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Persistent pneumoniaPersistent pneumonia
Soumya Ranjan ParidaSoumya Ranjan Parida
Basic B.Sc. Nursing 4Basic B.Sc. Nursing 4thth year year
Sum Nursing CollegeSum Nursing College
This slide shows the sputum Gram stain from that This slide shows the sputum Gram stain from that patient with an abundance of white blood cells as patient with an abundance of white blood cells as well as gram-positive lancet-shaped diplococci. well as gram-positive lancet-shaped diplococci. This sputum Gram stain is classic for This sputum Gram stain is classic for Streptococcus pneumoniaeStreptococcus pneumoniae
Chest x-ray of patient with atypical pneumoniaChest x-ray of patient with atypical pneumonia
Persistent pneumoniaPersistent pneumonia
DefinitionDefinition
It is defined as persistance of It is defined as persistance of
symptoms and radiographic symptoms and radiographic
abnormailties for more than 1 month.abnormailties for more than 1 month.
Signs and SymptomsSigns and Symptoms
1. Fever1. Fever
2. Cough2. Cough
3. Tachypnea3. Tachypnea
4. Chest pain4. Chest pain
5. Cynosis5. Cynosis
CausesCauses AA.. Congenital MalformationsCongenital Malformations:: 1.1. AirwaysAirways Cleft palateCleft palate Pierre Robin syndromePierre Robin syndrome Tracheoesophageal fistulaeTracheoesophageal fistulae TracheomalaciaTracheomalacia 2.2. LungsLungs Pulmonary hypoplasiaPulmonary hypoplasia Pulmonary sequestrationPulmonary sequestration Congenital adenomatoid malformation of the lungCongenital adenomatoid malformation of the lung Bronchogenic cystBronchogenic cyst 3.3. CardiovascularCardiovascular Congenital heart disease (L to R shunt) Congenital heart disease (L to R shunt) Vascular ringVascular ring
CONT’DCONT’D
B. AspirationsB. Aspirations:: Gastroesophageal refluxGastroesophageal reflux Swallowing abnormalitiesSwallowing abnormalities Foreign bodyForeign body Anomalies of the upper airwaysAnomalies of the upper airways C. Defects in the clearance of airways secretionsC. Defects in the clearance of airways secretions:: Cystic fibrosisCystic fibrosis Abnormalities of the ciliary structure of functionAbnormalities of the ciliary structure of function Abnormal clearance secondary to infections,repair of Abnormal clearance secondary to infections,repair of congenital defects.congenital defects.
CONT’DCONT’DD. Disorders of local / systemic immunity:D. Disorders of local / systemic immunity:
Primary immunodeficienciesPrimary immunodeficiencies
Acquired immunodeficienciesAcquired immunodeficiencies
HIV infectionHIV infection
Immunosuppresive therapy Immunosuppresive therapy
MalnutririonMalnutririon
Etiological OrganismsEtiological Organisms
1. Tuberculosis1. Tuberculosis
2. Cytomegalovirus virus2. Cytomegalovirus virus
3. Chlamydia 3. Chlamydia
4. 4. Pneumocystis cariniiPneumocystis carinii
5. Fungi5. Fungi
6. Legionella6. Legionella
7. Common organisms responsible for 7. Common organisms responsible for
acute LRTIacute LRTI
InvestigationsInvestigations 1. Hematological:Hb,TDLC,ESR1. Hematological:Hb,TDLC,ESR 2. Chest X-Ray2. Chest X-Ray 3. Montoux test3. Montoux test 4. Sputum test4. Sputum test 5. Pulse oxymetry5. Pulse oxymetry 6. Serum immunoglobulins6. Serum immunoglobulins 7. HRCT of the chest7. HRCT of the chest 8. MRI Chest8. MRI Chest 9. Pulmonary function tests9. Pulmonary function tests 10. Bronchoscopy( if abnormality of bronchial 10. Bronchoscopy( if abnormality of bronchial anatomy or foreign body is suspected)anatomy or foreign body is suspected) 11. Barium swallow for identifying disorders of 11. Barium swallow for identifying disorders of swallowingswallowing 12. Sweat chloride estimation for cystic fibrosis12. Sweat chloride estimation for cystic fibrosis
Staphylococcal pneumoniaStaphylococcal pneumonia
Approach to a child with persistant Approach to a child with persistant pneumoniapneumonia
1. Age of onset1. Age of onset
2. Details of the episodes2. Details of the episodes
3. Past history/Associated complaints3. Past history/Associated complaints
4. Perinatal history4. Perinatal history
5. Family history5. Family history
6. Environmental history6. Environmental history
TreatmentTreatment
1. Therapy for current infection 1. Therapy for current infection
2. Therapy for underlying disease2. Therapy for underlying disease
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