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The proper functioning of the respiratory system is also crucial for the smooth functioning of our body. It ensures that oxygen passes into the blood and is transported to the tissues to produce energy.

Pneumonia is a common disease that affects children of all ages, from newborns and infants to school-age and adolescent children. According to the World Health Organization, it remains the leading cause of death (15%) in children under five years of age worldwide.

Definitions

Pneumonia is the inflammation of the alveoli and the final airways or the interstitial tissue (space between the alveoli and the peripheral airways), while bronchopneumonia is the inflammation that extends to more central airways.

The result of the replacement of the air in the alveoli by the inflammatory material but also of the (partial or total) obstruction of the airways is their dysfunction, resulting in the need for greater effort from the body and especially the lungs (activation of reserves), in order to ensure the necessary oxygen.

Pneumonia can be due to infectious or non-infectious causes.

Infectious pneumonia is distinguished into:

• Community-acquired pneumonia
• Opportunistic opportunistic (immunocompromised patients)
• Nosocomial nosocomial (48 hours after admission to the hospital).

Symptoms – diagnosis

Community-acquired pneumonia is an acute lower respiratory tract infection that manifests in healthy individuals with fever, cough, tachypnea, dyspnea/respiratory distress and signs of lung infection on auscultation or simple chest X-ray.

The appearance of “density” on imaging is often considered to confirm the diagnosis, but fever and auscultation findings may precede the density or the imaging findings may persist after the disease has resolved/treated.

Finally, even the finding of “density” on radiography with cough and fever is not always proof that it is pneumonia, since there are other cases that manifest a similar picture (e.g. atelectasis).

In any case, the diagnosis of pneumonia is made using clinical criteria and X-rays are performed selectively.

Risk factors

Risk factors for pneumonia include:

• Age under five years of age
• Prematurity
• Winter months (pneumococcal and viral pneumonia)
• History of previous pneumonia
• Other respiratory disease or heart disease
• Attendance at daycare
• Exposure to cigarette smoke
• Air pollution
• Low socioeconomic status
• Poor diet.

Causes

The causes of pneumonia vary, depending on the patient’s age, the environment, the season of the year, the activity of the influenza virus and the vaccination history (against H. Influenzae type B, pneumococcus, influenza, etc.).

23-33% of cases are of mixed etiology (bacterial and viral). The most common typical bacterial cause in infants, preschoolers and school-age children is pneumococcus. Common causes in developed countries also include “atypical” microorganisms, such as mycoplasma pneumoniae. However, the most common cause in children under five, and especially under two years of age, are respiratory viruses, with RSV being the main one.

Treatment

The cause is assessed using clinical criteria.

If bacterial is considered likely, antibiotic treatment is administered.

The initial choice is empirical and is mainly determined by:

• Age
• The resistance of the strains circulating in the community
• The patient’s vaccination history

Prevention

The significant improvement in public health has contributed significantly to the prevention of community-acquired pneumonia.

Universal vaccination for pertussis, measles, Haemophilus B, influenza and pneumococcus has contributed greatly to reducing pneumonia cases and improving child survival worldwide.

Early prevention and vaccination are the most important means of protecting children from severe pneumonia and its complications.