Penyakit Paru pada Anak – Acute Respiratory Infections (ARI)

Developed and developing countries

High morbidity

5 – 8 episodes/year/child

30 – 50 % outpatient visit

10 – 30 % hospitalization

Developing countries

High mortality

30 – 70 times higher than in developed countries

1/4 – 1/3 death in children under five year of age


Distribution of 12.2 million deaths among children less than 5 years old in all developing countries, 1993

Magnitude of the Problem in Indonesia

Pneumonia in children (< 5 years of age)

Morbidity Rate 10-20 %

Mortality Rate 6 / 1000

Pneumonias kill

50.000 / a year

12.500 / a month

416 / a day = passengers of 1 jumbo jet plane

17 / an hour

1 / four minutes

Pneumonia is a no 1 killer for infants (Balita)

Pneumonia Classifications

Anatomical classification

Lobar pneumonia

Lobular pneumonia

Interstitial pneumonia


Etiological classification

Bacterial pneumonia

Viral pneumonia

Mycoplasma pneumonia

Aspiration pneumonia

Mycotic pneumonia

Etiology of Pneumonia

Predominantly : bacterial and viral

In developing countries: bacterial > viral

(Shann,1986): In 7 developing countries, bacterial – 60 %

(Turner, 1987): In developed countries,

bacterial – 19 % ; viral – 39 %

Bacterial etiology

Streptococcus pneumoniae

Hemophilus influenzae

Staphylococcus aureus

Streptococcus group A – B

Klebsiella pneumoniae

Pseudomonas aeruginosa

Chlamydia spp

Mycoplasma pneumoniae

Characteristic features

S pneumonia:

mucosal inflammation lesion

alveolar exudates

frequently – lobar pneumonia)

H influenzae, S viridans, Virus:

invasion and destruction of mucous membrane

Staphylococcus, Klebsiella:

destruction of tissues – multiple abscesses

Simple Clinical Signs of Pneumonia (WHO)

Pathology and Pathogenesis

Bacteriae — peripheral lung tissues — tissues reaction — oedematous

Red Hepatization Stadium — alveoli consist of : leucocyte, fibrine,erythrocyte, bacteria

Grey Hepatization Stadium –fibrine deposition, phagocytosis

Resolution Stadium — neutrophil degeneration, loose of fibrine, bacterial phagocytosis

Radiographic patterns

1. Diffuse alveolar and interstitial pneumonia (perivascular and interalveolar changes)

2. Bronchopneumonia (inflammation of airways and parenchyma)

3. Lobar pneumonia (consolidation in a whole lobe)

4. Nodular, cavity or abscess lesions ( immunocompromised patients)

Blood Gas Analysis & Acid Base Balance

Hypoxemia (PaO2 < 80 mm Hg)

with O2 3 L/min 52,4 %

without O2 100 %

Ventilatory insufficiency

(PaCO2 < 35 mmHg) 87,5 %

Ventilatory failure

(PaCO2 > 45 mmHg ) 4.8 %

Metabolic Acidosis

poor intake and/or hypoxemia 44,4 % (Mardjanis Said, et al. 1980)


Severe Pneumonia:


Antibiotic administration

Procain Pennicilline, Chloramphenicol

Amoxycillin + Clavulanic Acid

Intra Venous Fluid Drip


Detection and management of complications

WHO recommendations for treatment of infants less 2 months who have cough or difficulty breathing.

WHO recommendations for treatment of children aged 2 months to 4 years who have cough or difficulty breathing .

Initial empirical treatment based on age and severity of pneumonia


Pleural effusion (empyema)





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