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Dr. Andrew Rynne

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Child diagnosed with bacterial pneumonia. Should I consult a pulmonologist?

Answered by
Dr. Uma Rajah Ananth

Pediatrician, Neonatology

Practicing since :1970

Answered : 891 Questions

Posted on Fri, 18 Jan 2013 in Child Health
Question: Hello, my 2.5 year old daughter has been diagnosed with bacterial pneumonia twice in one month. She seemed fully recovered in between episodes. Both bouts started with a cold virus. She always gets coughs after a cold but has never developed pneumonia in the past. The first diagnosis was a clinical disgnosis of right sided pneumonia and she was given 14 days of amoxicillin which seemed to work. The second diagnosis was via xray, again right sided and she was giving amoxicillin agian but it didn't work. Now she is on azithromycin and seems to be improving. Her pediatrician does not seem overly concerned but I am very concerned. Should she see a pulmonologist? How can I keep this from happening again with every cold? She is otherwise healthy and she is fully immunized. In fact, this all started one week after some immunizations she got. Any advice would be greatly appreciated.
Answered by Dr. Uma Rajah Ananth 6 hours later

Here are a few points about your daughter!
The first attack was not a confirmed pneumonia as clinically it can not be confirmed !However the doctors are correct in not doing the X-ray as it is not good to expose the child .
All bacterial pneumonias do not respond to amoxyl.

Does your daughter have wheezing?
Is she on nebulisers?

Cough after colds are common as most of the colds are either viral or allergic!

What happened to your daughter is most likely to be a seasonal event .
Watch for one more month.
If this recurs ,you may have to consult the pediatric pulmonologist to rule out underlying problems like allergy,immunodeficiency,ciliary dyskinesia,etc.

Good luck
God bless
Dr Uma
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Uma Rajah Ananth 52 minutes later
Thank you very much. My daughter has not had any wheezing and has not needed a nebuliser. I am concerned about an immune deficiency. Do you see selective IgA deficiency show up like this?
Would you suggest taking her to a pediatric immunologist or a pediatric pulmonologist?
Also, is it possible that this is the same infection and it never went away completely (even though she seemed fine for a couple of weeks with no cough). My pediatrician thought that may be possible and he was also considering aspiration pneumonia as a possibility.
She did seem to recover with the first round of amoxicillin and now she is doing better with the azithromycin. Would that indicate a different germ or possibly resistance to amox? Thanks so much!
Answered by Dr. Uma Rajah Ananth 17 minutes later
Absence of wheezing rules out the whole spectrum of allergies and asthma generally in her.

It is highly possible that the first episode was also a viral lower respiratory infection and the second event was a secondary infection with bacteria.
There are also some cases with mycoplasma pneumonia which are a different group of organisms.

Generally pneumonia in children,it is difficult to identify the causative organisms unless extensive investgations are done.

That is why I suggested to wait for a month or so to recover from the present illness and then do the work up only if it is necessary.
Meanwhile watch her for her general health,appetite, well being,etc.

Immunondeficiency of any type can cause this.

I would suggest pediatric pulmonologist rather than allergist at this stage ,but again wait for some time
The child need not be unnecessarily subjected to pokes and pricks!!!
Take care
Dr Uma
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Uma Rajah Ananth 11 hours later
Thanks for the information. I do have one question that I am having a difficult time finding an answer to: I just recovered from one month of bacterial sinusitis. I know that most of the germs that cause both sinusitis and pneumonia are prexisting in our respiratory tracts but could my daughter have "caught" this pneumonia from my bacterial infection? In other words if she is susceptible could she have gotten it from my infection? Does the beginning of primary bacterial infections mimic the beginning of viral infections? For instance, could she have gotten a hib infection directly from my sinuses or is that not possible? Also my daughter is on day three of Zithromax and I have noticed today that she is sneezing and has a runny nose. Could this indicate an ongoing allergy or God forbid a new virus?
Answered by Dr. Uma Rajah Ananth 51 minutes later
Reg your first question,
Sinusitis is a XXXXXXX seated infection. When you have discharges from the sinus, a running nose, or a cough , the bacteria may be in the secretions and can be transmitted through contact easily.
Not directly from the sinuses!

Beginning of virus and bacterial infection present in the same way and usually is distinguished by blood tests .

Sneezing and running nose may be due to allergy or viruses.
You an try A tsp of benadryl (your over the counter medicine there)

Do not be worried !
She will get over soon from this!
Good luck
Dr Uma.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Uma Rajah Ananth 9 minutes later
Thank you so much. Last question: doc ordered iga and other immunoglobulin tests. In your opinion is it better to wait until after she has recovered to assess immunoglobulin status or get it done now?
Answered by Dr. Uma Rajah Ananth 5 minutes later
No dear!
You should wait for recovery from this episode.
Because any acute infection will raise Ig M leaves and some changes in IgG also.
Better to wait and do (for at least 3-4 Weeks) after the present infection.

Good luck
Dr Uma

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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