Zusammenfassung
Der Begriff „ambulant erworbene Pneumonie“ (AEP) beschreibt die Entzündung des Lungenparenchyms eines zuvor gesunden Individuums durch einen Erreger, der außerhalb eines Krankenhauses vom Individuum aufgenommen wurde. In Europa wird bei Kindern unter dem 5. Lebensjahr eine Inzidenz von 330:100.000 Einwohner und bei Kindern zwischen Geburt und dem 16. Lebensjahr eine Inzidenz von 145:100.000 beobachtet. Es gibt Hinweise darauf, dass Streptokokkenimpfprogramme nach Implementierung zu einer geringeren Anzahl von Pneumonien bei Kindern führen. In rund 55% der Fälle ist eine bakterielle Infektion ätiologisch zumindest mitbeteiligt. Häufigster Erreger ist bei Kindern Streptococcus pneumoniae. Bei der ambulanten Betreuung ist die klinische Diagnosestellung durch die Zeichen persistierendes oder remittierendes Fieber > 38,5 °C, thorakale Einziehungen und/oder Tachypnoe entscheidend. Röntgendiagnostik und Labordiagnostik haben bei Kindern nur bei schwereren Verlaufsformen eine Bedeutung. Da eine sichere Zuordnung zu einer viralen oder bakteriellen Genese bei Kindern mit AEP oft nicht möglich ist, sollten Kinder mit der Diagnose Pneumonie, insbesondere bei fehlender Grundimmunisierung gegen S. pneumoniae, ein oral applizierbares Penizillin erhalten. Zur Prävention der AEP im Kindesalter sind Bekämpfung von Hunger, hygienische Maßnahmen und Impfungen möglich.
Abstract
The term community acquired pneumonia (CAP) delineates an inflammation of the lungs with an infectious agent, which is acquired outside hospital. In Europe CAP has an incidence of 330:100,000 residents per year in children aged 0–5 years and in those between 0 and 16 years 145:100,000. There are reports which show that after the implementation of immunization programs against Streptococcus pneumoniae the incidence of pneumonia in children decreased in all age groups. In 55% bacteria are the cause of the pulmonary infection. In the community setting CAP is diagnosed clinically when there is persistent or remittent fever > 38.5 °C, chest retractions and tachypnea. Radiological methods and the estimation of acute phase reactants are important in more severe cases. Children with a diagnosis of pneumonia should receive oral antibiotics especially if they are not vaccinated against S. pneumoniae as bacterial and viral pneumonia cannot be distinguished from each other. If a bacterial etiology is suspected, the oral application of penicillin is the first therapy of choice. Methods of prevention are reduction of malnourishment and hunger, hygienic measures and vaccination.
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Interessenkonflikt
Der korrespondierende Autor weißt auf folgende Beziehungen hin: Tobias Ankermann hat Honorare für Fortbildungsvorträge von HAL, Infectopharm, Novartis und Roche erhalten.
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Ankermann, T. Ambulant erworbene Pneumonie im Kindesalter. Pneumologe 9, 375–379 (2012). https://doi.org/10.1007/s10405-012-0626-7
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DOI: https://doi.org/10.1007/s10405-012-0626-7