Recurrent Pneumonia in Children

Pneumonia is defined as inflammation of lung parenchyma due to various pathogenic organisms including bacteria, viruses, fungi and parasites. The key symptom to suspect childhood pneumonia is tachypnea. The World Health Organization (WHO) has defined tachypnea as respiratory rate \>60 breaths/min in infants less than 2 months, \>50 in infants 2 -12 months and \>40 in children 1 to 5 years and \>20 in children \>5 years of age \[1\]. WHO has categorized pneumonia in children under-five years of age into two categories, pneumonia and severe pneumonia. Tachypnea with or without chest retraction is categorized as pneumonia while tachypnea with any danger signs (unable to feed or drink, hypothermia, unconsciousness, convulsion, signs of hypoxia including cyanosis, grunting, groaning, head nodding) as severe pneumonia \[1\].

Pneumonia is a common and described as the overlooked killer of children\[2\] as killing 1.1-1.4 million children every year. It accounts for 17%-19% of all deaths amongst children under 5 years of age; the majority of them are in developing countries \[3,4\] .In Egypt, children under 5 years approximate 13.4% of the total population\[4\] and pneumonia constitutes 19% of under-five mortality\[5\].

Recurrent pneumonia (RP) is defined as at least two episodes of pneumonia in one year or three episodes ever, with intercritical radiographic clearing of densities \[6\]. Incidence data indicate that RP occurs in 7.7%-9% of all children with CAP \[7,8,9,10,11,12\]. As a result, RP represents a frequent presenting manifestation in the general pediatric practice and is a very common reason for referral to pediatric chest physicians \[7\]. Factors linked to these infections could be recurrent aspirations, congenital structural anomalies of pulmonary and cardiovascular systems, defects in the clearance of airway secretions and immunodeficiency \[13\]