Why is my child’s Pneumonia not improving?

Pneumonia is a common lung infection in children. It is usually caused by viruses or bacteria. With appropriate treatment most children with pneumonia improve in 3-5 days and get well. In some children symptoms and X-ray changes of pneumonia seem to persist beyond 2-4 weeks. This situation is described as persistent pneumonia. Here we discuss the causes of persistent pneumonia in children and how we diagnose the cause.

What are the causes of long standing or persistent pneumonia in children?
Commonest causes of persistent pneumonia in children include infection with atypical bugs like mycoplasma and tuberculosis. Some children with inadequately treated pneumonia (inadequate duration or dose of antibiotics) can also present like non-resolving pneumonia. Other common causes of persistent pneumonia in children include a long standing foreign body in the child’s airway.

child’s Pneumonia

Rare causes of persistent pneumonia are fungal infections. Children with underlying immune deficiency like common variable immunodeficiency, X-linked agammagloubinemia, neutropenia, leukocyte adhesion defect and chronic granulomatous disease can also develop persistent pneumonia. Some children have issues like cysts in lungs, sequestration or fistulas leading to persistent pneumonia. Mucociliary problems like cystic fibrosis and primary ciliary dyskinesia can also lead to persistent pneumonia due to chronic damage to the airways called bronchiectasis.

What investigations are required for diagnosis of a child with persistent pneumonia?
Proper and timely diagnosis of children with persistent pneumonia can facilitate prevention, diagnosis, and management of these diseases in children. Investigations for diagnosis of causes of persistent pneumonia depends on a case to case basis.

These investigations include a sputum examination for various microbes like bacteria and tuberculosis. Advanced tests in sputum like a GENEXPERT or Xpert RIF test can be very helpful for diagnosis of tuberculosis (TB). CT scan of the chest with contrast is a very useful investigation for evaluation of the lung in detail and identify disease patterns. Flexible Bronchoscopy is also a very important investigation which allows examination of the child’s airway from inside and collects sputum from inside for detailed microbiological analysis.

Other investigations which may be required are tests for immunodeficiency disorders like blood counts, immunoglobulin levels, CD 4 and CD 8 counts, flowcytometry for leukocyte adhesion defect and chronic granulomatous disease, HIV etc. Sweat chloride levels might be needed for diagnosis of cystic fibrosis in children.

In case your child’s pneumonia is not improving you need to consult a pediatric pulmonologist for a proper evaluation, diagnosis and further treatment.

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