atypical pneumonia - should we go to a specialist?

shabbatiscoming

Mon, Jan 25 2010, 3:05 am

my daughter is just getting over atypical pneumonia. she is 20 months old. this is already the second time that she had this sickness in 2 or 3 months.

both times we went to the doctor when she was just coughing (a VERY dry cough) for maybe two days and he could not find anything. and both times we went back after about 5 days and then he found the atypical pneumonia.

so my question is:
should we go to a specialist who can check out if there is something wrong with my daughter's chest/lungs? we did have an x-ray of her chest done last time she was sick.
also, the pediatrician that we use is wonderful. he is good with children and is very on top of things. but that being said, both times that she had this terrible sickness, he missed it with the first visit. what would you do in that situation? change doctors? or just hope that it would not happen again?

freidasima

Mon, Jan 25 2010, 8:45 am

Yes without a doubt.
I don't know pediatricians but one of the best pulmonologists in the country who heads the pulmo unit at Belinson hospital lives here in Yerushalayim and takes here privately, Prof. Motti (Mordechai) Kramer. He is excellent and both my husband and I have used him in the past, although it was for us as adults.

rydys

Mon, Jan 25 2010, 9:40 am

"Atypical Pneumonia" sounds a lot worse than it actually is. It does not mean an "unusual kind" of pneumonia. It means that the infection is due to mycoplasma bacteria. When these were first discovered, they were not the "common" bacteria that the doctors knew about, therefore they were called "atypicals", and the name sort of stuck. You may have heard this type of pneumonia referred to by its more common name, "walking pneumonia"

It is a very common cause of pneumonia in children ages 5-15, and relatively easily treated with azithromycin. It is also very hard to diagnose. If we were to x-ray every child with a dry cough and normal lung exam, we would be unnecessarily exposing many children to radiation, which can be harmful in the long run. Mycoplasma pneumonia often presents this way. The child looks fine, is acting pretty OK but has a cough and maybe a low grade fever, maybe not. Sometimes it can take several days to hear anything. Sometimes the child just gets worse and since no cause can be found an x-ray is done.

In the above case, while it is less common to see this in a 20 month old, it is not unusual. 2 cases of pneumonia in 2-3 months in an otherwise healthy child would not concern me too much. If it continues to recur, however, that might be a reason to look further.

shabbatiscoming

Mon, Jan 25 2010, 9:46 am

rydys wrote:

ummm, thanks for the overview of what atypical pneumonia is, but I read up all about it and I am just calling it what my doctor called.
whatever it is called, I would not think that it is such a good thing for a young child to get this very often. and you said that it is easy to treat, thats true, but when my daughter gets to cough for a full week before they can correctly diagnose it, thats already not such a good thing. also, you said that the child acts ok, well, my daughter was VERY lethargic and just sat on the couch for days. it was not normal at all.

rydys

Mon, Jan 25 2010, 9:55 am

I don't know the exact circumstances of your case, and you may indeed need to see a specialist. However in general, in an otherwise healthy kid, I would not be too concerned about 2 courses of pneumonia over the winter.

Have you considered a foreign body as the cause of a recurrent pneumonia? 20 month olds put all kinds of things in their mouths. If the pneumonia was always in the same area, it might be something to consider.

shabbatiscoming

Mon, Jan 25 2010, 9:59 am

rydys wrote:

that would have come up on an xray and we did an xray and it was fine (that was one of the reasons why the doctor told us to get an xray).

really? pneumonia twice in three months is not something to get concerned about? in such a young child?

Israeli Mother

Mon, Jan 25 2010, 10:57 am

shabbatiscoming wrote:

rydys wrote:

It is possible that your daughter didn't actually get pneumonia twice in three months; instead it is possible that she got it once and did not get rid of it completely the first time. Sometimes if the entire course of antibiotics is not taken [and sometimes even if parents say that the entire course was finished] the infection is not completely eradicated and flares up again.

The question of possible foreign bodies is a possibility as well. Sometimes they can be missed on an xray unless you are looking very carefully. I would advise you to wait and see if the pneumonia recurs before getting overly concerned and make sure that your child gets every dose of the antibiotic pretty much on time and finishes the entire course.

Mommy3.5

Mon, Jan 25 2010, 1:36 pm

pneumonia is rarely fully developed when the cough is only there 2 days. At that point it can be only a cold. A cough like that is usually treated with albuterol/pulmicort, and oral steroids (or has in my kids cases).

The fact that your child was not diagnosed right away sounds right with my own experience with pneumonia.

The fact that she has had 2 bouts in 3 months is troublesome IMVHO. sometimes it takes 2 courses of antibiotics to fully get rid of it. The first course just puts it into a bit of a hibernation, then it rears up with little provocation a few weeks later. (that has been my experience too.)

With my kids, Zithromax (azithromycin) causes this. Every time my kid has zithromax, we are back 3 weeks later with a full blown pneumonia. The last few times the kids had this diagnosis I insisted on a stronger antibiotic.

shabbatiscoming

Mon, Jan 25 2010, 2:46 pm

Mommy3.5 wrote:

so you think that twice in three months IS in fact troublesome.
also, for my daughter, BH, the zirthomycyn (thats the name in israel) is what helped both times. as soon as she started the meds, it took about a day and a bit and the coughing was better.

micki

Mon, Jan 25 2010, 10:52 pm

just wanted to add that rydys is too humble to mention, but she is a pediatrician.

and pnemonia does not show up too early- my son was fine on monday, getting lethargic on tue, went to doc on wednesday, (no problem they said but to watch and if it gets worse call) and on shabbos we were in the hospital with pnemonia.

it is also worth looking into the antibiotics your DD was on, perhaps they were not striong enough.

I took one for bronchitis and a week later had pnemonia.

rydys

Mon, Jan 25 2010, 10:55 pm

Mommy3.5 wrote:

A cough like that is usually treated with albuterol/pulmicort, and oral steroids (or has in my kids cases).

...

With my kids, Zithromax (azithromycin) causes this. Every time my kid has zithromax, we are back 3 weeks later with a full blown pneumonia. The last few times the kids had this diagnosis I insisted on a stronger antibiotic.

First of all, albuterol and steroids work for children who are wheezing. They do not help and can be harmful for children who are not. They need to be used judiciously.

Second of all, antibiotics need to be tailored to the bacteria they are treating. Most pneumonias in older children are caused by mycoplasma, for which zithromax works well. pennicillins and cephalosporins do not cover mycoplasma. In your children's case, it sounds like they have more of a routine pneumonia, for which a penicillin or cephalosporin would work better. It is not an issue of a "stronger" antibiotic, just an "appropriate" antibiotic.