DIAGNOSIS PNEUMONIA

M Sidhartani Zain

Divisi Respirologi
Departemen Ilmu Kesehatan Anak
Fak. Kedokteran Undip/RSUP Dr. Kariadi Semarang
 Introduction

 The Forgotten Killer in Child

 Pneumonia is the #1 killer of children under age 5
worldwide – responsible for nearly one in five global
child deaths annually
 WHO 2011  1.3 million died
 More than 99 percent of deaths from pneumonia
occur in the developing world
Incidence of childhood clinical pneumonia
at the country level
 Clinical Signs
 Respiratory • Non Respiratory
Symptoms Symptoms
◦ Cough – Lethargy, Irritability
◦ Tachypnea – Poor feeding, sign of
◦ Dyspnea dehydration
◦ Fever – Vomiting, diarrhea,
◦ Wheezing abdominal pain
◦ Chest pain – Headache
Pediatric RR
Pediatric Pulse
Normal HR (Resting)
Pediatric Systolic
Clinical diagnosis pneumonia: Evidence finding

Crain EF, Bulas D, Bijur PE, Goldman HS. Pediatrics.

1991;88(4):821-824
Lynch T, Platt R, Gouin S, Larson C, Patenaude Y.
Pediatrics. 2004;113(3 pt 1):e186-e189
Mahabee-Gittens EM, Grupp-Phelan J, Brody AS, et
al. Clin Pediatr (Phila). 2005;44(5):427-435
CLINICAL FINDINGS AS PREDICTORS OF PNEUMONIA

Ebbel MH. Am Fam Phsy July 2010;82(2):192-3

World Health Organization (WHO) guidelines for
children aged 2-59 months

WHO severity classifications

 Very Severe Pneumonia

 Severe Pneumonia
 Non Severe Pneumonia
defined as cough or difficulty breathing plus any of
central cyanosis
inability to breastfeed, drink, or vomiting everything
convulsions, lethargy, or unconsciousness
severe respiratory distress
defined as cough or difficulty breathing plus
any of
lower chest wall indrawing
nasal flaring
grunting (in young infants)
age < 2 months
no signs of very severe pneumonia
defined as
age ≥ 2 months
cough or difficulty breathing accompanied by tachypnea
(respiratory rate ≥ 50 breaths/minute in infant aged 2-11
months, ≥ 40 breaths/minute in child aged 12-59 months)
no signs of severe or very severe pneumonia
Simple Clinical Signs of Pneumonia (WHO)

Fast breathing (tachypnea)

Respiratory thresholds
Age Breaths/minute
< 2 months 60
2 - 12 months 50
1 - 5 years 40

Chest Indrawing
(subcostal retraction)
Pathology and Pathogenesis
Bacteriae peripheral lung tissues
 tissues reaction  oedematous
 Red Hepatization Stadium
alveoli consist of : leucocyte, fibrine,erythrocyte,
bacteria
 Grey Hepatization Stadium
fibrine deposition, phagocytosis
 Resolution Stadium
neutrophil degeneration, loose of fibrine,
bacterial phagocytosis
Pathogenesis
 ETIOLOGI

Streptococcus Pneumoniae
Bronchopneumonia
Early stages of acute bronchopneumonia. Abundant inflammatory cells fill the
alveolar spaces. The alveolar capillaries are distended and engorged.
Bronchopneumonia
Acute bronchopneumonia. The alveolar spaces contain abundant PMNs and an
inflammatory infiltrate rich in fibrin.
Acute Bronchopneumonia
Acute bronchopneumonia; the alveolar spaces are full and distended with
PMNs and a proteinaceous exudate. Only the alveolar septa allow identification
of the tissue as lung.
Radiographic patterns
1. Diffuse alveolar and interstitial
pneumonia (perivascular and
interalveolar changes)
2. Bronchopneumonia
(inflammation of airways and
parenchyma)
3. Lobar pneumonia
(consolidation in a whole lobe)
4. Nodular, cavity or abscess lesions
(esp.in immunocompromised
patients)
Radiographic
Radiographic
Radiographic
Thank you..........