Author Topic: Management of acute pneumonia in children under five !! PART I  (Read 7504 times)

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Offline Dandaawi

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Management of acute pneumonia in children under five !! PART I
« on: February 19, 2009, 12:04:41 PM »
MANAGEMENT OF ACUTE PNEUMONIA
UNDER FIVE CHILDREN


Definition
Pneumonia is the commonest infection of children wherever they live. Also it now among the major killers of children under five of age around the world or pneumonia is the single major killer of children under five of age in developing world.
Every year, more than dozen of thousands of Somalia children die of pneumonia - an inflammation of the lungs that's usually caused by infection with bacteria, viruses, fungi or other organisms.
As mentioned earlier, pneumonia is a particular concern for children under five of age, older adults and people with chronic illnesses or impaired immune systems, but as it can also strike young, healthy people. Worldwide, it's the leading cause of death in children, as it is known the leading killer of children under five years or the forgotten killer of children under five.
There is no doubt that the mortality rate for pneumonia occur in the developing world are hundreds of times higher amongst children who live in poverty and countries under volatile and political revolutions and halted civil war.
It has been claimed that variations in mortality rates are due to the fact that children in the developed world mainly catch viral pneumonia as opposed to the bacterial infections found in the developing world, and this is also much better explained by social reasons such as poverty, malnutrition and lack or low vaccination rates rather than by microbiological differences.

Diagnosis:
There is no strict definition of pneumonia because there is a lot of symptoms overlap with other diseases, particularly asthma. However, in most cases, the presentation makes the diagnosis fairly obvious.
There are usually fever, tachypnea, and increased sputum in older children, alar flare plus crackles and bronchial breathing on auscultation.
Chest x-ray will reveal areas of consolidation. Division of pneumonia into lobar or general bronchopneumonia based on x-ray findings is not clinically useful.
There are no radiological or clinical findings that can reliably differentiate between bacterial or viral agents. It is often difficult to determine the etiology of a child’s pneumonia even with access to a modern microbiology laboratory.


Treatment is frequently based on guesswork. Even if a virus as influenza has been isolated, it is still possible for bacterial super infection to occur so treatment usually relies on a shotgun approach.

The list of organisms causing pneumonia is long and depends on the patient’s age, season of the year, probably social class and certainly the presence of other serious diseases.
Most of the clinicians base their guesswork on child’s age.

Neonate:
The commonest organisms are group B streptococcus and gram-negative organisms (E. coli and Klebsiella). CMV, herps, Chlamydia and listeria are less common infections.

Under fives:
The commonest organism in toddlers is respiratory syncytial virus, as a cause both of pneumonia and of bronchiolitis. Other common viral infections include Parainfluenza, influenza, adenovirus and CMV.
Bacterial infection is usually either pneumococcal, group A streptococcus or H. influenzae.
Bacterial superinfection is probably common. Staphylococcal infection should always be considered if a child is deteriorating.

School age:
The commonest organisms in this age group are Mycoplasma, Streptococcus pneumoniae and Chlamydia. Legionella and viral pneumonia also occur.

As there are many kinds of pneumonia ranging in seriousness from mild to life threatening, so it is very crucial to go deeply the classification of pneumonia, causes, prevention and treatment.


Continue please go to Part II starting ( CLASSIFICATIONS)...............













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