Pediatric Community-Acquired Pneumonia

The term community-acquired pneumonia

(CAP) refers to a pneumonia in a previously
healthy person who acquired the infection
outside a hospital.

Etiology
Group B streptococcus and gram-
negative enteric bacteria are the most
common pathogens in neonates (i.e.,
birth to 20 days) and are obtained via
vertical transmission from the mother
during birth.
In infants older than four months and in
preschool-aged children, viruses are the
most frequent cause of CAP; respiratory
syncytial virus (RSV) is the most
common.
S. pneumoniae is the most common
bacterial cause of CAP after the
neonatal period. Less common bacterial
etiologies include Haemophilus
influenzae type B, Moraxella
catarrhalis, and Staphylococcus aureus.
Mycoplasma
pneumoniae and Chlamydia
pneumoniae frequently are associated
with CAP in pre-school-aged children
and are common causes of CAP in older
children and adolescents.
Mycobacterium tuberculosis also may
cause CAP in children at risk for
exposure.
Clinical Evaluation

The strongest predictors of pneumonia in
children are fever, cyanosis, and more than one
of the following signs of respiratory distress:
tachypnea, cough, nasal flaring, retractions,
rales, and decreased breath sounds.
Older children and adolescents are more likely
to have findings such as rales, dullness to
percussion, bronchial breath sounds, tactile
fremitus, and a pleural rub.
Diagnostic Testing
Gram stain and culture
Rapid antigen tests
Oxygen saturation
Management
Respiratory: inhaled oxygen
concentration, positive pressure
ventilation, Bi-level positive airway
pressure
Pharmacologic: Antibiotic agents, Anti-
inflammatory therapy, Antiviral agents,
Bronchodilators
For Pleural Effusion: Drainage of
parapneumonic effusions with or
without intrapleural instillation of a
fibrinolytic agent, Chest tube placement
for drainage of an effusion or empyema
Complications
refractory hypoxia
decompensated respiratory distress (eg,
lessening tachypnea due to fatigue,
hypercapnia)
sepsis
Pleural effusion
Empyema
Pneumatocele
Lung abscess
Prevention

Aside from avoiding infectious contacts (difficult
for many families who use daycare facilities),
vaccination is the primary mode of prevention.
Since the introduction of the conjugated HIB
vaccine, the rates of HIB pneumonia have
significantly declined. However, the diagnosis
should still be considered in unvaccinated
persons, including those younger than 2
months, who have not received their first shot.