Anaerobic Necrotizing Pneumonia: Another Potential Life-threatening Complication of Vaping?

Abstract

An adolescent girl with a history of frequent electronic cigarette use of nicotine was hospitalized with severe necrotizing pneumonia. Blood cultures obtained before the administration of empirical broad-spectrum intravenous antibiotics had positive results for the growth of Fusobacterium necrophorum. The pathogen is an uncommon but well-known cause of anaerobic pneumonia with unique features that are collectively referred to as Lemierre syndrome or postanginal sepsis. The syndrome begins as a pharyngeal infection. Untreated, the infection progresses to involve the ipsilateral internal jugular vein, resulting in septic thrombophlebitis with direct spread from the neck to the lungs causing multifocal necrotizing pneumonia. The teenager we present in this report had neither a preceding pharyngeal infection nor Doppler ultrasonographic evidence for the presence of deep neck vein thrombi, leading us to explore alternative mechanisms for her pneumonia. We propose the possibility that her behavior of frequent vaping led to sufficient pharyngeal irritation such that F necrophorum colonizing her oropharynx was inhaled directly into her lungs during electronic cigarette use. Preexisting, but not yet recognized, vaping-related lung injury may have also contributed to her risk of developing the infection. The patient was hospitalized for 10 days. At follow-up one month later, she still became short of breath with minimal exertion.

Case report: Metagenomics next-generation sequencing in the diagnosis of septic shock due to Fusobacterium necrophorum in a 6-year-old child

“…Metronidazole is recommended in combination with b-lactam antibiotics (Sacco et al, 2019;Tay and Vasoo, 2022). In current research, the average duration of antibiotic use was as long as 2-4 weeks, and some severe patients were treated for 8-16 weeks (Sheehan et al, 2019;Gama et al, 2020;Tamura et al, 2020;El Chebib et al, 2020;Repper et al, 2020;Monroe and Amlie-Lefond, 2018;Dal Bo et al, 2019;Whittle et al, 2018;Rana et al, 2017;Sinatra and Alander, 2017;He et al, 2015;Creemers-Schild et al, 2014). In this case, to cover the anaerobic bacteria as well as some pathogenic or coinfected G-bacilli and streptococci, the broad-spectrum carbapenem antibiotics were initially used empirically.…”

“…For pediatric patients, as the immune function was not complete, F. necrophorum was more direct and rapid-invading (Brennan and Garrett, 2019). Due to the high virulence and invasiveness of the bacteria, the body would directly respond to severe sepsis, leading to hemodynamic failure and multiple-organ failure prior to internal jugular vein thrombosis and septic embolism (Sheehan et al, 2019;Tamura et al, 2020;El Chebib et al, 2020;Habib et al, 2019). In this case, in the absence of suppurative thrombophlebitis of the internal jugular vein, the F. necrophorum infection progressed very rapidly, leading to septic shock within 24 h and causing life-threatening failure of vital organs, including respiratory failure and heart failure.…”

“…collected and analyzed, including baseline data, clinical symptoms, means of detection, complications, treatment, and outcome. The characteristics of reported cases are shown in Table 1 (Sheehan et al, 2019;Gama et al, 2020;Tamura et al, 2020;El Chebib et al, 2020;Repper et al, 2020;Monroe and Amlie-Lefond, 2018;Dal Bo et al, 2019;Whittle et al, 2018;Rana et al, 2017;Sinatra and Alander, 2017;He et al, 2015;Creemers-Schild et al, 2014).…”

Community-acquired pneumonia associated with influenza co-infection caused by fusobacterium necrophorum: a case report and literature review

“…The use of inappropriate antibiotics can also prolong hospital stay [12]. If patients are not promptly diagnosed and treated, they can develop severe pneumonia and multiple organ failure, which can be fatal [13]. Treatment should include a prolonged course of intravenous beta-lactam antibiotics in combination with metronidazole [14].…”

Lung abscess as a complication of Lemierre Syndrome in adolescents: a single center case reports and review of the literature

“…The mucosal alteration can be secondary to accidental or surgical local trauma, primary viral or bacterial infections, and chronic nicotine irritation [ 8 , 23 ]. Notably, our patients had an early habit of smoking and vaping, which could be acknowledged as an emerging risk factor for LS in adolescents [ 9 ]. Some authors have reported an association with Epstein-Barr virus pharyngitis, but the mechanism remains uncertain [ 5 , 6 , 29 , 37 – 39 ].…”