Pneumonia (PN): From Symptoms to Treatment

1. Definition:

Pneumonia is an inflammation of the lungs, usually caused by an infection.

2. Classification:

• Severe pneumonia: Caused by dangerous infectious agents such as Streptococcus pneumoniae, Haemophilus influenzae (Hib).
• Mild pneumonia: Caused by less dangerous infectious agents.

Note: Pneumonia can occur at any age, but it is most dangerous in children under 5 years old, especially infants under 2 months old and children in developing countries.

3. Symptoms:

• Most sensitive symptom: Rapid breathing
  • Infants under 2 months old: Rapid breathing > 60 breaths/minute
  • Infants from 2 to 12 months old: Rapid breathing > 50 breaths/minute
  • Children from 1 to 5 years old: Rapid breathing > 40 breaths/minute
  • Children over 5 years old: Rapid breathing > 30 breaths/minute
• Specific signs of severe pneumonia: Retractions (chest wall indrawing during inhalation)
  • Retractions are more pronounced in infants under 2 months old.
  • Older children may only have mild retractions, but they should still be monitored as they can quickly become severe.

4. Diagnosis:

• X-ray:
  • The most accurate method to determine the location and extent of inflammation in the lungs.
  • Not routinely required, not necessary when children are being monitored as outpatients.
• X-ray is indicated when:
  • Children with severe pneumonia requiring hospitalization.
  • Children who are not responding to treatment.
  • Unclear medical history.
  • Suspected complications.
• Blood tests:
  • Not necessary to assess the severity of pneumonia, except in cases of suspected complications.
  • May be done before discharge to monitor disease progression.

5. Treatment:

5.1. Outpatient treatment:

• Give your child antibiotics:
  • Typical pneumonia: Blactam antibiotic group.
  • Atypical pneumonia:
    • Mycoplasma: Macrolides.
    • Staphylococcus: Oxacillin.
• Give fever-reducing medication: Paracetamol or Ibuprofen.
• Drink plenty of fluids: Helps your child rehydrate and eliminate toxins.

5.2. Inpatient treatment:

• Hospitalization:
  • Infants under 2 months old.
  • Children with severe or very severe pneumonia.
  • Children with co-existing conditions.
  • Children who are dehydrated.
  • Suspected complications.
• Treatment:
  • Antibiotics: Depending on the type of causative agent and the condition of the disease.
  • Oxygen: Respiratory support when the child is having difficulty breathing.
  • IV fluids: Replenishing fluids and electrolytes for dehydrated children.
  • Symptomatic treatment: Fever-reducing medication, cough suppressants, nasal decongestants…

6. Complications:

• Early complications:
  • Pleural effusion, lung abscess, bronchitis.
• Late complications:
  • Respiratory failure, meningitis, sepsis.

Note:

• Any abnormal signs in children after 48 hours of treatment should be carefully monitored.
• It is recommended to perform tests to identify the causative agent, lung biopsy (gold standard) or examination of secretions, blood cultures, serum to identify the causative agent and effective treatment.

7. Respiratory Sounds:

• Rales: Heard in the lungs, often found in pneumonia due to alveolar damage.
• Rhonchi: Heard in the lungs, often found in lobar pneumonia.
• Wheezes: Heard in the bronchi, often found in bronchopneumonia.
• Stridor: Heard in the bronchi, often found in bronchiolitis/interstitial pneumonia.

8. Classification of pneumonia by severity:

• Outpatient pneumonia: Children can be treated at home.
• Inpatient pneumonia: Children need to be hospitalized for treatment.
• Severe pneumonia (SP): Children may have difficulty breathing, retractions, nasal flaring.
• Very severe pneumonia (VSP): Children may be cyanotic, experience respiratory failure, and be in a coma.

Note:

• Infants under 2 months old with pneumonia, especially those with additional signs of retractions, nasal flaring, cyanosis… should be taken to the hospital immediately.

9. Discharge:

• Children are discharged when:
  • Pneumonia symptoms have subsided.
  • The child is eating well.
  • They are tolerating antibiotics.

10. Prevention:

• Have your child fully vaccinated against Haemophilus influenzae (Hib) and Streptococcus pneumoniae pneumonia.
• Exclusively breastfeed your child for the first 6 months of life.
• Maintain a clean and sanitary environment.
• Avoid contact with sick people.
• Wash your hands frequently with soap and water.

Note:

• The information in this article is for informational purposes only and should not replace the advice of a doctor.
• If your child has any unusual symptoms, take them to the nearest health facility for prompt examination and treatment.