Pediatric Guidance
Community-Acquired Pneumonia

Community-Acquired Pneumonia

Definition

An acute illness affecting the lungs usually presenting with fever, cough, and rapid and difficult breathing with a new or worsening pulmonary infiltrate on a chest radiograph

Diagnosis

  • New onset (<2 weeks) or worsening cough with fever (≥38.0ºC), dyspnea, tachypnea, reduced oxygen saturation, crepitations, cyanosis, grunting, nasal flaring, pallor
  • Pneumonia is diagnosed on: fast breathing for age and/or chest indrawing
    • Check for hypoxia with oxygen saturometer if available
  • Children with runny nose and cough and no signs of severity usually do not have pneumonia and should not receive an antibiotic, only home care advice

Mild cases:

  • Usually not needed

Severe cases (to guide antimicrobial treatment):

  • Blood cultures
  • Tests for COVID-19 and influenza can be considered if clinically indicated and available

No test clearly differentiates viral or bacterial CAP

Consider: Full blood count and C-reactive protein

Note: tests depend on availability and clinical severity (e.g. blood gases will only be done in severe cases)

  • Chest X-ray not necessary in mild cases
  • Look for lobar consolidation or pleural effusion
  • Radiologic appearance cannot be used to accurately predict pathogen
  • Consider specific investigations for TB in endemic settings especially in high-risk patients (e.g. HIV)
  • A rapid molecular test performed on a single sputum specimen is the preferred first line diagnostic test for pulmonary TB and to detect rifampicin resistance
  • When available a lipoarabinomannan rapid urinary antigen test should be considered for HIV positive children with a possible diagnosis of active tuberculosis

Microbiology

Additional Information

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