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Important aspects of the history in a child with pneumonia

Important aspects of the history in a child with pneumonia
Historical feature Possible significance
Age of the child

Viral etiologies are most common in infants and preschool children

Atypical bacterial pathogens are more common in school-age children
Recent viral upper respiratory tract infection May predispose to bacterial superinfection with Streptococcus pneumoniae or Staphylococcus aureus
Associated symptoms Mycoplasma pneumoniae is often associated with extrapulmonary manifestations (eg, headache, sore throat, conjunctivitis, photophobia, rash)
Cough, chest pain, shortness of breath, difficulty breathing "Classic" features of pneumonia, but nonspecific
Increased work of breathing in the absence of stridor or wheezing Suggestive of severe pneumonia
Fluid and nutrition intake Difficulty or inability to feed suggests severe illness
Choking episode May indicate foreign body aspiration
Duration of symptoms Chronic cough (>4 weeks) suggests etiology other than acute pneumonia (refer to UpToDate topic on causes of chronic cough in children)
Previous episodes Recurrent episodes may indicate aspiration, congenital or acquired anatomic abnormality, cystic fibrosis, immunodeficiency, asthma, missed foreign body
Immunization status Completion of the primary series of immunizations for Haemophilus influenzae type b, S. pneumoniae, Bordetella pertussis, and seasonal influenza decreases, but does not eliminate, the risk of infection with these organisms
Previous antibiotic therapy Increases the likelihood of antibiotic-resistant bacteria
Maternal history of chlamydia during pregnancy (for infants <4 months of age) May indicate Chlamydia trachomatis infection
Exposure to tuberculosis May indicate Mycobacterium tuberculosis infection
Ill contacts More common with viral etiologies
Travel to or residence in certain areas that suggest endemic pathogens
  • Measles: Resource-limited countries
  • Coccidioidomycosis: Southwestern United States, northern Mexico, Central and South America
  • Blastomycosis: Southeastern and Central United States; states bordering the Great Lakes
  • Histoplasmosis: Ohio, Missouri, and Mississippi River valleys in the United States; Canada; Central America; eastern and southern Europe; parts of Africa; eastern Asia; and Australia
  • Hantavirus: West of the Mississippi River; four corners region of United States (where borders of Colorado, New Mexico, Arizona, and Utah meet)
  • Middle East respiratory syndrome (MERS): Countries in or near Arabian Peninsula
Animal exposure May indicate histoplasmosis, psittacosis, Q fever
Day care center attendance Exposure to viruses and antibiotic-resistant bacteria
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