AFEBRILE PNEUMONIA IN INFANTS

The syndrome of afebrile pneumonitis in infants is a relatively common disease that has gone by myriad names in the medical literature. Appellations for this clinical syndrome have included atypical pneumonia, infantile pneumonitis, interstitial pneumonia, viral pneumonia, or nonbacterial pneumonia.(5) Despite this confusion of names, most clinicians are familiar with the clinical picture of a patient with a pneumonia that is not a typical lobar or lobular process as seen with pyogenic bacteria such a Streptococcus pneumoniae. 1.. Acute or subacute onset; 2.. Lack of fever or low-grade fever (< 102°F); 3.. Clinical signs suggestive of a pulmonary process such as cough, tachypnea, or mild to moderate respiratory distress; 4.. Infiltrates on chest radiographs such as perihilar or interstitial infiltrates; 5.. Lack of evidence of on acute pyogenic bacterial process such as a normal or only mildly elevated white blood cell count and no response to -lactam antibiotics such as amoxicillin or cephalosporins.(24.) This definition is intended to apply to the majority of children, but clearly there are exceptions. For instance, some infants with an atypical pneumonia present with fever. Terms that imply a etiologic agent such as nonbacterial pneumonia should be avoided because bacterial agents are actually common causes of afebrile pneumonia, as is discussed. This article focuses mainly on afebrile pneumonia in infants, in particular, those younger than 6 months of age. Comparison are made to pneumonia in older children. Etiologic agents are discussed as well as the clinical presentations, diagnosis, and treatment of afebrile pneumonia in infancy.