Die ambulant erworbene Pneumonie im Kindesalter

Zusammenfassung

Der Begriff „ambulant erworbene Pneumonie (AEP)” beschreibt die Entzündung des Lungenparenchyms eines zuvor gesunden Individuums durch einen Erreger, der außerhalb eines Krankenhauses vom Individuum aufgenommen wurde. Die AEP hat bei Kindern in Europa und Nordamerika eine Inzidenz von 3000–4000 Erkrankungen pro 100 000 Einwohner und Jahr. Bei rund 55% der Fälle ist eine bakterielle Infektion ätiologisch zumindest mitbeteiligt. Bei der ambulanten Betreuung ist die klinische Diagnosestellung entscheidend. Röntgendiagnostik und Labordiagnostik haben bei schwereren Verlaufsformen eine Bedeutung. Bei vermuteter bakterieller Ätiologie einer AEP ist ein oral applizierbares Penicillin Mittel der ersten Wahl. Zur Prävention sind die Bekämpfung von Hunger, hygienische Maßnahmen und Impfungen möglich.

Summary

The term „community-acquired pneumonie (CAP)” delineates an inflammation of the lung with an infectious agent, which is acquired outside a hospital. CAP has in children in Europe and northamerica an incidence of 3000–4000/100 000 residents per year. In 55% a bacterium is cause of the pulmonary infection. In the community setting CAP is diagnosed clinically. Radiological methods and the estimation of acute phase reactants have importance in more severe cases. If bacterial etiology is suspected the oral application of penicillin is the first therapy of choice. Methods of prevention are the reduction of malnourishment and hunger, hygiene and vaccinations.

Schlüsselwörter

Ambulant erworbene Pneumonien - Entzündung des Lungenparenchyms - Erreger

Keywords

Community-acquired pneumonia - inflammation of the lung - infectious agent

• Literatur

• 1 Mcintosh K. Community-acquired pneumonia in children. N Engl J Med 2002; 346 (06) 429-37.
• 2 Weigl JA, Puppe W, Belke O. et al. Population-based incidence of severe pneumonia in children in Kiel, Germany. Klin Padiatr 2005; 217 (04) 211-9.
• 3 Murphy TF, Henderson FW, Clyde Jr WA. et al. Pneumonia: an eleven-year study in a pediatric practice. Am J Epidemiol 1981; 113 (01) 12-21.
• 4 Jokinen C, Heiskanen L, Juvonen H. et al. Incidence of community-acquired pneumonia in the population of four municipalities in eastern Finland. Am J Epidemiol 1993; 137 (09) 977-88.
• 5 Bryce J, Boschi-Pinto C, Shibuya K. et al. WHO estimates of the causes of death in children. Lancet 2005; 365 (9465): 1147-52.
• 6 WHO. Management of pneumonia in community settings. WHO/Unicef. May 2004 http://www.unicef.org (WHO/FCH/CAH/04.06) 2004
• 7 Schaad UB. Antibiotic therapy of childhood pneumonia. Pediatr Pulmonol Suppl 1999; 18: 146-9.
• 8 Juven T, Mertsola J, Waris M. et al. Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J 2000; 19 (04) 293-8.
• 9 Michelow IC, Olsen K, Lozano J. et al. Epidemiology and clinical characteristics of community-acquired pneumonia in hospitalized children. Pediatrics 2004; 113 (04) 701-7.
• 10 Allewelt M, Steinhoff D, Rahlwes M. et al. Changes in the spectrum of the causative agents of community-acquired pneumonias (1982–1992). Dtsch Med Wochenschr 1997; 122 (34–35): 1027-32.
• 11 Jadavji T, Law B, Lebel MH. et al. A practical guide for the diagnosis and treatment of pediatric pneumonia. CMAJ 1997; 156 (05) S703-11.
• 12 Klein J. Bacterial pneumonias. In: Feigin RD, Demmler GJ, Kaplan SL. (eds). Textbook of pediatric infectious Disease. 5th ed.. Philadelphia, USA: Saunders; 2004
• 13 Williams JV, Harris PA, Tollefson SJ. et al. Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children. N Engl J Med 2004; 350 (05) 443-50.
• 14 Williams JV. The clinical presentation and outcomes of children infected with newly identified respiratory tract viruses. Infect Dis Clin North Am 2005; 19 (03) 569-84.
• 15 Moustaki M, Zeis PM, Katsikari M. et al. Mesenteric lymphadenopathy as a cause of abdominal pain in children with lobar or segmental pneumonia. Pediatr Pulmonol 2003; 35 (04) 269-73.
• 16 British Thoracic Society. Guidelines for the Management of Community Acquired Pneumonia in Childhood. Thorax 2002; 57 (Suppl. 01) i1-24.
• 17 Courtoy I, Lande AE, Turner RB. Accuracy of radiographic differentiation of bacterial from nonbacterial pneumonia. Clin Pediatr (Phila) 1989; 28 (06) 261-4.
• 18 Zukin DD, Hoffman JR, Cleveland RH. et al. Correlation of pulmonary signs and symptoms with chest radiographs in the pediatric age group. Ann Emerg Med 1986; 15 (07) 792-6.
• 19 Bachur R, Perry H, Harper MB. Occult pneumonias: empiric chest radiographs in febrile children with leukocytosis. Ann Emerg Med 1999; 33 (02) 166-73.
• 20 Kramer MS, Roberts-Brauer R, Williams RL. Bias and ‘overcall’ in interpreting chest radiographs in young febrile children. Pediatrics 1992; 90 (01) (Suppl. 01) 11-3.
• 21 Swingler GH, Zwarenstein M. Chest radiograph in acute respiratory infections in children. Cochrane Database Syst Rev 2005; (03) CD001268.
• 22 Virkki R, Juven T, Mertsola J. et al. Radiographic follow-up of pneumonia in children. Pediatr Pulmonol 2005; 40 (03) 223-7.
• 23 Ramnath RR, Heller RM, Ben-Ami T. et al. Implications of early sonographic evaluation of parapneumonic effusions in children with pneumonia. Pediatrics 1998; 101 (01) (Suppl. 01) 68-71.
• 24 Virkki R, Juven T, Rikalainen H. et al. Differentiation of bacterial and viral pneumonia in children. Thorax 2002; 57 (05) 438-41.
• 25 Ruggeberg JU, Ketteler K, Mackenzie CR. et al. Blood culture sampling rates at a German pediatric university hospital and incidence of invasive pneumococcal disease. Infection 2004; 32 (02) 78-81.
• 26 Requejo HI, Guerra ML, Dos Santos M. et al. Immunodiagnoses of community-acquired pneumonia in childhood. J Trop Pediatr 1997; 43 (04) 208-12.
• 27 Singhi S, Dhawan A. Frequency and significance of electrolyte abnormalities in pneumonia. Indian Pediatr 1992; 29 (06) 735-40.
• 28 Dhawan A, Narang A, Singhi S. Hyponatraemia and the inappropriate ADH syndrome in pneumonia. Ann Trop Paediatr 1992; 12 (04) 455-62.
• 29 Singhi S, Sharma A, Majumdar S. Body water and plasma volume in severe community-acquired pneumonia: implications for fluid therapy. Ann Trop Paediatr 2005; 25 (04) 243-52.
• 30 Levine A. Chest physical therapy for children with pneumonia. J Am Osteopath Assoc 1978; 78 (02) 122-5.
• 31 Wallis C, Prasad A. Who needs chest physiotherapy? Moving from anecdote to evidence. Arch Dis Child 1999; 80 (04) 393-7.
• 32 Schuh S, Coates AL, Binnie R. et al. Efficacy of oral dexamethasone in outpatients with acute bronchiolitis. J Pediatr 2002; 140 (01) 27-32.
• 33 Hartling L, Wiebe N, Russell K. et al. Epinephrine for bronchiolitis. Cochrane Database Syst Rev 2004; (01) CD003123.
• 34 Friis B, Andersen P, Brenoe E. et al. Antibiotic treatment of pneumonia and bronchiolitis. A prospective randomised study. Arch Dis Child 1984; 59 (11) 1038-45.
• 35 Bruinsma N, Kristinsson KG, Bronzwaer S. et al. Trends of penicillin and erythromycin resistance among invasive Streptococcus pneumoniae in Europe. J Antimicrob Chemother 2004; 54 (06) 1045-50.
• 36 Hyde TB, Gay K, Stephens DS. et al. Macrolide resistance among invasive Streptococcus pneumoniae isolates. JAMA 2001; 286 (15) 1857-62.
• 37 Reinert RR, Lutticken R, Reinert S. et al. Antimicrobial resistance of Streptococcus pneumoniae isolates of outpatients in Germany, 1999–2000. Chemotherapy 2004; 50 (04) 184-9.
• 38 Juven T, Mertsola J, Waris M. et al. Clinical response to antibiotic therapy for community-acquired pneumonia. Eur J Pediatr 2004; 163 (03) 140-4.
• 39 Qazi S. Short-course therapy for community-acquired pneumonia in paediatric patients. Drugs 2005; 65 (09) 1179-92.
• 40 Jaffe A, Balfour-Lynn IM. Management of empyema in children. Pediatr Pulmonol 2005; 40 (02) 148-56.
• 41 Luby SP, Agboatwalla M, Feikin DR. et al. Effect of handwashing on child health: a randomised controlled trial. Lancet 2005; 366 (9481): 225-33.
• 42 Redelings MD, Sorvillo F, Simon P. et al. Declining early childhood mortality from invasive pneumococcal disease: the impact of vaccination. Arch Pediatr Adolesc Med 2005; 159 (02) 195-196.