Cause

Bordetella pertussis
aerobic, nonmotile,
gram-negative
coccobacillus that
attaches to and
multiplies on the
respiratory epithelium

Transmission

starting in the
nasopharynx bronchi
and bronchioles
human to human by
means of exposure to
aerosol droplets

incubation

Asymptomatic
lasts 7-10 days

catarrhal

lasts about 2-7 days

symptoms:
Minimal or no fever
Rhinorrhea
Anorexia
Mild but increasing cough

paroxysmal

lasts about 1-8 weeks.

paroxysms of coughing, which
are provoked by feeding (in
infants) and exertion
inspiratory gasp or whoop
especially in aged 6 months to 5
years.
Infants younger than 6 months
often have vomiting in
association with the cough, which
leads to dehydration.
cyanosis and apneic

Risk factors

Nonvaccination in
children
Contact with an
infected person
Epidemic exposure
Pregnancy

Blood

Lymphocytosis

Cultures

definitive culture
diagnosis is not always
possible
Results of blood culture
are uniformly negative
because B pertussis
grows solely in the
respiratory
epithelium
focal
atelectasis
and/or peribronchial

Imaging

Management
General supportive:
1. oxygenation
2. breathing treatments
3. mechanical ventilation
Isolation:
Patients should be isolated from susceptible

individuals (especially infants) for 4 weeks,

especially until 5-7 days of antibiotic therapy
is completed

Antibiotic:
Erythromycin is antibiotic of choice
Effective in reducing course and symptoms if

started within the first 10-14 day but not proven

beyond this period

When to consider admission:

Age younger than 1 year
Pneumonia
Apneic or cyanotic spells or hypoxia
Moderate-to-severe dehydration

Complications
Pneumonia
Hypoxic encephalopathy
Otitis media
Tuberculosis activation
Epistaxis, hemoptysis
Hernia
Reinduction of paroxysmal coughing with upper

respiratory infections
Seizures
Cerebral hemorrhage
Coma and death

definition

acute infectious
disease of the lower
respiratory tract

Age

3 months to 5 years
10-15% occurs in 6
months because of the
lack of maternal
immunity transfer
More than 90% of all
deaths occur in this same
age group

age

aged 2-24 months

viral infection of the small airways (bronchioles)

produces increased mucus secretion, cell death,

and sloughing

peribronchiolar lymphocytic infiltrate and

submucosal edema

combination of debris and edema produces

critical narrowing and obstruction of small
airways.

Cause

RSV

symptoms

rhinorrhea
cough
low-grade fever
Increased work of
breathing
Wheezing
Cyanosis
Grunting
Noisy breathing
Vomiting, especially
post-tussive
Irritability
Poor feeding or anorexia

Pysical findings

Tachypnea, often at
rates over 50-60 breaths
per minute (most
common physical sign)
Tachycardia
Fever, usually in the
range of 38.5-39C
Mild conjunctivitis or
pharyngitis
Diffuse expiratory
wheezing
Nasal flaring
Intercostal retractions
Cyanosis
Inspiratory crackles
Otitis media
Apnea, especially in
infants younger than

laboratory

Routine laboratory testing

is not warranted
ABG: severely ill patients,
especially thoseABG:
requiring mechanical
ventilation.

Chest xray are not routinely

necessary

Hyperinflation and patchy

infiltrates may be seen; these
findings are nonspecific and
may be observed in asthma,
viral or atypical pneumonia,
and aspiration.
Focal atelectasis
Air trapping
Flattened diaphragm
Increased anteroposterior
diameter

When to admit?
Oxygen saturation less than 94% after

therapy
Respiratory distress (eg, respiratory rate
>60/min or retractions at rest)
Apnea or risk of apnea
Age younger than 2 months or history of
prematurity
Underlying cardiopulmonary disease or
immunosuppression

Bronchopneumonia

febrile illness with

cough, respiratory
distress with evidence
of localized or
generalised patch
infiltrates

Lobar pneumonia

similar to
bronchopneumonia
except physical findings
and radiograph shows
lobar consolidation

Newborns

Group B streptococcus,
Escherichia coli, Klebsiella
species,
Enterobacteriaceae

1-3 month

Chlamydia trachomonas

Preschool

Preschool:Streptococcus
pneumoniae,
Haemophilus influenzae type
b, Staphylococcal aureus

School

Mycoplasma pneumoniae,
Chlamydia pneumoniae

Less common

group A Streptococcus,
Moraxella catarrhalis,
Pseudomonas aeruginosa

symptoms

poor feeding and

irritability
persistent cough
Congestion
Fever
wheezing or has noisy
breathing
vomiting, particularly
posttussive emesis
Dehydration, lethargic

signs

nasal flaring and retractions at

subcostal, intercostal, or
suprasternal site
grunting,
severe tachypnea
Cyanosis may be present in
severe cases.
crackles or rales
consolidation upon percussion

FBC

leucocytosis

Sputum gram stain and culture

gram-positive cocci in pairs and

chains

Blood culture

Inflammatory markers

Chest radiograph

CRP

Right lower lobe consolidation

Progression of pneumonia
Consolidation until right middle lobe and the

development of a large parapneumonic

pleural effusion.

Lobar pneumonia on chest radiographs should

raise suspicion that the disease has a

bacterial etiology, and particularly, that
Streptococcus pneumoniae or S aureus is the
causative agent

When to admit
- children aged 3 months and below, whatever

the severity of pneumonia.

- fever ( more than 38.5 C ), refusal to feed and
vomiting
- fast breathing with or without cyanosis
- associated systemic manifestation
- failure of previous antibiotic therapy
- recurrent pneumonia
- severe underlying disorder ( i.e. immunodefi
ciency )

Which antibiotics??
Pathogen

Antimicrobial agent

Streptococcus pneumonia

penicillin, cephalosporins

Haemophilus influenzae type b

ampicillin, chloramphenicol,
cephalosporins

Staphylococcus aureus

cloxacillin

Group A Streptococcus

penicillin, cephalosporin

Mycoplasma pneumoniae,
Chlamydia pneumoniae
Bordetella pertussis

macrolides , e.g. erythromycin,

azithromycin