Pneumonia

Pneumonia is commonly encountered in both outpatient and inpatient settings and continues to pose diagnostic and therapeutic challenges for pediatricians. Although bacterial, viral, and fungal pathogens can all cause pneumonia, the etiology can vary depending on the child's age, underlying chronic medical disease, and other risk factors and predictors. However, the epidemiology of pneumonia continues to be evolving given newly emerging viral etiologies and available vaccinations. The diagnosis of uncomplicated, community-acquired pneumonia continues to be based on patient history, physical exam, and clinical judgement in the outpatient setting, whereas laboratory tests and radiographic studies are more likely to be used as diagnostic adjuncts in patients requiring hospitalization. The medical management of pneumonia should be tailored based on the patient's clinical presentation and presumed etiology, immunization status, severity of illness, presence of treatment failure or complications, and local patterns of antibiotic resistance. Surgical management should be considered for patients with moderate parapneumonic effusions with worsening clinical course and with large effusions with or without loculations. Patients discharged from the hospital with a diagnosis of community-acquired pneumonia should follow up with their pediatrician to ensure continued clinical improvement. Repeat chest radiographs are not routinely advised unless there is recurrent or persistent pneumonia or a suspicion for anatomical anomalies.