Publication Date: April 2019 (Volume 16, Number 4)
CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 4/01/2022.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 0.5 Pharmacology CME and 4 Infectious Disease CME credits, subject to your state and institutional approval.
Worldwide, pneumonia is the most common cause of death in children aged < 5 years. Distinguishing viral from bacterial causes of pneumonia is paramount to providing effective treatment but remains a significant challenge. For patients who can be managed with outpatient treatment, the utility of laboratory tests and radiographic studies, as well as the need for empiric antibiotics, remains questionable. This issue reviews viral and bacterial etiologies of community-acquired pneumonia in pediatric patients, offers guidance for obtaining historical information and interpreting physical examination findings, discusses the utility of various diagnostic techniques, and provides recommendations for the treatment of previously healthy and medically fragile children.
Excerpt From This Issue
A previously healthy 4-year-old girl is brought to the ED for fever and abdominal pain that started 10 hours ago. The girl’s temperature is 39.4°C (103°F). On physical examination, she is ill-appearing, and she states that her belly really hurts. Her abdominal pain appears to be severe, and she is upset, so your abdominal examination is limited. There is no respiratory distress, and her lungs are clear to auscultation. You place an IV and give her morphine for pain. The girl’s peripheral WBC count is 26,000 cells/mcL, with 82% neutrophils. You perform an ultrasound, but the appendix cannot be visualized. You recall that pneumonia can present as abdominal pain and wonder if that could be the case for this patient. Should you order a CT scan of the abdomen or start with a chest x-ray?
A previously healthy 8-year-old girl is referred to the ED for fever ranging from 38.9°C-39.4°C (102°F-103°F) and cough for 8 days. She was started on amoxicillin-clavulanate 2 days prior but has not improved. On physical examination, she is alert, nontoxic, and not in respiratory distress. Chest auscultation reveals decreased breath sounds and questionable rales in the left lower lobe. The high fever and localized chest findings prompt you to obtain a chest x-ray that shows a large left-sided pleural effusion. As you look at the film, you begin to wonder… Should you order a CT scan? What is the utility of ultrasound in this patient? Is a chest tube indicated and, if so, what labs would be useful to run on the pleural fluid? What is the most appropriate antibiotic coverage for this patient?