Case Report

By : Winda Sofvina Nim. 0508111054 Supervisor: dr. Riza Yefri Sp.A

Senior clerkship-Departement of Pediatric FK UR- RSUD AA 2012

background Pneumonia is an infection of one or both lungs which

is usually caused by bacteria, viruses, or fungi Pneumonia is the leading cause of death in children worldwide Pneumonia is the single largest cause of death in children worldwide. Every year, it kills an estimated 1.4 million children under the age of five years

definition Pneumonia is a form of acute respiratory infection that

affects the lungs. When an individual has pneumonia, the alveoli are filled with pus and fluid, which makes breathing painful and limits oxygen intake

Etiology Pneumonia is caused by a number of infectious agents,

including viruses, bacteria and fungi. The most common are:

Streptococcus pneumoniae the most common cause

of bacterial pneumonia in children; Haemophilus influenzae type b (Hib) the second most common cause of bacterial pneumonia; respiratory syncytial virus is the most common viral cause of pneumonia;

pathophysiology Pneumonia develops when foreign matter such as viruses,

bacteria, parasites, or fungus enters the lungs and causes inflammation. There are also chemicals that can enter the lungs and cause pneumonia. Additionally, an injury to the lungs may cause pneumonia, but it is much less common. Once this foreign matter enters the body, it provokes a response of the immune system. After that, the person's oxygen levels begin to deplete and he or she begins to breathe faster.

Clinical Manifestation

Cough, Grunting, Chest pain, Tachypnea Retractions, Signs of consolidation, Crackles Wheezing , Cyanosis, Abdominal pain

How to diagnose pneumonia If pneumonia is suspected on the basis of a patient's

symptoms and findings from physical examination, further investigations are needed to confirm the diagnosis. A chest X-ray is usually ordered to confirm the diagnosis of pneumonia A blood test that measures white blood cell count (WBC) may be performed. An individual's white blood cell count can often give a hint as to the severity of the pneumonia and whether it is caused by bacteria or a virus. An increased number of neutrophils, one type of WBC, is

seen in most bacterial infections,

Differential diagnosis Chronic obstructive pulmonary disease(COPD) or

asthma similar to that of pneumonia congestive heart failure, bronkhiolitis, lung abscess, emphysema

Risk factor children whose immune systems are compromised are at higher

risk of developing pneumonia. A child's immune system may be weakened by malnutrition or undernourishment, especially in infants who are not exclusively breastfed. Pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia. The following environmental factors also increase a child's susceptibility to pneumonia: indoor air pollution caused by cooking and heating with biomass

fuels (such as wood or dung) living in crowded homes parental smoking.

Treatment Pneumonia can be treated with antibiotics. These are usually prescribed at a health centre or

hospital, but the vast majority of cases of childhood pneumonia can be administered effectively within the home. Hospitalization is recommended in infants aged two months and younger, and also in very severe cases.

Complication Pleuritis Empyema Pneumothorax

Lung abscess pericarditis

Name Age Father/mother Address

: S, female : 4 years 3 months : Mr. H dan Mrs. M : Pekanbaru

Chief complaint : Shortness of breath since 1 days before admitted

History Since 9 day before admission, the patient had a fever

that appear suddenly, high fever, shortness of breath (),seizures (-), nausea (-), vomiting (), abdominal pain (-), cough (-), cold (-), pain on swallowing (-), spots on skin (-), the patient felt pain in the joints, there was no defecation and mixturition complaints, the appetite was decreased, and the patient was taken to general practitioner and given medicine for fever, but after 4 days of taking the drug, patient did not recover.

5 day before admission, patient had a shortness of

breath, cyanotic lips (-), cyanotic extremities (-), there was no wheezing, chest pain (-), the shortness of breath was not reduced when the patient sit. The fever was still continue and patient returned to general practitioner and are asked to do routine blood examination. Patient went to Santa Maria Hospital to check the blood, and from the result, patient are recommended to be hospitalized. patient were hopitalized for 2 days. The family did not know what drugs was given during hospitalization.

1 day before admission, the shortness of breath was

worsening, the fever continues, there was joint pain, then the patient admitted to the AA General Hospital emergency room and hospitalized in pediatric ward. In the ward, patient was nebulized 3 times in one day. After 3 days of hospitalization, the shortness of breath gets worse, patient felt difficult to eat and drink, so that the patient had a nasal feeding tube installed, then moved to Pediatric Intensive Care Unit.

patient hospitalized in PICU for 2 days, the condition

was improved, the shortness of breath was decreased, and patient returned to pediatric ward.

Past illness history 6 months ago,the patient had a typhoid fever, and

was given chloramphenicol, then the patient had a skin exfoliation, the general practitioner said that the patient had chloramphenicol allergy. There was no history of cough.

Family illness history

There was no similar complaints History Parents Patient's father worked as an enterpreneur and the patient's mother was a housewife.

Pegnancy and birth history There was no serious illnesson pregnancy and mother never take drugs, jamu, and there was no smoke and alcohol history. The gestational age was 9 month, the labour was assisted by midwife. Birth weight 3300 grams. The mother control her pregnancy every month (on midwife).

Food And Drink History patient are breastfed since birth untill 2 years. patient often loss appetide.

Immunization history : no immunization History Of Physical Growth : according to the age History Of Mental Growth : according to the age

General appearance: moderate illness Awareness: composmentis

BP T pulse RR weight height Nutritional state

: 100/70 mmHg : 36,6 oC : 120 x/i : 60 x/i : 14 kg : 100cm : 87,7% mild malnutrition

Head

and eye lid Skin : cyanosis(-), jaundice (-), petechie (-) Hair : normal Eyes : palpebra edema(+/+), anemic conjunctiva (-/-), sclera jaundice (-/-), pupil isochor +/+, light reflex + / + Ears : normal Nose : Nostril breath (+), discharge (-), deformity(-)

: simmetric, normocefal, edema in face

Lip

: cyanosis (-), wet (+) Mucus membrane: wet (+) Palate : whole, pharyngeal hiperemis (-) Tongue : normal Teeth : normal Lymph nodes : enlarged (-) Stiff neck :-

THORAX : Lungs: Inspection symmetrical chest movements left and right, retraction (+)intercostal, supraclavicular Palpation :Right = Left fremitus percussion at both lung fields : dull Auscultation: fine crackles wet + / +, wheezing - / Kardiovaskuler:

Inspection : ictus cordis(-) palpation palpable ictus Cordis RIC V, 1 finger medial LMCS Percussion Limits the right heart: RIC V LSD Limit of the left heart: RIC VI LMCS medial fingers Auscultation : normal heart sounds heart , murmur (-), gallop (-) : normally

ABDOMEN

GENITALIA

female, normally EXTREMITY

Symmetric, pale (-), warm acral, CRT