Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Fever, cough, dyspnea Abnormal chest examination (crackles or decreased breath sounds) Abnormal chest radiograph (infiltrates, hilar adenopathy, pleural effusion) +++ General Considerations ++ Streptococcus pneumoniae is most common cause of bacterial pneumonia in children of all ages Bacterial pneumonia usually follows a viral lower respiratory tract infection Children with compromised pulmonary defense systems are at high risk for bacterial pneumonia +++ Clinical Findings +++ Symptoms and Signs ++ Fever (over 39°C) Tachypnea Cough Chest auscultation may reveal crackles or decreased breath sounds in the setting of consolidation or an associated pleural effusion Extrapulmonary findings caused by pneumonia Meningismus Abdominal pain Organism causing pneumonia may be responsible for other infections Meningitis Otitis media Sinusitis Pericarditis Epiglottitis Abscesses +++ Differential Diagnosis ++ Noninfectious pulmonary disease should be considered in the differential diagnosis of localized or diffuse infiltrates Gastric aspiration Foreign body aspiration Atelectasis Congenital malformations Heart failure Malignancy, tumors such as plasma cell granuloma Chronic interstitial lung disease Pulmonary hemosiderosis When effusions are present, additional noninfectious disorders should be considered Collagen diseases Neoplasm Pulmonary infarction +++ Diagnosis +++ Laboratory Findings ++ An elevated peripheral white blood cell count with a left shift may be a marker of bacterial pneumonia A low white blood cell count (< 5000/μL) can be an ominous finding Blood cultures should be obtained in children admitted to the hospital with pneumonia Sputum cultures may be helpful in older children capable of providing a satisfactory sample +++ Imaging ++ Radiography Air space disease or consolidation in a lobar distribution suggests bacterial pneumonia Interstitial or peribronchial infiltrates suggest a viral infection +++ Diagnostic Procedures ++ Bronchial brushing or washing, lung puncture, or open or thoracoscopic lung biopsy should be undertaken in critically ill patients when other means do not adequately identify the cause Viral antigen immunofluorescent staining (DFA) and polymerase chain reactivity (PCR) technology has improved the ability to detect a wide variety of viral infections Thoracocentesis should also be performed in a child with a pleural effusion +++ Treatment ++ Empiric antibiotic therapy should be considered if bacterial pneumonia is suspected Children younger than 4 weeks should be treated with ampicillin and an aminoglycoside Infants 4–12 weeks of age should be treated with intravenous ampicillin for 7–10 days Children 3 months to 5 years of age should be treated with oral amoxicillin (50–90 mg/kg/dose) for 7–10 days Children older than 5 years should also be treated with amoxicillin (50–90 mg/kg/dose) for 7–10 days Macrolide antibiotics should be used if an atypical infection is suspected Additional therapeutic considerations Oxygen Humidification of inspired gases Hydration Electrolyte supplementation Nutrition +++ Outcome... Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth