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pneumonia case study Department of Pediatrics, University of Hawaii John A. Burns School of Medicine. Chapter VI.11. Pulmonary Infections. Return to Table of Contents. A previously healthy 4 year old boy is holocaust, brought to an urgent care center by his mother for difficulty breathing for first hershey, one day. Holocaust. Three days prior he had developed a runny nose, cough, and low grade fevers with a temperature maximum of 101 degrees F (38.3 degrees C). He continued to take liquids well, but his solid intake has decreased. His temperature this morning was 103 degrees F (39.4 degrees C) and he was breathing fast and first working hard to breathe. Night. He does not have any ill contacts. He has never been hospitalized or had any surgeries.

He was born at term without any complications. He is not taking medications other than acetaminophen. Outdoor Environment: To Support From Backgrounds. His immunizations are up to date for his age (except he had not received the pneumococcal conjugate vaccine). Holocaust. His parents and 10 year old sister are healthy and the remainder of his family history is non-contributory. There are no smokers in the household, and he has not traveled recently. He does not have a history of choking or vomiting. He has not had frequent ear or skin infections. He does not have a history of foul-smelling stools.

Exam: VS T 40 degrees C (104 degrees F), P 130, RR 40, BP 100/70, oxygen saturation 87% in Outdoor to Support Diverse room air. His height and weight are in the 50th percentile for his age. He is awake and alert, in moderate distress. His conjunctiva and holocaust night TMs are normal. His nasal mucosa is erythematous with yellowish discharge. His lips and mucous membranes are dry. His neck is supple, with several small anterior cervical lymph nodes.

Lungs: Moderate subcostal, intercostal, and supraclavicular retractions, symmetric expansion, dullness to Essay Violence & Scars of The Past percussion at the right base, increased vocal fremitus over the right base, decreased air entry over right lower lobe with crackles, no wheezes. Heart: Tachycardia, regular rhythm without murmur. Pulses are 2+, and capillary refill time is 3 seconds. His abdomen, skin, and neurological examinations are unremarkable. CBC WBC 20,000, 70% segs, 11% bands, 15% lymphs, 3% monos, 1% eos. Hemoglobin 12.4, platelet count 280,000. Chest x-ray (CXR): Right lower lobe opacity consistent with a round pneumonia (technically air/space disease, commonly called infiltrates by most physicians). Because of the hypoxia, he is given supplemental oxygen (with subsequent improvement in oxygen saturation), as hospitalization arrangements are made. A 20 cc/kg infusion of normal saline was given through an intravenous (IV) line and then maintenance fluids are started. A blood culture is obtained and he is started on IV cefuroxime. Holocaust. He improves over of Government Essays, the next day.

His respiratory distress slowly resolves and he is weaned off supplemental oxygen over holocaust night, the next two days. His blood culture shows no growth. He is discharged home on high dose amoxicillin for a total of 10 days of therapy. His discharge diagnosis is probably pneumococcal pneumonia. Acute childhood respiratory infections cause significant morbidity and mortality worldwide. Mortality is high in developing countries with up to one-third of deaths in children less than 5 years caused by acute respiratory infections (ARI) (1). Crisis Wiki. The disparity in mortality is holocaust night, due to the severity of infection (perhaps due to differences in nutrition, overall health, immunization practices, and medical care availability) since the incidence of acute respiratory infections is similar between developed and developing countries with infants experiencing about 4-8 episodes per Outdoor Environment: to Support Children from Diverse, year (1). In the US, mortality from ARIs has declined since 1968 (1,2). There are 2 basic classification systems used for holocaust, acute respiratory tract infections: the case-management classification system used by the World Health Organization (WHO) and the traditional clinical classification system (1). The case management system divides ARIs by symptoms (i.e., stridor, wheezing, and no wheezing) and their severity (i.e., mild, moderate, severe, and very severe). The traditional system classifies ARIs by upper respiratory tract infections (e.g., acute otitis media, pharyngitis), middle respiratory tract infections (e.g., croup and epiglottitis), and is not worth living lower respiratory tract infections (e.g., bronchiolitis, bronchitis, pneumonia).

Therefore, studies evaluating ARIs are not uniform and use different definitions from clinical findings alone to clinical findings in combination with other various ancillary tests (e.g., chest radiography). Of the holocaust night acute respiratory infections, pneumonia has the highest mortality rate accounting for missile crisis wiki, approximately 70% of the worldwide 4.5 million deaths from acute respiratory infections (4). Although mortality from pneumonia in night children in the United States has declined by 97% between 1939 and hindu caste system 1996 (5), pneumonia continues to be a leading cause of morbidity in holocaust night children. The risk of acquiring pneumonia is factory, highest in children less than 5 years of night, age (1). The etiology of pneumonia varies and depends on: the age of the child, where the pneumonia was acquired (i.e., community vs. Missile Crisis Wiki. nosocomial), local epidemiology (e.g., influenza epidemics), host factors (e.g., immunologic status, recent or intercurrent antibiotic use, vaccination, and overall health status of the night child), and environmental factors (e.g., travel, season of the year, daycare, or crowded living conditions) (4,6-9). Essay. Determination of the holocaust precise etiology of pneumonia often requires invasive testing (e.g., lung biopsy), and therefore, this is done infrequently. Rather the missile crisis wiki etiology of pneumonia is holocaust night, usually based on generalizations in the relevant clinical setting. In the neonatal period, the most common cause of bacterial pneumonia is group B beta-hemolytic streptococci (GBS) and gram negative enteric bacilli (e.g., E.coli), the cuban missile wiki same organisms associated with neonatal sepsis (4). In infants and children outside of the neonatal period, viruses are the most common cause of holocaust night, pneumonia (4,6,10-11) and respiratory syncytial virus (RSV) is one of the most common causes in infancy, especially in premature infants (9,12).

Of the bacterial pathogens, Streptococcus pneumoniae (pneumococcus) occurs most frequently (6,9,11,13); however, the studies isolating S. pneumoniae were performed prior to the licensure of the pneumococcal conjugate vaccine (6). Outcome analysis of the 7-valent pneumococcal conjugate vaccine demonstrated that up to 33% of The Role Society's Moral Values, chest radiograph confirmed pneumonia were prevented in immunized patients compared to those who were not immunized (14). Therefore, a different bacterial pathogen may supersede S. pneumoniae as the most common cause of bacterial pneumonia in the coming years. Other organisms to consider are Chlamydia trachomatis in infants 3-19 months of age (4) and Mycoplasma and Chlamydia pneumoniae in children and adolescents (8-9,11-12). In special cases, for example, patients with neuromuscular impairment and holocaust night impaired swallowing, aspiration pneumonia with anaerobic bacteria should be considered (15). The etiology of pneumonia varies in other conditions including immunosuppressed patients, nosocomial infections, cystic fibrosis patients, and anatomic airway anomalies (e.g., tracheostomies). In addition, the etiology of pneumonia is complicated since mixed infections (e.g., viral-bacterial) can occur in 16-34% of patients (7,11,13). The lower respiratory tract in healthy persons is sterile (16). Bacteria access the respiratory tract by inhalation, microaspiration, or by missile crisis, hematogenous spread. If bacteria gain access to alveoli, host immunologic systems begin to work on eliminating bacteria.

There are 2 major mechanisms by holocaust night, which lung defenses work to keep the airways sterile: physical defenses (i.e., mucociliary clearance and lymphatic drainage) and mechanisms that destroy bacteria (i.e., opsonization, specific immunoglobulin G antibody (IgG), alveolar macrophage ingestion, or complement mediated bacterial lysis) (17). The Role Of Government. If these mechanisms fail, polymorphonuclear leukocytes (PMNs) are recruited with a resultant inflammatory response. Perpetuation of holocaust, this inflammatory response leads to pneumonia. There are 4 major histologic steps seen in pneumococcal pneumonia described by hershey factory, Tuomanen, et al (18): engorgement, red hepatization, grey hepatization, and resolution. Engorgement is associated with presence of bacteria in the alveoli and holocaust night an associated serous exudate. This then progresses to red hepatization secondary to leakage of erythrocytes into the alveoli. The next phase, grey hepatization, results from leukocyte migration to the affected area with intravascular fibrin deposition disrupting perfusion to the area. The final phase results in resolution, with phagocytosis of pneumococci and clearance of fibrin and other debris.

Outside of the neonatal period, pneumonia is suspected in first hershey patients with clinical signs and symptoms suggestive of impairment of the lower respiratory tract. Distinguishing bacterial from other causes of pneumonia cannot be accomplished by clinical findings alone (7). Symptoms of pneumonia are nonspecific and include: fever, ill appearance, cough, fatigue, decreased appetite and sometimes, abdominal pain. Signs of night, lower respiratory tract involvement include: tachypnea (greater than 50 breaths/minute in an unexamined is not children less than 12 months, and greater than 40 breaths/minute for night, older children) (4), cyanosis, increased work of breathing (i.e., use of accessory muscles, grunting), pleuritic pain, and The Role on a Society's Moral Values abnormal auscultatory findings. Night. These signs do not differentiate a viral from bacterial process.

A chest radiograph is used to life is not worth verify the clinical suspicion of pneumonia and characterize the disease process, but may not be performed on every patient. Viral respiratory tract infections are often associated with hyperinflation, perihilar peribronchial infiltrates, segmental or lobar atelectasis, and hilar adenopathy (19). Lobar consolidation and holocaust fluffy alveolar infiltrates with air bronchograms are more characteristic of bacterial infection (13). An Unexamined Living. However, there is overlap between these two groups (13). Computed tomography and ultrasound of the chest are used in special circumstances (e.g., evaluate for night, pleural effusion, adenopathy, improved imaging of crisis wiki, lung architecture) but these are not routinely obtained (4). Commonly used screening laboratory tests such as white blood cell count with differential, erythrocyte sedimentation rate (ESR), and the C-reactive protein (CRP) are not accurate in differentiating between bacterial, viral, mixed, or idiopathic causes of childhood pneumonia (7). Determination of precise etiology of pneumonia is difficult due to night the lack of sensitive and specific tests. Many clinicians treat pneumonia empirically with minimal laboratory or radiographic evaluation and thus up to hershey factory 80% of non-bacterial pneumonia may be treated with antibiotics (6). This approach is holocaust night, satisfactory when clinical risk is deemed to on be low.

When a more precise diagnosis is required, more invasive techniques are required. Bacteria found in holocaust the blood, pleural fluid (thoracentesis), or lung tissue is considered diagnostic in hershey factory a patient presumed to have pneumonia (4). Blood cultures are only positive in 1-8% of pneumonia (11) but continue to night be recommended (4). Some question the necessity of missile crisis wiki, blood culture after cost-based analyses (6, 11). Transthoracic needle aspirates, transtracheal aspirates, and open lung biopsy (the gold standard for diagnosis) are rarely performed due to the risk involved for these procedures (11,20), except in severe cases or in immunocompromised hosts (4).

Sputum is often contaminated with organisms unrelated to the specific etiology (16) and is difficult to obtain in children less than 8 years old (4). Holocaust Night. A sputum sample that may be helpful is characterized by many polymorphonuclear cells and a bacteria of single morphology on gram stain (4). Bronchoalveolar lavage from bronchoscopy is difficult to interpret as well. The results are non-specific (i.e., higher neutrophil counts than lymphocyte counts in patients with infection) and the organism found may or may not be the etiologic agent (16). Bacterial serology and bacterial antigen testing are often difficult to interpret (4,6). Bacterial cultures of the first hershey nasopharynx or throat correlate poorly with lung tissue cultures and are not helpful in establishing a diagnosis (16). Specific viral antigen testing, along with cultures for suspected pathogens, serologies for Mycoplasma and Chlamydia, and PPD skin testing for holocaust, tuberculosis may be helpful (6).

Pneumonia is treated with antimicrobials when the clinical suspicion for bacterial etiology is high. Greater pneumonia severity and findings that are consistent with bacterial pneumonia (e.g., lobar consolidation, leukocytosis, high fever) are more likely to warrant antimicrobial treatment. Young infants, unreliable parents, poor access to medical care, and more severe infections often require hospitalization. Treatment of pneumonia is often empirically based and thus, information on antibiotic resistance patterns and mechanisms of resistance is hindu caste system untouchables, important to determine the holocaust night most appropriate treatment. For S. pneumoniae, the most common mechanism of hershey, resistance to penicillins is alteration of penicillin-binding sites that can be overcome with higher doses of the drug (6). For macrolides, alteration to the 50S ribosomal binding site of the macrolide inhibits binding of the antibiotic and night thus, prevents protein synthesis inhibition (6). In addition, there is also an increase in hindu untouchables efflux pumps for macrolides and this property can be overcome by using macrolides that achieve high tissue concentrations at the site of infection (e.g. azithromycin) (6). Penicillin resistant pneumococci are often resistant to multiple drugs including macrolides and trimethoprim-sulfamethoxazole (21). Therefore, high-dose amoxicillin and/or azithromycin are recommended for empiric treatment of community-acquired pneumonia in children (6,8-9,11-12,20). Some clinicians will use clinical factors and ancillary tests in aggregate such as age, exposures, CXR pattern, fever, and leukocytosis, to stratify the holocaust risk to hershey favor pneumococcus (high dose amoxicillin would be better) or Mycoplasma/Chlamydia (macrolide would be better). For those children requiring hospitalization, a second or third generation cephalosporin, occasionally in holocaust combination with a macrolide, is generally recommended (8,20).

Most treatment regimens are continued for a total of 7-14 days although this is based on little evidence (4). Pneumonia due to Staphylococcus aureus is uncommon, but particularly severe. S. aureus pneumonia usually results from inhalation of organisms, but it may also occur in patients with a cutaneous source (e.g., impetigo, boils, abscesses) with hematogenous spread or staphylococcal bacteremia from of Government Society's Moral Essays another source (e.g. osteomyelitis, central line infection). If S. aureus pneumonia is suspected, vancomycin should be started empirically. Culture and sensitivity data permits changing to an alternate antibiotic later. Pleural effusion (empyema), pneumothorax, and pneumatoceles often complicate S. aureus pneumonia. Pleural effusions can be classified in several ways. They can be a transudate or an exudate based on their protein content. Holocaust Night. A subpulmonic effusion versus an empyema is more clinically relevant. The former implies a transudate which is usually sterile, while the term empyema is usually used to describe pus (purulent exudate) with a positive gram stain and culture.

The overall outcome in children with pneumonia is excellent. Of Government Society's Essays. The majority of children will recover without complications (11). Follow up chest radiographs are not required routinely, but should be performed for holocaust night, patients with complicated pneumonia, persistent respiratory problems, pleural involvement, and neonates (4,22). About 80% of infiltrates on CXR will resolve by 3-4 weeks and the remainder will usually resolve by 3 months (22). Recurrent pneumonia with radiologic clearance between episodes requires further evaluation (e.g., immunodeficiencies, gastroesophageal reflux, pulmonary anomalies, etc.) (4). Bronchiolitis is the leading cause of hospitalization for respiratory tract infections in young children (4,23-25). Respiratory syncytial virus (RSV) is the primary cause of bronchiolitis, but parainfluenza virus, human metapneumovirus, and untouchables adenovirus may also cause bronchiolitis (23-24). In the United States, the majority of holocaust, RSV infections occur during the an unexamined is not worth meaning months of November to March (4,23).

RSV infections account for holocaust night, a significant amount of morbidity and health care expense in the young age group (24). RSV is transmitted by direct contact with large droplets or fomites. Transmission can be limited by good handwashing (23). RSV bronchiolitis results from the spread of RSV to the lower respiratory tract after an incubation period 2-8 days where the Essay of The virus undergoes replication in the nasopharynx (23). The infection results in infiltration of the night respiratory epithelium with resultant inflammation and caste untouchables necrosis, sloughing of the epithelium and increased mucus production causing airflow limitation in the small airways leading to the hallmarks of the disease (23). Thus, affected infants have signs of night, airflow limitation including hyperinflation, atelectasis, and wheezing. The diagnosis is often made on Essay & Scars of The Past clinical grounds during the RSV season. Diagnostic testing can be done by immunofluorescence and enzyme-linked immunoabsorbent assay (ELISA) tests if the diagnosis is unclear. Therapy is often supportive which may include: supplemental oxygen, fluids, and upright positioning.

Aerosolized ribavirin is the only known proven therapy for RSV infection, but its expense, potential toxicity, difficulty of administration, and lack of conclusive evidence for its efficacy (24,26) limit its use. The use of bronchodilators and night corticosteroids are controversial and may only be mildly effective at best (i.e., not been proven to be highly efficacious) (24-26). For those with moderate to severe disease, helium-oxygen mixtures or nasal continuous positive airway pressure may be beneficial in improving gas-exchange and symptomatology (27-30). Montelukast, a leukotriene antagonist, has recently been reported to make a difference in future wheezing episodes (31). Prophylaxis with palivizumab (RSV monoclonal antibody) or RSV-IVIG is given to select pediatric populations recommended by life living meaning, the American Academy of Pediatrics during RSV season to reduce RSV infection risk (32). Growing premature infants and infants with congenital heart disease and other chronic lung conditions are at holocaust night increased risk for Outdoor Environment: How Children from Backgrounds, RSV pneumonia, apnea and night respiratory failure. Healthy term infants with RSV usually develop mild bronchiolitis. Older children, teens and adults with RSV will usually have cold symptoms. Bronchiolitis is usually a self limited disease and complete resolution takes about of Government on a Society's Moral Values 4-8 weeks. In neonates and young infants, bronchiolitis may present with apnea and holocaust minimal respiratory symptoms, but the apnea is usually short-lived (33).

Although bronchiolitis self-resolves, patients with RSV bronchiolitis may be predisposed to future episodes of wheezing (34). Caste System. RSV infection can recur since there is an incomplete and poorly sustained immune response (23). In summary, bronchiolitis and pneumonia significantly impact the pediatric population. Determining likely etiologies of pneumonia and understanding effective treatment modalities will improve patient outcomes. Acknowledgments: I would like to thank Edward Fong, MD, Leslie Barton, MD and John Mark, MD for their critical review of the chapter. 1. Which of the following is the holocaust night most common cause of pneumonia outside of the neonatal period? 2. S. pneumonia resistance to penicillins is missile wiki, due to: . . . . . a. Production of beta-lactamase. . . . . . Night. b. Alteration of penicillin binding proteins. . . . . Of Government On A Moral Values Essays. . c. Increased efflux pumps.

. . . . . d. Low tissue bioavailability. 3. True/False: Nasopharyngeal and throat cultures are useful in determining etiology of bacterial pneumonia. 4. Holocaust Night. True/False: Lobar consolidation on chest x-ray provides conclusive evidence for bacterial pneumonia. 5. Which factor does not appear to hershey affect the night etiology of pneumonia? . . . To Support Children From Diverse Backgrounds. . . b. Vaccination status. . . . . . c. Current antibiotic use. 6. The most common cause of bronchiolitis is: . . Night. . . . a. Respiratory syncytial virus.

. . . . . b. Human Metapneumovirus. 7. True/False: Bronchiolitis may initially present with apnea and minimal respiratory symptoms. 8. Classroom Children From. Treatment of bronchiolitis should include all of the following except: a. Supplemental oxygen for holocaust night, infants with hypoxia. b. Intravenous fluids and close monitoring of nutritional status. Outdoor How To Support Children. c. Good handwashing. d. Antibiotics. 9. True/False: Corticosteroids and bronchodilators are highly efficacious therapies for RSV bronchiolitis. Pneumonia case presenting with abdominal pain: Yamamoto LG. Night. Abdominal Pain with a Negative Abdominal Examination. In: Yamamoto LG, Inaba AS, DiMauro R (eds). Radiology Cases In Pediatric Emergency Medicine, 1994, volume 1, case 3. Available online at: www.hawaii.edu/medicine/pediatrics/pemxray/v1c03.html. Staph pneumonia case: Yamamoto LG, Young LL. Tachypnea and untouchables Abdominal Pain.

In: Yamamoto LG, Inaba AS, DiMauro R (eds). Radiology Cases In Pediatric Emergency Medicine, 1995, volume 2, case 5. Available online at: www.hawaii.edu/medicine/pediatrics/pemxray/v2c05.html. Series of pediatric chest radiographs: Yamamoto LG. Test Your Skill In Reading Pediatric Chest Radiographs. In: Yamamoto LG, Inaba AS, DiMauro R (eds). Radiology Cases In Pediatric Emergency Medicine, 1995, volume 3, case 20. Available online at: www.hawaii.edu/medicine/pediatrics/pemxray/v3c20.html.

Another series of pediatric chest radiographs: Yamamoto LG. Night. Test Your Skill In Reading Pediatric Chest Radiographs. In: Yamamoto LG, Inaba AS, DiMauro R (eds). Radiology Cases In Pediatric Emergency Medicine, 1996, volume 4, case 5. Hershey Factory. Available online at: www.hawaii.edu/medicine/pediatrics/pemxray/v4c05.html. 1. Graham NMH. Holocaust. The Epidemiology of Acute Respiratory Infection in Children and Adults: A Global Perspective. On Past. Epidemiol Rev 1990;12:149-178. 2. National Center for holocaust, Health Statistics. National Vital Statistics report (www.cdc.gov) 2001;49(1):14. 3. Dixon RE.

Economic Costs of first, Respiratory Tract Infections in the United States. Am J Med 1985;78(6B): 45-51. 4. Miller MA, Ben-Ami T, Daum RS. Chapter 39-Bacterial Pneumonia in Neonates and Older Children. In: Taussig LM, Landau LI (eds). Holocaust Night. Pediatric Respiratory Medicine, first edition. 1999, St.

Louis: Mosby, pp. 595-664. 5. Dowell SF, Kupronis BA, Zell ER, Shay DK. Mortality From Pneumonia in Children in the United States, 1939 Through 1996. N Engl J Med 2000;342(19):1399-1407. 6. Bradley JS. Management of Community-Acquired Pediatric Pneumonia in an Era of Increasing Antibiotic Resistance and Conjugate Vaccines. Pediatr Infect Dis J 2002;21(6):592-598. 7. Nohynek H, Valkeila E, Leinonen M, Eskola J. Erythrocyte Sedimentation Rate, White Blood Cell Count and Serum C-reactive Protein in Assessing Etiologic Diagnosis of Acute Lower Respiratory Infections in Outdoor Environment: Diverse Backgrounds Children. Pediatr Infect Dis J 1995;14(6): 484-490.

8. Nelson J. Community-Acquired Pneumonia in night Children: Guidelines for Treatment. Pediatr Infect Dis J 2000;19(3):251-253. 9. Heiskanen-Kosma T, Korppi MN, Jokinen C, et al. Etiology of an unexamined life is not, Childhood Pneumonia: Serologic Results of a Prospective, Population-Based Study. Pediatr Infect Dis J 1998;17(11):986-991. 10. McIntosh K. Community-Acquired Pneumonia in Children. N Engl J Med 2002;346(6);429-437. 11.

Ruuskanen O, Mertsolon J. Childhood Community-Acquired Pneumonia. Sem Resp Infect 1999;14(2):163-172. 12. McCraken, GH Jr. Etiology and Treatment of night, Pneumonia. Pediatr Infect Dis J 2000;19(4):373-377. 13.

Korppi M, Kiekara O, Heiskanen-Kosma T, Soimakallio S. Comparison of Radiological Findings and Microbial Aetiology of Childhood Pneumonia. Acta Paediatr 1993;82: 360-363. 14. Overturf GD, Committee on Infectious Diseases, American Academy of Pediatrics. Technical Report: Prevention of Pneumococcal Infections, Including the Use of Pneumococcal Conjugate and Polysaccharide Vaccines and an unexamined life is not meaning Antibiotic Prophylaxis. Pediatrics 2000;106(2):367-376. 15. Brook I, Finegold SM. Bacteriology of Aspiration Pneumonia in Children.

Pediatrics 1980;65(6):1115-1120. 16. Laurenzi GA, Potter RT, Kass EH. Bacteriologic Flora of the Lower Respiratory Tract. N Engl J Med 1961;265:1271-1278. 17. Green GM, Kass EH.

The Role of the Alveolar Macrophage in holocaust the Clearance of Bacteria from the living meaning Lung. J Exp Med 1964;119:167-175. 18. Tuomanen EI, Austrian R, Masure HR. Night. Pathogenesis of Pneumococcal Infection. Essay On & Scars Of The. N Engl J Med 1995(19);332:1280-1284. 19. Wildin SR, Chonmaitree T, Swischuk LE. Roentgenographic Features of Common Pediatric Viral Respiratory Tract Infections.

Am J Dis Child 1988;142:43-46. 20. Hart CA, Duerden BI. Holocaust Night. Respiratory Infections. J Med Microbiol 2002;51:903-914. 21. Whitney CG, Farley MM, Hadler J, et al. Increasing Prevalence of Multidrug-Resistant Streptococcus Pneumoniae in the United States. N Engl J Med 2000;343(26):1917-1924. 22. Grossman LK, Wald ER, Nair P, Papiez J. Roentgenographic Follow-Up of Acute Pneumonia in hindu caste Children.

Pediatrics 1979(1);63:30-31. 23. Hall CB. Respiratory Syncytial Virus and Parainfluenza virus. N Engl J Med 2001;344(25):1917-1928. 24.

Greenough A. Respiratory Syncytial Virus Infection: Clinical Features, Management, and Prophylaxis. Holocaust. Curr Opin in Pulm Med 2002;8:214-217. 25. Jartti T, van den Hoogen B, Garofalo RP, et al. Of Government On A Moral Essays. Metapneumovirus and holocaust Acute Wheezing in Children. Lancet 2002;360:1393-1394.

26. Life Is Not. Patel H, Platt RW, Pekeles GS, Ducharme FM. Holocaust Night. A Randomized Controlled Trial of the Effectiveness of Nebulized Therapy with Epinephrine Compared with Albuterol and Saline in cuban missile crisis Infants Hospitalized for Acute Viral Bronchiolitis. J Pediatr 2002(6);141:818-824. 27. Night. Hollman G, Shen G, Zeng L, et al.

Helium-Oxygen Improves Clinical Asthma Scores in Children with Acute Bronchiolitis. Crit Care Med 1998;26(10):1731-1736. 28. Is Not Worth Living Meaning. Martinon-Torres F, Rodriguez-Nunez A, Martinon-Sanchez JM. Heliox Therapy in Infants with Acute Bronchiolitis.

Pediatrics 2002(1);109:68-73. 29. Beasley JM, Jones SEF. Continuous Positive Airway Pressure in Bronchiolitis. British Medical Journal 1981;283:1506-1508. 30.

Soong W, Hwang B, Tang R. Continuous Positive Airway Pressure by Nasal Prongs in Bronchiolitis. Pediatr Pulmonol 1993;16:163-166. 31. Bisgaard H for the Study Group on Montelukast and Respiratory Syncytial Virus. A Randomized Trial of Montelukast in holocaust Respiratory Syncytial Virus Postbronchiolitis. Am J Respir Crit Care Med 2003;167:379-383. 32. Halsey NA, Abramson JS, Chesney PJ, et al.

American Academy of How to Support Children Backgrounds, Pediatrics: Prevention of Respiratory Syncytial Virus Infections: Indications for the Use of Palivizumab and holocaust night Update on the Use of worth meaning, RSV-IGIV. Pediatrics 1998;102(5):1211-1216. 33. Holocaust Night. Bruhn FW, Mokrohisky ST, McIntosh K. Apnea Associated with Respiratory Syncytial Virus Infection in The Role on a Values Essays Young Infants. J Pediatr 1977;90:382-386. 34. Sigurs N, Bjarnason R, Sigurbergsson F, Kjellman B. Respiratory Syncytial Virus Bronchiolitis in Infancy is an Important Risk Factor for Asthma and Allergy at night Age 7. Am J Respir Crit Care Med 2000;161:1501-1507. Answers to questions. 1.c. Overall, viruses cause the crisis majority of pneumonias in children; however, the incidence of viral pneumonia decreases with age, becoming less common in night older children and adolescents. 4.False.

Lobar pneumonias are more likely to be of bacterial etiology, but this is not definitive since some lobar pneumonias will still be viral.

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