This infection of the lungs can be potentially serious in young ones, and should be monitored closely.

Community-acquired pneumonia (CAP) is pneumonia occurring within, and acquired from, the general public.

It can be potentially life-threatening, especially in older adults and people with co-morbid diseases (i.e. high blood pressure, elevated cholesterol, heart disease, diabetes, osteoporosis, depression, cancer, etc).

It is defined as an infection of the lungs that is not acquired from hospitals, long-term care facilities or contact with other healthcare system infrastructures.

It is a significant cause of death worldwide.

What causes it

CAP can be a serious infection in children, and is caused by a number of different pathogenic microbes.

The most common pathogen in CAP, Streptococcus pneumoniae, accounts for about two-thirds of all pneumonia cases caused by bacteria and is the most common cause of cases in infants between three weeks and three months of age.

It usually causes symptoms similar to the common cold or influenza.

Pneumonia in neonates younger than three weeks of age is most often caused by an infection obtained from the mother at birth. 

Bacteria-like organisms, such as Mycoplasma pneumoniae, cause the so-called “walking pneumonia”, termed as such for its relatively mild effects, which do not require bed rest.

It is more common in children older than five, as well as adolescents. In countries like the United States, it occurs most often in summer or autumn.

Viruses, specifically respiratory syncytial virus (RSV), is the most common cause of pneumonia in children older than four months and younger than two years, but its effects are usually mild unless the child has a heart disease or other underlying illnesses.

Another cause of pneumonia, fungi, can be found in soil and bird droppings, and even in children’s bedrooms.

This type of pneumonia is most common in adults and children with underlying health problems (i.e. asthma, diabetes, obesity or heart disease) or weakened immune systems (i.e. HIV/AIDS), and in those who have inhaled a large dose of the fungal organisms (i.e. from poorly ventilated rooms or crowded households).

Suspecting CAP

The most definitive clinical features of pneumonia in children, whether community- or hospital-acquired, are fever, and one or more of the following: rapid breathing rate, cough, nasal flare, rib muscle retraction, decreased breathing sounds or general breathlessness.

Other common symptoms may include:

• wheezing sounds while breathing

• vomiting and headache

• chest and abdominal pain

• decreased activity, fatigue and general physical weakness

• loss of appetite (in older kids) or poor feeding (in infants), which may lead to dehydration

Your child may be more susceptible to CAP if they:

• are regularly exposed to prolonged secondary smoke from cigarette smokers, open burning, air pollution or irritants.

Do note that cigarette smoking is the strongest independent risk factor for invasive pneumococcal disease in immune-competent, non-elderly adults.

• have chronic underlying diseases such as asthma, congenital heart disease, recurrent respiratory infections, acute otitis media (middle ear infection), etc.

• suffer from a weakened immune system due to HIV/AIDS, chemotherapy and its related medications, prolonged steroid use or organ transplants.

What’s the treatment?

Infants between three weeks and three months of age should always be taken to the hospital if there are signs of respiratory distress like rapid breathing rate or breathlessness.

They will usually be given antibiotics and closely monitored.

On the other hand, pre-schoolers, who are usually infected by virus-induced CAP, may be prescribed antibiotics, but may also not be given medication if a virus agent is suspected (as antibiotics do not work on viruses) and close follow-up can be ensured.

Normal, milder forms of CAP can be treated at home with the help of antibiotics.

You can also help your child to ease the pain by:

• making sure he takes plenty of rest.

• using a humidifier and getting him to breathe in the warm mist.

• guiding him to take deep relaxing breaths every one to two hours.

• providing water, juice or any liquids in liberal amounts.

• ensuring that he drinks at least six to 10 cups of liquid a day.

• ensuring clean surroundings, for example, eliminating cigarette smoke, indoor or outdoor pollution, dust, thick carpets, etc.

The superbug problem

In most children with CAP, identification of the causative organism is not critical.

Therefore, the treatment for CAP is usually based on observation and experience, but knowing the age-specific causes of bacteraemic pneumonia will help guide antibiotic therapy.

However, in light of new drug-resistant strains of bacteria – also called superbugs – a policy for being more restrictive in antibiotic use has been implemented.

The emergence of newly-recognised pathogens, such as the novel severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses, has increased the challenge for appropriate management of these infections.

Studies have indicated that drug-resistant S. pneumoniae is increasing worldwide, particularly towards penicillin and macrolides (i.e. erythromycin, azithromycin and clarithromycin).

Patients who have had previous antibiotic therapy, specifically within the past three months before initially contracting pneumonia. are also of concern.

It is crucial that these patients receive a drug of a different class (usually oral beta-lactam antibiotics) than what they were prescribed before, to decrease the risk of pneumococcal resistance.

Parents should always be aware of the signs and symptoms of CAP in their children and take measures to address the issue promptly.

Datuk Dr Zulkifli Ismail is a consultant paediatrician and paediatric cardiologist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. It is also brought to you by an educational grant from Pfizer. For further information, please visit www.mypositiveparenting.org

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