???????????????? (hyperinflation)
  • ????????????? hyperinflation

British Thoracic Society of Standard of Care
Committee. BTS guidelines for the management of
community acquired pneumonia in childhood. Thorax
2002 57 i1-i24.
6
Distribution of pathogens associated with LRIs,
stratified by age
Michelow IC, Olsen K, Lozano J, et al.
Epidemiology and clinical characteristics of
community-acquired pneumonia in hospitalized
children. Pediatrics 2004 113 701-7.
7
INVESTIGATION
  • Hct 32, wbc 20,600/mm3 (N 70, L 23, M 5),
    platelet 583,000/mm3
  • UA normal
  • CBG pH 7.37, pO2 42, pCO2 50.2, HCO3 28, BE 3.2
  • Hemo C/S NG in 24 hrs

8
Differentiation of bacterial and viral pneumonia
in children
CXR findings in 215 children with CAP
Total bacteria (n134) () Exclusively viral (n81) ()
Alveolar infiltrates 72 49
Exclusively interstitial infiltrates 28 49
Total bacteria () Exclusively viral ()
Lobar alveolar infiltrates n 60 80 20
The proportion of patients with WBC did not
differ between bacterial and viral pneumonia
R Virkki, et al. Thorax 2002 57 438-441
9
Influenza pneumonia
Suntarattiwong P, et al. Influenza and Other
Respiratory viruses 2008 1 177-82.
10
Percentage of influenza and RSV in hospitalized
infants lt 1 year of age with LRIs (n264)
Sitaposa P, et al. Influenza and RSV in
hospitalized infants under 1 year at Queen
Sirikit National Institute of Child Health
Preliminary result.
11
Avian influenza
  • Criteria for AI screening
  • ??? ??? ????????????????????????????????????????
  • ?????????????????????/??? ?????? 7 ???????????
    ????
  • ??????????????????? ?????? 10 ??????????? ????
  • ??????????????????????????????????????? H5N1
    ???????????????? 14 ???????????

?????????????????????????? ??????????????????????
???????????. ????????????????????
???????????????/??????????? ????????????. ?? ???
??????????????, ???? ??????????????? ??.
??????????????????????????? ??????????????????????
?????????/??????????? ????????????. ????????
??????????????????????? 2551 9-10.
12
Avian influenza
  • AI screening
  • ??????????????
  • CXR
  • TS, NPS ??? PCR ??? H5
  • CXR ???????????
  • ???????? Antiviral treatment

?????????????????????????? ??????????????????????
???????????. ????????????????????
???????????????/??????????? ????????????. ?? ???
??????????????, ???? ??????????????? ??.
??????????????????????????? ??????????????????????
?????????/??????????? ????????????. ????????
??????????????????????? 2551 9-10.
13
Chlamydia trachomatis pneumonia
Finding Chlamydia-positive (n18) Chlamydia-negative (n42) P
Afebrile 72 57 NS
Staccato cough 22 12 NS
Conjuntivitis 33 19 NS
Bilateral symmetrical interstitial infiltrates on CXR 78 67 NS
Eosinophils gt 300/mm3 39 14 0.048
Chun-Jen Chen, et al. J Microbiol Immunol Infect
2007 40 255-9.
14
DISCUSSION Investigation Treatment

15
INITIAL ANTIMICROBIALS?
  • A. Cloxacillin
  • B. Ampicillin
  • C. Cefotaxime
  • D. Erythromycin
  • E. Oseltamivir
  • F. Others
  • G. No antibiotics

16
Antimicrobial treatment of severe pneumonia in
3-mo old baby girl
  • 1. Viral pneumonia
  • 2. Probable viral pneumonia
  • 3. Probable bacterial pneumonia
  • 4. Bacterial pneumonia

17
Choice of antibiotics
  • H. influenzae
  • Ampicillin
  • Ceftriaxone or cefotaxime or cefuroxime
  • Ampicillin/betalactamase inhibitor
  • S. pneumoniae
  • Penicillin, ampicillin (high dose)
  • Ceftriaxone or cefotaxime or cefuroxime
  • S. aureus

18
Thank you
About PowerShow.com