Penyakit Paru pada Anak – Acute Respiratory Infections (ARI)
Developed and developing countries
High morbidity
5 – 8 episodes/year/child
30 – 50 % outpatient visit
10 – 30 % hospitalization
Developing countries
High mortality
30 – 70 times higher than in developed countries
1/4 – 1/3 death in children under five year of age
ARI-ASSOCIATED DEATH RATE BY AGE
TEKNAF, BANGLADESH, 1982-1985
Distribution of 12.2 million deaths among children less than 5 years old in all developing countries, 1993
Magnitude of the Problem in Indonesia
Pneumonia in children (< 5 years of age)
Morbidity Rate 10-20 %
Mortality Rate 6 / 1000
Pneumonias kill
50.000 / a year
12.500 / a month
416 / a day = passengers of 1 jumbo jet plane
17 / an hour
1 / four minutes
Pneumonia is a no 1 killer for infants (Balita)
Pneumonia Classifications
Anatomical classification
Lobar pneumonia
Lobular pneumonia
Interstitial pneumonia
Bronchopneumonia
Etiological classification
Bacterial pneumonia
Viral pneumonia
Mycoplasma pneumonia
Aspiration pneumonia
Mycotic pneumonia
Etiology of Pneumonia
Predominantly : bacterial and viral
In developing countries: bacterial > viral
(Shann,1986): In 7 developing countries, bacterial – 60 %
(Turner, 1987): In developed countries,
bacterial – 19 % ; viral – 39 %
Bacterial etiology
Streptococcus pneumoniae
Hemophilus influenzae
Staphylococcus aureus
Streptococcus group A – B
Klebsiella pneumoniae
Pseudomonas aeruginosa
Chlamydia spp
Mycoplasma pneumoniae
Characteristic features
S pneumonia:
mucosal inflammation lesion
alveolar exudates
frequently – lobar pneumonia)
H influenzae, S viridans, Virus:
invasion and destruction of mucous membrane
Staphylococcus, Klebsiella:
destruction of tissues – multiple abscesses
Simple Clinical Signs of Pneumonia (WHO)
Pathology and Pathogenesis
Bacteriae — peripheral lung tissues — tissues reaction — oedematous
Red Hepatization Stadium — alveoli consist of : leucocyte, fibrine,erythrocyte, bacteria
Grey Hepatization Stadium –fibrine deposition, phagocytosis
Resolution Stadium — neutrophil degeneration, loose of fibrine, bacterial phagocytosis
Radiographic patterns
1. Diffuse alveolar and interstitial pneumonia (perivascular and interalveolar changes)
2. Bronchopneumonia (inflammation of airways and parenchyma)
3. Lobar pneumonia (consolidation in a whole lobe)
4. Nodular, cavity or abscess lesions (esp.in immunocompromised patients)
Blood Gas Analysis & Acid Base Balance
Hypoxemia (PaO2 < 80 mm Hg)
with O2 3 L/min 52,4 %
without O2 100 %
Ventilatory insufficiency
(PaCO2 < 35 mmHg) 87,5 %
Ventilatory failure
(PaCO2 > 45 mmHg ) 4.8 %
Metabolic Acidosis
poor intake and/or hypoxemia 44,4 % (Mardjanis Said, et al. 1980)
Management
Severe Pneumonia:
Hospitalization
Antibiotic administration
Procain Pennicilline, Chloramphenicol
Amoxycillin + Clavulanic Acid
Intra Venous Fluid Drip
Oxygen
Detection and management of complications
WHO recommendations for treatment of infants less 2 months who have cough or difficulty breathing.
WHO recommendations for treatment of children aged 2 months to 4 years who have cough or difficulty breathing .
Initial empirical treatment based on age and severity of pneumonia
Complications
Pleural effusion (empyema)
Piopneumothorax
Pneumothorax
Pneumomediastinum
