Pneumonia is the lead cause of mortality and morbidity among children under the age of 5 years old and has been referred to as the “forgotten killer of children” by UNICEF. It can cause inflammation and fluid to accumulate within the lower airway, such as within the lung parenchyma, due to a virus, bacteria, fungi, or a combination of these disease agents.
This infection has a global effect on children in both developing and developed countries. While a vast majority of developing countries experience difficulties with treating this condition, developed countries are also faced with high health-associated costs for treatment.
This infection can be acquired within a community or hospital setting and can manifest through various symptoms such as wheezing, coughing, difficulty breathing, abnormally increased secretions, and more.
A diagnosis of pneumonia can consist of a physical exam which may include observations for respiratory distress affecting the lungs, such as flaring the nostrils or lower chest in-drawing.
Additionally, physicians may also use a stethoscope to perform auscultatory observations within lung areas for further confirmation of pneumonia as well as critical laboratory testing.
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Pathophysiology
An infection resulting in pneumonia occurs through an invasion of the lower respiratory tract; pathogens can invade this space below the larynx through breathing, an invasion of the respiratory epithelium, or via the bloodstream.
While there are biological barriers that help to prevent this invasion, such as the nasal hairs, cilia, as well as the immune system, with the humoral or cell-mediated immune responses in place, these barriers can be breached. This can result in the inflammation or even cell death of epithelial cells as well as alveoli, which is associated with gaseous exchange in the lungs, ultimately impacting decreased oxygenation.
Common causes of pneumonia in children
While pneumonia can be caught in many ways, the method of contracting pneumonia in children varies depending on age.
At birth, neonates are at risk of contracting pneumonia through bacterial pathogens such as group B streptococci, Klebsiella, Escherichia coli, and Listeria monocytogenes which can lie within the birth canal. Additionally, other bacterial pathogens which can result in a later onset in neonates include Streptococcus pyogenes and Staphylococcus aureus.
However, as neonates grow into infants and toddlers between the ages of 30 days and 2 years old, the causative agent which results in pneumonia differs, with viruses becoming the main vector for the infection. Respiratory viruses which also be a common cause of pneumonia in children aged between 2 years and 5 years old; this is due to the high rise of viruses such as S. pneumoniae and H. influenzae type B being found in this age group.
While S. pneumoniae is the most commonly identified pathogen to cause pneumonia in young children, Mycoplasma pneumoniae can also frequently result in the infection, infecting children predominantly within the age range of 5 to 13 years of age.
Opportunistic infections
There is an increased risk of contracting pneumonia in children who have co-morbidities and chronic diseases. Globally, the approximate number of pneumonia cases is 120 million annually, which can cause 1.6 million deaths in children per year.
In children under the age of 2 within the developing world, pneumonia can account for an estimated 80% of pediatric deaths. While there is a better chance of prognosis within the developed world, the cases of pneumonia are still around 2.5 million yearly, with a third to a half of this number requiring hospitalization.
In children with cystic fibrosis, which also affects the lungs, pneumonia can be a common opportunistic infection due to pathogens such as S. aureus and Pseudomonas aeruginosa. Children who are also diagnosed with sickle cell anemia or are immunocompromised are also susceptible to contracting pneumonia due to their vulnerable immune system.
Treatment
The treatment of pneumonia may require specific targeting of specific pathogens that had caused the infection. Symptomatic management may be used such as supplemental oxygen for hypoxia or fluids for hydration. Additionally, if bacterial pneumonia is the root cause of infection, then antibiotics may be necessary, for example, neonates may be provided with ampicillin as well as an aminoglycoside.
S. pneumoniae, found commonly in children over the age of 3 months with pneumonia, is usually treated with a high dose of beta-lactam antibiotics such as amoxicillin. However, children with additional chronic conditions, such as cystic fibrosis or sickle cell anemia may require additional care and drug treatments.
The most significant component of treating children with pneumonia includes hospitalization of neonates and children younger than 90 days, those with co-morbidities, and the immunocompromised, to ensure their survival rate.
The developed world versus the developing world
There is a disproportionate level of healthcare and medical care available and provided in the developing world compared to the developed world. The developing world may struggle more with identifying, diagnosing, and treating pneumonia found in children due to the widespread of other respiratory disorders, which can ultimately lead to high mortality rates.
Additionally, with neonates being more susceptible to infections such as pneumonia, and the unfortunate hygiene disparity found in developing countries, there is a higher rate of developing this infection.
The level of healthcare and medical treatments in developed countries are significantly higher in comparison. Although this may be the case, due to high-associated costs some countries bestow within healthcare, this may cause treatment for pediatric pneumonia challenging to access.
The financial and social impact this has on those less able to afford healthcare is high, resulting in a reduced quality of living.
The onus of healthcare for these developing countries can be seen as a global issue that would befall developed countries to raise the level of healthcare found worldwide to reduce transmissible infections.
However, with appropriate governmental and health policies, treatment and access to healthcare can be made easier for the less fortunate and less capable of affording therapy for children with pneumonia, especially those requiring hospitalizations.
References:
- Ebeledike C, Ahmad T, Martin SD. Pediatric Pneumonia (Nursing) [Updated 2021 Aug 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK568682/
- Ebeledike C, Ahmad T. Pediatric Pneumonia. [Updated 2021 Aug 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536940/
- Mizgerd, J., 2017. Pathogenesis of severe pneumonia. Current Opinion in Pulmonary Medicine, [online] 23(3), pp.193-197. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5492380/> [Accessed 18 September 2021].
- Molyneux, E. and Graham, S., 2011. Community management of severe pneumonia in children. The Lancet, [online] 378(9805), pp.1762-1764. Available at: <https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61338-X/fulltext> [Accessed 18 September 2021].
Further Reading
A prospective study of antibiotic use and clinical factors in patients with suspected pneumonia