Pneumonia, staphylococcus aureus, specific to infants, often in poor general condition (malnutrition, skin infection, etc).
The Staphylococcal pneumonia is a classic complication of measles.
Clinical signs:
– General signs marked: deterioration of general condition, grunting, pallor, high temperature or hypothermia, frequently signs of shock (see Shock, page 17) and the presence of skin lesions (front door).
– Digestive signs: nausea, vomiting, diarrhea, painful abdominal bloating.
– Respiratory signs: dry cough, tachypnoea, signs of a struggle (nasal flaring, draw).
– Pulmonary examination: often normal. Sometimes dullness indicating pleural effusion.
If possible, take a chest X-ray: the presence of bubbles confirms the diagnosis. You can also see liquid levels or often unilateral pleural effusion.
Treatment:
Urgent because rapidly worsening: hospital
– Antibiotic:
cloxacillin IV: 200 mg / kg / day in 3 injections + gentamicin IM or IV: 7.5 mg / day in one injection. Take over with cloxacillin PO as soon as the child’s condition improves to complete 10 to 14 days of treatment.
or
chloramphenicol IV (children over 2 months): 100 mg / kg / day in 3 divided injections.
Take over with chloramphenicol PO as soon as the child’s condition improves to complete 10 to 14 days of treatment.
– Hydration orally (or by nasogastric tube) or infusion.
– Oxygen nasal probe at a rate of 1 liter / min.
– Local disinfection of skin lesions (see Bacterial skin infections, page 105).
– If significant pleural effusion: pleural tap with drainage (for pyopneumothorax: put two drains, one anterior and posterior) or without drainage (empyema, make repetitive taps with an IV catheter).
Evolution:
– Serious risk of decompensation from pneumothorax or suppurative pleurisy or pyopneumothorax.
– In a pediatric service, provide the opportunity to ask anytime pleural drain emergency.
