2. Upper respiratory tract
Cricoid cartilage
Lower respiratory tract

3. Common diseases Upper respiratory tract: Lower respiratory tract:
Influenza
Tonsillitis
laryngitis
Lower respiratory tract:
bronchitis
Asthma
Pneumonia

4. Ventilation and perfusion

5. Ventilation Perfusion Rate
Ventilation and perfusion
Ventilation Perfusion Rate
Alveolar space O2
CO2
70%
100%

6. Pathophysiology

7. According to WHO’s report:
Among all the pediatric patients, 90% suffered from infectious diseases;
Among all these patients with infectious diseases, 90% are diagnosed as URI.
Among all these URI patients, 90% are infected by virus.

8. Pneumonia
Pneumonia is termed as infections of the alveoli caused by microorganisms or other noninfectious factors.
Pneumonia still carries a high mortality rate in infants who are not treated promptly and properly.

9. There are many different causes of pneumonia in children
There are many different causes of pneumonia in children. The most common causes are germs. Viruses are usually the cause in 90% of pneumonia infants and young children. Children with a viral pneumonia may have a better chance of developing a bacterial pneumonia, too.

10. Pneumonia can also be caused by foreign material such as food or stomach acid, especially in newborn and infants. These materials are aspirated (inhaled) into the lungs.

11. Common causes Viruses group B Streptococcus
Newborns
group B Streptococcus
respiratory syncytial virus
Infants
Viruses
parainfluenza viruses, influenza virus, adenovirus
Atypical organisms
Chlamydia trachomatis, Pneumocystis carinii
Bacterial
B. pertussis, Streptococcus pneumoniae, Haemo-philus influenzae

12. Common causes
Young children
Viruses
parainfluenza viruses, influenza virus, adenovirus
Atypical organisms
Mycoplasma pneumoniae
Bacterial
Pneumococcus, mycobaterial tuberculosis
Older children and adolescents
Mycoplasma pneumoniae, Chlamydia trachomatis
Pneumococcus, B. pertussis, mycobaterial tuberculosis

13. Bacterial pneumonia
Viral pneumonia
Mycoplasmal pneumonia

14. Common Signs and symptoms
Cough
Breathing pattern
Cyanosis
Respiratory Sound

15. Cough
A cough is a voluntary or involuntary explosive expiration. The cough reflex is initiated by the stimulation of subepithelial
mechanoreceptors in the trachea,
bronchi and interstitium.

16. Cough
Paroxysm: A series of coughs that is difficult to stop. It is due to pertussis, viral infection and asthma, etc. During paroxysm of coughing, headache, vomitting, conjuctival hemorrhage may be induced by the increased intracranial pressure.
An acute cough may be benefit to eliminate the obstruction or facilitate mucociliary clearance when foreign bodies or excess mucus is present. A chronic cough may be harmful to cause complications, such as chest pain.

17. breath with Severe pneumonia
Breathing pattern
Normal breath
breath with Severe pneumonia

18. Cyanosis
When maximal respiratory efforts cannot provide sufficient ventilation to saturate the blood fully and the amount of unoxygenated Hb exceeds 50g/L, the children will appear cyanotic.

19. Respiratory sounds
Breath sounds are influenced by the depth of breathing, velocity of the air flow, position of the patients and the fluid in the air space.
The pitch of breath sounds depends on the size of the orifices or the diameter of the airway: the smaller the orifice or the airway, the higher the pitch.

20. Symptoms of different pneumonia
Viral pneumonia
The respiratory syncytial virus is the most common agent. It is often accompanied by a skin rash and unresponsive to antibiotics.
Adenovirus may produce viral pneumonia in children and young adults. It more commonly causes upper respiratory tract disease with prominent rhinitis.

21. RSV Pneumonia
Respiratory syncytial virus is the major respiratory pathogen of young children, causing lower respiratory tract disease in infants. Infection may occur at any time but is least frequent in the summer, accounting for 20 to 25% of hospital admissions for pneumonia of young infants and children.

22. RSV Pneumonia
lower respiratory diseases, primarily, pneumonia, bronchiolitis and tracheobronchitis occurs in 25-40% of cases
onset is gradual with rhinorrhoea, low-grade fever, cough, wheezing and mild systemic symptoms
tachypnoea, dyspnoea, frank hypoxia, cyanosis and apnoea may develop in severe cases
wheezing and crackles may be heard on auscultation
there may be an accompanying skin rash

23. Bacterial Pneumonia pneumococcal pneumonia
usually a history of preceding upper respiratory tract viral infection.
more common in winter months with sudden onset
marked fever; febrile convulsions in preschool children
cough - initially dry but replaced by a productive cough with rusty-coloured sputum after hours
breathing - rapid and shallow; diminished movement on the affected side
may be signs of consolidation and a friction rub

24. Bacterial Pneumonia staphylococcal pneumonia
usually a history of preceding upper respiratory tract viral infection.
more common in winter months with sudden onset
marked fever; febrile convulsions in preschool children
cough - initially dry but replaced by a productive cough with rusty-coloured sputum after hours
breathing - rapid and shallow; diminished movement on the affected side
may be signs of consolidation and a friction rub

25. Mycoplasmal pneumonia
peak rate of infection in autumn and early winter
initial influenza-like disease with headache, fever, malaise, myalgia, diarrhea and fatigue - often develop several days before the onset of respiratory problems; the malaise and fatigue may persist for long after the acute illness
wide variety of respiratory and non-respiratory complications

26. cough - initially dry and often insignificant; usually becomes productive with a mucoid and purulent sputum; often paroxysmal, disturbing sleep; may be absent in one-third of cases
isolated crackles or areas of wheezing may be heard over one of the lower lobes
subsegmental atelectasis and small effusions often detectable in the absence of prominent chest symptoms

27. Radiology RSV pneumonia
Radiologic features are variable depending upon the extent of the infection. Chest radiology
may show hyperexpansion,
peribronchial thickening, and
infiltrates ranging from diffuse
interstitial infiltrates to
segmental or lobar consolidation.

28. pneumococcal pneumonia
classically, shows consolidation with a lobular distribution
note that radiological
changes may lag behind
the clinical course of the
disease and conversely,
radiologic features may
persist for several weeks
after being cured.

29. staphylococcal pneumonia
The chest radiograph often appears cavitated. Infection starts in the
bronchi, causing areas
of patchy consolidation
in one or more lobes.
These break down to
form multiple thin walled
abscesses – pneumatocoeles
- which appear as cysts.

30. Mycoplasma pneumoniae
Chest radiology is highly variable. The most frequent pattern is one of bronchial thickening
with areas of interstitial
infiltration and subsegmental
atelectasis involving one of
the lower lobes; sometimes,
there may be dramatic
shadowing in both lower lobes.
Often there is no correlation
between radiologic appearance
and the clinical state of the patient.

31. Lab tests RSV pneumonia
Diagnosis is established by isolation of RSV from respiratory secretions, particularly, sputum or throat swabs. Immunologic reactions such as ELISA are then used to detect the virus in tissue culture.

32. Techniques based on complement fixation or neutralisation of antibody titers are more valuable in older children and adults.
A bedside immunoassay kit is now available which detects RSV; confirmation should be sought with the laboratory tests detailed above.

33. Lab tests pneumococcal pneumonia
white cells - raised; often greater than 15 x 109 per litre
ESR - raised; may exceed 100 mm in an hour
CRP - raised

34. Sputum examination, sputum and blood culture- positive in 25-40% of cases, are essential in management of a patient with pneumonia. It may possible to demonstrate
pneumococcal antigen
in both blood and sputum.

35. Lab tests staphylococcal pneumonia sputum examination and culture
blood culture - positive in % of cases
full blood count
ESR
CRP

36. Lab tests Mycoplasma pneumoniae
White cell count is usually normal but ESR may be raised and C reactive proteins may be elevated.
a rise of specific antibody titre - occurs in most instances, but, obviously, requires paired samples separated by a week or more, and is therefore not useful in the inital diagnosis

37. cold haemagglutination serology - present in about 50% of cases but may produce false positives in measles, infectious mononucleosis,
adenovirus pneumonias, certain
tropical diseases and collagen
vascular disease.

38. RSV pneumonia
Treatment is largely symptomatic. Intubation and ventilatory assistance are given if there is severe hypoxia. Humidified oxygen may be required if arterial oxygen tension is low.
Ribavarin, a nucleoside analogue which is active in vitro against RSV, has been shown to relieve lower respiratory tract illness in children. It is used by inhalation since oral administration is associated with liver and bone marrow toxicity. Studies have yet to be conducted in adults.

39. pneumococcal pneumonia
Pneumococcal pneumonia is generally treated with amoxycillin, ampicillin or co-amoxiclav.
For severe infections:
intravenous antibiotics e.g. ampicillin or co-amoxiclav. Oral amoxycillin or augmentin can be used when the pneumonia is resolving clinically and the patient is apyrexial.

40. For mild-moderate infections:
amoxycillin 500mg tids for days.
Alternative treatments in penicillin allergy include erythromycin or cefuroxime (but note 10% cross-sensitivity).
Prophylaxis:
pneumococcal vaccination

41. staphylococcal pneumonia
Antibiotic treatment should be started after blood and sputum has been taken for culture. Initial therapy is often blind.
Consult with a bacteriologist about appropriate drug treatment if in doubt:
penicillin-sensitive
first choice: benzylpenicillin
alternative: erythromycin
penicillinase producing
first choice: flucloxacillin
alternative: dependent on local sensitivities

42. Mycoplasma pneumoniae
Treatment is with either erythromycin or tetracycline:
erythromycin or other macrolide e.g. clarithromycin or azithromycin:
tetracycline:
an alternative to erythromycin for the treatment of chlamydial and mycoplasma infections
Treatment period is for a minimum of days.