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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. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2021; 39:486-492. [PMID: 34865709 DOI: 10.1016/j.eimce.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/15/2020] [Indexed: 06/13/2023]
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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Carloni I, Ricci S, Rubino C, Cobellis G, Rinaldelli G, Azzari C, de Benedictis FM. Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era. Pediatr Pulmonol 2021; 56:1127-1135. [PMID: 33442941 DOI: 10.1002/ppul.25270] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Necrotizing pneumonia (NP) is a severe complication of community-acquired pneumonia. The impact of 13-valent pneumococcal conjugate vaccine (PCV13) on the epidemiology of NP in children has not been assessed. PATIENTS AND METHODS Medical records of children less than 18 years admitted with NP to two pediatric hospitals in Italy between 2005 and 2019 were reviewed. The following four periods were defined: 2005-2010 (pre-PCV13), 2011-2013 (early post-PCV13), 2014-2016 (intermediate post-PCV13), and 2017-2019 (late post-PCV13). RESULTS Forty-three children (median age, 44 months) were included. Most of them (93%) were previously healthy. No differences in age, sex, season of admission, comorbidity, clinical presentation, or hospital course were identified between pre-PCV13 and post-PCV13 periods. A significant decrease in the rate of NP-associated hospitalizations was found between the early (1.5/1000 admissions/year) and the intermediate (0.35/1000 admissions/year) post-PCV13 period (p = .001). An increased trend in admissions was found thereafter. Streptococcus pneumoniae was the most common agent detected in both periods (pre-PCV13: 11/18, 61%; post-PCV13: 13/25, 52%). Serotype 3 was the most common strain in both periods (pre-PCV13: 3/11, 27%; post-PCV13; 4/13, 31%). There were no changes in the etiology over time, but most patients with Streptococcus pyogenes or Staphylococcus aureus infection were admitted during the post-PCV13 period. CONCLUSIONS The hospitalization rate for NP in children decreased a few years after the implementation of PCV13 immunization in Italy. However, an increased trend in admissions was found thereafter. S. pneumoniae was the most frequent causal agent in both pre- and post-PCV13 periods. Pneumococcal serotypes were mainly represented by Strain 3.
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Affiliation(s)
- Ines Carloni
- Pediatric Infectious Disease Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Silvia Ricci
- Department of Health Sciences, Meyer Children's University Hospital, Florence, Italy
| | - Chiara Rubino
- Department of Health Sciences, Meyer Children's University Hospital, Florence, Italy
| | - Giovanni Cobellis
- Pediatric Surgery Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Giampaolo Rinaldelli
- Pediatric Intensive Care Unit, Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
| | - Chiara Azzari
- Department of Health Sciences, Meyer Children's University Hospital, Florence, Italy
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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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Rose MA, Barker M, Liese J, Adams O, Ankermann T, Baumann U, Brinkmann F, Bruns R, Dahlheim M, Ewig S, Forster J, Hofmann G, Kemen C, Lück C, Nadal D, Nüßlein T, Regamey N, Riedler J, Schmidt S, Schwerk N, Seidenberg J, Tenenbaum T, Trapp S, van der Linden M. [Guidelines for the Management of Community Acquired Pneumonia in Children and Adolescents (Pediatric Community Acquired Pneumonia, pCAP) - Issued under the Responsibility of the German Society for Pediatric Infectious Diseases (DGPI) and the German Society for Pediatric Pulmonology (GPP)]. Pneumologie 2020; 74:515-544. [PMID: 32823360 DOI: 10.1055/a-1139-5132] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The present guideline aims to improve the evidence-based management of children and adolescents with pediatric community-acquired pneumonia (pCAP). Despite a prevalence of approx. 300 cases per 100 000 children per year in Central Europe, mortality is very low. Prevention includes infection control measures and comprehensive immunization. The diagnosis can and should be established clinically by history, physical examination and pulse oximetry, with fever and tachypnea as cardinal features. Additional signs or symptoms such as severely compromised general condition, poor feeding, dehydration, altered consciousness or seizures discriminate subjects with severe pCAP from those with non-severe pCAP. Within an age-dependent spectrum of infectious agents, bacterial etiology cannot be reliably differentiated from viral or mixed infections by currently available biomarkers. Most children and adolescents with non-severe pCAP and oxygen saturation > 92 % can be managed as outpatients without laboratory/microbiology workup or imaging. Anti-infective agents are not generally indicated and can be safely withheld especially in children of young age, with wheeze or other indices suggesting a viral origin. For calculated antibiotic therapy, aminopenicillins are the preferred drug class with comparable efficacy of oral (amoxicillin) and intravenous administration (ampicillin). Follow-up evaluation after 48 - 72 hours is mandatory for the assessment of clinical course, treatment success and potential complications such as parapneumonic pleural effusion or empyema, which may necessitate alternative or add-on therapy.
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Affiliation(s)
- M A Rose
- Fachbereich Medizin, Johann-Wolfgang-Goethe-Universität Frankfurt/Main und Zentrum für Kinder- und Jugendmedizin, Klinikum St. Georg Leipzig
| | - M Barker
- Klinik für Kinder- und Jugendmedizin, Helios Klinikum Emil von Behring, Berlin
| | - J Liese
- Kinderklinik und Poliklinik, Universitätsklinikum an der Julius-Maximilians-Universität Würzburg, Würzburg
| | - O Adams
- Institut für Virologie, Universitätsklinikum Düsseldorf
| | - T Ankermann
- Klinik für Kinder- und Jugendmedizin 1, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - U Baumann
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - F Brinkmann
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Ruhr-Universität Bochum
| | - R Bruns
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - M Dahlheim
- Praxis für Kinderpneumologie und Allergologie, Mannheim
| | - S Ewig
- Kliniken für Pneumologie und Infektiologie, Thoraxzentrum Ruhrgebiet, Bochum/Herne
| | - J Forster
- Kinderabteilung St. Hedwig, St. Josefskrankenhaus , Freiburg und Merzhausen
| | | | - C Kemen
- Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg
| | - C Lück
- Institut für Medizinische Mikrobiologie und Hygiene, Technische Universität Dresden
| | - D Nadal
- Kinderspital Zürich, Schweiz
| | - T Nüßlein
- Klinik für Kinder- und Jugendmedizin, Gemeinschaftsklinikum Mittelrhein, Koblenz
| | - N Regamey
- Pädiatrische Pneumologie, Kinderspital Luzern, Schweiz
| | - J Riedler
- Kinder- und Jugendmedizin, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Österreich
| | - S Schmidt
- Zentrum für Kinder- und Jugendmedizin, Ernst-Moritz-Arndt-Universität Greifswald
| | - N Schwerk
- Pädiatrische Pneumologie, Allergologie und Neonatologie, Medizinische Hochschule Hannover
| | - J Seidenberg
- Klinik für pädiatrische Pneumologie und Allergologie, Neonatologie, Intensivmedizin und Kinderkardiologie, Klinikum Oldenburg
| | - T Tenenbaum
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Mannheim
| | | | - M van der Linden
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Aachen
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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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Gentile A, Bakir J, Firpo V, Casanueva EV, Ensinck G, Lopez Papucci S, Lución MF, Abate H, Cancellara A, Molina F, Gajo Gane A, Caruso AM, Santillán Iturres A, Fossati S. PCV13 vaccination impact: A multicenter study of pneumonia in 10 pediatric hospitals in Argentina. PLoS One 2018; 13:e0199989. [PMID: 30020977 PMCID: PMC6051625 DOI: 10.1371/journal.pone.0199989] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 06/17/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction In 2012, PCV13 was introduced into the National Immunization Program in Argentina, 2+1 schedule for children <2 years. Coverage rates for 1st and 3rd doses were 69% and 41.0% in 2012, 98% and 86% in 2013; 99% and 89% in 2014, respectively. The aims of this study were to evaluate impact of PCV13 on Consolidated Pneumonia (CP) and Pneumococcal Pneumonia (PP) burden, and to describe epidemiological-clinical pattern of PP during the three-year period following vaccine introduction. Methods Hospital-based study at 10 pediatric surveillance units in Argentina. CP and PP discharge rates per 10,000 hospital discharges were compared between the pre-vaccination period 2007–2011 (preVp), the year of intervention (2012) and the post-vaccination period 2013–2014 (postVp). Results Significant reduction in CP and PP discharge rates was observed in patients <5 years [% reduction (95%CI)]: 10.2% (6.3; 14.0) in 2012 and 24.8% (21.3; 28.2) in postVp for CP discharge rate; 59.5% (48.0; 68.5) in 2012 and 68.8% (58.3; 76.6) in postVp for PP discharge rate. Significant changes were also observed in children ≥5 years, mainly in PP discharge rate. A total of 297 PP cases were studied; 59.3% male; 31.3% <2 years; 42.9% had received PCV13 in 2012 and 84.5% in posVp. Case fatality rate was 3.4%. PCV13 serotypes decreased from 83.0% (39/47) in 2012 to 64.2% (52/81) in postVp, p = 0.039. Conclusions After PCV13 introduction, significant reduction in CP and PP discharge rates was observed in hospitalized children <5 years. In patients ≥5 years, PP discharge rate also decreased significantly.
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Affiliation(s)
- Angela Gentile
- Epidemiology, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina
- * E-mail:
| | - Julia Bakir
- Epidemiology, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina
| | - Verónica Firpo
- Infectology, Niño Jesus Children’s Hospital, Tucumán, Argentina
| | | | - Gabriela Ensinck
- Infectology, Victor Vilela Children’s Hospital, Rosario, Santa Fe, Argentina
| | | | - María F. Lución
- Epidemiology, Ricardo Gutiérrez Children’s Hospital, Buenos Aires, Argentina
| | - Hector Abate
- Infectology, Humberto Notti Pediatric Hospital, Mendoza, Argentina
| | - Aldo Cancellara
- Infectology, Pedro Elizalde Children's Hospital, Buenos Aires, Argentina
| | - Fabiana Molina
- Clinic, Orlando Alassia Children's Hospital, Santa Fe, Argentina
| | - Andrea Gajo Gane
- Infectology, Juan Paul II Pediatric Hospital, Corrientes, Argentina
| | | | | | - Sofía Fossati
- INEI- ANLIS "Dr. Carlos G. Malbran ", Buenos Aires, Argentina
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7
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Wojsyk-Banaszak I, Krenke K, Jończyk-Potoczna K, Ksepko K, Wielebska A, Mikoś M, Bręborowicz A. Long-term sequelae after lung abscess in children - Two tertiary centers' experience. J Infect Chemother 2018; 24:376-382. [PMID: 29454633 DOI: 10.1016/j.jiac.2017.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/06/2017] [Accepted: 12/26/2017] [Indexed: 10/18/2022]
Abstract
AIM The aim of the study was to describe the epidemiology and clinical characteristic of children hospitalized with pneumonia complicated by lung abscess, as well as to evaluate the long-term sequelae of the disease. METHODS A retrospective review of medical records of all patients treated for pulmonary abscess in two tertiary centers was undertaken. Pulmonary function tests and lung ultrasound were performed at a follow-up. RESULTS During the study period, 5151 children with pneumonia were admitted, and 49 (0.95%) cases were complicated with lung abscess. In 38 (77.5%) patients, lung abscess was treated solely with antibiotics, and in nine cases (16.3%) surgically. In 21 (51.21%) children complete radiological regression was documented. The mean time for radiological abnormalities regression was 84.14 ± 51.57 days, regardless of the treatment mode. Fifteen patients were followed up at 61.6 ± 28.3 months after discharge. Lung ultrasound revealed minor residual abnormalities: pleural thickening, subpleural consolidations and line B artefacts in 11 (73.3%) children. Pulmonary function tests results were abnormal in eight (53.3%) patients, the most frequent abnormality being hyperinflation. We did not find a restrictive disorder in any of the children. There were no deaths in our study. CONCLUSIONS Lung abscess is a rare but severe complication of pneumonia in children. Most children recover uneventfully with no significant long-term pulmonary sequelae.
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Affiliation(s)
- I Wojsyk-Banaszak
- Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - K Krenke
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland.
| | - K Jończyk-Potoczna
- Department of Pediatric Radiology, Poznań University of Medical Sciences, Poznań, Poland
| | - K Ksepko
- Department of Pediatric Pneumonology and Allergy, Medical University of Warsaw, Warsaw, Poland
| | - A Wielebska
- Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - M Mikoś
- Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - A Bręborowicz
- Department of Pulmonology, Pediatric Allergy and Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
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Masters IB, Isles AF, Grimwood K. Necrotizing pneumonia: an emerging problem in children? Pneumonia (Nathan) 2017; 9:11. [PMID: 28770121 PMCID: PMC5525269 DOI: 10.1186/s41479-017-0035-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 06/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND In children, necrotizing pneumonia (NP) is an uncommon, severe complication of pneumonia. It is characterized by destruction of the underlying lung parenchyma resulting in multiple small, thin-walled cavities and is often accompanied by empyema and bronchopleural fistulae. REVIEW NP in children was first reported in children in 1994, and since then there has been a gradual increase in cases, which is partially explained by greater physician awareness and use of contrast computed tomography (CT) scans, and by temporal changes in circulating respiratory pathogens and antibiotic prescribing. The most common pathogens detected in children with NP are pneumococci and Staphylococcus aureus. The underlying disease mechanisms are poorly understood, but likely relate to multiple host susceptibility and bacterial virulence factors, with viral-bacterial interactions also possibly having a role. Most cases are in previously healthy young children who, despite adequate antibiotic therapy for bacterial pneumonia, remain febrile and unwell. Many also have evidence of pleural effusion, empyema, or pyopneumothorax, which has undergone drainage or surgical intervention without clinical improvement. The diagnosis is generally made by chest imaging, with CT scans being the most sensitive, showing loss of normal pulmonary architecture, decreased parenchymal enhancement and multiple thin-walled cavities. Blood culture and culture and molecular testing of pleural fluid provide a microbiologic diagnosis in as many as 50% of cases. Prolonged antibiotics, draining pleural fluid and gas that causes mass effects, and maintaining ventilation, circulation, nutrition, fluid, and electrolyte balance are critical components of therapy. Despite its serious nature, death is uncommon, with good clinical, radiographic and functional recovery achieved in the 5-6 months following diagnosis. Increased knowledge of NP's pathogenesis will assist more rapid diagnosis and improve treatment and, ultimately, prevention. CONCLUSION It is important to consider that our understanding of NP is limited to individual case reports or small case series, and treatment data from randomized-controlled trials are lacking. Furthermore, case series are retrospective and usually confined to single centers. Consequently, these studies may not be representative of patients in other locations, especially when allowing for temporal changes in pathogen behaviour and differences in immunization schedules and antibiotic prescribing practices.
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Affiliation(s)
- I. Brent Masters
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Alan F. Isles
- Department of Respiratory and Sleep Medicine, Lady Cilento Children’s Hospital, South Brisbane, QLD Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Gold Coast campus, Griffith University, Building G40, Southport Gold Coast, QLD Australia
- Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Southport Gold Coast, QLD Australia
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9
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Stelle KA, Mornand A, Bajwa N, Vidal I, Anooshiravani M, Kanavaki A, Argiroffo CB, Blanchon S. Should Empyema with or without Necrotizing Pneumonia in Children Be Managed Differently? Health (London) 2017. [DOI: 10.4236/health.2017.92014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Lu S, Tsai JD, Tsao TF, Liao PF, Sheu JN. Necrotizing pneumonia and acute purulent pericarditis caused by Streptococcus pneumoniae serotype 19A in a healthy 4-year-old girl after one catch-up dose of 13-valent pneumococcal conjugate vaccine. Paediatr Int Child Health 2016; 36:235-9. [PMID: 25936434 DOI: 10.1179/2046905515y.0000000022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Streptococcus pneumoniae is a common cause of infectious diseases in children that may lead to life-threatening complications. Acute purulent pericarditis is an uncommon complication of S. pneumoniae in the antibiotic era. A healthy 4-year-old girl was admitted with pneumonia and pleural effusion. She had received one catch-up dose of 13-valent pneumococcal conjugate vaccine at 2 years of age. She rapidly developed necrotizing pneumonia, complicated by bronchopleural fistula presenting as subcutaneous emphysema and pneumothorax and acute purulent pericarditis. S. pneumoniae serotype 19A was subsequently identified from blood, empyema and pericardial fluid cultures. After appropriate antibiotic therapy and a right lower lobectomy, her condition stabilized and she promptly recovered. This case highlights two rare potential clinical complications of pneumococcal disease in a child: necrotizing pneumonia and acute purulent pericarditis. This is the first report of a child who received just one catch-up dose of 13-valent pneumococcal conjugate vaccine at 2 years of age, as per the United States' Advisory Committee on Immunization Practice's recommendations, but who still developed severe invasive pneumococcal disease with life-threatening complications caused by S. pneumoniae serotype 19A.
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Affiliation(s)
- Shay Lu
- a Department of Paediatrics , Chung Shan Medical University Hospital
| | - Jeng-Dau Tsai
- a Department of Paediatrics , Chung Shan Medical University Hospital.,b School of Medicine , Chung Shan Medical University
| | - Ten-Fu Tsao
- b School of Medicine , Chung Shan Medical University.,c Department of Medical Imaging , Chung Shan Medical University Hospital , Taichung , Taiwan
| | - Pei-Fen Liao
- a Department of Paediatrics , Chung Shan Medical University Hospital.,b School of Medicine , Chung Shan Medical University
| | - Ji-Nan Sheu
- a Department of Paediatrics , Chung Shan Medical University Hospital.,b School of Medicine , Chung Shan Medical University
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11
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Pleural disease in infants and children: management updates. CURRENT PULMONOLOGY REPORTS 2016. [DOI: 10.1007/s13665-016-0134-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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12
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Affiliation(s)
- Mohamed A Hendaus
- Hamad Medical Corporation, Doha, Qatar Weill-Cornell Medical College, Ar-Rayyan, Qatar
| | - Ibrahim A Janahi
- Hamad Medical Corporation, Doha, Qatar Weill-Cornell Medical College, Ar-Rayyan, Qatar
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Krenke K, Sanocki M, Urbankowska E, Kraj G, Krawiec M, Urbankowski T, Peradzyńska J, Kulus M. Necrotizing Pneumonia and Its Complications in Children. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 857:9-17. [PMID: 25468010 DOI: 10.1007/5584_2014_99] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Necrotizing pneumonia (NP) is an emerging complication of community acquired pneumonia (CAP) in children. This study aimed at the evaluation of etiology, clinical features, treatment, and prognosis of NP. The institutional database of children with CAP treated between April 2008 and July 2013 was searched to identify children with NP. Then, data on the NP characteristics were retrospectively reviewed and analyzed. We found that NP constituted 32/882 (3.7%) of all CAPs. The median age of children with NP was 4 (range 1-10) years. The causative pathogens were identified in 12/32 children (37.5%) with Streptococcus pneumoniae being the most common (6/32). All but one patient developed complications: parapneumonic effusion (PPE), pleural empyema or bronchopleural fistula (BPF), which required prompt local treatment. The median duration of hospital stay and antibiotic treatment was 26 (IQR 21-30) and 28 (IQR 22.5-32.5) days, respectively. Despite severe course of the disease no deaths occurred. A follow-up visit after 6 months revealed that none of the patients presented with any signs and symptoms which could be related to earlier pneumonia. Chest radiographs showed complete or almost complete resolution of pulmonary and pleural lesions in all patients. We conclude that necrotizing pneumonia is a relatively rare but severe form of CAP that is almost always complicated by PPE/empyema and/or BPF. It can be successfully treated with antibiotics and pleural drainage without major surgical intervention.
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Affiliation(s)
- Katarzyna Krenke
- Department of Pediatric Pneumology and Allergy, Medical University of Warsaw, Warszawa, Poland
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14
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Abstract
We describe the demographic, clinic and radiologic features of nontuberculous cavitary pulmonary diseases in 42 patients with a mean age of 91.1±6.8 months. Infectious etiology was the most common cause (64%), including necrotizing pneumonia (n=15), ruptured hydatid cyst (n=5), lung abscess (n=5) and fungal infection (n=2). Other causes were bronchiectasis, congenital anomalies, foreign body aspiration, sarcoidosis and tumor.
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15
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Mortensen KH, Babar JL, Balan A. Multidetector CT of pulmonary cavitation: filling in the holes. Clin Radiol 2015; 70:446-56. [PMID: 25623513 DOI: 10.1016/j.crad.2014.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 12/03/2014] [Accepted: 12/11/2014] [Indexed: 12/17/2022]
Abstract
Pulmonary cavitation causes significant morbidity and mortality. Early diagnosis of the presence and aetiology of a cavity is therefore crucial in order to avoid further demise in both the localized pulmonary and systemic disorders that may manifest with pulmonary cavity formation. Multidetector CT has become the principal diagnostic technique for detecting pulmonary cavitation and its complications. This review provides an overview of the aetiologies and their imaging findings using this technique. Combining a literature review with case illustration, a synopsis of the different imaging features and constellations is provided, which may suggest a particular cause and aid the differentiation from diseases with similar findings.
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Affiliation(s)
- K H Mortensen
- University Department of Radiology, Cambridge University, Cambridge, UK; Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
| | - J L Babar
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
| | - A Balan
- Department of Radiology, Addenbrooke's Hospital, Cambridge, UK
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16
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Abstract
PURPOSE OF REVIEW The aim of this review is to highlight recent changes concerning the incidence of empyema. In this article we have focused on community-acquired empyema RECENT FINDINGS The incidence of empyema seems to have been increasing both in children and adults worldwide in the past decades, mainly in healthy young adults and in older patients. The bacteriology of pleural infection is changing as well. In children, the most common microorganism that causes empyema continues to be Streptococcus pneumoniae. Interestingly, the widespread use of the seven valent conjugate vaccine has produced a replacement phenomenon with the emergence of some pneumococcal serotypes such as serotypes 1, 3 and 19A, which have a higher propensity to cause empyema. Moreover increases in the incidence of empyema due to Staphylococcus aureus have also been observed. In adults, increases in the rate of empyema due to Streptococcus milleri group and S. aureus have been reported. SUMMARY Continued surveillance in the epidemiology of empyema is needed. Progress in new strategies of prevention, such as a new generation of conjugate pneumococcal vaccines and protein-based vaccines, could become an important step in the control of this important complication.
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Demirel N, Quizon A, Beltetón De Leon EL, Reiter J, Colin AA. On the nature of pleural involvement in necrotizing pneumonia: a report of two cases of life threatening late complications. Pediatr Pulmonol 2014; 49:E90-5. [PMID: 24273123 DOI: 10.1002/ppul.22943] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 09/03/2013] [Indexed: 11/05/2022]
Abstract
Suppurative complications of pneumonia such as empyema, lung abscess, pyopneumothorax, and necrotizing pneumonia (NP) are uncommon in children. Over the last decade an increasing incidence of NP has been reported. Streptococcus pneumoniae continues to be the predominant causative organism of NP, and while sporadic cases were reported prior to routine administration of heptavalent pneumococcal vaccine, a marked increase in NP appears to relate to replacement pneumococcal strains. Pleural involvement is almost universal in NP, and the course of pleural disease often determines its duration and outcome, particularly as it relates to complication of bronchopleural fistula. Cavities are formed in NP within the lung parenchyma and in the pleural space as the fibrosing pleural process organizes. The similarity of the radiologic appearance of parenchymal and pleural space cavities often makes the differentiation of pneumatocele versus residua of loculated pneumothorax challenging. The prevailing perception from most reports on childhood NP is of a favorable outcome with conservative approach. We report two pediatric cases with pneumonia who presented with prolonged fever despite antibiotic treatment, eventually diagnosed with NP. After stabilization on prolonged IV antibiotics, and weeks after discharge, they presented with unexpected acute respiratory failure due to a life-threatening tension air collection. In this article we discuss the nature of NP, its typical presentation, benign course and outcome, albeit its potential to cause serious late complications in the light of our recent experiences. Increasing awareness of such complications will result in more careful follow-up and in providing appropriate recommendations to parents of patients recovering from NP.
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Affiliation(s)
- Nadir Demirel
- Division of Pediatric Pulmonology, Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
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18
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Fletcher MA, Schmitt HJ, Syrochkina M, Sylvester G. Pneumococcal empyema and complicated pneumonias: global trends in incidence, prevalence, and serotype epidemiology. Eur J Clin Microbiol Infect Dis 2014; 33:879-910. [PMID: 24563274 PMCID: PMC4110404 DOI: 10.1007/s10096-014-2062-6] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 01/15/2014] [Indexed: 12/23/2022]
Abstract
This review evaluates the serotype epidemiology of complicated pneumococcal pneumonia (CPP) during the period 1990–2012. PubMed and EMBASE were searched using the terms “empyema”, “complicated pneumonia”, “pleural infection”, “necrotizing pneumonia”, “pleural effusion”, “parapneumonic effusion”, “pneumatocele”, or “lung abscess”; “pneumococcal” or “Streptococcus pneumoniae”; and “serotype” for studies on the epidemiology of complicated pneumonias published from January 1, 1990 to October 1, 2013. Studies with data on incidence and serotypes were included; reviews, case reports, and conference abstracts were excluded. Of 152 papers, 84 fitted the inclusion criteria. A few pneumococcal serotypes were predominant causes of CPP, particularly serotypes 1, 19A, 3, 14, and 7F. CPP was a more common manifestation of pneumococcal disease among older (>2 years old) than younger children. The data support increases in both reported incidence rates and proportions of CPP in children and adults during the period 1990–2012; specific increases varied by geographic region. The proportions of serotype 3 and, particularly in Asia, serotype 19A CPP have increased, whereas most studies show declines in serotype 14. Serotype 1 has been a predominant cause of CPP since 1990, while antibiotic resistance was infrequent among serotype 1 isolates. The reported incidence and proportions of CPP among pneumonia cases steadily increased from 1990 to 2012. Several factors might account for these increases, including enhanced disease detection due to a higher index of suspicion, more sophisticated diagnostic assays, and changes in the prevalence of serotypes with capacity to invade the pleural space that were not targeted by the 7-valent pneumococcal conjugate vaccine (PCV7).
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Affiliation(s)
- M A Fletcher
- Pfizer, Inc., 23-25, avenue du Dr Lannelongue, 75668, Paris Cedex 14, France,
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19
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Peters RT, Child F, Long AM, Humphrey GME, Rakoczy G. Pneumonectomy: The final cut in a rare incidence of persistent bronchopleural fistula following empyema. Pediatr Pulmonol 2013; 48:617-21. [PMID: 22911950 DOI: 10.1002/ppul.22649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Accepted: 07/01/2012] [Indexed: 11/09/2022]
Abstract
The incidence of necrotizing pneumonia and empyema complicated by bronchopleural fistula is rising. We describe the case of a 2-year-old boy who presented with empyema thoracis and necrotizing pneumonia who developed a bronchopleural fistula. At initial thoracotomy for decortication, necrotic lung was found and resected. He subsequently underwent further thoracotomy, prolonged chest tube drainage and endobronchial glue application attempts to close a bronchopleural fistula. The fistula was only sealed at third thoracotomy and completion pneumonectomy. This case highlights the potential challenges faced when dealing with air leaks in the setting of infection and we discuss the treatment options available.
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Affiliation(s)
- Robert T Peters
- Department of Paediatric Surgery, Royal Manchester Children's Hospital, Manchester, UK.
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20
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Pande A, Nasir S, Rueda AM, Matejowsky R, Ramos J, Doshi S, Kulkarni P, Musher DM. The incidence of necrotizing changes in adults with pneumococcal pneumonia. Clin Infect Dis 2011; 54:10-6. [PMID: 22042878 DOI: 10.1093/cid/cir749] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Necrotizing pneumonia is generally considered a rare complication of pneumococcal infection in adults. We systematically studied the incidence of necrotizing changes in adult patients with pneumococcal pneumonia and examined the severity of infection, role of causative serotypes, and association with bacteremia. METHODS We used a database of all pneumococcal infections identified at our medical center between 2000 and 2010. Original readings of chest X-rays (CXR) and computerized tomography (CT) were noted. Images were then independently reevaluated by 2 radiologists. The severity of disease at admission was assessed using SMART-COP and Pneumonia Outcomes Research Team (PORT) scoring systems. RESULTS In 351 cases of pneumococcal pneumonia, necrosis was reported in no (0%) original CXR readings and in 6 of 136 (4.4%) CTs. With rereading, 8 of 351 (2.3%) CXR and 15 of 136 (11.0%) CT had necrotizing changes. Overall, these changes were identified in 23 of 351 (6.6%) patients. The incidence of bacteremia and the admitting SMART-COP and PORT scores were similar in patients with and without necrosis (P = 1.00, P = .32, and P = .54, respectively). Type 3 pneumococcus was more commonly isolated from patients with necrosis than from patients without necrosis (P = .05), but 10 other serotypes were also implicated in 16 cases for which the organism was available for typing. CONCLUSIONS Necrotizing changes in the lungs were seen in 6.6% of a large series of adults with pneumococcal pneumonia but were often overlooked on initial readings. Patients with necrosis were not more likely to have bacteremia or more severe disease. Type 3 pneumococcus was the most commonly identified serotype.
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Affiliation(s)
- Anupam Pande
- School of Public Health, University of Texas Health Science Center, Houston, Texas, USA
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21
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Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH, Moore MR, St Peter SD, Stockwell JA, Swanson JT. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis 2011; 53:e25-76. [PMID: 21880587 PMCID: PMC7107838 DOI: 10.1093/cid/cir531] [Citation(s) in RCA: 974] [Impact Index Per Article: 74.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 07/08/2011] [Indexed: 02/07/2023] Open
Abstract
Evidenced-based guidelines for management of infants and children with community-acquired pneumonia (CAP) were prepared by an expert panel comprising clinicians and investigators representing community pediatrics, public health, and the pediatric specialties of critical care, emergency medicine, hospital medicine, infectious diseases, pulmonology, and surgery. These guidelines are intended for use by primary care and subspecialty providers responsible for the management of otherwise healthy infants and children with CAP in both outpatient and inpatient settings. Site-of-care management, diagnosis, antimicrobial and adjunctive surgical therapy, and prevention are discussed. Areas that warrant future investigations are also highlighted.
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Affiliation(s)
- John S Bradley
- Department of Pediatrics, University of California San Diego School of Medicine and Rady Children's Hospital of San Diego, San Diego, California, USA.
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22
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Guidi R, Osimani P, Azzari C, Resti M, De Benedictis F. Severe Necrotizing Pneumonia Complicating Influenza A (H1N1): The Role of Immunologic Interaction. Int J Immunopathol Pharmacol 2011; 24:1093-7. [DOI: 10.1177/039463201102400429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This report describes the successful management of a documented necrotizing pneumonia due to Streptococcus pneumoniae in a child with pandemic influenza A (H1N1). The importance of early recognition of bacterial superinfection in patients with influenza and the immunologic interactive mechanisms between viruses and bacteria in determining respiratory diseases are highlighted. The role of modern molecular techniques in improving diagnostic microbiology sensitivity and informing consequent clinical care is emphasized.
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Affiliation(s)
- R. Guidi
- Department of Pediatrics, Azienda Ospedaliero-Universitaria, Salesi Children's Hospital, Ancona
| | - P. Osimani
- Department of Pediatrics, Azienda Ospedaliero-Universitaria, Salesi Children's Hospital, Ancona
| | - C. Azzari
- Department of Pediatrics, University of Florence and Anna Meyer Children's Hospital, Florence, Italy
| | - M. Resti
- Department of Pediatrics, University of Florence and Anna Meyer Children's Hospital, Florence, Italy
| | - F.M. De Benedictis
- Department of Pediatrics, Azienda Ospedaliero-Universitaria, Salesi Children's Hospital, Ancona
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23
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McKee AJ, Ives A, Balfour-Lynn IM. Increased incidence of bronchopulmonary fistulas complicating pediatric pneumonia. Pediatr Pulmonol 2011; 46:717-21. [PMID: 21626711 DOI: 10.1002/ppul.21396] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 09/27/2010] [Accepted: 10/27/2010] [Indexed: 11/12/2022]
Abstract
BACKGROUND The frequency of complicated pneumococcal disease, including necrotizing pneumonia, has increased over the last decade. During 2008-2009, we noted an increase in the number of children whose empyema was complicated by the development of a bronchopleural fistula and air leak. We studied these children to see if there was an associated cause. METHODS This was a retrospective case note and database review of children admitted to our tertiary unit with a parapneumonic effusion or empyema from 2002 to 2007, compared with 2008 to 2009. For the latter period, we also compared the outcomes of those with a bronchopleural fistula to those without. RESULTS During the 8-year period, 310 children were admitted. In the first 6 years, the frequency of air leaks was 1% (2/258) rising to 33% (16/49) in the last 2 years (P<0.0001). Three children were excluded as their fistulas were possibly iatrogenic. This was associated with a significant increase in median hospital stay (7 vs. 10 days, P<0.0001) and surgical intervention rate (2% vs. 14%, P=0.001). In the latter 2 years, S. pneumoniae serotype 3 was identified in 10/16 (91%) of those with a bronchopleural fistula compared to 1/33 (3%) of those without. CONCLUSIONS The frequency of bronchopleural fistulas increased markedly in the 2 years 2008-2009. Although these cases were associated with pneumococcal serotype 3 infection, which was not covered by the heptavalent pneumococcal vaccine Prevenar® in use at that time, we do not know whether the increased incidence of fistulas was due to a change in serotype 3 prevalence.
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Affiliation(s)
- A J McKee
- Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Royal Brompton & Harefield NHS Foundation Trust, Sydney Street, London, UK
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François P, Desrumaux A, Cans C, Pin I, Pavese P, Labarère J. Prevalence and risk factors of suppurative complications in children with pneumonia. Acta Paediatr 2010; 99:861-6. [PMID: 20178517 DOI: 10.1111/j.1651-2227.2010.01734.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM To identify the baseline characteristics associated with suppurative complications in children with community-acquired primary pneumonia. METHODS A retrospective study included all children from 28 days to 15 years old, who presented with community-acquired pneumonia at two French hospitals from 1995 to 2003. Complicated pneumonia was defined by the presence of empyema and/or lung abscess. RESULTS Of 767 children with community-acquired pneumonia, 90 had suppurative complications: 83 cases of pleural empyema and seven cases of lung abscess. The mean prevalence of complicated pneumonia was 3% during the 1995-1998 period, and then steadily increased following a linear trend to reach 23% in 2003. Children with complicated pneumonia were older and had a longer symptomatic period preceding hospitalization. They were more likely to receive antibiotics, especially aminopenicillins (p < 0.01), and nonsteroidal anti-inflammatory drugs, especially ibuprofen (p < 0.001). In multivariable analysis, ibuprofen was the only preadmission therapy that was independently associated with complicated pneumonia [adjusted OR = 2.57 (1.51-4.35)]. CONCLUSION This study confirms an association between the use of prehospital ibuprofen and suppurative pneumonic complications.
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Affiliation(s)
- Patrice François
- Quality of Care Unit, Centre Hospitalier Universitaire de Grenoble, Grenoble, France.
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25
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Calado C, Nunes P, Pereira L, Nunes T, Barreto C, Bandeira T. Estarão diferentes as pneumonias agudas adquiridas na comunidade com internamento hospitalar em idade pediátrica na última década? REVISTA PORTUGUESA DE PNEUMOLOGIA 2010. [DOI: 10.1016/s0873-2159(15)30027-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Fretzayas A, Moustaki M, Alexopoulou E, Nychtari G, Nicolaidou P, Priftis KN. Clinical notations on bacteremic cavitating pneumococcal pneumonia in nonvaccinated immunocompetent children. J Trop Pediatr 2009; 55:257-61. [PMID: 19028727 DOI: 10.1093/tropej/fmn098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We describe 10 children who developed lung cavitation during the treatment of bacteremic pneumococcal lobar pneumonia. Chest CT scan showed extensive consolidation with several small lucencies and air-filled cavities. Invasive procedures like aggressive pleural intervention were not needed and the children recovered attaining normal lung function on long-term follow-up.
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Affiliation(s)
- A Fretzayas
- 3rd Department of Pediatrics, University of Athens, Attikon University Hospital, 12462 Haidari, Athens, Greece.
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27
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Spencer DA, Cliff D. The changing epidemiology of parapneumonic empyema in children. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.paed.2008.07.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Langley JM, Kellner JD, Solomon N, Robinson JL, Le Saux N, McDonald J, Ulloa-Gutierrez R, Tan B, Allen U, Dobson S, Joudrey H. Empyema associated with community-acquired pneumonia: a Pediatric Investigator's Collaborative Network on Infections in Canada (PICNIC) study. BMC Infect Dis 2008; 8:129. [PMID: 18816409 PMCID: PMC2571094 DOI: 10.1186/1471-2334-8-129] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 09/25/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although the incidence of serious morbidity with childhood pneumonia has decreased over time, empyema as a complication of community-acquired pneumonia continues to be an important clinical problem. We reviewed the epidemiology and clinical management of empyema at 8 pediatric hospitals in a period before the widespread implementation of universal infant heptavalent pneumococcal vaccine programs in Canada. METHODS Health records for children<18 years admitted from 1/1/00-31/12/03 were searched for ICD-9 code 510 or ICD-10 code J869 (Empyema). Empyema was defined as at least one of: thoracentesis with microbial growth from pleural fluid, or no pleural fluid growth but compatible chemistry or cell count, or radiologist diagnosis, or diagnosis at surgery. Patients with empyemas secondary to chest trauma, thoracic surgery or esophageal rupture were excluded. Data was retrieved using a standard form with a data dictionary. RESULTS 251 children met inclusion criteria; 51.4% were male. Most children were previously healthy and those<or=5 years of age comprised 57% of the cases. The median length of hospitalization was 9 days. Admissions occurred in all months but peaked in winter. Oxygen supplementation was required in 77% of children, 75% had chest tube placement and 33% were admitted to an intensive care unit. While similarity in use of pain medication, antipyretics and antimicrobial use was observed, a wide variation in number of chest radiographs and invasive procedures (thoracentesis, placement of chest tubes) was observed between centers. The most common organism found in normally sterile samples (blood, pleural fluid, lung biopsy) was Streptococcus pneumoniae. CONCLUSION Empyema occurs most commonly in children under five years and is associated with considerable morbidity. Variation in management by center was observed. Enhanced surveillance using molecular methods could improve diagnosis and public health planning, particularly with regard to the relationship between immunization programs and the epidemiology of empyema associated with community-acquired pneumonia in children.
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Affiliation(s)
- Joanne M Langley
- Department of Pediatrics, Dalhousie University, Halifax, Canada.
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29
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Bender JM, Ampofo K, Korgenski K, Daly J, Pavia AT, Mason EO, Byington CL. Pneumococcal necrotizing pneumonia in Utah: does serotype matter? Clin Infect Dis 2008; 46:1346-52. [PMID: 18419434 DOI: 10.1086/586747] [Citation(s) in RCA: 106] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Streptococcus pneumoniae is the most common cause of bacterial pneumonia in children. Despite the use of the 7-valent pneumococcal conjugate vaccine, the incidence of pneumococcal necrotizing pneumonia (PNP) has been increasing. Our objectives were to describe temporal trends in PNP and to evaluate pneumococcal serotypes associated with PNP in Utah. METHODS We performed a retrospective review of all children <18 years of age who were cared for at a tertiary care children's hospital and who had blood, lung tissue, broncheoalveolar lavage, or pleural fluid cultures that grew S. pneumoniae, as well as radiographic evidence of pneumonia, from January 1997 through March 2006. All S. pneumoniae isolates were typed. RESULTS A total of 124 children with pneumococcal pneumonia were identified, and 33 (27%) of these children had radiographic evidence of PNP. During the period 1997-2000, 5 (13%) of 39 cases of culture-confirmed pneumococcal pneumonia were associated with PNP. In contrast, during the period 2001-2006, 28 (33%) of 85 pneumococcal pneumonia cases were complicated by PNP (odds ratio, 3.34; 95% confidence interval, 1.11-12.03). Non-7-valent pneumococcal conjugate vaccine serotypes comprised 49% of the isolates during 1997-2000 and 88% of isolates during 2001-2006 (odds ratio, 7.89; 95% confidence interval, 2.91-21.90). Pneumonia due to serotype 3 was most often associated with PNP. Eleven (79%) of 14 cases of serotype 3-associated pneumonia were associated with PNP. When compared with all other serotypes, serotype 3 was strongly associated with necrosis (odds ratio, 14.67; 95% confidence interval, 3.39-86.25). CONCLUSIONS PNP is a serious and increasingly common complication of S. pneumoniae pneumonia in Utah. Infection with serotype 3 is associated with an increased risk of developing PNP. The increase in the incidence of infection due to nonvaccine serotypes reported worldwide and the changing epidemiology of invasive pneumococcal disease should be considered when developing vaccine strategies.
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Affiliation(s)
- Jeffrey M Bender
- Department of Pediatrics, Division of Infectious Diseases, University of Utah, USA.
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Abstract
A pulmonary cavity is a gas-filled area of the lung in the center of a nodule or area of consolidation and may be clinically observed by use of plain chest radiography or computed tomography. Cavities are present in a wide variety of infectious and noninfectious processes. This review discusses the differential diagnosis of pathological processes associated with lung cavities, focusing on infections associated with lung cavities. The goal is to provide the clinician and clinical microbiologist with an overview of the diseases most commonly associated with lung cavities, with attention to the epidemiology and clinical characteristics of the host.
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Abstract
Empyema is an important cause of childhood morbidity with an increasing worldwide incidence. Despite many treatment options being available, there is no general consensus on the optimal management approach due to conflicting reports and lack of properly conducted studies to challenge the personal bias of a physician or surgeon. The reason for this is likely to be the fact that, irrespective of the treatment children receive, they ultimately make an excellent clinical recovery. This review summarises the current evidence and evaluates the clinical efficacy of various treatment modalities in the context of relevant outcome measures in an attempt to demonstrate the differences in treatment options for the child with empyema.
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Affiliation(s)
- Samatha Sonnappa
- Portex Respiratory Unit, Great Ormond Street Hospital and Institute of Child Health London, UK.
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Affiliation(s)
- Andrew Bush
- F.R.C.P., Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK.
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