title: Necrotizing pneumococcal pneumonia with bronchopleural fistula among children in Taiwan.
abstract: BACKGROUND
  Severe necrotizing pneumococcal pneumonia may progress to the development of bronchopleural fistula (BPF). The purpose of this study was to describe the clinical courses and identify risk factors for the development of bronchopleural fistula in children with pneumococcal pneumonia. Histopathologic features of children receiving surgical resections of the lung because of BPF were analyzed to explore the pathogenesis of destructive lung disease caused by Streptococcus pneumoniae.
  
  
  METHODS
  A total of 112 cases of culture-proven pneumococcal pneumonia were identified between January 2001 and March 2010 at Chang Gung Children's Hospital. The medical charts of all cases of culture-proven pneumococcal pneumonia were reviewed.
  
  
  RESULTS
  Pneumococcal pneumonia in 18 children (18/112, 16.1%) was complicated by BPF. As compared with children without BPF, children with BPF had significantly lower white blood cell counts at admission (P = 0.03) and significantly longer durations of fever and hospitalization (P < 0.001). Multivariate analysis revealed that acute respiratory failure (odds ratio = 8.9; 95% confidence interval = 2.6-30.9; P = 0.001) and serotype 19A infection (odds ratio = 5.0; 95% confidence interval = 1.2-22.1; P = 0.03) were risk factors for the development of BPF. Histopathologic analyses were available for 12 children who underwent surgical resections of the lung. Coagulative necrosis with pulmonary infarction was found in 11 of the 12 cases.
  
  
  CONCLUSIONS
  Serotype 19A was strongly associated with BPF. Vaccines containing this serotype will be important for prevention.
authors.affiliation: Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan. pidlin@adm.cgmh.org.tw
authors.forename: Yu Chia
authors.initials: YC
authors.lastname: Hsieh
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Wang
authors.forename: Shen-Hao
authors.initials: SH
authors.lastname: Lai
authors.forename: Jin-Yao
authors.initials: JY
authors.lastname: Lai
authors.forename: Kin-Sun
authors.initials: KS
authors.lastname: Wong
authors.forename: Yhu-Chering
authors.initials: YC
authors.lastname: Huang
authors.forename: Kuang-Yi
authors.initials: KY
authors.lastname: Chang
authors.forename: Cheng-Hsun
authors.initials: CH
authors.lastname: Chiu
authors.forename: Tzou-Yien
authors.initials: TY
authors.lastname: Lin
mesh_terms: D001983:Bronchial Fistula / Q000382:microbiology* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D060005:Genotyping Techniques; D006801:Humans; D008297:Male; D010995:Pleural Diseases / Q000382:microbiology* / Q000473:pathology; D011018:Pneumonia, Pneumococcal / Q000150:complications*; D012307:Risk Factors; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D013624:Taiwan