Community-acquired Pneumonia (CAP) is one of the major childhood illnesses in India, resulting in hospitalizations. CAP continues to be the leading cause of mortality in children under 5 years of age. Every year, there are 151.8 million new cases of CAP. The incidence of CAP is more in states with low maternal and child health indicators.
CAP in Children: Introduction and Causative Agents
Community-acquired Pneumonia (CAP) is an infection of the lower respiratory tract in a child who has not been or stayed in the hospital for a minimum of 14 days.
CAP is an inflammation of the lung parenchyma (the substance of the lung outside of the circulatory system that is involved with gas exchange) due to bacterial or viral pathogens which include Pneumococcus, H. influenzae type B, Staphylococcus, Mycoplasma, Chlamydiae, Klebsiella, Acinetobacter. Viruses causing CAP are respiratory syncytial virus (RSV), influenza virus, parainfluenza virus, and adenovirus.
Risk Factors for CAP
Risk factors for CAP are malnutrition, aneamia, air pollution (both indoors and outdoors), overcrowding, upper or lower respiratory infection in a family, poor housing, passive smoking, incomplete immunization, lack of handwashing, etc.
Signs and Symptoms
Children with pneumonia usually present with a fever, along with fast breathing, with or without cough.
They may also have chest retractions, irritability or lethargy, inability to feed, cyanosis (bluish or greyish colour of the skin, nails, lips, or around the eyes), convulsion (seizures), and respiratory failure.
Wheezing (high-pitched whistling sound produced on breathing due to narrowed/blocked airway(s)) is present when the etiology of CAP is viral rather than bacterial.
Pneumonia due to Mycoplasma or Chlamydia generally presents with subacute onset of headache, malaise (feeling of being unwell and fatigued), nonproductive cough (cough that is dry and does not produce sputum), low-grade fever, and a wheeze.
CAP can also present with local complications like pleural effusion (collection of fluid in the outer covering of lungs), pus in the pleura (empyema), lung abscess, or remote complications like:
Meningitis: Inflammation of the brain and spinal cord membranes, typically caused by an infection
Pyopericardium: Pus accumulation in the pericardial space in the heart, by pus causing bacteria, especially Staphylococcus aureus
Septicemia: A serious bloodstream infection, also known as blood poisoning
Septic ileus: A condition when the intestines do not move food through in the normal way due to loss of blood supply
Diarrhea: Loose, watery stools that occur more frequently than usual
Steomyelitis: Inflammation of the bone caused by infection
Diagnosis of CAP is largely clinical, based on the history and physical examination of the child. Supportive investigations like Chest x-ray, CBC (Complete Blood Count) test, CRP (C-reactive protein), blood culture can be done to gauge the severity of the infection and look for complications.
Treatment and Management
The mainstay of treatment in pneumonia are antibiotics. Also important is oxygen supplementation, if required. Fluids, nebulization, and other supportive care can also be part of the treatment.
Pneumonia can be prevented by vaccinating children against Pneumococcus, H.influenzae type B, and Influenza virus. Maintaining good nutritional status and hygiene, avoiding pollution, and decreasing contact of children with ill family members can decrease the risk of CAP.
Pneumonia remains a common and potentially serious problem in children. Getting children vaccinated on time is an important step towards preventing pneumonia and its complications. Talk to your pediatrician to know more.
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