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Andrés Sacristán P, Montero Gato J, Vázquez NL, Rodeño Fernández L. Neonatal lung ultrasound: early diagnosis of necrotizing pneumonia. An Pediatr (Barc) 2024; 100:155-157. [PMID: 38262818 DOI: 10.1016/j.anpede.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/28/2023] [Indexed: 01/25/2024] Open
Affiliation(s)
| | - Jon Montero Gato
- Hospital Universitario Basurto, Unidad Neonatal, Bilbao, Vizcaya, Spain
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2
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Kocer SY, Hull NC, Dean Potter D, Madigan T, Boland JM, Demirel N. Late development of pneumatoceles in necrotizing pneumonia. Pediatr Pulmonol 2024; 59:502-505. [PMID: 38014600 DOI: 10.1002/ppul.26777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/09/2023] [Accepted: 11/18/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Sila Y Kocer
- Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - Nathan C Hull
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Donald Dean Potter
- Department of Surgery, Division of Pediatric Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Theresa Madigan
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer M Boland
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nadir Demirel
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Pulmonology, Mayo Clinic, Rochester, Minnesota, USA
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López JR, González JJM, Rivas RDP. Necrotizing Pneumonia Due to Dialister Pneumosintes. Arch Bronconeumol 2023; 59:593-594. [PMID: 37407338 DOI: 10.1016/j.arbres.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
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Correia RS. Necrotizing pneumonia in intensive care unit. Pan Afr Med J 2023; 45:132. [PMID: 37790149 PMCID: PMC10543982 DOI: 10.11604/pamj.2023.45.132.40882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/09/2023] [Indexed: 10/05/2023] Open
Affiliation(s)
- Rui Soares Correia
- Department of Internal Medicine, Centro Hospitalar de Tondela-Viseu, Avenida Rei D Duarte, 3504-509 Viseu, Portugal
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Hrubovčák J, Tulinský U, Ihnát P, Jelínek P, Slívová I, Mitták M, Roman J, Stránský J. Is abdominal pain after an injury just an injury? Case report of rare aspiration pneumonia with lung gangrene and peritoneal response in a 5-year-old child. Cas Lek Cesk 2023; 162:160-163. [PMID: 37734942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Although pneumonia presents a relatively common diagnosis, it does not always present with classic clinical symptoms, nor does it follow a regular course without complications. The presented case describes a rare case of aspiration necrotizing pneumonia, which despite intensive therapy, progressed to lung gangrene and required a lung lobectomy. Another peculiarity is that the correct diagnosis was established only after the onset of abdominal pain, surprisingly by a trauma surgeon. This case emphasizes the necessity of a thorough general examination and draws attention to a rare, but conservatively intractable necrotizing pneumonia complicated by lung gangrene.
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钱 婧, 魏 友, 程 毅, 张 奕, 彭 博, 朱 春. [Analysis of clinical features and risk factors of necrotizing pneumonia in children]. Beijing Da Xue Xue Bao Yi Xue Ban 2022; 54:541-547. [PMID: 35701133 PMCID: PMC9197706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To investigate the clinical characteristics and risk factor analysis of necrotizing pneumonia in children. METHODS A retrospective study was used to analyze the case data of 218 children with severe pneumonia hospitalized in the Department of Respiratory Medicine, Children's Hospital of Capital Institute of Pediatrics from January 2016 to January 2020, and they were divided into 96 cases in the necrotizing pneumonia group (NP group) and 122 cases in the non-necrotizing pneumonia group (NNP group) according to whether necrosis of the lung occurred. The differences in clinical characteristics (malnutrition, fever duration, hospitalization time, imaging performance, treatment and regression follow-up), laboratory tests [leukocytes, neutrophil ratio, platelet (PLT), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and lactate dehydrogenase (LDH)] and bronchoscopic performance between the two groups were compared, and Logistic regression analysis of clinical risk factors associated with necrotizing pneumonia was performed to further determine the maximum diagnostic value of each index by subject operating characteristic curve (ROC). The critical value of each index was further determined by the ROC. RESULTS The differences in age, gender, pathogenic classification, and bronchoscopic presentation between the two groups of children were not statistically significant (P>0.05); whereas the imaging uptake time of the children in the NP group was higher than that in the NNP group (P < 0.05). The differences in malnutrition, fever duration, length of stay, white blood cell count, neutrophil ratio, CRP, PCT, and D-dimer were statistically significant between the two groups (P < 0.05). The imaging uptake time was lower in children under 6 years of age than in those over 6 years of age, and the imaging uptake time for bronchoalveolar lavage within 10 d of disease duration was lower than that for those over 10 d; the imaging uptake time was significantly longer in the mixed infection group than that in the single pathogen infection group. Logistic regression analysis of the two groups revealed that the duration of fever, hospital stay, CRP, PCT, and D-dimer were risk factors for secondary pulmonary necrosis (P < 0.001, P < 0.001, P < 0.001, P=0.013, P=0.001, respectively). The ROC curves for fever duration, CRP, PCT, and D-dimer were plotted and found to have diagnostic value for predicting the occurrence of pulmonary necrosis when fever duration >11.5 d, CRP >48.35 mg/L, and D-dimer > 4.25 mg/L [area under ROC curve (AUC)=0.909, 0.836, and 0.747, all P < 0.001]. CONCLUSION Children with necrotizing pneumonia have a longer heat course and hospital stay, and the imaging uptake time of mixed pathogenic infections is significantly longer than that of single pathogenic infections. Children with necrotizing pneumonia under 6 years of age have more advantageous efficacy of electronic bronchoscopic alveolar lavage within 10 d of disease duration compared with children in the group over 6 years of age and children in the group with disease duration >10 d. Inflammatory indexes CRP, PCT, and D-dimer are significantly higher. The heat course, CRP, PCT, and D-dimer are risk factors for secondary lung necrosis in severe pneumonia. Heat course >11.5 d, CRP >48.35 mg/L, and D-dimer >4.25 mg/L have high predictive value for the diagnosis of necrotizing pneumonia.
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Affiliation(s)
- 婧 钱
- 首都儿科研究所附属儿童医院呼吸内科,国家临床重点专科,北京 100020Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, National Key Clinical Specialty, Beijing 100020, China
| | - 友加 魏
- 首都儿科研究所附属儿童医院呼吸内科,国家临床重点专科,北京 100020Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, National Key Clinical Specialty, Beijing 100020, China
| | - 毅菁 程
- 首都儿科研究所大数据中心,北京 100020Big Data Center of Capital Institute of Pediatrics, Beijing 100020, China
| | - 奕 张
- 首都儿科研究所附属儿童医院呼吸内科,国家临床重点专科,北京 100020Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, National Key Clinical Specialty, Beijing 100020, China
| | - 博 彭
- 首都儿科研究所附属儿童医院呼吸内科,国家临床重点专科,北京 100020Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, National Key Clinical Specialty, Beijing 100020, China
| | - 春梅 朱
- 首都儿科研究所附属儿童医院呼吸内科,国家临床重点专科,北京 100020Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, National Key Clinical Specialty, Beijing 100020, China
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7
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钱 婧, 魏 友, 程 毅, 张 奕, 彭 博, 朱 春. [Analysis of clinical features and risk factors of necrotizing pneumonia in children]. Beijing Da Xue Xue Bao Yi Xue Ban 2022; 54:541-547. [PMID: 35701133 PMCID: PMC9197706 DOI: 10.19723/j.issn.1671-167x.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To investigate the clinical characteristics and risk factor analysis of necrotizing pneumonia in children. METHODS A retrospective study was used to analyze the case data of 218 children with severe pneumonia hospitalized in the Department of Respiratory Medicine, Children's Hospital of Capital Institute of Pediatrics from January 2016 to January 2020, and they were divided into 96 cases in the necrotizing pneumonia group (NP group) and 122 cases in the non-necrotizing pneumonia group (NNP group) according to whether necrosis of the lung occurred. The differences in clinical characteristics (malnutrition, fever duration, hospitalization time, imaging performance, treatment and regression follow-up), laboratory tests [leukocytes, neutrophil ratio, platelet (PLT), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and lactate dehydrogenase (LDH)] and bronchoscopic performance between the two groups were compared, and Logistic regression analysis of clinical risk factors associated with necrotizing pneumonia was performed to further determine the maximum diagnostic value of each index by subject operating characteristic curve (ROC). The critical value of each index was further determined by the ROC. RESULTS The differences in age, gender, pathogenic classification, and bronchoscopic presentation between the two groups of children were not statistically significant (P>0.05); whereas the imaging uptake time of the children in the NP group was higher than that in the NNP group (P < 0.05). The differences in malnutrition, fever duration, length of stay, white blood cell count, neutrophil ratio, CRP, PCT, and D-dimer were statistically significant between the two groups (P < 0.05). The imaging uptake time was lower in children under 6 years of age than in those over 6 years of age, and the imaging uptake time for bronchoalveolar lavage within 10 d of disease duration was lower than that for those over 10 d; the imaging uptake time was significantly longer in the mixed infection group than that in the single pathogen infection group. Logistic regression analysis of the two groups revealed that the duration of fever, hospital stay, CRP, PCT, and D-dimer were risk factors for secondary pulmonary necrosis (P < 0.001, P < 0.001, P < 0.001, P=0.013, P=0.001, respectively). The ROC curves for fever duration, CRP, PCT, and D-dimer were plotted and found to have diagnostic value for predicting the occurrence of pulmonary necrosis when fever duration >11.5 d, CRP >48.35 mg/L, and D-dimer > 4.25 mg/L [area under ROC curve (AUC)=0.909, 0.836, and 0.747, all P < 0.001]. CONCLUSION Children with necrotizing pneumonia have a longer heat course and hospital stay, and the imaging uptake time of mixed pathogenic infections is significantly longer than that of single pathogenic infections. Children with necrotizing pneumonia under 6 years of age have more advantageous efficacy of electronic bronchoscopic alveolar lavage within 10 d of disease duration compared with children in the group over 6 years of age and children in the group with disease duration >10 d. Inflammatory indexes CRP, PCT, and D-dimer are significantly higher. The heat course, CRP, PCT, and D-dimer are risk factors for secondary lung necrosis in severe pneumonia. Heat course >11.5 d, CRP >48.35 mg/L, and D-dimer >4.25 mg/L have high predictive value for the diagnosis of necrotizing pneumonia.
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Affiliation(s)
- 婧 钱
- 首都儿科研究所附属儿童医院呼吸内科,国家临床重点专科,北京 100020Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, National Key Clinical Specialty, Beijing 100020, China
| | - 友加 魏
- 首都儿科研究所附属儿童医院呼吸内科,国家临床重点专科,北京 100020Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, National Key Clinical Specialty, Beijing 100020, China
| | - 毅菁 程
- 首都儿科研究所大数据中心,北京 100020Big Data Center of Capital Institute of Pediatrics, Beijing 100020, China
| | - 奕 张
- 首都儿科研究所附属儿童医院呼吸内科,国家临床重点专科,北京 100020Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, National Key Clinical Specialty, Beijing 100020, China
| | - 博 彭
- 首都儿科研究所附属儿童医院呼吸内科,国家临床重点专科,北京 100020Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, National Key Clinical Specialty, Beijing 100020, China
| | - 春梅 朱
- 首都儿科研究所附属儿童医院呼吸内科,国家临床重点专科,北京 100020Department of Respiratory Medicine, Children's Hospital Affiliated to Capital Institute of Pediatrics, National Key Clinical Specialty, Beijing 100020, China
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Olivo Freites C, Sy H, Miguez P, Salonia J. Uncommon pathogens in an immunocompetent host: respiratory isolation of Cunninghamella bertholletiae, Aspergillus niger, Staphylococcus pseudintermedius and adenovirus in a patient with necrotising pneumonia. BMJ Case Rep 2022; 15:e240484. [PMID: 34992060 PMCID: PMC8738981 DOI: 10.1136/bcr-2020-240484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/03/2022] Open
Abstract
We present the unusual case of a 60-year-old immunocompetent woman with chronic obstructive pulmonary disease who developed a necrotising pneumonia with isolation of Cunninghamella bertholletiae, Aspergillus niger, Staphylococcus pseudintermedius and adenovirus. The patient recovered with antimicrobial therapy and supportive care in the intensive care unit. The current literature on diagnosis and treatment of these pathogens is reviewed.
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Affiliation(s)
| | - Hendrik Sy
- Internal Medicine, Mount Sinai Health System, New York, New York, USA
| | - Patricia Miguez
- Internal Medicine, Mount Sinai Health System, New York, New York, USA
| | - James Salonia
- Pulmonary and Critical Care Medicine, Mount Sinai Health System, New York, New York, USA
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9
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González-Peris S, Campins M, García-García JJ, Díaz-Conradi Á, Domínguez Á, Ciruela P, de Sevilla MF, Hernández S, Muñoz-Almagro C, Izquierdo C, Codina G, Uriona S, Esteva C, Solé-Ribalta A, Soldevila N, Planes AM, Martínez-Osorio J, Salleras L, Moraga-Llop F. Necrotizing pneumonia due to Streptococcus pneumoniae in children during the period of non-systematic use of PCV13 in Catalonia, Spain. Enferm Infecc Microbiol Clin (Engl Ed) 2021; 39:486-492. [PMID: 34865709 DOI: 10.1016/j.eimce.2020.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/15/2020] [Indexed: 06/13/2023]
Abstract
BACKGROUND Some studies have observed an increased incidence of necrotizing pneumonia (NP) in recent years. This might be related to the emergence of non-vaccine S. pneumoniae serotypes after PCV7 introduction although it is suggested that evolutionary factors may have modified the virulence and the interactions of pneumococci. The aim of this study was to clinically and microbiologically define NP in the population served by the three major paediatric hospitals in Barcelona (Catalonia, Spain). METHODS A prospective observational study was conducted in patients <18 years hospitalized due to invasive pneumococcal disease (January 2012-June 2016). Data of confirmed cases of pneumococcal NP (diagnosed by culture or DNA detection and serotyped) were collected. PCV13 was not systematically administered in Catalonia during the study period, but was available in the private market so the vaccination coverage in children increased from 48.2% to 74.5%. RESULTS 35 cases of NP were identified. 77.1% of cases were associated with empyema. In the first 4 years, a trend to a decrease in NP incidence was observed (p=0.021), especially in children <5 years (p=0.006). Serotype 3 was responsible for 48.6% of NP cases. Five patients with NP due to serotype 3 were fully vaccinated for their age with PCV13. CONCLUSIONS Serotype 3 has a preeminent role in pneumococcal NP and was associated with all PCV13 vaccination failures. Although in our series the incidence does not seem to be increasing, evolution of pneumococcal NP rates should be monitored after inclusion of PCV13 in the systematic calendar.
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Affiliation(s)
| | - Magda Campins
- Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Juan José García-García
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | | | - Ángela Domínguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | - Pilar Ciruela
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Mariona F de Sevilla
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Malalties Prevenibles amb Vacunes, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | | | - Carmen Muñoz-Almagro
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Departament de Medicina, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Conchita Izquierdo
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Agència de Salut Pública de Catalunya, Barcelona, Spain
| | - Gemma Codina
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sonia Uriona
- Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grup de Recerca en Epidemiologia i Salut Pública, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Cristina Esteva
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Anna Solé-Ribalta
- Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Núria Soldevila
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Luis Salleras
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Departament de Medicina, Universitat de Barcelona, Barcelona, Spain
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Abstract
BACKGROUND Necrotizing pneumonia (NP) is a severe complication of community-acquired pneumonia in children. This article assesses the risk factors and the diagnostic value of D-dimer for NP in children. METHODS The selected patients with lobar pneumonia were divided into two groups, namely: the NP group and the pneumonia only group. This article conducted a comparative study in the differences between the two groups. The authors identified the independent factors of NP with the assistance of multivariate logistic regression analysis upon the completion of the univariate analysis. The authors applied the receiver operating characteristic (ROC) curve for the purpose of discovering the indicators with the most predictive abilities of NP. RESULTS Three risk factors were observed to be independently associated with the development of NP: Total duration of fever (OR 1.406, 95% CI 1.264 - 1.834), WBC counts (OR 2.662, 95% CI 1.592 - 3.981), and D-dimer (OR 2.878, 95% CI 1.671 - 4.902). D-dimer levels present with higher accuracy in terms of predicting the development of NP than the other two, with a value that is under the ROC of 0.886 (95% CI, 0.815 - 0.958). CONCLUSIONS Significantly higher D-dimer levels are observed in children with NP. D-dimer could be considered as one of the most important risk factors and predictive indicators of NP.
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Cori MS, Ronconi G, Masiello E, Valentini P, Ferriero G, Maccauro G, Ferrara PE. Staphylococcus Aureus Panton-Valentine Leukocidin causing hip osteomyelitis, thrombophlebitis and necrotizing pneumonia in an immuocompetent child. J BIOL REG HOMEOS AG 2020; 34:53-56. ADVANCES IN MUSCULOSKELETAL DISEASES AND INFECTIONS-SOTIMI 2019. [PMID: 32856440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Panton-Valentine leukocidin (PVL) represents an important virulence factor for many strains of Staphylococcus aureus. PVL is an esotoxin causing leucocyte destruction and tissue necrosis. We report on a case of osteomyelitis involving the hip joint with thromblophlebitis complicated by necrotizing pneumonia and life-threatening septic shock. The child required advance respiratory support for 14 days with circulatory support for 7 days in ICU (intensive care unit), surgical draninage via arthrotomy of hip joint and second-line antibiotic treatment for 1 month. Among a wide literature, in Europe over half of Panton-Valentine St. Aureus (PVL-SA) is MSSA. Investigations for PVL are not always available determining an under-recognition of the episodes. Data on prevalence of PVL-SA in Italy are scarce. With this clinical report, we emphasize the recognition of clinical features that must lead to suspect PVL-SA osteomyelitis in children, providing their adequate management.
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Affiliation(s)
- M S Cori
- Pediatric Institute Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy
| | - G Ronconi
- UO Degenza e Servizi di Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy
| | - E Masiello
- Pediatric Institute Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy
| | - P Valentini
- Pediatric Institute Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy
| | - G Ferriero
- Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - G Maccauro
- Orthopedic and Traumatology Institute, Catholic University of the Sacred Heart, Rome, Italy
| | - P E Ferrara
- UO Degenza e Servizi di Riabilitazione, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome Italy
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