title: Necrotizing pneumococcal pneumonia in children: the role of pulmonary gangrene.
abstract: 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.
authors.affiliation: Section of Infection, Department of Medicine, Wan-Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yu-Chia
authors.initials: YC
authors.lastname: Hsieh
authors.forename: Cheng-Hsiang
authors.initials: CH
authors.lastname: Hsiao
authors.forename: Po-Nien
authors.initials: PN
authors.lastname: Tsao
authors.forename: Jann-Yuan
authors.initials: JY
authors.lastname: Wang
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
authors.forename: Bor-Luen
authors.initials: BL
authors.lastname: Chiang
authors.forename: Wen-Sen
authors.initials: WS
authors.lastname: Lee
authors.forename: Li-Min
authors.initials: LM
authors.lastname: Huang
mesh_terms: 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