Community-acquired pneumonia in children
Differentials
Pertussis
SIGNS / SYMPTOMS
Paroxysmal cough, inspiratory whooping, post-tussive vomiting, and, in infants, cyanosis or apnea. Symptoms occur in three phases: catarrhal, paroxysmal, and convalescent.[41]
Croup
Bronchiolitis
SIGNS / SYMPTOMS
Primarily a disease of infancy (rare in children >3 years old); usually starts with upper respiratory tract symptoms (e.g., rhinitis and cough); fever, if present, usually low-grade. Cough then increases in severity, and lower respiratory tract symptoms develop (e.g., wheeze, retractions, tachypnea).[46]
INVESTIGATIONS
Usually a clinical diagnosis.
Foreign body aspiration (FBA)
征象/症状
History of a choking episode with sudden onset of respiratory distress associated with coughing, gagging, or stridor. Unilateral decreased breath sounds and/or unilateral wheezing.[47]
辅助检查
Chest x-ray: visualization of radio-opaque foreign body or indirect signs if the foreign body is radiolucent (e.g., atelectasis, air trapping, pneumomediastinum).
Bronchoscopy is the standard of care for diagnosis and treatment of FBA.
Asthma exacerbation
征象/症状
History of asthma and/or atopic disease (e.g., boggy mucous membranes); nocturnal cough, particularly if associated with wheeze; family history of asthma or atopy; may be triggered by physical exertion or airway irritants; fever and other signs of infection absent (unless exacerbation is virally triggered).[8]
辅助检查
Bronchoconstriction responds to short-acting beta-2 agonist; no signs of infiltration on chest x-ray (normal or may show hyperinflation).[48]
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