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Chapter-08 Pulmonology

BOOK TITLE: IAP Management Algorithms for Common Pediatric Illnesses

Author
1. Balachandran A
2. Subramaniam L
ISBN
9789352501977
DOI
10.5005/jp/books/12810_9
Edition
1/e
Publishing Year
2016
Pages
16
Author Affiliations
1. Mehta Hospital, Chennai, F/177 Plot # 235, Anna Nagar, Chennai, Tamil Nadu, Email:dr_abalachandran@hotmail.com;, drabalachandran@yahoo.com, Mehta’s Children Hospital, Chennai, Tamil Nadu, India, Mehta Children’s Hospital, Chetput, Chennai, Tamil Nadu, Dr Mehta’s Children’s Hospital, Chennai, Tamil Nadu, Dr. Mehta’s Hospitals Pvt. Ltd., Chennai, Dr. Mehta’s Hospitals Pvt. Ltd, Chennai, F-177, Anna Nagar East, Chennai, Dr Mehta Children’s Hospital, Chennai, Tamil Nadu, Dr Mehta Children's Hospital, Chennai, Tamil Nadu, India, Dr Mehta Children’s Hospital, Chennai, Tamil Nadu, India, Mehta Multispecialty Hospitals, India Pvt Ltd, Chennai, Tamil Nadu
2. Dr Mehta’s Children’s Hospital, Chennai, Tamil Nadu
Chapter keywords
pleural effusion, community-acquired pneumonia, pulmonary parenchyma, oncotic pressure, parapneumonic effusion, chest skiagram, pleural fluid analysis, noninflammatory pleural effusions, fluid movement, intrapulmonary pressure, pleural cavity, hydrostatic pressure

Abstract

This chapter provides an overview of pneumonia, pleural effusion, empyema and cough. Community-acquired pneumonia (CAP) is defined as an acute infection of the pulmonary parenchyma in a patient who has acquired the infection in the community as distinguished from hospital-acquired (nosocomial) pneumonia. Pneumonia is an acute inflammation of the lung parenchyma usually caused by infections. There is no universally accepted definition of pneumonia. Diagnostic criteria suggested by WHO are very cost effective for CAP. Children with nonsevere CAP with no danger signs should be treated on outpatient care with oral antibiotics and antipyretics. Treatment decisions are based on the child\'s age, clinical and epidemiologic factors. Factors that may help in selection of appropriate antibiotics include knowledge of etiological agents, sensitivity of pathogens to antibiotics, severity of the disease, immune status, nutritional status, previous antimicrobial usages in the recent past, history of hospitalization, duration of illness, associated complications and cost and safety of antibiotics. Pleural cavity is a potential space between parietal and visceral pleura. The movement of pleural fluid is dynamic and hardly any fluid is seen in normal conditions. The hydrostatic pressure, oncotic pressure and the negative intrapulmonary pressure are the important forces, which decide the fluid movement. Analysis of the pleural fluid is the single best method to determine the cause of a pleural effusion. Simple observation of the gross appearance of the fluid may provide a clue as to the cause of the pleural effusion. Microbiologic analysis of the pleural fluid should be obtained from patients with undiagnosed exudative pleural effusion. Pleural biopsy may be needed in cases of unexplained inflammatory effusion, suspected tuberculosis, or malignancy. Noninflammatory pleural effusions (such as transudates) are managed by treating the underlying causes and by supportive care of any functional disturbances. Empyema is derived from a Greek word meaning \"pus\" in the body cavity especially, pleural cavity. Empyema in children occurs primarily in association with an underlying pneumonia. To differentiate and manage parapneumonic effusion from empyem, a classification based on chest skiagram and pleural fluid analysis may be used. Cough is a frequent presenting symptom to general practitioners and is one of the most common problems for which child are referred to pediatricians and respiratory physicians.

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