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2. Respiratory diseases
– I f only th e soft tissues betw een th e ribs or abov e th e clav icles d epress, th ere is no
ch est ind raw ing .
C onsid er also:
– M alaria in end em ic areas, as it m ay also cause coug h and tach ypnoea.
– Staph ylococcal pneum onia ( see pag e 7 3 ) in patients w ith em pyem a or painful
abd om inal sw elling and d iarrh oea. 2
– P neum ocystosis in patients w ith confirm ed or suspected H I V infection (pag e 2 1 5 ).
– T uberculosis:
• in a ch ild w ith coug h , fev er and poor w eig h t g ain and a h istory of close contact
w ith a tuberculous patient 1. F or th e d iag nosis, refer to th e M SF h and book,
Tuberculosis.
• in th e ev ent of pneum onia com plicated w ith em pyem a (pus in th e pleural space).
Diagnosis of pneumonia in children under 5 presenting with cough or difficulty
breathing:
Chest indrawing present?
w ith ou w ith out oth er
sig ns of serious illness
NO YES
Increased RR? Severe pneumonia
NO YES
C h ild ren und er 2 m onth s R R ≥ 6 0 breath s/ m inute
C h ild ren from 2 to 1 1 m onth s R R ≥ 5 0 breath s/ m inute
C h ild ren from 1 2 to 5 9 m onth s R R ≥ 4 0 breath s/ m inute
C oug h Pneumonia
Upper respiratory
tract infections
1 Contact is defined as living in the same household, or in close and regular contact with any known or suspected
TB case within the last 12 months.
67
– I f only th e soft tissues betw een th e ribs or abov e th e clav icles d epress, th ere is no
ch est ind raw ing .
C onsid er also:
– M alaria in end em ic areas, as it m ay also cause coug h and tach ypnoea.
– Staph ylococcal pneum onia ( see pag e 7 3 ) in patients w ith em pyem a or painful
abd om inal sw elling and d iarrh oea. 2
– P neum ocystosis in patients w ith confirm ed or suspected H I V infection (pag e 2 1 5 ).
– T uberculosis:
• in a ch ild w ith coug h , fev er and poor w eig h t g ain and a h istory of close contact
w ith a tuberculous patient 1. F or th e d iag nosis, refer to th e M SF h and book,
Tuberculosis.
• in th e ev ent of pneum onia com plicated w ith em pyem a (pus in th e pleural space).
Diagnosis of pneumonia in children under 5 presenting with cough or difficulty
breathing:
Chest indrawing present?
w ith ou w ith out oth er
sig ns of serious illness
NO YES
Increased RR? Severe pneumonia
NO YES
C h ild ren und er 2 m onth s R R ≥ 6 0 breath s/ m inute
C h ild ren from 2 to 1 1 m onth s R R ≥ 5 0 breath s/ m inute
C h ild ren from 1 2 to 5 9 m onth s R R ≥ 4 0 breath s/ m inute
C oug h Pneumonia
Upper respiratory
tract infections
1 Contact is defined as living in the same household, or in close and regular contact with any known or suspected
TB case within the last 12 months.
67
