Differential Diagnosis for Pediatric Community Acquired Pneumonia
Single Most Likely Diagnosis
- Viral Pneumonia: This is often the most common cause of community-acquired pneumonia in children, with respiratory syncytial virus (RSV), influenza, and adenovirus being frequent culprits. The diagnosis is typically made based on clinical presentation and can be supported by rapid antigen tests or PCR for specific viruses.
Other Likely Diagnoses
- Streptococcus pneumoniae Infection: A common bacterial cause of pneumonia in children, which can range from mild to severe. Diagnosis is often made clinically and supported by blood cultures or PCR.
- Mycoplasma pneumoniae Infection: More commonly seen in older children and adolescents, presenting with symptoms that can be similar to viral pneumonia but may have a more prolonged course. Diagnosis can be made through serology or PCR.
- Haemophilus influenzae Type b (Hib) Infection: Though less common due to vaccination, Hib can still cause pneumonia in non-vaccinated or under-vaccinated children. Diagnosis is made through blood cultures.
Do Not Miss Diagnoses
- Pneumococcal Pneumonia with Complications (e.g., Empyema, Abscess): While pneumococcal pneumonia itself is common, its complications can be severe and life-threatening. Early recognition through imaging (e.g., chest X-ray, ultrasound) and prompt treatment are crucial.
- Influenza Pneumonia with Secondary Bacterial Infection: Influenza can lead to secondary bacterial pneumonia, which significantly increases the risk of severe disease and complications. Rapid diagnosis and treatment of both the influenza and any secondary bacterial infection are critical.
- Pertussis (Whooping Cough): Though vaccination has reduced its incidence, pertussis can still cause severe respiratory illness in infants and young children, especially if they are not fully vaccinated. The diagnosis is clinical, supported by PCR.
Rare Diagnoses
- Tuberculosis (TB): While rare in many parts of the world, TB can cause pneumonia in children, especially those exposed to individuals with active TB or in areas with high TB prevalence. Diagnosis involves a combination of clinical suspicion, imaging, and microbiological confirmation.
- Pneumonia due to Less Common Pathogens (e.g., Chlamydia pneumoniae, Legionella pneumophila): These pathogens can cause pneumonia in children but are less common. Diagnosis may require specific serologic tests or PCR.
- Fungal Pneumonia: Rare in immunocompetent children but can occur in those with immunodeficiency or on immunosuppressive therapy. Diagnosis involves a combination of clinical suspicion, imaging, and microbiological confirmation.