Respiratory

A 3-month-old African American boy was referred for evaluation of poor weight gain and vomiting. The infant had been evaluated by his primary care physician 15 times within the past 6 weeks; he had no change in symptoms despite various treatments.

A 2-month-old boy is brought to the emergency department (ED) because of “noisy breathing” that has been present since birth. The parents report that they occasionally see the child’s ribs during inspiration when he is lying down.

Tuberculosis (TB) remains one the most important infectious diseases in the world. More than 8 million people are infected every year. The vast majority of infections--95%--occur in developing countries, where the disease accounts for 25% of avoidable adult deaths.

Day-old boy born at term via vaginal delivery complicated by shoulder dystocia. He had very mild cyanosis in the extremities at birth, which resolved after 5 minutes. Referred for evaluation of respiratory distress. Birth weight, 3.3 kg (7.4 lb). Apgar scores: 7 at 1 minute, and 9 at 5 minutes.

Pneumonia is one of the most common conditions encountered by primary care providers. Certain organisms cause pneumonia in particular age groups. For example, group B streptococci, Gram-negative bacilli Escherichia coli in particular) and, rarely, Listeria monocytogenes cause pneumonia in neonates. In infants younger than 3 months, group B streptococci and organisms encountered by older children occasionally cause pneumonia, as does Chlamydia trachomatis. Older infants and preschoolers are at risk for infection with Streptococcus pneumoniae and Haemophilus influenzae. In children older than 5 years, S pneumoniae and Mycoplasma pneumoniae are the key pathogens. Let the patient's age, history, clinical presentation, and radiographic findings guide your choice of therapy. Even though most patients with uncomplicated pneumonia can be treated as outpatients, close follow-up is important. Hospitalize patients younger than 6 months and those with complications.