TABLE 21-9.

Clinical Features of Acute Pneumonia in Children and Adolescents

	Bacteria	Virus	Mycoplasma	Tuberculosis
History
Age	Any; infants especially	Any	School age	Any; <4 years and 15–19 years especially
Temperature (°C)	Most ≥39	Most <39	Most <39	Most <39 (unless empyema)
Onset	Abrupt	Gradual	Worsening cough	Insidious cough
Others in home ill	No	Yes, concurrent; upper respiratory tract infection, rash, conjunctivitis	Yes, weeks apart; pharyngitis, “flu,” cough	Yes, persistent cough
Associated signs, symptoms	Toxicity, rigors	Myalgia, rash, mucous membrane involvement	Headache, sore throat, chills, myalgia, rash, pharyngitis, myringitis	Weight loss, night sweats (late)
Cough	Wet, productive	Nonproductive	Hacking, paroxysmal, usually nonproductive	Irritative or productive
Physical examination
Predominant feature	Toxicity, respiratory distress	Respiratory distress	Cough	Persistent cough
Degree of illness: respiratory finding	Degree of illness > findings	Degree of illness ≥ findings	Degree of illness < findings	Well → no findings (± cough); ill → findings
Pleuritic chest pain	No/yes	No	No	No/occasional
Auscultation	Unilateral, anatomically confined or no crackles; dullness, diminished or tubular sounds	Diffuse, bilateral crackles, wheezes	Unilateral, anatomically confined crackles; ± wheezes	Most normal; or unilateral crackles ± dullness
Laboratory studies
Chest radiograph	Hyperaeration, patchy alveolar infiltrate or consolidation in lobe, segment, subsegment	Hyperaeration, interstitial infiltrate in diffuse or perihilar distribution; “wandering” atelectasis	Patchy alveolar and/or interstitial infiltrate in single or contiguous, usually lower lobe(s), unilaterally; perihilar adenopathy	Patchy alveolar infiltrate in single or contiguous lobes with disproportionate hilar adenopathy; or miliary or lobar consolidation
Pleural fluid	No/yes → large	No/yes → small	No/yes → small	No/yes → small, large
Peripheral white blood cell count (cells per mm3)	Majority >15,000; neutrophils ± bands	Majority <15,000; lymphocytes	Majority <15,000; neutrophils	Majority <15,000; neutrophils, monocytes
Sedimentation rate >40 mm/hour	Usual	Infrequent	Infrequent	Frequent
Sputum	Copious, purulent; neutrophils, abundant bacteria	Scant mucoid; epithelial, mononuclear cells	Scant mucoid; mixed mononuclear cells/neutrophils	Scant → copious; neutrophils (if copious)
Diagnostic tests	Sputum Gram stain, culture; blood culture	Nasal wash, throat, bronchoscopy specimen for antigen detection, culture; acute and convalescent serology	Cold agglutinin; acute and convalescent specific serology; throat culture, antigen detection, DNA techniques	Gastric aspirate; sputum stain and culture