PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA A Case Study Presented to The Faculty of the College of Nursing LORMA COLLEGES City of San Fernando, La Union In Partial Fulfillment of the Requirements for the Degree of Bachelor of Science in Nursing By: Abaggo, Hershey Clarisse Agaid, Grethel Joey Aguda, Tia Marie Bautista, Nikkola Cabagbag, Kristel Elumba, Penny Joy Galindo, Ellen Lorie Gaona, Elemyr Laroco, Abegael L. Vendiola, Loryn
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60620506 Community Acquired Pneumonia a Case Study
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PEDIATRIC COMMUNITY ACQUIRED PNEUMONIA
A Case Study Presented to
The Faculty of the College of Nursing
LORMA COLLEGES
City of San Fernando, La Union
In Partial Fulfillment
of the Requirements for the
Degree of Bachelor of Science in Nursing
By:
Abaggo, Hershey Clarisse
Agaid, Grethel Joey
Aguda, Tia Marie
Bautista, Nikkola
Cabagbag, Kristel
Elumba, Penny Joy
Galindo, Ellen Lorie
Gaona, Elemyr
Laroco, Abegael L.
Vendiola, Loryn
August 2010
I. INTRODUCTION
Pediatric community-acquired is diseases in which individuals
who have not recently been hospitalized develop on infection of the lungs
(pneumonia). PCAP is a common illness that affects infants and children.
PCAP often causes problems like difficulty in breathing, fever, chest pain and
cough. PCAP occurs because the atmosphere or the areas of the lungs which
absorb oxygen (alveoli) from the atmosphere become filled with fluid and
cannot work effectively.
PCAP occurs throughout the world and is a leading cause of illness and
death. The cause of PCAP includes bacteria, viruses, fungi and parasites.
PCAP can be diagnosed by symptoms and physical examination alone,
through x-rays, examination of the sputum and other tests are often used.
Individuals with PCAP are primarily treated with antibiotic medication in the
hospital some forms of PCAP can be prevented by vaccination.
PCAP usually acquired via inhalation or aspiration of pulmonary
pathogenic organisms into a lung segment or lobe. Less commonly, PCAP
results from secondary bacteria from a distant source, such as Escherichia
coli urinary tract infection and/or bactericidal. PCAP is due to aspiration of
oropharyngeal contents is the only form of PCAP involving multiple
pathogens.
The proportion of children with pneumonia who are diagnosed with a
specific etiology is low. Unlike adults, children usually do not produce
adequate sputum specimens for Gram stain and culture. Blood cultures have
a yield of less than 10% in patients with bacterial pneumonia. “Lung
puncture” studies that are conducted in developing countries are obviously
not met with enthusiasm in general pediatric practices. Prospective studies
that have employed sensitive antibody tests and polymerase chain reaction
techniques have suggested that in up to 20% of pediatric community-
acquired pneumonias, the infection is “mixed” (i.e., both S. pneumoniae and
M. pneumoniae or C. pneumoniae); in these cases, the primary pathogen is
not clear. Authors of these studies have also suggested that mixed infection
with bacteria and respiratory viruses is likely to be common as well.
Many studies have looked at causes of pediatric pneumonia as it
relates to certain readily available laboratory measurements. Many clinicians
consider S. pneumoniae to be the likely cause of the lower respiratory
infection if the picture is characterized by acute onset of high fever, lobar
pneumonia on chest radiograph, leukocytosis, and a rapid response to β-
lactam antibiotics. Numerous studies have found that chest radiographs do
not readily distinguish between bacterial, atypical bacterial, and viral
pneumonia. A variety of laboratory tests have been used in the attempt to
distinguish bacterial from viral pneumonia, including the C-reactive protein
and absolute neutrophil counts. One problem in using “screening” tests is
that specific cutoff levels have often not been established. A recent study
done in Europe found that although white blood cell count and C-reactive
proteins were statistically higher in patients with pneumococcal infections,
other clinical and laboratory and radiographic studies were of little value.
Given the clinical, epidemiologic, and laboratory difficulties in pinpointing the
cause of pediatric pneumonia, an additional approach is to divide patients by
age.
The primary bacterial pathogen in neonatal pneumonia is group B
streptococci, although Escherichia coli and Listeria monocytogenes have also
been reported. The mechanism is similar to that in neonatal sepsis, where
colonization from the mother results in neonatal colonization and
breakthrough infection.
Chlamydia trachomatis is the most common sexually transmitted infection in
the United States. The organism may reside in the genital tract of pregnant
women and be transmitted in about 60% of cases to infants at the time of
delivery. About one half of infants who acquire the organism develop
conjunctivitis, and 20% eventually develop lower respiratory disease.
Pneumonia caused by bacteria such as group B streptococcus typically
occurs in the first weeks of life, presenting with fever, increased work of
breathing, and hypoxia. C. trachomatis infection usually occurs between 2
and 19 weeks after birth. The infants are afebrile, have increased respiratory
rate, and cough. Children with chlamydial pneumonia often have
hyperinflation, and bilateral infiltrates on chest x-ray, eosinophilia, and
elevated serum immunoglobulin levels. Cultures of the blood, urine, and
even cerebrospinal fluid are often obtained and intravenous antibiotic
started. C. trachomatis can be diagnosed by culture or direct fluorescent
antibody staining of nasopharyngeal secretions.
The management of the febrile tachypneic neonate suspected of
having pneumonia is similar to that of neonatal fever. Empiric intravenous
antibiotics are started until culture results are final. Empiric treatment
usually consists of ampicillin combined with gentamicin or a third-generation
cephalosporin. Treatment of C. trachomatis is with oral erythromycin, 50
mg/kg per day in four divided doses for 2 weeks. In the past, erythromycin
was given to neonates exposed to C. trachomatis at the time of delivery.
Recently, there has been an association reported between oral erythromycin
and the subsequent development of hypertrophic pyloric stenosis in infants
younger than 6 weeks of age. The current recommendation is to treat with
oral erythromycin, 50 mg/kg per day in four divided doses for 14 days all
infants with chlamydial conjunctivitis and pneumonia. Patients who are
exposed at the time of delivery are not presumptively treated, but rather
monitored closely for the development of disease. Routine screening of all
pregnant women for sexually transmitted disease is helpful in reducing
disease by C. trachomatis.
The peak incidence of this viral pathogen is in the first 6 months of life.
Respiratory syncytial virus (RSV) typically occurs annually during the winter
months. The spectrum of disease includes significant bronchiolitis and
pneumonia in infants and younger children to a mild upper respiratory
infection in older children. Patients with underlying conditions such as
bronchopulmonary dysplasia, congenital heart disease, or underlying
immunodeficiency are at risk for a more severe course. RSV is diagnosed
rapidly using a direct fluorescent antibody on nasal secretions. An
aerosolized antibiotic agent, ribavirin, has been used in the treatment of RSV
disease in infants. The use of ribavirin remains the subject of continuing
debate. Citing new evidence, the American Academy of Pediatrics changed
its recommendation in the 1990s regarding the use of ribavirin and now has
a less stringent “may be considered” recommendation for its use in RSV
infections in children with underlying conditions such as immunodeficiency,
congenital heart disease, or chronic lung disease. Children with less serious
disease need only supportive treatment.
Pneumonia in children 4 months to 5 years of age was caused by viral
pathogens again predominate in this age group, with RSV, parainfluenza,
influenza, and adenovirus being common pathogens. The primary bacteria
causing pneumonia in infants and children remains S. pneumoniae. Some
studies also report M. catarrhalis, and nontypeable H. influenzae as
pathogens.
STATISTICS:
World Wide
According to WHO and BTS criteria, severe CAP was present in 57 (50%) and in
96 (85%) cases, respectively; 29 (26%) were aged less than 1 year. The median age (months)
was 22 (mean 24 ± 14, range 2-58). Overall, radiographic finding was right-sided in 77
(68%) cases and the upper lobe was compromised in 36 (32%) cases. By analyzing data
stratified to age, the frequency of upper lobe involvement was significantly higher among
severe cases (WHO criteria) only for those patients aged 1 year (13/35 [37%] vs. 7/45
[16%], P = 0.03, OR [95% CI] 3.2 [1.1-9.2]). The specificity and positive predictive value of
upper lobe involvement for severity among the latter group of patients were 84% (95% CI
70-93%) and 65% (95% CI 41-84%), respectively. No association was found by using the
BTS criteria. The admission chest radiography was useful to predict severity of children aged