Necrotizing pneumococcal pneumonia in children: the role of pulmonary gangrene.
Little is known about the mechanism of necrotizing pneumonia caused by Streptococcus pneumoniae in children. Pulmonary gangrene secondary to vascular thrombosis was reported in adults with necrotizing pneumococcal pneumonia. We conducted a retrospective study of 15 children with a diagnosis of necrotizing pneumococcal pneumonia at National Taiwan University Hospital to explore its association with pulmonary gangrene, based on evidence from chest computed tomography, serial chest radiographic patterns, and pathologic results. S. pneumoniae serotype 14 was the prevalent pneumococcal serotype. Overall, 63.6% of isolates were not susceptible to penicillin. One child with pneumonia caused by S. pneumoniae serotype 3 complicated by hemolytic uremic syndrome had a rapidly fatal course. An autopsy in this patient documented lung necrosis and pulmonary gangrene. Radiographic follow-up was performed during the clinical course in 9 patients, and showed no evidence of pulmonary gangrene. Four children had no radiographic follow-up. The relationship between pulmonary gangrene and necrotizing pneumonia was unclear in the remaining one. In conclusion, necrotizing pneumococcal pneumonia may be infrequently associated with pulmonary gangrene in children.
Hsieh
Yu-Chia
YC
Section of Infection, Department of Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Hsiao
Cheng-Hsiang
CH
Tsao
Po-Nien
PN
Wang
Jann-Yuan
JY
Hsueh
Po-Ren
PR
Chiang
Bor-Luen
BL
Lee
Wen-Sen
WS
Huang
Li-Min
LM
D002648:Child; D002675:Child, Preschool; D005260:Female; D005734:Gangrene; D006801:Humans; D007223:Infant; D008168:Lung / Q000473:pathology*; D008297:Male; D009336:Necrosis; D011018:Pneumonia, Pneumococcal / Q000209:etiology* / Q000473:pathology*; D012189:Retrospective Studies