Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ Key Features +++ Essentials of Diagnosis ++ Upper respiratory infection prodrome (fever, coryza, cough, hoarseness) Wheezing or rales Myalgia, malaise, headache (older children) +++ General Considerations ++ Viral infection is a common cause of community-acquired pneumonia in children; responsible viruses in most cases follow: Respiratory syncytial virus (RSV) Parainfluenza (1, 2, and 3) viruses Influenza (A and B) viruses Human metapneumovirus Viral pneumonia is most common in children younger than 2 years Viral infections may predispose to bacterial pneumonia +++ Clinical Findings +++ Symptoms and Signs ++ Wheezing or stridor may be prominent in viral disease However, other findings that are similar to those in bacterial pneumonia include Cough Signs of respiratory distress (tachypnea, retractions, grunting, and nasal flaring) Rales and decreased breath sounds +++ Differential Diagnosis ++ Same as for bacterial pneumonia Patients with prominent wheezing may have Asthma Airway obstruction caused by foreign body aspiration Acute bacterial or viral tracheitis +++ Diagnosis +++ Laboratory Findings ++ Peripheral white blood cell count Can be normal or slightly elevated Not useful in distinguishing viral from bacterial disease Rapid viral diagnostic methods, such as fluorescent antibody tests, enzyme-linked immunosorbent assay, and/or polymerase chain reaction (PCR), should be performed on nasopharyngeal secretions to identify a viral etiology in high-risk patients as well as for epidemiology or infection control +++ Imaging ++ Chest radiography Frequently show perihilar streaking, increased interstitial markings, peribronchial cuffing, or patchy bronchopneumonia Lobar consolidation or atelectasis may occur Hyperinflation of the lungs may occur when involvement of the small airways is prominent +++ Treatment ++ General supportive care for viral pneumonia does not differ from that for bacterial pneumonia Because bacterial disease often cannot be definitively excluded, antibiotics may be indicated. Patients at risk for life-threatening RSV infections should be hospitalized and ribavirin should be considered Children with suspected viral pneumonia should be placed in respiratory isolation +++ Outcome +++ Complications ++ Viral pneumonia or laryngotracheobronchitis may predispose the patient to subsequent bacterial tracheitis or pneumonia as immediate sequelae Bronchiolitis obliterans or severe chronic respiratory failure may follow adenovirus pneumonia Bronchiectasis, chronic hypersensitivity pneumonia, and unilateral hyperlucent lung (Sawyer-James syndrome) may follow measles, adenovirus, and influenza pneumonias +++ Prognosis ++ Most children recover uneventfully Patients with adenovirus infection or those concomitantly infected with RSV and second pathogens (such as influenza, adenovirus, cytomegalovirus, or Pneumocystis jirovecii) have a worse prognosis +++ References + +Esposito S: Antibiotic therapy for pediatric community-acquired pneumonia: do we know when, what and for how long to treat? Pediatr Infect Dis 2012;31(6):e78–e85 [PubMed: 22466326] .CrossRef+ +... 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