SEMEY STATE MEDICAL UNIVERSITY DEPARTMENT OF RUSSIAN AND

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SEMEY STATE MEDICAL UNIVERSITY DEPARTMENT OF RUSSIAN AND FOREIGN LANGUAGE The theme:  Child diseases. PneumoniaSEMEY STATE MEDICAL UNIVERSITY DEPARTMENT OF RUSSIAN AND FOREIGN LANGUAGE The theme: Child diseases. Pneumonia in infants. Checked by: Mukhametzhanova Z. A. Prepared by : Kanapin D. K 210 group GMFSIW SEMEY

     PLAN:  1. Discuss the common causes of pneumonia in children PLAN: 1. Discuss the common causes of pneumonia in children of various ages; 2. Classifications of pneumonia in children; 3. Clinical manifestations of pneumonia in children; 4. Outline the approach to the diagnosis of pneumonia in children; 5. Select appropriate antibiotic therapy for a child with pneumonia based on child’s age and severity of illness; 6. Discuss the diagnosis and management of common complications of pneumonia

Pneumonia in pediatric patients  Basic facts  Childhood pneumonia remains an important cause of morbidityPneumonia in pediatric patients Basic facts Childhood pneumonia remains an important cause of morbidity and mortality in developing world – 4 million deaths annually in the developing world; About 20% of all deaths in children under 5 ys are due to Acute Lower Respiratory Infections (ALRIs — pneumonia, bronchiolitis and bronchitis); 90% of these deaths are due to pneumonia. Annual incidence in the U. S. in: Children under 5 yo is ~ 40 cases/1000 Children age 12 -15 ~ 7 cases/1000 Mortality rate < 1/1. 000 in the U. S.

Causes of 10. 5 million deaths among children  5 in developing countries  Причины 10,Causes of 10. 5 million deaths among children < 5 in developing countries Причины 10, 5 миллиона смертей среди? Дети <5 в развивающихся странах One in every two child deaths in developing countries are due to just five infections diseases and malnutrition. Один из каждых двух детей, умерших в развивающихся странах из-за всего пять инфекционных заболеваний и недоедания.

Pneumonia in pediatric patients  Early recognition and prompt treatment of pneumonia is life saving. LowPneumonia in pediatric patients Early recognition and prompt treatment of pneumonia is life saving. Low birth weight, malnourished and non-breastfed children and those living in overcrowded conditions are at higher risk of getting pneumonia. These children are also at a higher risk of death from pneumonia. About one-half of all children < 5 yo with community-acquired pneumonia will require hospitalization;

Pneumonia Is an acute infectious inflammatory disease of various nature with involving of lower respiratory tractPneumonia Is an acute infectious inflammatory disease of various nature with involving of lower respiratory tract into pathologic process and intra-alveolar inflammatory exudation; Э то острое инфекционное воспалительное заболевание различной природы с участием нижних отделов дыхательных путей в патологический процесс и внутри альвеол воспалительной экссудации;

Possible causes of Pneumonia Bacterial – streptococcus pneumonia,  mycoplasma (atypical) And any other Viral –Possible causes of Pneumonia Bacterial – streptococcus pneumonia, mycoplasma (atypical) And any other Viral – RSV (respiratory syncytial virus) In children younger than 2 years, viral infections were found in 80% of children with pneumonia; in children older than 5 years, viral infections were detected only 37% of the time. Aspiration Depends on patient age, immune status, and location (hospital vs. community)

Infectious causes of pneumonia Инфекционные причины пневмонии Age Causative organisms Perinatal  +  4 weeksInfectious causes of pneumonia Инфекционные причины пневмонии Age Causative organisms Perinatal + 4 weeks Group B haemolytic streptococci E. coli and other gram negati ve enteric organisms , Chlamydia trachomatis Infancy Viruses — RSV Pneumococcus Haemophilus influenzae

Pathophysiology Often, follows upper respiratory tract infection;  Lower respiratory tract invaded by bacteria, viruses orPathophysiology Often, follows upper respiratory tract infection; Lower respiratory tract invaded by bacteria, viruses or other pathogens; Preceding viral illness (influenza, parainfluenza, RSV, adenovirus) leads to increased incidence of pneumococcal pneumonia; Bacterial pneumonias usually due to spread of invasive organisms from the nasopharynx by inhalation or aspiration; In children, bacteremia may lead to hematogenous seeding of the pulmonary parenchyma and result in pneumonia

Pathophysiology Immune response leads to inflammation;  Lung compliance is decreased, small airways become obstructed andPathophysiology Immune response leads to inflammation; Lung compliance is decreased, small airways become obstructed and air space collapse progresses; Ventilation-perfusion mismatch and decreased diffusion capacity leads to hypoxemia;

CLASSIFICATION: E tiology Morp h ological class  - Bronchopneumonia  -  L obar CLASSIFICATION: E tiology Morp h ological class — Bronchopneumonia — L obar pneumonia — Interstitial pneumonia — C o ngenital pneumonia — Community acquired pneumonia -N osocomial ( hospital acquired) pneumonia -Aspiration pneumonia -N on complicated pneumonia — C omplicated pneumonia

M orp h ological class ification   M orp h ological class ification

Complications of pneumonia Pulmonary: - pleuritis, parapneumonic effusions and empyema, - pneumothorax, - f ailure ofComplications of pneumonia Pulmonary: — pleuritis, parapneumonic effusions and empyema, — pneumothorax, — f ailure of resolution intra-alveolar scarring (‘carnification’) permanent loss of ventilatory function of affected parts of lung ; Pneumonia may be complicated by a pleuritis

Complications of pneumonia Extrapulmonary: - i nfective endocarditis - c erebral abscess / meningitis - sComplications of pneumonia Extrapulmonary: — i nfective endocarditis — c erebral abscess / meningitis — s eptic arthritis — Infectious-toxic shock — DIC (disseminated intravascular coagulation) syndrome

Significant risk factors younger age (2 -6 months), low parental education, smoking at home, prematurity, weaningSignificant risk factors younger age (2 -6 months), low parental education, smoking at home, prematurity, weaning from breast milk at < 6 months, anaemia malnutrition Trop Doct 2001 Jul; 31(3): 139 —

Clinical case 1  2 y old boy with complaints of fever,  cough, vomiting, decreasedClinical case 1 2 y old boy with complaints of fever, cough, vomiting, decreased appetite, chest pain, right lower quadrant (RLQ) abdominal pain; T 39 C, chills, HR 140, RR 50; Retractions, signs of respiratory distress; Decreased breath sounds, rales, egophony, dullness to percussion rate; Symptoms since yesterday afternoon; Recent upper respiratory infection;

Clinical case 1 Physical examination  Tachypnea Fever (T 39 C) – nonspecific and not 100Clinical case 1 Physical examination Tachypnea Fever (T 39 C) – nonspecific and not 100% sensitive sign; Hypoxemia (pulse oximetry – 5 th vital sign) Signs of respiratory distress (retractions, flaring, grunting) X-ray: infiltrates of lung tissue

Clinical case 1 Physical examination  Wheezing is rare with bacterial pneumonia – more common inClinical case 1 Physical examination Wheezing is rare with bacterial pneumonia – more common in pneumonia caused by atypical bacterial or viruses less than 5% of children with wheezing had pneumonia; only 2% of children without fever in the ED had pneumonia; hypoxemia (Sp. O 2 < 92 %) increased risk;

Atypical Pneumonia Chlamydia – – Diffuse intersitial markings – hyperinflation Mycoplasma – – Normal, or canAtypical Pneumonia Chlamydia – – Diffuse intersitial markings – hyperinflation Mycoplasma – – Normal, or can look like viral or typical bacterial PNA CXR in:

Symptoms-pleuritic  Referred pain to neck and back Abdominal pain if diaphragmatic involvement   Symptoms-pleuritic Referred pain to neck and back Abdominal pain if diaphragmatic involvement

Pneumococcal pneumonia complicated by lung necrosis and abscess formation      A lateralPneumococcal pneumonia complicated by lung necrosis and abscess formation A lateral chest radiograph shows air-fluid level characteristic of lung absces

Lung abscess in the posterior segment of the right upper lobe  CT scan shows aLung abscess in the posterior segment of the right upper lobe CT scan shows a thin-walled cavity with surrounding consolidation

    Disposition Admit if:  Toxic appearance;  Respiratory compromise, including marked tachypnea Disposition Admit if: Toxic appearance; Respiratory compromise, including marked tachypnea (>60 breaths/min in infant and > 40 -50 breaths/min in older children); Hypoxemia (Sp. O 2 < 92 -94% in room air); Dehydration or inability to maintain oral hydration or tolerate oral medications; Indications of severe disease;

Disposition Admit if:  Young age -  4 -6 months of age;  Underlying diseases:Disposition Admit if: Young age — < 4 -6 months of age; Underlying diseases: — cardiac disease — renal disease — hematological disease Inability of family to provide care at home; Failure of outpatient therapy;

 Antibiotic therapy I – beta-lactam : - Penicillin ; - Cephalosporin ; - Carbopenem ; Antibiotic therapy I – beta-lactam : — Penicillin ; — Cephalosporin ; — Carbopenem ; Aminoglycoside Macrolide Linkozamide – linkomycin, clindomycin Vancomycin

Treatment  •  Bacterial 1 month Ampicillin 75– 100 mg/kg/day and Gentamicin 5 mg/kg dTreatment • Bacterial 1 month Ampicillin 75– 100 mg/kg/day and Gentamicin 5 mg/kg d 1– 3 months Cefuroxime (75– 150 mg/kg/day) or co-amoxiclav (40 mg/kg/day) 3 months Benzylpenicillin or erythromycin (change to cefuroxime or amoxycillin if no response)

Treatment  Supportive for atypical pneumonia  •  Chlamydia and mycoplasma should be treated withTreatment Supportive for atypical pneumonia • Chlamydia and mycoplasma should be treated with erythromycin 40– 50 mg/kg/day usually orally. • If pneumocystis carinii pneumonia is suspected co-trimoxazole 18– 27 mg/kg/day IV should be prescribed.

 Treatment Age  Start Alternative 6 mo. -6 yr Ampicillin 100 mg/kg/day  Or amoksiklav Treatment Age Start Alternative 6 mo. -6 yr Ampicillin 100 mg/kg/day Or amoksiklav 20 -40 mg/kg (Amoxicillin/clavulanate) Cefotaxime (Claforan) Cefuroxime (Zinacef) 100 -150 mg/kg/day Clarithromycin Azithromycin Age Start 6 mo. -6 yr Complicated Ceftazidime 150 mg/kg/day or Cefotaxime or ceftriaxone + netilmicin (6 -7. 5 mg/kg) ( amikacinum 15 mg/kg)

     Literature: 1. A. M. Maslova, Z. I. Winestein, L. S. Plebeyskaya Literature: 1. A. M. Maslova, Z. I. Winestein, L. S. Plebeyskaya “ Essential English for medical students” 2003 2. www. yandex. ru 3. www. google. kz

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