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- Benjamin Gaston, MD*
- *Department of Pediatrics, Respiratory Medicine Division, University of Virginia Health System, Charlottesville, VA
Objectives
After completing this article, readers should be able to:
Describe the findings of pneumonia on physical examination of preschool children.
Name the most important cause of bacterial pneumonia in children older than 6 months of age.
Delineate the differential diagnosis of atypical pneumonia in school-age children and adolescents.
Describe the treatment of pulmonary abscesses, generally caused by Staphylococcus aureus (primary) or anaerobic species (secondary).
Characterize the circumstances under which a follow-up chest radiograph is required for pneumonia.
Introduction
Pneumonia is an inflammation or infection of the lungs. Some have considered any lower (sublaryngeal) respiratory tract infection to be pneumonia, including viral croup, bronchitis, and bronchiolitis of viral etiology. This review, however, focuses on infections of the gas exchange units (terminal and respiratory bronchioles, alveoli, and interstitium) commonly seen in pediatric practice. Note that croup, bronchiolitis, and pneumonia can occur simultaneously.
Worldwide, more than 2 million children die of pneumonia annually. However, mortality is extremely rare in the United States and other parts of the developed world. Dowell and coworkers recently reported a 97% decline in annual mortality from pneumonia in the United States between the years of 1939 and 1996. The steepest rate of decline coincided with the initiation of Medicaid and was proportional to the number of children covered by the program. In the United States, 35 to 40 episodes of community-acquired pneumonia occur per 1,000 children per year. Rates are on the order of three-fold higher or more in the developing world.
Pathophysiology
If all normal host defense mechanisms function properly, pneumonia will not occur. These normal functions include: nasopharyngeal air filtration; laryngeal protection of the airway from oral and gastric fluid; mucociliary clearance of particles and pathogens from the upper and lower airways; normal cough reflexes and strength; anatomically normal, unobstructed airway drainage; normal humoral and cellular immune function; …
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