According to figures released by the UN Children's Fund, pneumonia remains the main culprit in the deaths of children under the age of 5, killing 2,500 children a day. Pneumonia accounted for 15% of all deaths under 5 years of age and caused 920,000 deaths in 2015. Most of her victims were under 2 years old. Regardless, the good news is that most children recover fully from pneumonia if diagnosed and treated on time. Read on to learn about the symptoms, causes, treatment, and prevention of viral pneumonia in children.
What is viral pneumonia?
Pneumonia is an infection in the lungs, one or both. It can be caused by a bacterium, virus or fungus.
Viral pneumonia in children is a complication of exposure to viruses that lead to colds and flu. Viruses account for the largest proportion of the causes of childhood pneumonia.
Studies show that viruses are the second most common etiological factor in pneumonia (compared to Streptococcus pneumoniae), occurring in the range from 13 to 50% of diagnosed cases.
The reported incidence of viral pneumonia has increased over the past decade. In part, this apparent increase simply reflects improved diagnostic techniques, but there has also been an actual increase. This observation is attributed to the growing population of immunocompromised individuals.
Causes of the disease
It often starts after a child has an upper respiratory infection (cold). Sticky mucus begins to accumulate in the air spaces of the lungs, making it difficult for the latter to work and reducing the amount of oxygen entering the body. The child may eventually develop difficulty breathing (shortness of breath).
The following organisms are common viruses that cause pneumonia.
Human metapneumovirus
Human metapneumovirus is a virus that is a ubiquitous and frequent causative agent of respiratory infections. Metapneumovirus was discovered in 2001 in the Netherlands in young children with acute respiratory diseases, from mild upper respiratory tract infections to severe bronchiolitis and pneumonia. Then it became clear that it was he who was the culprit of severe acute respiratory infections in children around the world.
Although human metapneumovirus is a distinct and distinct strain from respiratory syncytial virus, they share many similarities.
The study of blood samples showed that almost all children 5 years old are infected with this virus. Moreover, asymptomatic and subclinical infections caused by human metapneumovirus are rare.
Metapneumovirus is not a new virus. Serological studies of antibodies to it showed that the virus circulated in humans for 50 years before it was discovered.
Flu virus
Influenza leads to both mild and serious illness. The severe consequences of influenza infection sometimes lead to hospitalization or death. Young children are at high risk of severe complications from influenza.
There are three types of virus: A, B and C. Types A and B are primary human pathogens and cause epidemic disease. Type C causes sporadic, unrelated diseases of the upper respiratory tract. Types A and B are classified into serotypically distinct strains that circulate through the population annually.
Rhinovirus
Human rhinoviruses are the most common causes of colds in children.
Some authors report that rhinovirus accounts for up to 30% of all viral pneumonia cases. Clinical studies have shown that rhinovirus is the second most recognized agent associated with pneumonia and bronchiolitis in infants and young children.
A survey of 211 French children with rhinovirus infection revealed bronchiolitis or bronchitis in 25.6% and pneumonia in 6.2% of cases.
Parainfluenza virus
Parainfluenza virus is a common virus that infects children. It is the second most important cause of lower respiratory tract disease in children after respiratory syncytial virus, as well as pneumonia and bronchiolitis in infants under six months of age.
There are four subtypes of the virus. Type 3 is endemic throughout the year, and types 1 and 2 peak during the fall season. Immunity is short-term, and recurrent upper and lower respiratory tract infections occur throughout life. Infection occurs in varying degrees, from mild illness to life-threatening croup, bronchiolitis, or pneumonia.
Infection in immunocompromised children can lead to dangerous pneumonia and respiratory failure.
Adenoviruses
Adenoviruses cause a wide range of diseases, depending on the serotype of the infectious agent. These include: asymptomatic disease, conjunctivitis, upper respiratory tract disease with fever, pneumonia, gastrointestinal disease, hemorrhagic cystitis, rash, and neurological diseases. Pneumonia is less common in adults, but fulminant disease has been described in infants and immunocompromised individuals, and may occur in apparently healthy individuals.
Adenovirus serotype 14 (subgroup B) is a more pathogenic strain that has been reported to cause severe respiratory illness and pneumonia.
Respiratory syncytial virus
Respiratory syncytial virus (RSV) is the most common cause of lower respiratory tract infection in infants and children and the second most common cause of viral pneumonia in adults.
Most children are infected before the age of 5. The infection rate during the epidemic approaches 100% in schools and kindergartens, but the resulting immunity is unstable. Reinfection is common but milder in older children and adolescents. However, the likelihood of more severe illness and pneumonia increases with age.
Coronavirus
Coronaviruses cause up to 15% of colds and are associated with exacerbations of croup, asthma and lower respiratory tract infections. Coronoviruses were not considered a cause of pneumonia until relatively recently.
The discovery that severe acute respiratory syndrome (SARS) is caused by a novel human coronavirus has led to increased surveillance and recognition of additional human coronaviruses. It was revealed that new coronaviruses enter the human population from zoonotic foci. For example, from bats.
Varicella-zoster virus
Pneumonia is a significant and life-threatening complication of chickenpox in healthy adults and immunocompromised people (including pregnant women). This pneumonia rarely occurs in healthy children, but it does happen in immunocompromised babies.
Measles virus
Measles is a respiratory virus that causes fever with rashes in children. Under the influence of this virus, pneumonia most often develops in a mild form.
Measles sometimes leads to serious lower respiratory tract infection and high morbidity in children with immunodeficiency and food intolerances.
Cytomegalovirus
Cytomegalovirus (CMV) belongs to the herpes virus family. Cytomegalovirus pneumonia can occur and is often fatal in immunocompromised people. The severity of pneumonia is related to the intensity of immunosuppression (suppression of immunity).
In addition, CMV infection is itself immunosuppressive, resulting in a further decrease in immune defenses in these patients.
Herpes simplex virus
Herpes simplex virus (HSV) is a rare cause of lower respiratory tract infections and is found in severely immunocompromised patients. Pneumonia can develop from a primary infection or from reactivation of the virus.
How does viral pneumonia spread?
The viruses that cause pneumonia travel through the air in droplets of liquid when someone sneezes or coughs. These fluids can enter the baby's body through the nose or mouth. A child can also get viral pneumonia if they touch their mouth, eyes, or nose with hands that have the virus.
Symptoms of viral pneumonia differ depending on the etiological agents. Pneumonia of viral origin usually occurs at certain times of the year, characteristic of increased circulation of the virus.
Common signs of viral pneumonia in children
In the early days of the disease, it looks like the flu, with manifestations such as:
- fever;
- dry cough, gradually turning into wet, in which the process of sputum discharge occurs;
- headache;
- sore throat;
- loss of appetite;
- muscle pain.
After one or two days, the fever may get worse. The child may also feel unable to catch their breath (shortness of breath).
Symptoms of viral pneumonia are similar to those of bacterial pneumonia, although studies have shown a lower likelihood of chest pain and seizures in viral pneumonia.
Physical examination results for viral pneumonia are similar to those for purulent pneumonia and are therefore non-specific. During an objective examination of the patient, wheezing is determined, wheezing in the lungs is heard, vocal tremor increases and noisy bronchial breathing is detected over the areas of the lungs involved in the pathological process.
Signs of influenza pneumonia
There are three clinical forms of influenza pneumonia: primary pneumonia, secondary bacterial pneumonia, and combined bacterial and viral.
Primary pneumonia caused by the influenza virus manifests itself with persistent symptoms of cough, sore throat, headache, muscle pain, and malaise for more than 3 to 5 days. The manifestations may worsen over time, and new respiratory manifestations such as shortness of breath and cyanosis may appear. This form is the least common, but the most severe in terms of pulmonary complications.
Secondary bacterial pneumonia is characterized by a relapse with a high body temperature, cough with purulent sputum after a period of initial improvement. The most common pathogen is Streptococcus pneumoniae (48%), followed by Staphylococcus aureus, Haemophilus influenzae and Gram-negative pathogens.
Avian influenza (H5N1) has an incubation period of 2 to 5 days, but there is an extension of up to seven days after exposure to the virus. The primary symptom is fever, as well as symptoms of cough, malaise, muscle and headache, sore throat, abdominal pain, vomiting, and diarrhea. Gastrointestinal complaints may initially suggest gastroenteritis.
When pneumonia develops, a cough with shortness of breath, tachypnea, and chest pain has been reported. In severe cases, encephalitis / encephalopathy, heart failure, renal failure, and multiple organ failure may develop.
The H1N1 flu is a similar seasonal flu. Fever and cough are almost universal symptoms. Shortness of breath, fatigue / weakness, chills, myalgia (muscle pain), rhinorrhea (excess mucus from the nose), sore throat, headache, vomiting, wheezing in the lungs and diarrhea are the most common accompanying symptoms.
Combined viral and bacterial pneumonia is very common, sometimes manifesting itself as a gradual progression of the disease or as a hint of recovery, followed by worsening. With this type of pneumonia, both bacterial pathogens and the influenza virus are released.
Respiratory syncytial virus (RSV) pneumonia symptoms
Patients with RSV pneumonia usually have fever, nonproductive cough, shortness of breath, and ear pain. Pathological wheezing is a common auscultatory sign.
Compared to influenza, RSV is more commonly associated with a runny nose, sputum, and wheezing, and less commonly with gastrointestinal complaints and fever.
Immunocompromised (frequently ill) children can have a wide range of respiratory tract involvement. These patients develop fever, cough, rhinorrhea, nasal congestion, and trouble breathing. Symptoms range from mild shortness of breath to severe respiratory distress and respiratory failure.
Most patients with RSV infection, including infants, have only symptoms of upper respiratory tract involvement, 25–40% develop bronchiolitis and / or pneumonia. Statistics show that 20-25% of children with pneumonia requiring hospitalization are infected with RSV.
Lower respiratory tract involvement in infants is preceded by a runny nose and decreased appetite. Usually there is a low-grade fever (up to 38˚Ϲ), cough, wheezing and rapid breathing.
The majority of children admitted to hospital with RSV are under six months of age.
Parainfluenza virus and manifestations of pneumonia
The clinical manifestations of parainfluenza can range from mild upper respiratory tract infections (mainly in immunocompetent patients) to severe croup, bronchiolitis, or life-threatening pneumonia in an immunosuppressed setting.
Parainfluenza type 3 is the main strain causing pneumonia and bronchiolitis. Signs and symptoms are nonspecific, more pronounced in children, similar (but milder) to RSV pneumonia. These include fever, cough, wheezing, wheezing, runny nose, wheezing.
Parainfluenza pneumonia, once resolved, may be similar to other pulmonary diseases in children.
Human metapneumovirus and manifestations of pneumonia when exposed
Symptoms of an infection with human metapneumovirus are similar to those that appear with other viral pneumonias. Nasal congestion and coughing are present in 82-100% of cases. Other symptoms include rhinorrhea, shortness of breath, wheezing, productive cough, hoarseness, and sore throat. The incubation period is 5 - 6 days.
Manifestations of coronavirus pneumonia
The incubation period is 2 - 5 days, the average is 3 days. Symptoms are similar to those of other respiratory viruses, including cough, rhinorrhea, sore throat, headache, and malaise, although fever occurs in only 21 to 23% of cases.
Chickenpox virus and symptoms of pneumonia with it
Pneumonia from chickenpox begins gradually, 1 to 6 days after the onset of the rash, and manifests itself with fever, seizures, tachypnea, shortness of breath, dry cough, cyanosis, and (rarely) hemoptysis. Pneumonia can develop as a mild illness or in a severe form, up to death, especially in immunocompromised individuals.
Cytomegalovirus pneumonia
CMV pneumonia is usually mild in children who do not have any other underlying pathology. It begins as a syndrome similar to mononucleosis (malaise, fever, myalgia).
In immunocompromised children, the clinical picture may change.
Adenovirus pneumonia
Adenovirus pneumonia most often occurs with fever and cough. Other common symptoms include shortness of breath, vomiting, diarrhea, headache, myalgia, runny nose, chills, and sore throat and chest pain.
Diagnosis of the disease
If the doctor suspects pneumonia, he or she will order a chest x-ray. This will assess the severity of the pneumonia. Blood tests, mucus and sputum tests are also performed to identify the pathogen.
Treatment
The doctor deals with the treatment of such diseases, in no case do you treat your child yourself, as this can lead to deadly complications.
Parents, for their part, must adhere to a number of recommendations.
- Creating a favorable microclimate in the room where the child is most of the time (bedroom), by using a humidifier. This will make his breathing easier.
- Providing your child with adequate rest.
- An increase in the amount of fluid consumed by the child.
- Control of the child's body temperature. When the temperature rises above 38 ° C for infants under 6 months or 38.9 ° C for older children, call an ambulance immediately. Paracetamol can help relieve pain and fever. Be sure to follow the recommended dosage, as exceeding the recommended doses of Paracetamol is dangerous.
- Antibiotics are ineffective against viral pneumonia. Depending on the type of virus that causes pneumonia, antiviral drugs for pneumonia in children may be beneficial when taken early in the illness. For example, the drugs oseltamivir (Tamiflu) and zanamivir (Relenza) can be used to treat influenza.
The prognosis is positive in the vast majority of children with viral pneumonia.
