- The incidence of pneumonia in children varies inversely with age.
- The primary predictor of the etiologic agent for infectious pneumonia is the patient's age.
- Pneumonia is usually part of a sepsis syndrome in the newborn, and, in an infant, presenting symptoms may be nonspecific.
- The most sensitive finding for diagnosing pneumonia in an infant is tachypnea.
- Most children with pneumonia can be managed as outpatients. Indications for admission include the following:
- Respiratory distress
- Toxic appearance
- Dehydration, age <3 months
- Impaired immune function
- Infections unresponsive to oral therapy
- The presence of underlying disease and the ability of the caregivers to provide care for the child should also be considered.
- Empiric antibiotic therapy should be based on the most likely etiologic organisms based on the child's age and clinical presentation.
Pneumonia, an inflammation of lung parenchyma, is most commonly due to an infectious etiology but may also have a noninfectious etiology from physical or chemical agents (Table 43–1). Various signs (such as rales) and symptoms (especially cough and fever) may lead to a presumptive “clinical” diagnosis of pneumonia, although in practice, pneumonia is determined by an abnormal chest radiograph showing pulmonary infiltrates. The clinical spectrum of pneumonia is highly variable whether in children, infants, or adults. It ranges from a mild illness to a life-threatening disease with significant morbidity and mortality. Considering the large numbers of microorganisms and other agents that can cause pneumonia, and the limitations of diagnostic testing, the exact cause is often difficult to determine. However, a constellation of clinical, radiologic, and ancillary/laboratory findings may suggest a likely pathogen, and therefore, appropriate therapy (Table 43–2).
Table 43-1. Causes of Pneumonia* |Favorite Table|Download (.pdf)
Table 43-1. Causes of Pneumonia*
- Inflammation due to physical agents
- Inhalation (smoke/toxic inhalants) injury/pneumonia
- Lipoid pneumonia
- Kerosene pneumonia
- Inflammation due to chemical agents
- Drugs (chemotherapeutic agents: bleomycin, antibiotics: nitrofurantoin)
- Radiation pneumonitis
- Iatrogenic lung disease
- Graft versus host disease
- “Typical”: streptococcus pneumonia (“pneumococcal pneumonia”)
- “Atypical”: M. pneumoniae, chlamydophilia (formerly, chlamydia pneumoniae)
- Less common
- Typical: staphylococcus, group B streptococcus, Listeria, Klebsiella
- Pseudomonas, Hemophilus (type B and nontype B), M. catarrhalis
- Atypical: Legionella, Bordetella pertussis
- Respiratory syncytial virus
- Human metapneumovirus
- Less Common
Table 43-2. Pneumonia Syndromes: Presentation Based on Etiologic Agent* |Favorite Table|Download (.pdf)
Table 43-2. Pneumonia Syndromes: Presentation Based on Etiologic Agent*
Signs and Symptoms
Chlamydia (Afebrile Pneumonia of Infancy)
Any, especially neonates
Any, especially toddlers/preschoolers
1–4 mo (3–16 wk)
Any age >4 mo
Sudden (<50% occur after URI)
Usually gradual may be acute
If age >10 y, ± sputum (if age <10 y, no sputum)
Dry cough can be only symptom