Pneumonia (ER Story)

Three-year-old Kimbriana
comes to the emergency department at Children’s Healthcare
of Atlanta with a high fever. Also, for the past few days, she
has been coughing, vomiting, and hardly eating.

Her dad says, “She’s been talking about her stomach
hurts real bad. She’ll hold her stomach.”

It sounds like a stomach virus, except for one thing. Dr. Michael
Ziegler says, “Her white blood cell count is quite high.” That
means Kimbriana may have a bacterial infection. Dr. Ziegler says, “She’s
got this kind of moist sounding cough. I’d like to do an
X-ray.”

The X-ray reveals the problem. Dr. Ziegler says, “She’s
got pneumonia. If you look at her X-ray, in the left side of her
chest, she’s got a little touch of pneumonia. It’s
like a shadow on the X-ray.”

“Lower lobe pneumonias are notorious for presenting with
abdominal pain,” he says. “Of course, they often have
fever and cough as well, but I’ve seen many cases where the
only presenting symptom was pain in the abdomen.”

Dr. Ziegler will start Kimbriana on an anti-biotic and let her
go home, but if she can’t hold down her medicine, or if she
has trouble breathing, then she will have to be hospitalized. “It’s
very important though,” he says, “that we have her
get a re-check if she looks at all worse in the next day or so.”

Pneumonia is a generic term for lung disease caused by a variety of viruses,
bacteria and sometimes fungi. According to the National Institute of Allergy
and Infectious Diseases, pneumonia is the fifth leading cause of death in the
United States. Worldwide, it kills more than a million children under the age
of 5 each year. Some additional facts about pneumonia from the Centers for
Disease Control and Prevention (CDC):

• Causes 90,000 deaths annually in the U.S.
• Leads to 13 deaths per 100,000 in population
• Cases reported annually: 4,800,000
• Hospitalizes 1.4 million annually
• Number of emergency room visits annually: 1.3 million
• Rates are three times higher in African-Americans than in whites
  and 10 times higher in Native American children.

Pneumonia often begins after an infection of the nose and throat.
Symptoms usually become noticeable after two or three days of a cold
or sore throat. The symptoms of pneumonia may vary, but usually include:

• Chills
• High fever
• Shortness of breath
• Rapid breathing
• Chest pains
• Nausea
• Vomiting
• Headache
• Tiredness
• Muscle aches

A doctor or healthcare provider diagnoses pneumonia based on symptoms,
a physical examination, laboratory tests and chest X-rays. If your
child has any of the symptoms, it is recommended you receive a diagnosis
early and start taking the right medicine (usually antibiotics such
as penicillin).

According to the American Lung Association (ALA), chances
for a fast recovery from pneumonia are good for most children, especially
if the disease is caught early. Antibiotics are used to treat bacterial
pneumonia. There is not yet a general treatment for viral pneumonia, although
antiviral drugs are used for certain kinds (walking pneumonia).

In addition to antibiotics, patients may be given supportive treatment,
including a proper diet to follow and oxygen to increase oxygen in
the blood if needed. In some patients, medication to ease chest pain
and provide relief from violent coughing may be necessary. Prevention
of pneumonia is possible. One way, according to the ALA, is to get
a flu shot, because pneumonia is a common complication of influenza.
Environmental factors can also put children at risk for pneumonia,
including second-hand smoke from cigarettes.

In addition, a vaccine known as pneumococcal conjugate vaccine,
or PCV7 (Prevnar) is available for children. The CDC and the American
Academy of Pediatrics (AAP) recommend the vaccine for all children
under 2 years of age and for children over 2 who may be at high risk
for pneumococcal disease. According to experts at Mayo Clinic, pneumococcal
disease is the leading cause of bacterial meningitis and ear infection
in children under the age of 5. It is also the cause of thousands
of blood infections (bacteremia) and the “most common” cause
of bacterial pneumonia in this age group. Prevnar is also recommended
for children between the ages of 2 and 5 who are at high risk of
pneumonia, including children with sickle cell disease, those who
have problems with their spleen, those who have HIV or AIDS (or other
diseases that affect the immune system like cancer or diabetes),
and those who taking medications that affect the immune system, like
chemotherapy or steroids.

If you think your child may have pneumonia, call your doctor immediately.
Even with effective antibiotics, early diagnosis and treatment are
important. Don’t wait.