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Elmeazawy R, Ayoub D, Morad LM, El-Moazen AMF. Role of systemic immune-inflammatory index and systemic inflammatory response index in predicting the diagnosis of necrotizing pneumonia in children. BMC Pediatr 2024; 24:496. [PMID: 39095744 PMCID: PMC11295883 DOI: 10.1186/s12887-024-04818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 05/08/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Necrotizing pneumonia (NP) is a rare serious complication of community-acquired pneumonia (CAP) in children, which is characterized by a protracted course of the disease and a prolonged hospital stay. This study aimed to assess the role of systemic immune-inflammatory index and systemic inflammatory response index in predicting early lung necrotization in children with CAP. METHODS This study included all children hospitalized in Pediatric Pulmonology Unit, Tanta University, Egypt, with CAP between the ages of two months and 18 years. Systemic inflammatory indices, including the neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), systemic immune-inflammatory index (SII), and systemic inflammation response index (SIRI), were calculated on patients' admission. RESULTS The study involved a total of 228 children, 42 patients had NP, 46 patients had parapneumonic effusion, and 140 patients had non-complicated CAP. Patients with NP were substantially younger (p = 0.002), stayed in the hospital longer (p < 0.001), had a longer duration of symptoms before hospital admission (p < 0.001), and had fever for a longer duration than those in the other groups (p < 0.001). Regarding the inflammatory ratios, patients with NP had significantly higher MLR, PLR, SII, and SIRI than those in the other groups (p = 0.020, p = 0.007, p = 0.001, p = 0.037, respectively). ROC curve analysis showed that the combined SII + SIRI + D-dimer showed the highest AUC with a good specificity in predicting the diagnosis of NP. CONCLUSIONS SII, SIRI, and D-dimer may be beneficial biomarkers for predicting the occurrence of NP in children when performed on patients' admission. In addition, it was found for the first time that combined SII + SIRI + D-dimer had a good sensitivity and specificity in the diagnosis of NP.
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Affiliation(s)
- Rehab Elmeazawy
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Dalia Ayoub
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Lamia M Morad
- Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt
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2
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Ehsanipur F, Ebrahimi P, Tahernia L, Vafaee‐Shahi M. A fulminant presentation of post-COVID-19 necrotizing pneumonia and ischemic stroke in an 8-year-old girl: A case report and literature review. Clin Case Rep 2024; 12:e9222. [PMID: 39077727 PMCID: PMC11284262 DOI: 10.1002/ccr3.9222] [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: 03/07/2024] [Revised: 05/31/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024] Open
Abstract
Necrotizing pneumonia (NP) is the destruction of the interstitial part of the lung due to severe infection. One cause of this rare and fatal condition in pediatrics is Acinetobacter. Severe infections, especially pneumonia, can prone pediatric patients to ischemic stroke. This study reports an 8-year-old girl presented to the emergency department complaining of shortness of breath, fever, and fatigue. She was admitted to the intensive care unit due to respiratory distress and pericardial effusion. Swab and respiratory secretion tests for COVID-19 and Acinetobacter were positive. In her admission course, her condition deteriorated, and on the fifth day, she underwent a craniotomy due to the signs of increased intracranial pressure (ICP). The computed tomography (CT) scan showed an ischemic stroke. Despite all efforts and medical efforts, the patient's clinical condition got worse, and she died 10 days after the surgery. COVID-19 can lead to vulnerability to severe bacterial infections such as NP in pediatrics. Severe infections are a significant risk factor for ischemic stroke. The presentation might be different in intubated unconscious patients, such as detecting increased ICP signs. In severe and extensive cases of NP and ischemia, the destruction of the lungs and brain tissue might be irreversible and even lethal. Doctors and parents should consider neurologic complaints in children with infectious diseases as a serious issue since infections make children vulnerable to complications such as stroke.
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Affiliation(s)
- Fahimeh Ehsanipur
- Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Faculty of MedicineIran University of Medical SciencesTehranIran
| | - Pouya Ebrahimi
- Cardiovascular Disease Research Institute, Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | | | - Mohammad Vafaee‐Shahi
- Pediatric Growth and Development Research Center, Institute of Endocrinology and Metabolism, Faculty of MedicineIran University of Medical SciencesTehranIran
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3
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Onyishi N. Invasive Community-Acquired Methicillin-Resistant Staphylococcus aureus With Aortic Aneurysm in a 10-Year-Old Patient: A Case Report. Cureus 2024; 16:e62712. [PMID: 39036215 PMCID: PMC11259233 DOI: 10.7759/cureus.62712] [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: 06/19/2024] [Indexed: 07/23/2024] Open
Abstract
The clinical presentation of disseminated community-acquired Methicillin-resistant Staphylococcus aureus (MRSA) in young pediatric patients without a known predisposing risk factor poses a diagnostic dilemma due to its non-specific clinical symptoms. This can lead to delayed initiation of appropriate antibiotics and surgical interventions to achieve a favorable outcome and prevent mortality. Appropriate imaging with good clinical judgment is required in the management of this infection. Outpatient surveillance for subacute and chronic complications is required for a good long-term prognosis. Few reported cases of disseminated infections with aortic aneurysm exist in the literature. We report a case of a child without predisposing risk factors managed for community-acquired MRSA sepsis, acute respiratory distress syndrome (ARDS), multiple abscesses, osteomyelitis, and necrotizing pneumonia with a post-discharge unruptured aortic aneurysm. This case emphasizes the importance of post-discharge monitoring even in patients with favorable outcomes.
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Affiliation(s)
- Ngozi Onyishi
- Pediatrics, Driscoll Children's Hospital, Corpus Christi, USA
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Ham SD, Shah N, Hamerla B, Zaretsky J. A Very Complicated Pneumonia in a 1-Year-Old Boy. Clin Pediatr (Phila) 2024; 63:176-178. [PMID: 37846069 DOI: 10.1177/00099228231205471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- Steven D Ham
- Division of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA
- Residency in General Pediatrics, Cohen Children's Medical Center, Queens, NY, USA
| | - Nehal Shah
- Division of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA
| | - Berenice Hamerla
- Division of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA
- Residency in General Pediatrics, Cohen Children's Medical Center, Queens, NY, USA
| | - Jami Zaretsky
- Division of Pediatrics, Cohen Children's Medical Center, New Hyde Park, NY, USA
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5
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Dá Mesquita Faustino F, Morgado C, Palmares I, Ferrão J, Freitas P. Necrotizing Pneumonia: A Rare Outcome of a Rare Complication. Cureus 2024; 16:e51527. [PMID: 38304676 PMCID: PMC10833058 DOI: 10.7759/cureus.51527] [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: 12/30/2023] [Indexed: 02/03/2024] Open
Abstract
Necrotizing pneumonia is a rare complication of community-acquired pneumonia, characterized by lung parenchymal destruction in affected areas. It has been sporadically documented over the years, mostly with insidious progression and a higher incidence among individuals with risk factors. Its diagnosis relies on clinical, analytical, and imaging data, and the treatment encompasses medical and surgical measures. The persistently high morbidity and mortality result from delayed diagnosis and the intricate therapeutic approach. In this report, the authors describe an unusual case of necrotizing pneumonia in a patient without risk factors.
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Affiliation(s)
| | - Catarina Morgado
- Critical Care Unit, Hospital Prof. Doutor Fernando da Fonseca, Amadora, PRT
| | - Inês Palmares
- Critical Care Unit, Hospital Prof. Doutor Fernando da Fonseca, Amadora, PRT
| | - Joana Ferrão
- Critical Care Unit, Hospital Prof. Doutor Fernando da Fonseca, Amadora, PRT
| | - Paulo Freitas
- Intensive Care Unit, Hospital Prof. Doutor Fernando da Fonseca, Amadora, PRT
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Mehta K, Modh D, Mehta S, Tenkorang PO. A rare case of squamous cell carcinoma within the necrotic mass of acute necrotizing pneumonia: when cancer strikes unpredictably. Ann Med Surg (Lond) 2023; 85:5795-5799. [PMID: 37915634 PMCID: PMC10617814 DOI: 10.1097/ms9.0000000000001353] [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: 08/14/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction and importance This case report presents an intriguing instance of a 35-year-old nonsmoker female who exhibited a convergence of acute necrotizing pneumonia (ANP) and squamous cell carcinoma (SCC), two distinct pulmonary conditions. ANP involves severe lung infection and tissue necrosis, while SCC is a non-small cell lung carcinoma originating from the bronchial epithelium. Such a unique combination in a nonsmoker female patient emphasizes the intricate interplay of diverse pulmonary pathologies and the importance of comprehensive diagnostic evaluation and effective patient management strategies. Case presentation The patient's symptoms include fever, pain, cough, and sporadic hemoptysis. Initial imaging suggested ANP due to a multilobulated necrotic lung mass. Despite empirical antibiotic therapy, no improvement occurred, prompting further investigation. Positron emission tomography and computed tomography revealed intense fluorodeoxyglucose avidity in the lesion. A computer tomography-guided Tru-cut biopsy confirmed non-small cell carcinoma with squamous differentiation in the necrotic mass. Clinical discussion ANP is a severe manifestation of pneumonia, predominantly affecting young, healthy individuals, while SCC, commonly linked to smoking, presents as non-small cell lung carcinoma. Overlapping symptoms and radiological findings complicate diagnosis. Early diagnosis and appropriate management are crucial for both conditions to prevent progression and complications. Conclusion This case highlights the significance of precise diagnosis and adaptable treatment approaches. The coexistence of ANP and SCC in a nonsmoker female patient underscores the necessity of meticulous diagnostic evaluation and personalized treatment strategies. The scarcity of such presentations emphasizes the need for further research to comprehend the mechanisms underlying these occurrences.
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Affiliation(s)
- Kahan Mehta
- Department of Internal Medicine, GMERS Medical College and Hospital, Vadodara
| | - Deep Modh
- Department of Respiratory Medicine, Veer Narmad University of South Gujarat, India
| | | | - Pearl O. Tenkorang
- Department of Medicine, University of Ghana Medical School, Accra, Ghana
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7
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Wang Y, Tang M, Deng H, Hong Z, Liang Z, Huang Y, Zeng C, Yang K. Ampelopsin attenuates Staphylococcus aureus Alpha-Toxin-Induced Lung Injury. Microb Pathog 2023; 183:106316. [PMID: 37634577 DOI: 10.1016/j.micpath.2023.106316] [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: 06/25/2023] [Revised: 08/18/2023] [Accepted: 08/20/2023] [Indexed: 08/29/2023]
Abstract
Staphylococcus aureus is a prevalent cause of lung infections in hospitals and communities, and can cause a wide spectrum of human infections. Due to the bottleneck caused by antibiotic resistance and substantial increases in morbidity and mortality, targeting the virulence factors released by S. aureus as an alternative prevention and treatment method has become a promising approach. Ampelopsin, a component of vine tea, has promising potential for treating S. aureus-induced acute lung injury. In this study, the effects of ampelopsin were investigated on a mouse model of acute lung injury established using S. aureus 8325-4 and the α-hemolysin (hla) silent strain DU1090. The hla silent strain did not cause mortality in mice, whereas lethal and sublethal concentrations of S. aureus 8325-4 caused high mortality. Notably, ampelopsin treatment protected against mortality stemming from S. aureus infection. Ampelopsin yielded enhancements in lung barrier function, decreased total protein leakage in the alveolar lavage fluid, and modulated inflammatory signaling pathway-related proteins, thereby reducing the release of pro-inflammatory factors and improving respiratory dysfunction. Moreover, ampelopsin prevented the upregulation of ADAM10 activity, leading to E-cadherin mucin cleavage. In conclusion, our findings establish the key role of alpha -toxin in infectious lung injury in S. aureus and provide support for ampelopsin as an effective therapeutic approach to improve lung injury.
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Affiliation(s)
- Yi Wang
- School of Pharmacy, Guangxi University of Chinese Medicine, Nanning, 530200, PR China
| | - Mulan Tang
- School of Pharmacy, Guangxi University of Chinese Medicine, Nanning, 530200, PR China
| | - Haojian Deng
- School of Pharmacy, Guangxi University of Chinese Medicine, Nanning, 530200, PR China
| | - Zhengshan Hong
- School of Pharmacy, Guangxi University of Chinese Medicine, Nanning, 530200, PR China
| | - Zhi Liang
- School of Pharmacy, Guangxi University of Chinese Medicine, Nanning, 530200, PR China
| | - Yumei Huang
- School of Pharmacy, Guangxi University of Chinese Medicine, Nanning, 530200, PR China
| | - Chunhui Zeng
- School of Pharmacy, Guangxi University of Chinese Medicine, Nanning, 530200, PR China.
| | - Ke Yang
- School of Pharmacy, Guangxi University of Chinese Medicine, Nanning, 530200, PR China.
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Cura Yayla BC, Bedir Demirdag T, Akkuzu E, Kara N, Tezer H, Tapisiz A. A pediatric case series of invasive pneumococcal disease caused by S.Pneumonia serotype-19A despite full dose vaccination. Hum Vaccin Immunother 2023:2219186. [PMID: 37334472 DOI: 10.1080/21645515.2023.2219186] [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: 02/20/2023] [Revised: 05/06/2023] [Accepted: 05/21/2023] [Indexed: 06/20/2023] Open
Abstract
Streptococcus pneumoniae is the leading cause of community-acquired pneumonia and bacterial meningitis in children. Although pneumococcal conjugate vaccines (PCVs) are commonly available, invasive pneumococcal disease (IPD) still remains a life-threatening complication. Serotype 19A has high invasive potential and is capable of causing extensive and destructive lung disease. This strain has greater invasive potential, may have a growth advantage over other pneumococcal serotypes in normally sterile sites, and is often resistant to multiple antibiotics. Although being a component of PCV13 vaccine, serotype 19A may still be seen in fully vaccinated children and can cause invasive disease. Herein, we present four cases of IPD caused by S. pneumoniae serotype 19A who received the full regimen of PCV13 vaccination.
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Affiliation(s)
- Burcu Ceylan Cura Yayla
- Department of Pediatric Infectious Diseases, University of Health Science Ankara Training and Research Hospital, Ankara, Turkey
| | - Tugba Bedir Demirdag
- Department of Pediatric Infectious Diseases, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Emine Akkuzu
- Department of Pediatric Intensive Care Unit, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nursel Kara
- Department of Pediatric Infectious Diseases, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Hasan Tezer
- Department of Pediatric Infectious Diseases, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Anıl Tapisiz
- Department of Pediatric Infectious Diseases, Gazi University Faculty of Medicine, Ankara, Turkey
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Tsukamoto S, Nagata K, Tomii K. Management of alveolar-pleural fistula secondary to invasive pulmonary aspergillosis with bronchial occlusion using a combination of Endobronchial Watanabe Spigot and N-butyl-2-cyanoacrylate: A case report. Respirol Case Rep 2023; 11:e01163. [PMID: 37206158 PMCID: PMC10188900 DOI: 10.1002/rcr2.1163] [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] [Received: 03/17/2023] [Accepted: 05/06/2023] [Indexed: 05/21/2023] Open
Abstract
Alveolar-pleural fistulas that do not improve with thoracic drainage can be conservatively treated via endobronchial occlusion and pleurodesis, among other options. However, for inoperable cases, the treatment strategy to be followed, in the event that conventional conservative management fails, is unclear. Herein, we report a case of alveolar-pleural fistula managed by bronchial occlusion using a combination of Endobronchial Watanabe Spigot (EWS) and N-butyl-2-cyanoacrylate (NBCA). A 79-year-old man on prednisolone for interstitial pneumonia with autoimmune features was diagnosed with invasive pulmonary aspergillosis and Aspergillus pyothorax infection. He was administered voriconazole; however, a pneumothorax developed and did not improve with thoracic drainage. Bronchial occlusion with EWS failed due to spigot migration. However, a combination of EWS with NBCA could control the alveolar-pleural fistula. Thus, an EWS and NBCA combination may help prevent EWS migration, providing another option for patients who are unfit for surgery.
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Affiliation(s)
- Shinya Tsukamoto
- Department of Respiratory MedicineKobe City Medical Centre General HospitalKobeJapan
| | - Kazuma Nagata
- Department of Respiratory MedicineKobe City Medical Centre General HospitalKobeJapan
| | - Keisuke Tomii
- Department of Respiratory MedicineKobe City Medical Centre General HospitalKobeJapan
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10
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Luo Y, Wang Y. Risk Prediction Model for Necrotizing Pneumonia in Children with Mycoplasma pneumoniae Pneumonia. J Inflamm Res 2023; 16:2079-2087. [PMID: 37215376 PMCID: PMC10198274 DOI: 10.2147/jir.s413161] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/09/2023] [Indexed: 05/24/2023] Open
Abstract
Objective To analyze the predictive factors for necrotizing pneumonia (NP) in children with Mycoplasma pneumoniae pneumonia (MPP) and construct a prediction model. Methods The clinical data with MPP at the Children's Hospital of Kunming Medical University from January 2014 to November 2022 were retrospectively analyzed. Eighty-four children with MPP who developed NP were divided into the necrotizing group, and 168 children who did not develop NP were divided into the non-necrotizing group by propensity-score matching. LASSO regression was used to select the optimal factors, and multivariate logistic regression analysis was used to establish a clinical prediction model. The receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the discrimination and calibration of the nomogram. Clinical decision curve analysis was used to evaluate the clinical predictive value. Results LASSO regression analysis showed that bacterial co-infection, chest pain, LDH, CRP, duration of fever, and D-dimer were the influencing factors for NP in children with MPP (P < 0.05). The results of ROC analysis showed that the AUC of the prediction model established in this study for predicting necrotizing MPP was 0.870 (95% CI: 0.813-0.927, P < 0.001) in the training set and 0.843 (95% CI: 0.757-0.930, P < 0.001) in the validation set. The Bootstrap repeated sampling for 1000 times was used for internal validation, and the calibration curve showed that the model had good consistency. The Hosmer-Lemeshow test showed that the predicted probability of the model had a good fit with the actual probability in the training set and the validation set (P values of 0.366 and 0.667, respectively). The clinical decision curve showed that the model had good clinical application value. Conclusion The prediction model based on bacterial co-infection, chest pain, LDH, CRP, fever duration, and D-dimer has a good predictive value for necrotizing MPP.
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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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Hakimi T, Mangal M, Ibrahimi MA, Aslamzai M, Ekram K, Shiwa MH, Hakimi Z, Noory AT, Hamdard AG, Halimi SA, Jawed MA. A challenging high-risk surgery for necrotizing pneumonia in a right bilobed lung. BMC Pediatr 2023; 23:170. [PMID: 37046243 PMCID: PMC10099639 DOI: 10.1186/s12887-023-03999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/08/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Necrotizing pneumonia is rare in children and is one of the most serious complications of a lung infection caused by antibiotic failure. We present a 12-year-old leukopenic child with a long-lasting lung infection, presenting as having a lung hydatid cyst, but diagnosing with necrotizing pneumonia in the right bilobed lung. Failure to medical treatment and ongoing leukopenia justified surgical intervention with positive results. CASE PRESENTATION The patient was referred to our teaching hospital's pediatric surgery department. He had previously been diagnosed with intestinal tuberculosis (TB) and received anti-TB treatment. On referral to our hospital, the patient was suffering from restlessness, frequent coughing, fever, vomiting, and diarrhea. Following the completion of the clinical work-up, a blood test revealed leukopenia (white blood cell count of 2100/microliter), a normal platelet count, and a lesion in the right lung. Computerized tomography scanning (CT-Scan) image reported a lung hydatid cyst. In the pediatrics ward, a broad-spectrum antibiotics regimen with triple-antibiotic therapy (linezolid, vancomycin, and metronidazole) was instituted and continued for a week with no response, but worsening of the condition. In the pediatric surgery ward, our decision for surgical intervention was due to the failure of medical treatment because of a pulmonary lesion. Our team performed right lung upper lobe anterior segment wedge resection due to necrotizing pneumonia and followed the patient 45 days post-operation with a reasonable result. CONCLUSION Living in remote rural areas with low resources and inaccessibility to proper and specialized diagnostic and treatment centers will all contribute to an improper diagnosis and treatment of lung infection. In total, all of these will increase the morbidity and mortality due to lung necrosis in the pediatric population, regardless of their age. In low-resource facilities, high-risk patients can benefit from surgical intervention to control the ongoing infection process.
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Affiliation(s)
- Turyalai Hakimi
- Department of Pediatric Surgery, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan.
| | - Mohmand Mangal
- Department of Pediatrics, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
| | - Mohammad Akbar Ibrahimi
- Department of Pediatrics, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
| | - Mansoor Aslamzai
- Department of Neonatology, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
| | - Khesrow Ekram
- Department of Pediatrics, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
| | - Mohammad Hussain Shiwa
- Department of General Surgery, Kabul University of medical science, Ali Abad teaching hospital, Kabul, Afghanistan
| | - Zamaryalai Hakimi
- Department of Infectious disease, Kabul University of medical science, Ali Abad teaching hospital, Kabul, Afghanistan
| | - Abdul Tawab Noory
- Department of Infectious disease, Kabul University of medical science, Ali Abad teaching hospital, Kabul, Afghanistan
| | - Abdul Ghafar Hamdard
- Department of Dermatology, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
| | - Sultan Ahmad Halimi
- Department of Pathology, Kabul University of medical science, Kabul, Afghanistan
| | - Mohammad Anwar Jawed
- Department of Pediatric Surgery, Kabul University of medical science, Maiwand teaching hospital, Kabul, Afghanistan
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12
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Alidrisi DA, Alharthi W, Alfawaz T. Invasive Community-Acquired Methicillin-Resistant Staphylococcus aureus (MRSA) Infection in Children: A Report of Five Cases and Literature Review. Cureus 2023; 15:e37974. [PMID: 37223206 PMCID: PMC10202042 DOI: 10.7759/cureus.37974] [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: 04/19/2023] [Indexed: 05/25/2023] Open
Abstract
Staphylococcus aureus developed resistance against most antibiotics; the most known resistant form is methicillin-resistant Staphylococcus aureus (MRSA), which can be acquired either from healthcare facilities or the community. The prevalence of hospital-acquired MRSA is higher than community-acquired MRSA (CA-MRSA). CA-MRSA has become an emerging infection and has been increasingly reported recently. Usually, CA-MRSA presents with skin and soft tissue infection but can cause severe invasive infection with significant morbidity. Invasive CA-MRSA needs rapid and aggressive treatment to prevent complications. For MRSA bacteremia that is persistent despite appropriate treatment, the possibility of metastatic invasive infection should be thought of. In this case series, we describe five pediatric cases of different age groups that had different presentations for invasive CA-MRSA infection. This report aims to highlight that physicians should be aware of the growing role of CA-MRSA in pediatrics; they should be meticulous in treating patients with CA-MRSA, and be aware of the complications of this disease and the appropriate empiric and target antibiotics regimen for such infections.
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Affiliation(s)
- Dhuha A Alidrisi
- Pediatric Infectious Diseases, Security Forces Hospital Makkah, Makkah, SAU
| | - Waad Alharthi
- Pediatric Infectious Diseases, King Fahad Specialist Hospital, Dammam, SAU
| | - Tariq Alfawaz
- Pediatric Infectious Diseases, King Fahad Medical City, Riyadh, SAU
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13
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Hirai J, Mori N, Asai N, Mikamo H. Necrotizing pneumonia due to Pseudomonas aeruginosa secondary to severe COVID-19 pneumonia. Clin Case Rep 2023; 11:e7164. [PMID: 37006846 PMCID: PMC10064028 DOI: 10.1002/ccr3.7164] [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: 01/17/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
Abstract
Necrotizing pneumonia (NP) can occur as a secondary infection even if the clinical course of COVID-19 pneumonia is favorable, particularly in patients on mechanical ventilation and under immunosuppression.
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Affiliation(s)
- Jun Hirai
- Department of Clinical Infectious DiseasesAichi Medical University HospitalNagakuteJapan
- Department of Infection Control and PreventionAichi Medical University HospitalNagakuteJapan
| | - Nobuaki Mori
- Department of Clinical Infectious DiseasesAichi Medical University HospitalNagakuteJapan
- Department of Infection Control and PreventionAichi Medical University HospitalNagakuteJapan
| | - Nobuhiro Asai
- Department of Clinical Infectious DiseasesAichi Medical University HospitalNagakuteJapan
- Department of Infection Control and PreventionAichi Medical University HospitalNagakuteJapan
| | - Hiroshige Mikamo
- Department of Clinical Infectious DiseasesAichi Medical University HospitalNagakuteJapan
- Department of Infection Control and PreventionAichi Medical University HospitalNagakuteJapan
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14
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Newell R, El-Shakankery K, Bhowmik A, Rajakulasingam RK. Panton–Valentine leucocidin Staphylococcus aureus necrotising pneumonia in a clinically well patient. Br J Hosp Med (Lond) 2023; 29:1-4. [PMID: 36989153 DOI: 10.12968/hmed.2022.0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Rebecca Newell
- Department of Respiratory Medicine/Allergy, Homerton University Hospital, London, UK
- Department of Acute Medicine, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Karim El-Shakankery
- Department of Respiratory Medicine/Allergy, Homerton University Hospital, London, UK
- Department of Acute Medicine, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Angshu Bhowmik
- Department of Respiratory Medicine/Allergy, Homerton University Hospital, London, UK
- Department of Acute Medicine, Barts Health NHS Trust, Royal London Hospital, London, UK
| | - Raj K Rajakulasingam
- Department of Respiratory Medicine/Allergy, Homerton University Hospital, London, UK
- Department of Acute Medicine, Barts Health NHS Trust, Royal London Hospital, London, UK
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15
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Bharti P, Agarwal V, Kuruvilla J, Singla S. An unusual case of bronchopericardial fistula secondary to necrotizing pneumonia. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00852-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Pneumopericardium is a rare complication in patients with bacterial necrotizing pneumonia and proven to be lethal with a high incidence of mortality due to cardiopulmonary failure.
Case presentation
This is a rare case of broncho-pericardial fistula in a 21 year old, who was a known case of T-cell acute lymphoblastic leukemia status post-chemotherapy, presented with relapse of acute lymphoblastic leukemia. He was evaluated for febrile neutropenia. Further investigation showed features of necrotizing pneumonia and follow-up chest X-ray during the hospital stay showed evidence of pneumopericardium. To localize the cause, computed tomography chest was performed, further confirming the etiology of bronchopericardial fistula.
Conclusions
Our case illustrates broncho-pericardial fistula as a rare complication of necrotizing pneumonia and the utility of multimodality imaging in its diagnosis and determination of tension pneumopericardium.
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Muacevic A, Adler JR. A Case of Bronchopleural Fistula and Hydropneumothorax in a Patient With Necrotizing Pneumonia Complicated by Mycobacterium avium Complex. Cureus 2022; 14:e30280. [PMID: 36407137 PMCID: PMC9653535 DOI: 10.7759/cureus.30280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 01/25/2023] Open
Abstract
A bronchopulmonary fistula is a pathological connection that develops between the bronchi and the pleural cavity as a result of etiologies including surgery, infection, blunt or penetrating trauma, radiation, chemotherapy, and chronic obstructive pulmonary disease sequela. Diagnosis and treatment are challenging for intensivists. We present a case report of bronchopulmonary fistula resulting in hydropneumothorax caused by necrotizing pneumonia and complicated by mycobacterium avium complex that resolved spontaneously. The aim of this case report is to discuss the presentation and treatment of bronchopleural fistulas.
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17
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Singh P, Tiwari S, Yadav A, Singh S, Thareja S, Mohimen A, Dhull P, Ahuja NB, Mitra D. Pulmonary cavitation in follow-up COVID 2019 cases: An etiological perspective. Med J Armed Forces India 2022:S0377-1237(22)00098-3. [PMID: 35999863 PMCID: PMC9388290 DOI: 10.1016/j.mjafi.2022.06.015] [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: 02/26/2022] [Accepted: 06/19/2022] [Indexed: 12/01/2022] Open
Abstract
Background The current COVID-19 pandemic is an ongoing global healthcare challenge that has caused morbidity and mortality at unprecedented levels. Since the post-COVID pulmonary complications are evolving and challenging, a study was carried out to assess pulmonary cavitation in follow-up COVID cases from an etiological perspective. The aim of this study was to assess the incidence of pulmonary cavitation and describe its etiology and evolution in moderate and severe post-COVID pneumonia patients. Methods A prospective observational study of all patients admitted to our institution with moderate or severe COVID pneumonia was carried out. Some of these patients again became symptomatic after discharge and developed pulmonary cavitation on imaging. Results 6.2% (n = 37) out of 589 patients admitted to our institution with moderate or severe COVID pneumonia developed pulmonary cavitation on follow-up. We describe the imaging characteristics of post-COVID cavitation and present these patients' clinical, laboratory, and microbiological parameters. Conclusion Cavitary lung disease in patients with moderate to severe COVID-19 disease is not uncommon, and an etiological workup is necessary to institute timely and correct therapy.
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Affiliation(s)
- Priyanka Singh
- Pulmonologist, Command Hospital (Central Command), Lucknow, India
| | - Saurabh Tiwari
- Pulmonologist, Command Hospital (Central Command), Lucknow, India
| | - Aseem Yadav
- Pulmonologist, Command Hospital (Central Command), Lucknow, India
| | | | - Sandeep Thareja
- Commandant, Command Hospital (Central Command), Lucknow, India
| | - Aneesh Mohimen
- Intervention Radiologist, Command Hospital (Central Command), Lucknow, India
| | - Pawan Dhull
- Neurologist, Command Hospital (Central Command), Lucknow, India
| | - Nitin B Ahuja
- Instructor, Officers Training College, Lucknow, India
| | - Debdeep Mitra
- Dermatologist, Command Hospital (Air Force), Bengaluru, India
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Fujiki Y, Mato N, Watanabe S, Shibano T, Tonai K, Takahashi K, Saito T, Okuyama A, Takigami A, Bando M, Suzuki T, Cui L, Hagiwara K. Virulent Pseudomonas aeruginosa pneumonia in an immunocompetent adult associated with a home whirlpool bath: A case report. Respir Med Case Rep 2022; 38:101673. [PMID: 35694132 PMCID: PMC9178473 DOI: 10.1016/j.rmcr.2022.101673] [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: 01/31/2022] [Revised: 04/05/2022] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
We present a case of life-threatening pneumonia caused by Pseudomonas aeruginosa (P. aeruginosa) in a healthy 67-year-old man. Rapid disseminated infection resulted in the right hemorrhagic pneumonia and bacteremia. Antimicrobial therapy had limited effects, radical pneumonectomy eventually resolved the prolonged infection. Concurrently, we explored the environmental factors responsible for fulminant P. aeruginosa infection. Multi-locus sequence typing demonstrated that P. aeruginosa isolated from the patient was identical to that collected from home whirlpool bath by the common virulent factor gene. Massive inhalation of contaminated aerosol and pathogen virulence may have synergistically contributed to the severity in this case.
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Affiliation(s)
- Yasumaro Fujiki
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Naoko Mato
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
- Corresponding author. 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan.
| | - Shinya Watanabe
- Division of Bacteriology, School of Medicine, Jichi Medical University, Tochigi, Japan
| | - Tomoki Shibano
- Division of General Thoracic Surgery, Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Ken Tonai
- Division of Intensive Care, Department of Anesthesiology & Intensive Care Medicine, Jichi Medical University, Tochigi, Japan
| | - Kento Takahashi
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Tatsuya Saito
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Akiko Okuyama
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ayako Takigami
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Masashi Bando
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takuji Suzuki
- Department of Respirology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Longzhu Cui
- Division of Bacteriology, School of Medicine, Jichi Medical University, Tochigi, Japan
| | - Koichi Hagiwara
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Tochigi, Japan
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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) 2021; 95:298-306. [PMID: 34776098 DOI: 10.1016/j.anpede.2020.10.002] [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: 02/11/2020] [Accepted: 04/21/2020] [Indexed: 10/23/2022] 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
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, Son Espases University Hospital, Palma de Mallorca, Spain; Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain.
| | - Borja Osona
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, Son Espases University Hospital, Palma de Mallorca, Spain; Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Jose Antonio Gil
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, Son Espases University Hospital, Palma de Mallorca, Spain; Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Jose Antonio Peña-Zarza
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, Son Espases University Hospital, Palma de Mallorca, Spain; Research Group in Sleep Apnea and Hypopnea Syndrome, IdISBa, Palma de Mallorca, Spain
| | - Joan Figuerola
- Department of Pediatrics, Division of Pediatric Respiratory Medicine, Son Espases University Hospital, Palma de Mallorca, Spain; Multidisciplinary Research Group in Pediatrics, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
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20
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Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation. Infect Dis Rep 2021; 13:835-842. [PMID: 34563000 PMCID: PMC8482120 DOI: 10.3390/idr13030075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Few reports of necrotizing pneumonia in patients with COVID-19 have been published. We have observed an elevated incidence at two hospitals in our city, suggesting this complication is not uncommon, and may have been overlooked. (2) Methods: This article presents a retrospective, descriptive cohort study that was undertaken from 22 March 2020 to 15 June 2021 in two tertiary care hospitals in Medellín, Colombia. All adult patients admitted to the intensive care unit (ICU) for respiratory failure related to confirmed COVID-19, on invasive mechanical ventilation (IMV), with imaging or surgical findings documenting necrotizing pneumonia (NP) were included. (3) Results: Of 936 patients with COVID-19 that required IMV, 42 (4.5%) developed NP. Overall mortality was 57% and in-hospital mortality was 71%, occurring 15–79 days after COVID-19 diagnosis. NP was diagnosed at a median of 27 days after COVID-19 symptom onset and 15.5 days after initiation of IMV. Infections were polymicrobial in 52.4% of patients. Klebsiella pneumoniae (57%) and Pseudomonas aeruginosa (33%) were the most common etiologic agents. Pulmonary embolism (PE) was documented in 13 patients overall (31%), and in 50% of patients who underwent an angioCT. Drainage and/or surgical procedures were performed on 19 patients (45.2%) with a 75% mortality rate. (4) Conclusions: In our experience, NP is a relatively common, albeit neglected, complication in mechanically ventilated COVID-19 patients, possibly originating in poorly vascularized areas of lung parenchyma. Associated mortality is high. Although drainage procedures did not seem to favorably impact patient outcomes, diagnosis and treatment were late events in the overall disease course, suggesting that early recognition and timely treatment could have a positive impact on prognosis.
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21
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Vertelney H, Lin-Martore M. A Baffling Bump: A Case Report of an Unusual Chest Wall Mass in a Pediatric Patient. Clin Pract Cases Emerg Med 2021; 5:316-319. [PMID: 34437037 PMCID: PMC8373172 DOI: 10.5811/cpcem.2021.3.51958] [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: 01/28/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Chest wall masses are rare in children, but the differential diagnosis is broad and can include traumatic injury, neoplasm, and inflammatory or infectious causes. We report a novel case of an eight-year-old, previously healthy female who presented to the emergency department (ED) with one month of cough, fevers, weight loss, and an anterior chest wall mass. Case Report The patient’s ultimate diagnosis was necrotizing pneumonia with pneumatocele extending into the chest wall. This case is notable for the severity of the patient’s pulmonary disease given its extension through the chest wall, and for the unique speciation of her infection. Conclusion Although necrotizing pneumonia is a rare complication of community-acquired pneumonia, it is important for the emergency physician to recognize it promptly as it indicates severe progression of pulmonary disease even in children with normal and stable vital signs, as in this case. The emergency physician should consider complications of pneumonia including pneumatocele and empyema necessitans when presented with an anterior chest wall mass in a pediatric patient. Additionally, point-of-care ultrasound was used in the ED to facilitate the diagnosis of this illness and was particularly useful in determining the continuity of the patient’s lung infection with her extrathoracic chest wall mass.
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Affiliation(s)
- Haley Vertelney
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
| | - Margaret Lin-Martore
- University of California, San Francisco, Department of Emergency Medicine, San Francisco, California
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22
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Wang J, Yun L, Zhao H, Li X. Combination Therapy of Polymyxin B and Amikacin for Community-Acquired Pseudomonas aeruginosa Pneumonia with MODS in a Previously Healthy Patient: A Case Report. Infect Drug Resist 2021; 14:2895-2900. [PMID: 34349524 PMCID: PMC8327293 DOI: 10.2147/idr.s312601] [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: 03/24/2021] [Accepted: 06/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Pseudomonas aeruginosa (P. aeruginosa) is an uncommon but fatal causative pathogen for community-acquired pneumonia (CAP). Few case reports described the previously healthy individuals with CAP caused by P. aeruginosa. Case Presentation A 67-year-old male farmer was referred to our hospital with a 6-day history of fever and shortness of breath. The radiologic findings revealed a dense consolidation site in the right lung, considering infection lesion, accompanying with mediastinal and right hilar lymphadenopathy. Sputum sample results showed P. aeruginosa and multidrug-resistant Acinetobacter baumannii. The combination of polymyxin B and amikacin was given to him based on the lab results, the manifestations of the patient were alleviated and he returned to his home after a 35-day hospitalization. Conclusion We need to keep close attention to community-acquired P. aeruginosa pneumonia due to its high mortality, further studies are needed to identify the infectious source, effective examination, and optimal therapy including medications and duration.
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Affiliation(s)
- Junyu Wang
- Department of Pharmacy, Qingdao Central Hospital, Qingdao, 266042, Shandong, People's Republic of China
| | - Lu Yun
- Department of Pharmacy, Qingdao Central Hospital, Qingdao, 266042, Shandong, People's Republic of China
| | - Hong Zhao
- Department of Pharmacy, Qingdao Central Hospital, Qingdao, 266042, Shandong, People's Republic of China
| | - Xiangpeng Li
- Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao, 266003, Shandong, People's Republic of China
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23
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Sekarsari D, Handoyo S, Amal MY, Kharismarini P. Necrotizing pneumonia with bronchopleural fistula as an uncommon complication of pneumonia in children: a case report. Radiol Case Rep 2021; 16:2077-2080. [PMID: 34158897 PMCID: PMC8203581 DOI: 10.1016/j.radcr.2021.05.008] [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: 03/17/2021] [Revised: 05/04/2021] [Accepted: 05/04/2021] [Indexed: 11/04/2022] Open
Abstract
Necrotizing pneumonia is an uncommon but severe complication of community acquired pneumonia characterized by the development of necrosis, liquefaction, and cavitation of the lung parenchyma. It occurs infrequently in children, ranging from 0.8% to 7% of community acquired pneumonia cases. We reported a case of 28-month-old female infant with a history of severe dyspnea and fever 5 days before admission. After administration of appropriate antibiotics for pneumonia, the patient's condition was still unresolved. Then, contrast CT scan showed cavitary lesions within consolidated lungs with loss of volume and lack of contrast enhancement that confirmed the diagnosis as necrotizing pneumonia. The presence of pneumothorax in the patient depicts a possible bronchopleural fistula which significantly increase morbidity and mortality risk. Surgical management could not be implemented due to worsening condition of the patient. It is suggested that patients with suspicion of necrotizing pneumonia are subjected to chest CT scan to avoid delay in diagnosis and appropriate management.
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Affiliation(s)
- Damayanti Sekarsari
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Syeida Handoyo
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mohamad Yanuar Amal
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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24
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Akagi Fukushima E, Bhargava A. Unusual case of necrotizing pneumonia caused by Fusobacterium nucleatum complicating influenza a virus infection. Anaerobe 2021; 69:102342. [PMID: 33567343 DOI: 10.1016/j.anaerobe.2021.102342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 01/27/2021] [Accepted: 02/04/2021] [Indexed: 10/22/2022]
Abstract
We report a rare case of Fusobacterium nucleatum necrotizing pneumonia following an influenza viral infection. This rare bacterial lung infection can have severe complications such as respiratory failure and septic shock, so early recognition and treatment are necessary.
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Affiliation(s)
| | - Ashish Bhargava
- Division of Infectious Disease, Ascension St. John Hospital, USA.
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25
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Renduchintala K, Nanjappa S, Ramsakal A, Greene J. Successful Treatment of Community-Acquired Methicillin-Resistant Staphylococcus Aureus Necrotizing Pneumonia in the Setting of Chronic Graft-Versus-Host Disease. Cureus 2021; 13:e13123. [PMID: 33728140 PMCID: PMC7935285 DOI: 10.7759/cureus.13123] [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] [Indexed: 11/30/2022] Open
Abstract
Necrotizing pneumonia (NP) is a rare complication of community-acquired pneumonia that results in tissue necrosis and permanent destruction of the lung parenchyma. This study presents a case of a 21-year old male patient with T-cell acute lymphoblastic lymphoma who was treated with chemotherapy and matched-unrelated donor stem cell transplantation. His post-transplant course included chronic graft-versus-host disease (GVHD) and subsequent community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) necrotizing pneumonia. In addition to antibiotics, steroids were used to help blunt the proinflammatory response following CA-MRSA pneumonia and this led to a rapid improvement in our patient’s clinical course. CA-MRSA pneumonia is often treated with vancomycin. Given the nature of necrotizing pneumonia, the use of a toxin reducing agent like linezolid and adjunct therapy with corticosteroids was beneficial in the management of this disease process in our patient with chronic GVHD. Further prospective studies are needed to evaluate this regimen as a therapeutic alternative.
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Affiliation(s)
| | - Sowmya Nanjappa
- Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Asha Ramsakal
- Internal Medicine, Moffitt Cancer Center, Tampa, USA
| | - John Greene
- Infectious Diseases, Moffitt Cancer Center, Tampa, USA
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Perret C, Le Corre N, Castro-Rodriguez JA. Emergent Pneumonia in Children. Front Pediatr 2021; 9:676296. [PMID: 34222146 PMCID: PMC8247473 DOI: 10.3389/fped.2021.676296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/21/2021] [Indexed: 12/11/2022] Open
Abstract
In recent decades there have been multiple pathogens, viruses and bacteria, which have emerged as causal agents of pneumonia affecting adults, albeit less frequently, to children. For the purposes of this article we have classified emerging pathogens as follows: True emerging, to pathogens identified for the very first time affecting human population (SARS-CoV-1, SARS-CoV-2, MERS-CoV, avian influenza, and hantavirus); Re-emerging, to known pathogens which circulation was controlled once, but they have reappeared (measles, tuberculosis, antimicrobial resistant bacteria such as CA-MRSA, Mycoplasma pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and new serotypes of post-vaccine pneumococcal); and finally, those that we have called old known with new presentations, including common pathogens that, in particular condition, have changed their form of presentation (rhinovirus, and non-SARS coronavirus). We will review for each of them their epidemiology, forms of presentation, therapy, and prognosis in children compared to the adult with the aim of being able to recognize them to establish appropriate therapy, prognostics, and effective control measures.
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Affiliation(s)
- Cecilia Perret
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Nicole Le Corre
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jose A Castro-Rodriguez
- Department of Pediatric Pulmonology and Cardiology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
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27
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Widysanto A, Liem M, Puspita KD, Pradhana CML. Management of necrotizing pneumonia with bronchopleural fistula caused by multidrug-resistant Acinetobacter baumannii. Respirol Case Rep 2020; 8:e00662. [PMID: 32999723 PMCID: PMC7507560 DOI: 10.1002/rcr2.662] [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: 06/24/2020] [Revised: 08/08/2020] [Accepted: 08/24/2020] [Indexed: 11/08/2022] Open
Abstract
We report the case of a 53-year-old male that presented to our hospital with a history of a brain tumour. He was hospitalized 10 days prior in another hospital. Before surgery, he complained of mild cough. Routine chest radiography demonstrated right upper lobe consolidation which was diagnosed as hospital-acquired pneumonia. Broad-spectrum empirical antimicrobial was initiated. After surgery, his clinical condition deteriorated and he felt breathlessness. Chest radiography and computed tomography (CT) scan without contrast revealed necrotizing and cavitating pneumonia complicated by bronchopleural fistula (BPF) and hydropneumothorax. Sputum culture revealed infection of multidrug-resistant Acinetobacter baumannii (MDRAB). Despite optimal antibiotic therapy, BPF and hydropneumothorax failed to resolve and surgical approach was performed to debride the necrotic area and seal the fistula. After a month in the hospital, he was discharged and the serial chest X-ray showed good recovery of the lung.
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Affiliation(s)
- Allen Widysanto
- Department of Respiratory MedicineSiloam Hospital Lippo VillageTangerangIndonesia
- Faculty of MedicinePelita Harapan UniversityTangerangIndonesia
| | - Maranatha Liem
- Faculty of MedicinePelita Harapan UniversityTangerangIndonesia
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28
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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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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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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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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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Xia H, Gao J, Xiu M, Li D. Community-acquired pneumonia caused by methicillin-resistant Staphylococcus aureus in a Chinese adult: A case report. Medicine (Baltimore) 2020; 99:e20914. [PMID: 32590802 PMCID: PMC7329007 DOI: 10.1097/md.0000000000020914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Methicillin-resistant Staphylococcus aureus (MRSA) has been established as an important cause of severe community-acquired pneumonia (CAP) with very high mortality. Panton-Valentine leukocidin (PVL) producing MRSA has been reported to be associated with necrotizing pneumonia and worse outcome. The incidence of community-acquired MRSA (CA-MRSA) pneumonia is very low, as only a few CA-MRSA pneumonia cases were reported in the last few years. We present a case of severe CAP caused by PVL-positive MRSA with ensuing septic shock. PATIENT CONCERNS A 68-year-old male with no concerning medical history had developed a fever that reached 39.0°C, a productive cough that was sustained for 5 days, and hypodynamia. He was treated with azithromycin and alexipyretic in a nearby clinic for 2 days in which the symptoms were alleviated. However, 1 day later, the symptoms worsened, and he was taken to a local Chinese medicine hospital for traditional medicine treatment. However, his clinical condition deteriorated rapidly, and he then developed dyspnea and hemoptysis. DIAGNOSIS CA-MRSA pneumonia and septic shock. The sputum culture showed MRSA. Polymerase chain reaction of MRSA isolates was positive for PVL genes. INTERVENTIONS Mechanical ventilation, fluid resuscitation, and antibiotic therapy were performed. Antibiotic therapy included mezlocillin sodium/sulbactam sodium, linezolid, and oseltamivir. OUTCOMES He died after 12 hours of treatment. LESSONS This is a report of severe pneumonia due to PVL-positive CA-MRSA in a healthy adult. CA-MRSA should be considered a pathogen of severe CAP, especially when combined with septic shock in previously healthy individuals.
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Affiliation(s)
- Huan Xia
- Department of Respiratory Medicine
| | | | - Ming Xiu
- Department of Intensive Care Unit Group One, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Dan Li
- Department of Respiratory Medicine
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Liebler-Tenorio EM, Lambertz J, Ostermann C, Sachse K, Reinhold P. Regeneration of Pulmonary Tissue in a Calf Model of Fibrinonecrotic Bronchopneumonia Induced by Experimental Infection with Chlamydia Psittaci. Int J Mol Sci 2020; 21:ijms21082817. [PMID: 32316620 PMCID: PMC7215337 DOI: 10.3390/ijms21082817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/10/2020] [Accepted: 04/15/2020] [Indexed: 11/16/2022] Open
Abstract
Pneumonia is a cause of high morbidity and mortality in humans. Animal models are indispensable to investigate the complex cellular interactions during lung injury and repair in vivo. The time sequence of lesion development and regeneration is described after endobronchial inoculation of calves with Chlamydia psittaci. Calves were necropsied 2-37 days after inoculation (dpi). Lesions and presence of Chlamydia psittaci were investigated using histology and immunohistochemistry. Calves developed bronchopneumonia at the sites of inoculation. Initially, Chlamydia psittaci replicated in type 1 alveolar epithelial cells followed by an influx of neutrophils, vascular leakage, fibrinous exudation, thrombosis and lobular pulmonary necrosis. Lesions were most extensive at 4 dpi. Beginning at 7 dpi, the number of chlamydial inclusions declined and proliferation of cuboidal alveolar epithelial cells and sprouting of capillaries were seen at the periphery of necrotic tissue. At 14 dpi, most of the necrosis had been replaced with alveoli lined with cuboidal epithelial cells resembling type 2 alveolar epithelial cells and mild fibrosis, and hyperplasia of organized lymphoid tissue were observed. At 37 dpi, regeneration of pulmonary tissue was nearly complete and only small foci of remodeling remained. The well-defined time course of development and regeneration of necrotizing pneumonia allows correlation of morphological findings with clinical data or treatment regimen.
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Affiliation(s)
- Elisabeth M. Liebler-Tenorio
- Institute for Molecular Pathogenesis, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Naumburgerstr. 96a, 07743 Jena, Germany; (J.L.); (C.O.); (K.S.); (P.R.)
- Correspondence: ; Tel.: +49-3641-804-2411
| | - Jacqueline Lambertz
- Institute for Molecular Pathogenesis, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Naumburgerstr. 96a, 07743 Jena, Germany; (J.L.); (C.O.); (K.S.); (P.R.)
- Chemisches und Veterinäruntersuchungsamt Rhein-Ruhr-Wupper (CVUA-RRW), Deutscher Ring 100, 47798 Krefeld, Germany
| | - Carola Ostermann
- Institute for Molecular Pathogenesis, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Naumburgerstr. 96a, 07743 Jena, Germany; (J.L.); (C.O.); (K.S.); (P.R.)
| | - Konrad Sachse
- Institute for Molecular Pathogenesis, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Naumburgerstr. 96a, 07743 Jena, Germany; (J.L.); (C.O.); (K.S.); (P.R.)
- Institute of Bioinformatics, Friedrich-Schiller-Universität Jena, Leutragraben 1, 07743 Jena, Germany
| | - Petra Reinhold
- Institute for Molecular Pathogenesis, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Naumburgerstr. 96a, 07743 Jena, Germany; (J.L.); (C.O.); (K.S.); (P.R.)
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Dalponte RDS, Heluany GCV, Michels M, Madeira K, Prado CDE. Surgical treatment of necrotizing pneumonia in children: a 10-year assessment. ACTA ACUST UNITED AC 2020; 47:e20202374. [PMID: 32236292 DOI: 10.1590/0100-6991e-20202374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/11/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Necrotizing pneumonia (PNZ) is a severe and rare complication of a community-acquired pneumonia, affecting mainly children. We aimed to analyze medical records of children undergoing surgical treatment for PNZ and compare our results with those found in the medical literature. METHODS Retrospective analysis of children's medical charts who underwent an operation for PNZ, between July 2006 and July 2016, in two hospitals in southern Santa Catarina, Brazil. RESULTS A total of 26 children with a median age of 2.70 years and mostly females (61.5%) were included in the current study. The main symptoms were fever (88.5%) and cough (65.4%). There was an average use of 4.31 antibiotics per patient. The primary etiological agent was Staphylococcus aureus (23.1%), but cultures were negative in 69% of the patients. Decortication and debridement of necrotic areas were performed in 23 patients (88.5%). The mean postoperative pleural drainage was 8.12 days. The presence of bronchopleural fistula occurred in 50.0% in the preoperative period and 46.2% in the postoperative. The total length of hospital stay was, on average, 27.52 days and the postoperative length of stay was 12.60 days (mean). Postoperative complications occurred in 13 children and there was no mortality. CONCLUSION The surgical approach is indicated to patients with no response to clinical treatment. Late surgical intervention is associated with progressive parenchyma infection and higher rates of complications. Surgery can lead to better clinical outcomes and earlier recovery.
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Affiliation(s)
| | | | - Monique Michels
- Universidade do Extremo Sul Catarinense, Laboratório de Fisiopatologia Experimental - Criciuma - Santa Catarina - Brasil
| | - Kristian Madeira
- Universidade do Extremo Sul Catarinense, Laboratório de Epidemiologia - Criciuma - Santa Catarina - Brasil
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35
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de Benedictis FM, Carloni I. Management of necrotizing pneumonia in children: Time for a patient-oriented approach. Pediatr Pulmonol 2019; 54:1351-1353. [PMID: 31254327 DOI: 10.1002/ppul.24412] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 11/09/2022]
Affiliation(s)
| | - Ines Carloni
- Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy
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36
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Feki W, Ketata W, Bahloul N, Ayadi H, Yangui I, Kammoun S. [Lung abscess: Diagnosis and management]. Rev Mal Respir 2019; 36:707-719. [PMID: 31202603 DOI: 10.1016/j.rmr.2018.07.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 07/09/2018] [Indexed: 11/29/2022]
Abstract
Lung abscesses are necrotic cavitary lesions of the lung parenchyma. They are usually caused by anaerobic bacteria or mixed flora and typically occur after aspiration. Primary lung abscesses occur in previously healthy patients with no underlying medical disorders and are usually solitary. Secondary lung abscesses occur in patients with underlying or predisposing conditions and may be multiple. The initial diagnosis is usually made by chest radiography showing a lung cavity with an air-fluid level. Typically, the cavity wall is thick and irregular, and a surrounding pulmonary infiltrate is often present. The differential diagnosis of pulmonary cavitation is wide, including different types of possible infections, neoplasia and malformations of the bronchial tree. Management is usually based on prolonged antibiotic treatment. Failure of conservative management, manifested by the persistence of sepsis and/or other abscess complications, may necessitate drainage with invasive techniques (percutaneous, endoscopic or surgical) or open surgical removal of the lung lesion in patients with good performance status and sufficient respiratory reserve.
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Affiliation(s)
- W Feki
- Service de pneumologie de Sfax, hôpital Hédi Chaker, route Ain km 0,5, Sfax 3029, Tunisie; Université de Sfax, Sfax, Tunisie.
| | - W Ketata
- Service de pneumologie de Sfax, hôpital Hédi Chaker, route Ain km 0,5, Sfax 3029, Tunisie; Université de Sfax, Sfax, Tunisie
| | - N Bahloul
- Service de pneumologie de Sfax, hôpital Hédi Chaker, route Ain km 0,5, Sfax 3029, Tunisie; Université de Sfax, Sfax, Tunisie
| | - H Ayadi
- Service de pneumologie de Sfax, hôpital Hédi Chaker, route Ain km 0,5, Sfax 3029, Tunisie; Université de Sfax, Sfax, Tunisie
| | - I Yangui
- Service de pneumologie de Sfax, hôpital Hédi Chaker, route Ain km 0,5, Sfax 3029, Tunisie; Université de Sfax, Sfax, Tunisie
| | - S Kammoun
- Service de pneumologie de Sfax, hôpital Hédi Chaker, route Ain km 0,5, Sfax 3029, Tunisie; Université de Sfax, Sfax, Tunisie
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Preventing lung pathology and mortality in rabbit Staphylococcus aureus pneumonia models with cytotoxin-neutralizing monoclonal IgGs penetrating the epithelial lining fluid. Sci Rep 2019; 9:5339. [PMID: 30926865 PMCID: PMC6441091 DOI: 10.1038/s41598-019-41826-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 03/19/2019] [Indexed: 12/23/2022] Open
Abstract
Staphylococcus aureus pneumonia is associated with high mortality irrespective of antibiotic susceptibility. Both MRSA and MSSA strains produce powerful cytotoxins: alpha-hemolysin(Hla) and up to five leukocidins - LukSF-PV, HlgAB, HlgCB, LukED and LukGH (LukAB) - to evade host innate defense mechanisms. Neutralizing cytotoxins has been shown to provide survival benefit in rabbit S. aureus pneumonia models. We studied the mechanisms of protection of ASN100, a combination of two human monoclonal antibodies (mAbs), ASN-1 and ASN-2, that together neutralize Hla and the five leukocidins, in rabbit MRSA and MSSA pneumonia models. Upon prophylactic passive immunization, ASN100 displayed dose-dependent increase in survival and was fully protective against all S. aureus strains tested at 5 or 20 mg/kg doses. Macroscopic and microscopic lung pathology, edema rate, and bacterial burden were evaluated 12 hours post infection and reduced by ASN100. Pharmacokinetic analysis of ASN100 in bronchoalveolar-lavage fluid from uninfected animals detected efficient penetration to lung epithelial lining fluid reaching peak levels between 24 and 48 hours post dosing that were comparable to the mAb concentration measured in serum. These data confirm that the ASN100 mAbs neutralize the powerful cytotoxins of S. aureus in the lung and prevent damage to the mucosal barrier and innate immune cells.
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Egyud M, Suzuki K. Post-resection complications: abscesses, empyemas, bronchopleural fistulas. J Thorac Dis 2018; 10:S3408-S3418. [PMID: 30505528 PMCID: PMC6218366 DOI: 10.21037/jtd.2018.08.48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/07/2018] [Indexed: 11/06/2022]
Abstract
The role of thoracic surgeons in the management of pulmonary infection has evolved over time as the medical treatments have improved. We herein review historical and current management for surgically-treated pulmonary infections-lung abscesses, empyemas, and bronchopleural fistulas. In particular, we review when the surgeons need to be involved for infectious cases, our algorithm/approach to empyemas, and summary of post-operative bronchopleural fistula in tuberculosis cases.
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Affiliation(s)
- Matthew Egyud
- Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
| | - Kei Suzuki
- Department of Surgery, Division of Thoracic Surgery, Boston University School of Medicine, Boston, MA, USA
- Boston Medical Center, Boston, MA, USA
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Gafoor K, Patel S, Girvin F, Gupta N, Naidich D, Machnicki S, Brown KK, Mehta A, Husta B, Ryu JH, Sarosi GA, Franquet T, Verschakelen J, Johkoh T, Travis W, Raoof S. Cavitary Lung Diseases. Chest 2018. [DOI: 10.1016/j.chest.2018.02.026] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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40
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Hilton B, Tavare AN, Creer D. Necrotising pneumonia caused by non-PVL Staphylococcus aureus with 2-year follow-up. BMJ Case Rep 2017; 2017:bcr-2017-221779. [PMID: 29222217 DOI: 10.1136/bcr-2017-221779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Necrotising pneumonia (NP) is a rare but life-threatening complication of pulmonary infection. It is characterised by progressive necrosis of lung parenchyma with cavitating foci evident upon radiological investigation. This article reports the case of a 52-year-old woman, immunocompetent healthcare professional presenting to Accident and Emergency with NP and Staphylococcus aureus septicaemia. The cavitating lesion was not identified on initial chest X-ray leading to a delay in antimicrobial optimisation. However, the patient went on to achieve a full symptomatic recovery in 1 month and complete radiological recovery at 2-year follow-up. Long-term prognosis for adult cases of NP currently remains undocumented. This case serves as the first piece of published evidence documenting full physiological and radiological recovery following appropriate treatment of NP in an immunocompetent adult patient.
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Affiliation(s)
- Bryn Hilton
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aniket N Tavare
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Dean Creer
- Department of Respiratory Medicine, Royal Free London NHS Foundation Trust, London, UK
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Lee S, Cho K, Alfajaro MM, Lee J, Yu D, Choi J. Use of computed tomography and minimum intensity projection in the detection of lobar pneumonia mimicking lung lobe torsion in a dog. Vet Radiol Ultrasound 2017; 60:E48-E53. [DOI: 10.1111/vru.12565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 06/26/2017] [Accepted: 08/04/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sang‐Kwon Lee
- College of Veterinary Medicine and BK 21 Plus Project TeamChonnam National University Gwangju 61186 South Korea
| | - Kyoung‐Oh Cho
- College of Veterinary Medicine and BK 21 Plus Project TeamChonnam National University Gwangju 61186 South Korea
| | - Mia Madel Alfajaro
- College of Veterinary Medicine and BK 21 Plus Project TeamChonnam National University Gwangju 61186 South Korea
| | - Juhwan Lee
- Chonnam National University Veterinary Teaching Hospital Gwangju 61186 South Korea
| | - Dohyeon Yu
- College of Veterinary MedicineGyeongsang National University Jinju 52828 South Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK 21 Plus Project TeamChonnam National University Gwangju 61186 South Korea
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Alzomor O, Alfawaz T, Alshahrani D. Invasive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in children: case series and literature review. Int J Pediatr Adolesc Med 2017; 4:119-123. [PMID: 30805514 PMCID: PMC6372568 DOI: 10.1016/j.ijpam.2017.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/08/2017] [Accepted: 07/11/2017] [Indexed: 12/31/2022]
Abstract
The majority of CA-MRSA infections present as skin and soft tissue infections such as abscesses or cellulitis. However, CA-MRSA can cause invasive infections such as joint infections, necrotizing pneumonia or septicemia. Here we describe five cases with CA-MRSA bacteremia complicated with osteoarticular infection, necrotizing pneumonia, and infective endocarditis. We report these case series to outline the spectrum of invasive CA-MRSA diseases and to demonstrate clinical outcome. Early proper intervention with regular revisiting the empirical treatment based on local susceptibility data is crucial. More data on the risk factors for acquiring and spread of CA-MRSA in children are required.
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Affiliation(s)
- Omar Alzomor
- Section of Pediatric Infectious Diseases, Children's Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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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: 70] [Impact Index Per Article: 10.0] [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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Necrotizing Pseudomonas aeruginosa Community-Acquired Pneumonia: A Case Report and Review of the Literature. Case Rep Infect Dis 2017; 2017:1717492. [PMID: 28596927 PMCID: PMC5449726 DOI: 10.1155/2017/1717492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 04/19/2017] [Accepted: 04/26/2017] [Indexed: 01/09/2023] Open
Abstract
Lung cavities are not typically associated with community-acquired pneumonia (CAP). CAP due to P. aeruginosa is rare and even less commonly causes necrotizing pneumonia. We report a case of P. aeruginosa CAP that progressed to necrotizing pneumonia and was eventually fatal. Procalcitonin (PCT) has been well investigated in guiding antibiotic therapy (especially CAP) in adults. In this case, PCT at presentation and sequentially was negative. We discuss this caveat and present hypotheses as to the sensitivity and specificity of PCT and C-reactive protein (CRP) in these patients. To better characterize P. aeruginosa CAP, we undertook a review of cases indexed in PubMed from 2001 to 2016 (n = 9). The data reveal that risk factors for P. aeruginosa CAP include smoking, alcohol use, obstructive lung disease, sinusitis, and hot tub use. The route of infection for P. aeruginosa CAP remains unknown. One of the most interesting findings on reviewing cases was that P. aeruginosa CAP involves the right upper lobe in the vast majority. We suggest that when physicians in the community see patients with distinctly upper lobe necrotizing or cavitary pneumonia, they should consider P. aeruginosa in their differential diagnosis. Further studies are needed to clarify route of infection, role of PCT and CRP, and optimal therapy including drug and duration.
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Seo H, Cha S, Shin K, Lim J, Yoo S, Lee J, Lee S, Kim C, Park J, Lee W. Clinical relevance of necrotizing change in patients with community-acquired pneumonia. Respirology 2017; 22:551-558. [PMID: 27862706 PMCID: PMC7169103 DOI: 10.1111/resp.12943] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 06/22/2016] [Accepted: 08/22/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVE Few studies have analysed a large number of patients with necrotizing pneumonia (NP) diagnosed based on computed tomography (CT) scans. The aim of the present study was to document the incidence and clinical features of NP in patients with community-acquired pneumonia (CAP). METHODS This retrospective study was conducted on CAP patients who had been admitted to a tertiary referral centre and who had available enhanced CT scan images. Patients were allocated into NP and non-NP groups, and they were compared with respect to various clinical variables. RESULTS Of the 830 patients included in the present study, necrotizing change was observed in 103 patients (12%). Patients with NP experienced more symptoms of pneumonia, had higher blood levels of inflammatory markers and more often required pleural drainage compared to patients with non-NP. Although the use of mechanical ventilation, vasopressor infusion, 30-day mortality, in-hospital mortality and clinical deterioration did not differ between the NP and non-NP groups, the median length of hospital stay (LOS) was significantly longer in the NP group. Multivariate analysis using Cox proportional hazards model showed that necrotizing change independently predicted LOS in patients with CAP. CONCLUSION NP affects approximately one-tenth of hospitalized CAP patients. It may be associated with more severe clinical manifestations and may increase the need for pleural drainage. NP was found to be an independent predictor of LOS, but not of mortality in CAP patients.
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Affiliation(s)
- Hyewon Seo
- Department of Internal MedicineKyungpook National University School of MedicineDaeguKorea
| | - Seung‐Ick Cha
- Department of Internal MedicineKyungpook National University School of MedicineDaeguKorea
| | - Kyung‐Min Shin
- Department of RadiologyKyungpook National University School of MedicineDaeguKorea
| | - Jae‐Kwang Lim
- Department of RadiologyKyungpook National University School of MedicineDaeguKorea
| | - Seung‐Soo Yoo
- Department of Internal MedicineKyungpook National University School of MedicineDaeguKorea
| | - Jaehee Lee
- Department of Internal MedicineKyungpook National University School of MedicineDaeguKorea
| | - Shin‐Yup Lee
- Department of Internal MedicineKyungpook National University School of MedicineDaeguKorea
| | - Chang‐Ho Kim
- Department of Internal MedicineKyungpook National University School of MedicineDaeguKorea
| | - Jae‐Yong Park
- Department of Internal MedicineKyungpook National University School of MedicineDaeguKorea
| | - Won‐Kee Lee
- Department of Preventive MedicineKyungpook National University School of MedicineDaeguKorea
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Lee KY. Pneumonia, Acute Respiratory Distress Syndrome, and Early Immune-Modulator Therapy. Int J Mol Sci 2017; 18:ijms18020388. [PMID: 28208675 PMCID: PMC5343923 DOI: 10.3390/ijms18020388] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/14/2017] [Accepted: 02/06/2017] [Indexed: 12/21/2022] Open
Abstract
Acute respiratory distress syndrome (ARDS) is caused by infectious insults, such as pneumonia from various pathogens or related to other noninfectious events. Clinical and histopathologic characteristics are similar across severely affected patients, suggesting that a common mode of immune reaction may be involved in the immunopathogenesis of ARDS. There may be etiologic substances that have an affinity for respiratory cells and induce lung cell injury in cases of ARDS. These substances originate not only from pathogens, but also from injured host cells. At the molecular level, these substances have various sizes and biochemical characteristics, classifying them as protein substances and non-protein substances. Immune cells and immune proteins may recognize and act on these substances, including pathogenic proteins and peptides, depending upon the size and biochemical properties of the substances (this theory is known as the protein-homeostasis-system hypothesis). The severity or chronicity of ARDS depends on the amount of etiologic substances with corresponding immune reactions, the duration of the appearance of specific immune cells, or the repertoire of specific immune cells that control the substances. Therefore, treatment with early systemic immune modulators (corticosteroids and/or intravenous immunoglobulin) as soon as possible may reduce aberrant immune responses in the potential stage of ARDS.
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Affiliation(s)
- Kyung-Yil Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea.
- Department of Pediatrics, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon 34943, Korea.
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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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Improved Protection in a Rabbit Model of Community-Associated Methicillin-Resistant Staphylococcus aureus Necrotizing Pneumonia upon Neutralization of Leukocidins in Addition to Alpha-Hemolysin. Antimicrob Agents Chemother 2016; 60:6333-40. [PMID: 27527081 DOI: 10.1128/aac.01213-16] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/06/2016] [Indexed: 12/31/2022] Open
Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), especially the USA300 pulsotype, is a frequent cause of skin and soft tissue infections and severe pneumonia. Despite appropriate antibiotic treatment, complications are common and pneumonia is associated with high mortality. S. aureus strains express multiple cytotoxins, including alpha-hemolysin (Hla) and up to five bicomponent leukocidins that specifically target phagocytic cells for lysis. CA-MRSA USA300 strains carry the genes for all six cytotoxins. Species specificity of the leukocidins greatly contributes to the ambiguity regarding their role in S. aureus pathogenesis. We performed a comparative analysis of the leukocidin susceptibility of human, rabbit, and mouse polymorphonuclear leukocytes (PMNs) to assess the translational value of mouse and rabbit S. aureus models. We found that mouse PMNs were largely resistant to LukSF-PV, HlgAB, and HlgCB and susceptible only to LukED, whereas rabbit and human PMNs were highly sensitive to all these cytotoxins. In the rabbit pneumonia model with a USA300 CA-MRSA strain, passive immunization with a previously identified human monoclonal antibody (MAb), Hla-F#5, which cross-neutralizes Hla, LukSF-PV, HlgAB, HlgCB, and LukED, provided full protection, whereas an Hla-specific MAb was only partially protective. In the mouse USA300 CA-MRSA pneumonia model, both types of antibodies demonstrated full protection, suggesting that Hla, but not leukocidin(s), is the principal virulence determinant in mice. As the rabbit recapitulates the high susceptibility to leukocidins characteristic of humans, this species represents a valuable model for assessing novel, cytotoxin-targeting anti-S. aureus therapeutic approaches.
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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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