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González-Peris S, Campins M, García-García JJ, Díaz-Conradi Á, Domínguez Á, Ciruela P, de Sevilla MF, Hernández S, Muñoz-Almagro C, Izquierdo C, Codina G, Uriona S, Esteva C, Solé-Ribalta A, Soldevila N, Planes AM, Martínez-Osorio J, Salleras L, Moraga-Llop F. Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30291-3. [PMID: 33131931 DOI: 10.1016/j.eimc.2020.08.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 08/11/2020] [Accepted: 08/15/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). METHODS A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. RESULTS 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. CONCLUSIONS Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.
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Affiliation(s)
| | - Magda Campins
- Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Juan José García-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | | | - Ángela Domínguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Ciruela
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Mariona F de Sevilla
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | | | - Carmen Muñoz-Almagro
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Conchita Izquierdo
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Gemma Codina
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sonia Uriona
- Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Cristina Esteva
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Anna Solé-Ribalta
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Núria Soldevila
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Luis Salleras
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
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Bover-Bauza C, Osona B, Gil JA, Peña-Zarza JA, Figuerola J. [Long-term outcomes of necrotizing pneumonia]. An Pediatr (Barc) 2020; 95:S1695-4033(20)30292-7. [PMID: 33082085 DOI: 10.1016/j.anpedi.2020.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Necrotizing pneumonia (NP) is a serious complication of community-acquired pneumonia characterised by the destruction of normal lung parenchyma. No study has evaluated the repercussions of the lung damage in the years following the episode. The aim of this study was to assess the long-term impact on lung function and respiratory symptoms in children hospitalised due to NP. METHODS We analysed outcomes in children given a diagnosis of NP between January 2003 and April 2016. We selected patients aged more than 4 years capable of undergoing a lung function test, that had been followed up for at least 2 years. The patients completed a respiratory questionnaire and underwent a lung function test. RESULTS We included a total of 24 patients (12 male). The median age at the time of diagnosis was 28 months, the median length of stay was 15 days, and 18 patients required pleural drainage. The mean duration of follow-up after NP was 8.75 years. During the evaluation, none of the patients exhibited asthma, cough, or exercise-induced symptoms. Three children had a second episode of pneumonia that did not require hospital admission. The spirometry results were the following (given as mean ± standard deviation): FEV1 z-score, -0.47±0.65; FVC z-score, -0.56±0.73; and FEV1/FVC z-score, 0.19±0.98. We found no evidence of obstructive pulmonary disease or restrictive patterns. CONCLUSIONS The long-term outcomes of paediatric NP are good. However, patients exhibited mildly impaired lung function several years after the episode. We recommend follow-up of these patients due to potential impairments in lung function in adulthood.
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Affiliation(s)
- Catalina Bover-Bauza
- Unidad de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, España; Grupo de Investigación Multidisciplinar en Pediatría, Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España.
| | - Borja Osona
- Unidad de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, España; Grupo de Investigación Multidisciplinar en Pediatría, Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España
| | - Jose Antonio Gil
- Unidad de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, España; Grupo de Investigación Multidisciplinar en Pediatría, Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España
| | - Jose Antonio Peña-Zarza
- Unidad de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, España; Grupo de Investigación en Síndrome de Apneas e Hipoapneas del Sueño, IdISBa, Palma de Mallorca, España
| | - Joan Figuerola
- Unidad de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, España; Grupo de Investigación Multidisciplinar en Pediatría, Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, España
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Dozie-Nwakile OC, Dozie NC, Kingsley UI, Catherine OF, Felicia ON. Effects of Kolaviron on Pneumonia-like Infection Induced in Albino Wistar Rats. Antiinflamm Antiallergy Agents Med Chem 2020; 20:219-227. [PMID: 32933465 DOI: 10.2174/1871523019666200915085729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Pneumonia is an acute or chronic inflammatory disorder of the lungs, affecting the mucosal areas of the lung. It can be caused by bacteria, viruses or fungi. In some cases, it may be caused by physical or chemical irritants. Kolaviron, a natural bioflavonoid extract from Garcinia kola seeds, has been shown to possess anti-inflammatory properties in Flu-like conditions which are associated with cough. There has been a paucity of information on the likelihood of the effectiveness of kolaviron against pneumonia infections. OBJECTIVE To evaluate the antibacterial and anti-inflammatory effects of kolaviron on albino Wistar rats induced with pneumonia using Klebsiella pneumonia. MATERIALS AND METHODS Powdered Garcinia kola seeds were extracted with n-hexane and 100% methanol as solvents by using Soxhlet extractor. A standard method was used to obtain kolaviron from the seed extracts. A total of 24 albino Wistar rats were randomly divided into six groups A to F, each comprising four rats. The rats were allowed to acclimatize for 1 hour in very cold environments using ice packs. A standardized 1.0 x10 -5 mg/ml culture suspension was intranasally inoculated to the rats for 10 days to induce pneumonia-like symptoms. Thereafter, the kolaviron was administered to the rats such that a 500mg/kg kolaviron extract was given once daily to groups A (male rats) and B (female rats). Groups C (male rats) and D (female rats) received 250mg/kg of kolaviron extract once daily, while group E rats were given 0.5 ml of dimethyl sulfoxide (DMSO) once daily, which served as the negative control. The rats in Group F received 2.86 mg/kg of ofloxacin once daily and served as the positive control. All the treatments were done for a period of 5 days. Then 10 days after the treatments, the animals were sacrificed and the lungs were harvested for hydrostatic lung test and histopathological examination. An overnight broth culture of Klebsiella pneumonia was streaked in sterile molten nutrient agar maintained at 37°C for 24hrs. Later, a stock of 500mg/ml of kolaviron was prepared in DMSO. Two-fold dilutions were performed to obtain the following concentrations of 100%, 50%, 25%, 12.5%, 6.25%, 3.125%, and 1.565% with the stock. The anti-Klebsiella pneumonia activity of the kolaviron extract was determined using agar well diffusion methods and incubation was done at 37 o C for 24 hrs. Student t-test and Oneway Analysis of variance (ANOVA) were used for comparison of mean differences between and among the groups. RESULTS AND DISCUSSION The sensitivity of Klebsiella pneumonia to kolaviron was concentration- dependent. There was an increase in anti-Klebsiella pneumonia activity with a decrease in kolaviron concentration. Kolaviron (KV), at 500mg/kg concentration, was efficacious and showed significant anti-inflammatory effects (P<0.0001). This was also confirmed in the histopathological examinations. The 3.125% concentration of the kolaviron gave IZDs that ranged from 25.68±3.33 mm on day 1 to 27.33±2.78 mm on day 5. Treatment with kolaviron showed to be sex-dependent with a significant difference (p<0.0001), when pre-treatment and post-treatment effects were compared between male and female rats. CONCLUSION Kolaviron can be used as an agent in the treatment of pneumonia as it possesses anti- inflammatory and anti-Klebsiella pneumonia activities.
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Affiliation(s)
- Ogechukwu Calista Dozie-Nwakile
- Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Nsukka, Enugu State, Nigeria
| | - Nwakile Calistus Dozie
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmaceutical Sciences Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
| | - Uchendu Ikenna Kingsley
- Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Nsukka, Enugu State, Nigeria
| | - Okonkwo Francis Catherine
- Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Nsukka, Enugu State, Nigeria
| | - Onyemelukwe Ngozi Felicia
- Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Nsukka, Enugu State, Nigeria
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de Benedictis FM, Kerem E, Chang AB, Colin AA, Zar HJ, Bush A. Complicated pneumonia in children. Lancet 2020; 396:786-798. [PMID: 32919518 DOI: 10.1016/s0140-6736(20)31550-6] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 12/13/2022]
Abstract
Complicated community-acquired pneumonia in a previously well child is a severe illness characterised by combinations of local complications (eg, parapneumonic effusion, empyema, necrotising pneumonia, and lung abscess) and systemic complications (eg, bacteraemia, metastatic infection, multiorgan failure, acute respiratory distress syndrome, disseminated intravascular coagulation, and, rarely, death). Complicated community-acquired pneumonia should be suspected in any child with pneumonia not responding to appropriate antibiotic treatment within 48-72 h. Common causative organisms are Streptococcus pneumoniae and Staphylococcus aureus. Patients have initial imaging with chest radiography and ultrasound, which can also be used to assess the lung parenchyma, to identify pleural fluid; CT scanning is not usually indicated. Complicated pneumonia is treated with a prolonged course of intravenous antibiotics, and then oral antibiotics. The initial choice of antibiotic is guided by local microbiological knowledge and by subsequent positive cultures and molecular testing, including on pleural fluid if a drainage procedure is done. Information from pleural space imaging and drainage should guide the decision on whether to administer intrapleural fibrinolytics. Most patients are treated by drainage and more extensive surgery is rarely needed; in any event, in low-income and middle-income countries, resources for extensive surgeries are scarce. The clinical course of complicated community-acquired pneumonia can be prolonged, especially when patients have necrotising pneumonia, but complete recovery is the usual outcome.
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Affiliation(s)
| | - Eitan Kerem
- Department of Pediatrics, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Darwin, NT, Australia; Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, Cape Town, South Africa; MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andrew Bush
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, UK; National Heart and Lung Institute, Imperial School of Medicine, Imperial College London, London, UK.
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Brand EM, Lim CK, Biswell E, Jones-Hall Y, Heng HG. Concurrent bullous emphysema, bronchointerstitial pneumonia with necrosis, and tension pneumothorax in an 8-week-old puppy. THE CANADIAN VETERINARY JOURNAL = LA REVUE VETERINAIRE CANADIENNE 2020; 61:951-955. [PMID: 32879519 PMCID: PMC7424943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
An 8-week-old, male, mixed breed puppy was presented because of progressive respiratory distress. Thoracic radiographs revealed innumerable coalescing pulmonary bullae throughout the lungs with increased soft tissue opacity of the remaining pulmonary parenchyma and tension pneumothorax. Necropsy and histopathological findings were compatible with bullous emphysema and marked neutrophilic to histiocytic bronchointerstitial pneumonia with necrosis, bronchiectasis, fibrosis, dystrophic mineralization, and vasculitis with thrombosis. Tests for agents of infectious disease did not reveal an underlying etiological agent. This case highlights the radiographic, gross necropsy, and histopathologic features of a puppy with bullous emphysema and severe bronchointerstitial pneumonia with necrosis.
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Affiliation(s)
- Emily M Brand
- Department of Veterinary Clinical Sciences (Brand, Lim, Heng) and Department of Comparative Pathobiology (Biswell, Jones-Hall), College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Chee Kin Lim
- Department of Veterinary Clinical Sciences (Brand, Lim, Heng) and Department of Comparative Pathobiology (Biswell, Jones-Hall), College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Ethan Biswell
- Department of Veterinary Clinical Sciences (Brand, Lim, Heng) and Department of Comparative Pathobiology (Biswell, Jones-Hall), College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Yava Jones-Hall
- Department of Veterinary Clinical Sciences (Brand, Lim, Heng) and Department of Comparative Pathobiology (Biswell, Jones-Hall), College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences (Brand, Lim, Heng) and Department of Comparative Pathobiology (Biswell, Jones-Hall), College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
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Arruda AA, Fortuna JP, Raposo AT, Soares MRP, Gonçalves JA, Gomes MF. Influenza virus infection complicated by bacterial necrotising pneumonia: two case reports. Paediatr Int Child Health 2020; 40:202-206. [PMID: 32281523 DOI: 10.1080/20469047.2020.1748955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Necrotising pneumonia (NP) is a potentially severe complication of community-acquired pneumonia characterised by necrosis of consolidated lung tissue. A 7-year-old boy and a 6-year-old boy are presented, both of whom had a complicated influenza infection which evolved into severe NP caused by Streptococcus pneumoniae. Both needed intensive care for invasive respiratory support. Despite extensive pleural involvement in both cases, only one required thoracic surgery. Case 1 also developed anaemia, hyponatraemia and hypo-albuminaemia, resulting in generalised oedema. Despite the severe morbidity, both boys made a full recovery. The diagnosis of NP should always be considered in a child with pneumonia who remains unwell despite 72 hours of appropriate antibiotics, particularly if there is evidence of pleural disease. Although S. pneumoniae is the main agent for NP, the influenza virus may be a precipitating factor.
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Affiliation(s)
- Augusta Aragão Arruda
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
| | - Joana Pacheco Fortuna
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
| | - Ana Teresa Raposo
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
| | - Marina Rita Paulo Soares
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
| | - Juan António Gonçalves
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
| | - Maria Fernanda Gomes
- Department of Paediatrics, Hospital Divino Espirito Santo, de Ponta Delgada EPER , Açores, Portugal
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Blanco-Iglesias E, Oñoro G, Almodovar-Martín JL, García-Salido A, De Lama Caro-Patón G, Martínez de Azagra-Garde A, Serrano-González A, Casado-Flores J. Retrospective Study in Children With Necrotizing Pneumonia: Nine Years of Intensive Care Experience. Pediatr Infect Dis J 2020; 39:571-575. [PMID: 32150006 DOI: 10.1097/inf.0000000000002633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although necrotizing pneumonia (NN) is one of the most feared complications of community-acquired pneumonia, data in pediatric patients are scarce. The objective of this article is to describe children admitted to pediatric intensive care unit (PICU) because of NN. METHODS Retrospective-prospective observational study in children admitted with NN to PICU (from January 1, 2010, to December 31, 2018). The data collected included information on disease epidemiology, PICU management, respiratory assistance and disease evolution. RESULTS Fifty-one children were included, 42 of 51 had received 7-valent or 13-valent pneumococcal vaccine. Median age was 3.2 years (1.9-4.2), 15 of 51 had signs of sepsis at admission. Forty-nine patients presented pleural effusion with drainage in 46. The most common respiratory support modality was high-flow oxygen nasal cannula (17/51). Computed tomography was the gold standard for diagnosis. Etiologic diagnosis was obtained in 34 of 51, and pneumococcus was isolated in 29 of 34. In all of these cases, initial detection was made by capsular antigen in pleural fluid. Children with pneumococcal NN had fewer days of evolution prior to PICU admission (P = 0.041). Cefotaxime with clindamycin was used in 49 of 51. Surgery was necessary in 3 of 51 patients. After PICU discharge, only 5 of 51 were readmitted. There were deaths. CONCLUSIONS In our study, the NN was mainly observed in children around 3 years old. The main causal agent was pneumococcus. The evolution towards NN appeared to be faster than in case of other etiologies. Surgery management was unusual. All children required prolonged admissions but had a full clinical recovery.
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Affiliation(s)
- Elena Blanco-Iglesias
- From the Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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Frau M, Novellas R, Mallol C, Espada Y. What Is Your Diagnosis? J Am Vet Med Assoc 2020; 255:895-897. [PMID: 31573860 DOI: 10.2460/javma.255.8.895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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[Antibiotic strategy in pleural empyema in children: Consensus by the DELPHI method]. Rev Mal Respir 2020; 37:443-450. [PMID: 32439250 DOI: 10.1016/j.rmr.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 04/11/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The evolution of the microbial epidemiology of pleuropulmonary infections complicating community-acquired pneumonia has resulted in a change in empirical or targeted antibiotic therapy in children in the post Prevenar 13 era. The three main pathogens involved in pleural empyema in children are Streptococcus pneumoniae, Staphylococcus aureus and group A Streptococcus. METHODS A questionnaire according to the DELPHI method was sent to experts in the field (paediatric pulmonologists and infectious disease specialists) in France with the purpose of reaching a consensus on the conservative antibiotic treatment of pleural empyema in children. Two rounds were completed as part of this DELPHI process. RESULTS Our work has shown that in the absence of clinical signs of severity, the prescription of an intravenous monotherapy is consensual but there is no agreement on the choice of drug to use. A consensus was also reached on treatment adjustment based on the results of blood cultures, the non-systematic use of a combination therapy, the need for continued oral therapy and the lack of impact of pleural drainage on infection control. On the other hand, after the second round of DELPHI, there was no consensus on the duration of intravenous antibiotic therapy and on the treatment of severe pleural empyema, especially when caused by Staphylococci. CONCLUSIONS The result of this work highlights the needed for new French recommendations based on the evolution of microbial epidemiology in the post PCV13 era.
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Abstract
PURPOSE OF REVIEW Necrotizing pneumonia is a severe form of community-acquired pneumonia characterized by rapid progression of consolidation to necrosis and cavitation which may lead to pulmonary gangrene. Morbidity and mortality are high and chronic sequelae are frequent. The lack of guidance supports the review of the latest recommendations in the management of these pneumonias. RECENT FINDINGS Antibiotic therapy alone may not be enough to alter the course of the infection, and regimens, adjunctive therapies like intravenous immunoglobulins, surgery may be required to alter the course of the disease especially with pulmonary gangrene. SUMMARY The causative agents, clinical features and management of necrotizing pneumonias are discussed.
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Successful Right Atrium-Pulmonary Artery ECMO in an Infant With Severe Necrotizing Pneumonia and Bilateral Bronchopleural Fistula. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-1768-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Zapata H, Wahba A. Severe necrotizing pneumonia complicated by empyema in a neonate. Respir Med Case Rep 2020; 31:101248. [PMID: 33101896 PMCID: PMC7569210 DOI: 10.1016/j.rmcr.2020.101248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/11/2020] [Accepted: 10/07/2020] [Indexed: 12/01/2022] Open
Abstract
Necrotizing pneumonia is a severe complication of pneumonia, characterized by local destruction of lung tissue with development of multiple small cavities (abscesses) and may be associated with empyema. Empyema is an unusual complication in neonates with limited data reported. We present a healthy term neonate with late-onset sepsis caused by Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia due to severe necrotizing pneumonia associated with advanced stage empyema. To the best of our knowledge this is the youngest reported patient with multifocal lung abscesses associated with stage 2 empyema treated successfully without surgical intervention.
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Neumonías adquiridas en la comunidad por Staphylococcus aureus resistente a meticilina en lactantes. Enferm Infecc Microbiol Clin 2019; 37:551-552. [DOI: 10.1016/j.eimc.2018.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/25/2018] [Accepted: 11/27/2018] [Indexed: 01/03/2023]
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Martens T, Saini R, Crook R, Robertson A, Muthialu N, Brown K. Deep hypothermic extracorporeal membrane oxygenation cannula exchange in a child with necrotic pneumonia. Perfusion 2019; 35:169-171. [PMID: 31303113 DOI: 10.1177/0267659119859121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Necrotizing pneumonia can lead to respiratory insufficiency in previously healthy children. Extracorporeal membrane oxygenation can be used for hemodynamic salvage and subsequent lung rest awaiting recovery. We present a case of a child initially placed on veno-arterial extracorporeal membrane oxygenation and converted to veno-venous extracorporeal membrane oxygenation. This was done under deep hypothermia in the operating theater.
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Affiliation(s)
- Thomas Martens
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK.,Department of Cardiac Surgery, University Hospital Gent, Gent, Belgium
| | - Rajan Saini
- Department of Cardiac Intensive Care Medicine, Great Ormond Street Hospital for Children, London, UK
| | - Richard Crook
- Department of Perfusion, Great Ormond Street Hospital for Children, London, UK
| | - Alex Robertson
- Department of Perfusion, Great Ormond Street Hospital for Children, London, UK
| | - Nagarajan Muthialu
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital for Children, London, UK
| | - Katherine Brown
- Department of Cardiac Intensive Care Medicine, Great Ormond Street Hospital for Children, London, UK
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Gross I, Gordon O, Cohen-Cymberknoh M, Reiter J, Tsabari R, Gileles-Hillel A, Erlichman I, Hevroni A, Shoseyov D, Kerem E. Giant lung cysts following necrotizing pneumonia: Resolution with conservative treatment. Pediatr Pulmonol 2019; 54:901-906. [PMID: 30897292 DOI: 10.1002/ppul.24321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 01/13/2019] [Accepted: 02/24/2019] [Indexed: 11/06/2022]
Abstract
RATIONALE Necrotizing pneumonia is characterized by destruction and liquefaction of the lung tissue and loss of the normal pulmonary parenchymal architecture. During the course of resolution areas of hyperlucency are formed, sometimes with the development of giant lung cysts that can be a field with fluid resembling lung abscess. There is no consensus on the management of these abnormalities. OBJECTIVE To assess the prevalence of giant lung cysts as a complication of necrotizing pneumonia and to report our experience with conservative treatment that achieved complete resolution. METHODS Medical chart reviews of all children aged 0 to 18 years hospitalized with necrotizing pneumonia in a single tertiary center from 2015 to 2017, demographic data, and clinical course during and after hospitalization as well as serial chest imaging were collected. RESULTS During the study period, 761 children were diagnosed with community-acquired pneumonia, 16 of 761 (2.3%) had necrotizing pneumonia and 6 of 16 (37.5%) with necrotizing pneumonia complicated by a giant lung cyst or lung abscess. All were closely observed and showed complete clinical and radiographic resolution with antibiotic treatment. CONCLUSIONS Treatment of giant lung cyst formation following necrotizing pneumonia by a conservative approach with prolonged antibiotics results in complete recovery with no need for invasive procedures.
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Affiliation(s)
- Itai Gross
- Departments of Paediatrics, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Departments of Paediatric Emergency Medicine, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Oren Gordon
- Departments of Paediatrics, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Departments of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Malena Cohen-Cymberknoh
- Departments of Paediatrics, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Departments of Pediatric Pulmonology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Joel Reiter
- Departments of Paediatrics, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Departments of Pediatric Pulmonology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Reuven Tsabari
- Departments of Paediatrics, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Departments of Pediatric Pulmonology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Alex Gileles-Hillel
- Departments of Paediatrics, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Departments of Pediatric Pulmonology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Ira Erlichman
- Departments of Paediatrics, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Departments of Neonatology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Avigdor Hevroni
- Departments of Paediatrics, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Departments of Pediatric Pulmonology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Department of Pediatric Pulmonology, Kaplan medical Centre, Rehovot, Israel
| | - David Shoseyov
- Departments of Paediatrics, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Departments of Pediatric Pulmonology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - Eitan Kerem
- Departments of Paediatrics, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.,Departments of Pediatric Pulmonology, Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
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Retrospective study of pneumonia due to Panton-Valentine leukocidin-producing Staphylococcus aureus in Reunion. Med Mal Infect 2019; 49:534-539. [PMID: 30765285 DOI: 10.1016/j.medmal.2019.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 04/19/2018] [Accepted: 01/23/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Panton-Valentine leukocidin-producing Staphylococcus aureus necrotizing pneumonia is an unusual cause of community-acquired pneumonia, although associated with a high case fatality. This infection mainly affects young individuals, without any history, and is most often preceded by flu-like symptoms. METHOD We focused on patients presenting with Staphylococcus aureus necrotizing pneumonia in Reunion (Indian Ocean) admitted to the emergency department. We performed a retrospective study based on data collected from laboratory registers and medical files of patients presenting with Staphylococcus aureus necrotizing pneumonia in Reunion between December 2014 and December 2017. RESULTS A total of 16 patients were recruited for this study, with a median age of 40.5 years. More than half of patients had previously been admitted to the emergency department for acute respiratory distress syndrome or severe sepsis. Fourteen patients were admitted to the intensive care unit and six patients died (five premature deaths). CONCLUSION Physicians should be aware of this infection during the flu season and quickly adapt the specific antibiotic treatment, including a drug inhibiting toxin production. As methicillin-resistant Staphylococcus aureus is very rarely observed in Reunion, physicians can still adapt the empirical treatment, without glycopeptides.
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Garba MA, Umar LW, Akeredolu FD, Mayaki S. Severe necrotising pneumonia in a toddler: A rare presentation with dual bacterial aetiology. Niger Postgrad Med J 2019; 26:65-68. [PMID: 30860202 DOI: 10.4103/npmj.npmj_1_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Necrotising pneumonia (NP) is a rare complication of bacterial pneumonia which is associated with severe morbidity and mortality. Pneumonia of polymicrobial aetiology predicts worse pathology with fulminating clinical course. Reports of necrotising pneumonia from multiple bacterial infections are scanty in published literature. We report a case of a toddler with NP in whom Klebsiella pneumonia and Staphylococcus aureus, two pathogens which are well documented in its aetiopathogenesis, were isolated concurrently from his sputum and blood. Severe pneumonia, which shows slow response to recommended antibiotics treatment, should raise the suspicion of NP and possibly one of the polymicrobial origins. Even in resource-constrained settings, prompt institution of antibiotics and supportive care can result in resolution of pulmonary lesions.
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Affiliation(s)
- Maria Ahuoiza Garba
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Lawal Waisu Umar
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | | | - Suleiman Mayaki
- Department of Paediatrics, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
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68
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Apilánez Urquiola MA, Sardón Prado O, Korta Murua J, Corcuera Elosegui P, Cortajarena MÁ. Streptococcus pneumoniae, an unusual cause of early-onset neonatal sepsis and necrotizing pneumonia. Clin Case Rep 2018; 6:1604-1607. [PMID: 30147914 PMCID: PMC6099037 DOI: 10.1002/ccr3.1640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/08/2018] [Accepted: 05/15/2018] [Indexed: 11/10/2022] Open
Abstract
Vertically transmitted sepsis due to Streptococcus pneumoniae has a low incidence, and vaginal colonization among pregnant women is exceptional. Necrotizing pneumonia is uncommon in immunocompetent term neonates, and the prognosis is uncertain. At present, systematic screening does not seem warranted in pregnant women. Therefore, aggressive treatment of neonates remains the best treatment.
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Affiliation(s)
| | - Olaia Sardón Prado
- Division of Pediatric Respiratory Medicine Donostia University Hospital San Sebastian Spain
- Department of Pediatrics University of the Basque Country (UPV/EHU) San Sebastian Spain
| | - Javier Korta Murua
- Division of Pediatric Respiratory Medicine Donostia University Hospital San Sebastian Spain
- Department of Pediatrics University of the Basque Country (UPV/EHU) San Sebastian Spain
| | - Paula Corcuera Elosegui
- Division of Pediatric Respiratory Medicine Donostia University Hospital San Sebastian Spain
- Department of Pediatrics University of the Basque Country (UPV/EHU) San Sebastian Spain
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Ionescu MD, Popescu NA, Balan G, Marcu V, Enculescu A, Vatra L, Oancea M, Balgradean M. Evolutionary Particularities in a Case of Severe Pneumonia in Children - Case Report. MAEDICA 2018; 13:55-60. [PMID: 29868142 PMCID: PMC5972790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Necrotizing pneumonia remains an uncommon complication of pneumonia in children, but its incidence is increasing. Pneumococcal infection is the predominant cause of severe necrotizing pneumonia in children, but methicillin resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL) staphylococcal infections are also important. We present the case of a four-year-old girl,with an unremarkable medical history, who was admitted in our hospital with a history of high fever, productive cough and tachypnea lasting for 10 days, progressive worsening despite empirical oral antibiotic. Following physical examination, laboratory investigations and thoracic radiography, we established the diagnosis of left lower lobe pneumonia with parapneumonic effusion, acute respiratory failure and sepsis. Medical treatment with systemic antibiotics was initiated, but the evolution was unfavorable. Seriated chest X-rays and also high resolution computed tomography with contrast of the lung were performed, revealing the progression to extensive necrotizing pneumonia with multiple cystic lesions causing right mediastinal deflection. The parenteral broad spectrum antibiotic regimen was adjusted, still with unfavorable evolution, requiring surgical treatment (left inferior lobectomy and pleural draining). Postoperatively, recovery was uneventful. The patient was discharged with clinical and laboratory improvement of his condition, a repeated chest X-ray showing good expansion of upper left parenchyma.
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Affiliation(s)
| | | | - Georgiana Balan
- 1st Pediatric Department, "MS Curie" Emergency Children's Hospital, Bucharest, Romania
| | - Veronica Marcu
- Radiology Department, "MS Curie" Emergency Children's Hospital, Bucharest, Romania
| | - Augustina Enculescu
- ePathology Department,"MS Curie" Emergency Children's Hospital, Bucharest, Romania fPediatric Surgery Department, "MS Curie" Emergency Children's Hospital, Bucharest, Romania
| | - Lorena Vatra
- Pediatric Surgery Department, "MS Curie" Emergency Children's Hospital, Bucharest, Romania
| | - Marcel Oancea
- Pediatric Surgery Department, "MS Curie" Emergency Children's Hospital, Bucharest, Romania
| | - Mihaela Balgradean
- 2nd Pediatric Department, "MS Curie" Emergency Children's Hospital, Bucharest, Romania
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