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Grochowska M, Strzelak A, Krenke K. Complicated pneumonia caused by group A Streptococcus in children - 2022/2023 infectious season outbreak and update on clinical characteristics. J Infect Chemother 2024; 30:1047-1053. [PMID: 38631479 DOI: 10.1016/j.jiac.2024.04.006] [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] [Received: 12/15/2023] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND An increased incidence of group A Streptococcus (GAS) infections has been observed in pediatric population post-COVID-19 pandemic. While the majority of reports refer to scarlet fever or invasive GAS disease, detailed data on pulmonary manifestations such as complicated community-acquired pneumonia (CAP) are scarce. The aim of this study was to assess the contribution of GAS to complicated CAP in children during the 2022/2023 infectious season. METHODS We retrospectively analyzed the etiology and clinical presentation of complicated CAP patients hospitalized in our tertiary care center in Warsaw, Poland, between August 2022 and May 2023. RESULTS Among 91 patients with complicated CAP, GAS was the dominant cause constituting 24.2% (22/91; 95% CI 15.8-34.3%) of the study group. 68.2% of GAS pneumonia patients presented symptoms of scarlet fever, and 27.3% had preceding or concurrent viral infection. GAS complicated CAP was associated with longer hospitalization, higher incidence of chest tube insertion, but shorter duration of chest tube drainage than complicated CAP of other etiology. Children with GAS complicated CAP had higher procalcitonin concentration (28.1 vs. 1.5 ng/dL; p<0.0001) and a lower platelets level (254.5 vs. 422 × 103/μL; p = 0.0031) than those with non-GAS infection. CONCLUSIONS GAS is currently the predominant pathogen of complicated CAP in children. Clinicians should be aware of the current epidemiological situation and a more severe course of GAS pneumonia in this age group, and should monitor patients presenting with symptoms of scarlet fever and preceding viral infection closely.
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Affiliation(s)
- Magdalena Grochowska
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Warsaw, Poland; Doctoral School, Medical University of Warsaw, Warsaw, Poland.
| | - Agnieszka Strzelak
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Warsaw, Poland.
| | - Katarzyna Krenke
- Department of Pediatric Pulmonology and Allergy, Medical University of Warsaw, Warsaw, Poland.
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Cathalau M, Michelet M, Rancé A, Martin-Blondel G, Abbo O, Dubois D, Labouret G, Grouteau E, Claudet I, Ricco L, Roditis L, Mansuy JM, Simon S, Bréhin C. Necrotizing pneumonia in children: Report of 25 cases between 2008 and 2018 at a French tertiary care center. Arch Pediatr 2024; 31:183-187. [PMID: 38485569 DOI: 10.1016/j.arcped.2023.12.004] [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] [Received: 07/18/2022] [Revised: 11/21/2023] [Accepted: 12/30/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND Necrotizing pneumonia (NP) is a serious and rare disease in children. Pediatric data on NP are limited and the impact of the 13-valent pneumococcal conjugate vaccine has been very poorly evaluated. PATIENTS AND METHODS We conducted a retrospective study at Toulouse University Hospital between 2008 and 2018. Children who presented with thin-walled cavities in the areas of parenchymal consolidation on imaging were included in the study. RESULTS The incidence of NP did not decrease during this period. Bacterial identification occurred in 56% of cases (14/25) and included six cases of Streptococcus pneumoniae, five of Staphylococcus aureus, two of Streptococcus pyogenes, and one of Streptococcus viridans. Streptococcus pneumoniae NP are more frequently associated with empyema/parapneumonic effusion compared to S. aureus NP (p = 0.02). Patients with S. pyogenes NP more often required volume expansion than did S. pneumoniae cases (p = 0.03). When comparing children born before and after implementation of the 13-valent pneumococcal conjugate vaccine, we identified a relative modification of the bacterial epidemiology, with an increase in the proportion of S. pyogenes NP and S. aureus NP and a decrease in the proportion of NP caused by S. pneumoniae. CONCLUSION Future studies are needed to assess the epidemiology of NP in children. Continued surveillance of identified pneumococcal serotypes is essential to document epidemiological changes in the coming years.
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Affiliation(s)
- Manon Cathalau
- Children's Hospital, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Marine Michelet
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Aurélien Rancé
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Guillaume Martin-Blondel
- Infectious Diseases Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Olivier Abbo
- Infantile Visceral Surgery Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Damien Dubois
- Federal Institute of Biology, Bacteriology unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Géraldine Labouret
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Erick Grouteau
- General Pediatrics Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Isabelle Claudet
- Pediatric Emergency Care Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Lucas Ricco
- General Pediatrics Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Léa Roditis
- Pediatric Pneumology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Jean-Michel Mansuy
- Federal Institute of Biology, Virology unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Sophie Simon
- Pediatric Radiology Department, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France
| | - Camille Bréhin
- General Pediatrics Unit, University Hospital Center of Toulouse, 330 avenue de Grande Bretagne, 31300, Toulouse, France.
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Suleac M, Naranjo S, Djassi M, Lavadinho I. Necrotizing Pneumonia With Extensive Lobar Cavitation. Cureus 2024; 16:e56437. [PMID: 38638719 PMCID: PMC11024767 DOI: 10.7759/cureus.56437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
Pneumonia occupies one of the leading positions in morbidity and mortality worldwide. It is frequently categorized depending on the site of acquisition. Here, we present a case of a young woman who was admitted to the Emergency Department (ED) with cough, dyspnea, fever, and progressive worsening associated with palpitations and hypotension. An initial x-ray was followed by a computed tomography (CT) scan of the chest, which revealed signs of extensive left lung pneumonia with pleural effusion. Despite initial improvement after antibiotic treatment, the patient's condition declined. A repeat chest CT showed evidence of extensive lobar cavitations, leading to suspicion of tuberculosis.
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Affiliation(s)
- Maxim Suleac
- Internal Medicine Department, Unidade Local de Saúde do Norte Alentejano, Portalegre, PRT
| | - Socrates Naranjo
- Internal Medicine Department, Unidade Local de Saúde do Norte Alentejano, Portalegre, PRT
| | - Malam Djassi
- Internal Medicine Department, Unidade Local de Saúde do Norte Alentejano, Portalegre, PRT
| | - Isabel Lavadinho
- Internal Medicine Department, Unidade Local de Saúde do Norte Alentejano, Portalegre, PRT
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Luo Y, Wang Y. Clinical Characteristics of Necrotizing Pneumonia Caused by Different Pathogens. Infect Drug Resist 2023; 16:3777-3786. [PMID: 37337573 PMCID: PMC10276989 DOI: 10.2147/idr.s419294] [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: 04/29/2023] [Accepted: 06/02/2023] [Indexed: 06/21/2023] Open
Abstract
Objective To explore the clinical characteristics of necrotizing pneumonia (NP) caused by different pathogens. Methods A total of 282 children with NP admitted to Kunming Children's Hospital from January 2014 to November 2022 were enrolled. The clinical data of all children was collected. According to the different pathogens causing NP, the children were divided into three groups: the Mycoplasma pneumoniae necrotizing pneumonia (MPNP) group, the bacterial necrotizing pneumonia (BNP) group, and necrotizing pneumonia with no pathogen detected (NNP) group. The basic information, symptoms, signs, laboratory tests, radiological features, treatment, and prognosis of the three groups were compared. Results Among the 282 cases of NP, there were 62 (22.0%) cases of MPNP, 98 (34.75%) cases of BNP, and 142 (50.35%) cases of NNP. The most common bacteria causing NP were Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, and Acinetobacter baumannii, respectively. Most clinical features of the three groups were statistically significant. The area under the concentration curve of white blood cell, C-reactive protein, albumin, neutrophil percentage, and fibrinogen in differentiating MPNP from BNP were 0.743 (0.638-0.849), 0.797 (0.711-0.883), 0.766 (0.671-0.861), 0.616 (0.509-0.724), and 0.634 (0.523-0.744), respectively. The decision curve showed that white blood cells, albumin, and C-reactive protein had good clinical application in differentiating MPNP from BNP. All patients were improved and discharged without death. Conclusion Bacteria are the most common cause of NP, and the most common bacteria are Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae. NP with no pathogen detected accounted for a large proportion. white blood, C-reactive protein, and albumin can identify the pathogens of NP. Patients with BNP were more severe, had a longer hospital stay, and were more likely to undergo closed drainage and surgery.
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Affiliation(s)
- Yonghan Luo
- Second Department of Infectious Disease, Kunming Children's Hospital, Kunming, Yunnan, People's Republic of China
| | - Yanchun Wang
- Second Department of Infectious Disease, Kunming Children's Hospital, Kunming, Yunnan, People's Republic of China
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Frybova B, Koucky V, Pohunek P, Cejnarova K, Coufal S, Kokesova A, Dotlacil V, Petrasova N, Pos L, Snajdauf J, Hlava S, Polivka N, Rygl M. Lung Resection in Children with Necrotizing Pneumonia: Outcome and Follow-up. Eur J Pediatr Surg 2022; 32:280-286. [PMID: 33677824 DOI: 10.1055/s-0041-1725188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The number of patients with necrotizing pneumonia has increased in recent years. The aim of this study is to review the incidence, management, and outcome of pediatric necrotizing pneumonia requiring surgical therapy and to prove that lung resection results in favorable development of patients. We hypothesize that overall lung function in children after lung resection does not differ from that of the healthy population. MATERIALS AND METHODS A retrospective tertiary referral center study with a prospective follow-up spirometric study of patients with necrotizing pneumonia managed between January 2010 and December 2019 was performed. RESULTS The study cohort consisted of 1,295 patients admitted to the pediatric department for community-acquired pneumonia; 47 patients developed necrotizing pneumonia, 36 of whom underwent parenchymal lung resection. A 5-year rise in the occurrence of necrotizing pneumonia requiring resection was 77%, with a significant increase in the last 3 years (p < 0.05). The median age at the time of surgery was 32.5 (interquartile range [IQR]: 32.25) months. Streptococcus pneumoniae was the most prevalent pathogen (83%), although 53.3% of these patients were vaccinated against the agent. In 67% of patients, preresection procedures were performed: drainage of pneumothorax (17%), drainage of empyema (46%), drainage of empyema with use of alteplase (25%), and thoracoscopic decortication (12%). Surgical procedures included lobectomy (72.2%), wedge resection (13.9%), bilobectomy (8.3%), and pneumonectomy (5.6%). The postoperative complication was bronchopleural fistula in three patients. There were two (5.5%) postoperative deaths due to multiple organ failure. The follow-up spirometry was performed 43.3 (median, IQR 23.8-66.7) months after surgical intervention. Normal lung function was detected in 35 (64.8%) patients, restrictive pattern in 6 (11.1%) patients, obstructive pattern in 11 (20.4%) patients, and combined in 2 (3.7%) patients. CONCLUSION The number of patients with necrotizing pneumonia requiring resection has increased significantly in the last 3 years (p < 0.05). Aggressive surgical treatment results in significant clinical improvement in most cases and favorable lung function outcome. Long-term follow-up showed normal spirometry in 64.8% of cases.
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Affiliation(s)
- Barbora Frybova
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Vaclav Koucky
- Department of Pediatrics, Motol University Hospital, Praha, Czech Republic
| | - Petr Pohunek
- Department of Pediatrics, Motol University Hospital, Praha, Czech Republic
| | - Kristyna Cejnarova
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Stepan Coufal
- Institute of Microbiology Czech Academy of Sciences, Institute of Microbiology, Praha, Czech Republic
| | - Alena Kokesova
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Vojtech Dotlacil
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Natalia Petrasova
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Lucie Pos
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Jiri Snajdauf
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Stepan Hlava
- Department of Internal Medicine, Motol University Hospital, Praha, Czech Republic
| | - Natali Polivka
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
| | - Michal Rygl
- Department of Pediatric Surgery, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
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Nieto-Moro M, Ecclesia FG, Tomé-Masa I, De Lama Caro-Patón G, Leoz-Gordillo I, Cabrero-Hernández M, García-Salido A. SARS-CoV-2 and Streptococcus pneumoniae coinfection as a cause of severe pneumonia in an infant. Pediatr Pulmonol 2020; 55:2198-2200. [PMID: 32602267 PMCID: PMC7361827 DOI: 10.1002/ppul.24916] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/18/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Montserrat Nieto-Moro
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Irene Tomé-Masa
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Inés Leoz-Gordillo
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | - Alberto García-Salido
- Pediatric Critical Care Unit, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
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