Pneumonia In Children: Causes, Transmission, Symptoms, Diagnosis And Treatment

Overview of Pneumonia.

Pneumonia is a form of acute respiratory infection that affects the lungs. The lungs are made up of small sacs called alveoli, which fill with air when a healthy person breathes. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake.

Pneumonia is the single largest infectious cause of death in children worldwide. 

There are more than 1.5 million cases of Pneumonia in Nigeria yearly.

Pneumonia killed 808 694 children under the age of 5 in 2017, accounting for 15% of all deaths of children under five years old. Pneumonia affects children and families everywhere, but is most prevalent in South Asia and sub-Saharan Africa. Children can be protected from pneumonia, it can be prevented with simple interventions, and treated with low-cost, low-tech medication and care.

Causes

Pneumonia is caused by a number of infectious agents, including viruses, bacteria and fungi. The most common are:

Streptococcus pneumoniae the most common cause of bacterial pneumonia in children;

Haemophilus influenzae type b (Hib) – the second most common cause of bacterial pneumonia;

respiratory syncytial virus is the most common viral cause of pneumonia;

in infants infected with HIV, Pneumocystis jiroveci is one of the most common causes of pneumonia, responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.

Transmission of pneumonia

Pneumonia can be spread in a number of ways. The viruses and bacteria that are commonly found in a child's nose or throat, can infect the lungs if they are inhaled. They may also spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. More research needs to be done on the different pathogens causing pneumonia and the ways they are transmitted, as this is of critical importance for treatment and prevention.

Presenting features

The presenting features of viral and bacterial pneumonia are similar. However, the symptoms of viral pneumonia may be more numerous than the symptoms of bacterial pneumonia. In children under 5 years of age, who have cough and/or difficult breathing, with or without fever, pneumonia is diagnosed by the presence of either fast breathing or lower chest wall indrawing where their chest moves in or retracts during inhalation (in a healthy person, the chest expands during inhalation). Wheezing is more common in viral infections.

Very severely ill infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.

Risk factors

While most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed.

Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.

The following environmental factors also increase a child's susceptibility to pneumonia:

indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung)

living in crowded homes

parental smoking.

What are the stages of Pneumonia?

*Congestion

This stage occurs within the first 24 hours of contracting pneumonia. During congestion, the body will experience vascular engorgement, intra-alveolar fluid, and multiple bacteria. The lungs will be very heavy and red. Capillaries in the alveolar walls become congested and the infection will spread to the hilum and pleura. During this stage, a person will experience coughing and deep breathing. 

*Red Hepatization

This stage occurs two to three days after congestion. At this point, the lungs will be red, firm, and airless with a resemblance to the liver. Alveolar capillaries will be engorged with blood and vascular congestion will persist. During the red hepatization stage, the alveoli will contain many erythrocytes, neutrophils, desquamated epithelial cells, and fibrin. 

*Grey Hepatization 

This stage will occur two to three days after red hepatization and is an avascular stage. The lungs will appear to be a grayish brown or yellow color because of the disintegration of red cells. Your lungs will also appear to be paler and drier than usual. There will be a persistence of fibrin exudate during this stage.  

Diagnosis of Pneumonia

Your doctor will start with questions about your symptoms and your medical history, like whether you smoke and whether you’ve been around sick people at home, school, or work. Then, they’ll listen to your lungs. If you have pneumonia, they might hear cracking, bubbling, or rumbling sounds when you breathe in.

If your doctor thinks you might have pneumonia, they’ll probably give you tests, including:

Blood tests to look for signs of a bacterial infection.

A chest X-ray to find the infection in your lungs and how far it’s spread

Pulse oximetry to measure the level of oxygen in your blood

A sputum test to check the fluid in your lungs for the cause of an infection

If your symptoms started in the hospital or you have other health problems, your doctor might give you more tests, such as:

An arterial blood gas test to measure the oxygen in a small amount of blood taken from one of your arteries

Bronchoscopy to check your airways for blockages or other problems

A CT scan to get a more detailed image of your lungs.

A pleural fluid culture, in which the doctor removes a small amount of fluid from the tissues around your lungs to look for bacteria that might cause pneumonia

Complications of Pneumonia.

Pneumonia can have complications, including:

Bacteremia, in which bacteria spread into your blood. This can cause septic shock and organ failure.

Trouble breathing, which might mean you need to use a breathing machine while your lungs heal.

Fluid buildup between the layers of tissue that line your lungs and chest cavity. This fluid can also become infected.

Lung abscess, when a pocket of pus forms inside or around your lung.

Resolution.

The resolution, or complete recovery, occurs when the exudate experiences progressive enzymatic digestion. This will produce debris that is eventually reabsorbed, ingested by macrophages, coughed up, or reorganized by fibroblasts. 

Pneumonia Treatment.

Your doctor can tell you which treatment is right for you.

If you have bacterial pneumonia, you’ll get antibiotics. Make sure you take all of the medicine your doctor gives you, even if you start to feel better before you’re through with it.

If you have viral pneumonia, antibiotics won’t help. You’ll need to rest, drink a lot of fluids, and take medicine for your fever.

If your symptoms are severe or if you have other conditions that make you more likely to have complications, your doctor may send you to the hospital. 

With any kind of pneumonia, recovery will take time. You’re going to need lots of rest. You might need a week off your usual routines, and you could still feel tired for a month.

Prevention of Pneumonia.

*Pneumonia in children can be prevented if a child received complete three doses of Pneumococcal Conjugate Vaccine (PCV) as scheduled. That is, six weeks after birth; ten weeks after birth; then fourteen weeks after birth.

*Avoid overcrowded place

*Avoid contact with mucus membrane secretions from the infected person.

* Improve personal hygiene.

Sources:

World Health Organization WHO

Web MD