• common cuase of admission

• mortality 6.5-8%

• 3 times more prevalent in maori than non maori

• maori have higher mortality

  • 6x increase

  • risk factors

    • low ses

    • poor nutrition

    • low birth weight

    • decrease breastfeeding

    • exposure to tobacco

    • lower housing quality

    • reduced access to primary care

Children

signs and symptoms

• fever

• tachypnoea

• increase resp effort

• irritability/fatigue

• difficulty feeding

• dyspnoea

• cough

  • less common in infants

• pleuritic chest pain

• signs less frequently found in young children

  • temp, tachycardia and increase resp effort and rate may be only signs

Investigations

• not routinely recommended

  • cxr

  • fbc/crp

  • micro

• cxr may be considered where cliical diagnosis is difficult or unclear

  • or there are chest signs

when to refer

• \< 6/12

• drinking less htan 1/2 normal

• spo2 \<92%

• severe tachypnoea/apnoea

• increase resp effort

• signs fo fatigue

• temp \<35, > 40

• decrease breath sounds or dullness to percussion

• concern re home situation

management

• usually strep pneumo

• viruses, chlamydia penumonoia, mycoplasma, hib, s.aureus

• given antibiotics

  • emperic

  • amoxicillin 25mg/kg tds for 7/7

• atypical infectiosn uncommon in cheildren \<5yo

  • erythromycin if treatment fails or suspected to be atypical

• maintain hydration

  • frequent intake of small amount

• paracetamol for chest pain

Follow-up

• most show improvement within 24-48hrs

• continue to improve over time

• persistent symptoms - should reviewed as cough and mild shortness of breath on exertion may persist for several weeks

• atelectasis: 6wk f/u and referrla if not resovled

Adults

• symptoms;

  • cough

  • fever

  • tachypnoea

  • tachycardia

  • dyspnoea

  • sputum production

  • pleuritic chest pain

  • focal signs on auscultiation

  • rigors, ngiht sweats

  • myalgia

  • confusion

  • gastrointestinal symptoms

investigations

• CXR, labs, micro

  • not routinely recommended

• CXR if:

  • diagnosis unclear

  • dullness to percussion or other signs of effusion or collapse

  • when likelihood of malignancies increased

  • smoker aged 55yo

refer

• >65

• comorbidities - cardiac failure, renal or hepatic impairment

• confusion

• HR >125

• RR .>30

• spO2 ≤92%

• sBP \< 90, dBP\< 60

• Temp \<35 >40

• concern re home

• CRB-65

Management

• Amoxicillin 1g tds 7/7

• for suspected atypical or if patient not improved within 24-48hrs

  • erythro/roxithro or doxy added

• doxy/amox clav appropriate choices if post viral/influenza pneumonia suspected

  • provide coverage for S.Aureus

• stay hydrated

• use analgeisa for chest pain

• antitussive unlikley to be beneficial

Immunisation

• all children 4 funded doses of 10-valent pneumococcal vaccine PCV 10

  • 6wk, 3,5,15mo

• PCV13

  • children at high risk of complications

• 23PPV

  • after 2yrs

• high risk:

  • immunosuppresive treatmetn or radiation

  • primary immune deficieincies

  • HIV

  • renal fialure or nephrotic syndrome

  • organ transplants

  • cochlear implants or intracranial shunts

  • chronoic csf leaks

  • corticosteroid therapy for more than 2 eeks ≥2mg/kg

  • iddm

  • cardiac disease

  • chronic pulmomnary disease

    • including ashtma with high dose corticosteroid rx

  • down syndrome

• high risk adults

  • functional/anatomic asplenia

  • chronic illness

  • immunocompromised or taking immunosupressive treatment

  • csf leak

  • cochlear implants or intracrnail shunts