Pneumonia: Past and Present. Dr. Pushpa Raj Sharma Professor of Child Health Institute of Medicine. Disease Pattern. Epidemiology. Each year, acute respiratory infections
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Dr. Pushpa Raj Sharma
Professor of Child Health
Institute of Medicine
Place % of children
London (UK) 35.0
Herston (Australia) 34
Ethiopia (Whole country) 25.5
Sau aulo (Brazil) 41.8
Place Annual Incidence per 100
Seattle (USA) 3.0
Gadchiorili (India) 13.0
Basse, (Gambia) 17.0
Bankok (Thailand) 7.0
Currently pneumonias are defined as either community-acquired (CAP) or nosocomial or hospital-acquired .
The exact incidence varies but in a meta-analysis of 122 cases of CAP, it accounted for 66% of cases in which a microbiological diagnosis was made.
Clinical evaluation of pneumonia
Method Sensitivity Specificity
Stethoscope 53% 59%
Simple clinical signs 77% 58%
(fast breathing or
Note: Pneumonia diagnosis confirmed by Chest X-ray
Diagnostic evaluation of lower respiratory infections:
Recent studies have concluded that generally radiology is not helpful for determining the aetiology of the infection.
for aetiological diagnosis.
Reduction in all respiratory diseases.
(Indian J Pediatr 1995; 62,181-93
2.5 fold decrease in respiratory infection.
(Am J Clin Nutr; 1996; 63; 514-9
Significant reduction in upper respiratory tract disease.
(Am J Clin. Nutr. 1996; 63;514-9)
Reduction of 45% incidence of lower respiratory tract infection.
(PEDIATRICS 1998; 102 ;1-5)
A - Only Antitussive F - Expectorant + Antitussive
B - Only expectorant G - Expectorant + Bronchodilator
C - Only mucolytics H - Expectorant + Mucolytics
D - Only bronchodilator I - Expectorant + Antihistamines
E - Only Antihistamine J - Having more than 2 of the A,B,C,D,E.
K - Bronchodilator + Antihistamine
Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults BMJ 2002;324:329 ( 9 February )
Treatment must assess the severity of the illness, appropriate setting for treatment (outpatient vs. inpatient), socioeconomic conditions, and local susceptibilitypatterns of common pathogens.
polyribosyl ribitol phosphate (PRP) capsule is an important virulence factor which renders type b H. influenzae resistant to phagocytosis by PMNs in the absence of specific anticapsular antibody .
Ccapsular polysaccharide is most important virulence factor; approximately 85 capsular types
special attachment organelle; attach to epithelium via protein adhesins on the attachment organelle; major adhesin is a 170-kilodalton (kDa) protein, named P1
Does the child have cough or difficulty in breathing?
If Yes Ask:Signs Clsssify as
For How Long? Any general danger sign or Severe Chest indrawing or pneumonia Stridor
Look, Listen Fast breathing Pneumonia Count the breaths
Chest indrawing No signs of pneumonia No Pneumonia:
Stridor or very severe disease cough or cold
Eur J Clin Microbiol Infect Dis 1995 Nov;14(11):935-48
Acta Paediatr 2001 May;90(5):473-6
Strains are classified as either serotypable (if they display a capsular polysaccharide antigen) or nontypable (no capsule); seven generally recognized serotypes: a, b, c, d, e, e' and f; H. influenzae type b (Hib) is the most virulent
Data suggest that repeated infections are required before symptomatic disease occurs - antibodies to M. pneumoniae can be found in most children age 2 - 5 years while illness occurs with greater frequency among older children and young adults .
encapsulated organisms can penetrate the epithelium of the nasopharynx and invade blood capillaries directly; nontypable strains are less invasive, but they, as well as typable strains, induce an inflammatory response that causes diseaseStructure, Virulence Factors and Pathogenesis
M. pneumoniae acts as a superantigen (macrophage activation, cytokine induction) and stimulates inflammation; pneumonia is induced largely by local immunologic and phagocytic responses to the parasites.
Secretory IgA protease - inhibits function of secretory IgA which normally binds bacteria to mucin to facilitate clearance from the respiratory tract