Clinical characteristics and outcome of complicated pneumococcal pneumonia in a pediatric population

Wexler, Isaiah D.; Knoll, Sharon; Picard, Éric; Villa, Yael; Shoseyov, David; Engelhard, Dan; Kerem, Eitan

doi:10.1002/ppul.20383

Cited by 61 publications

(70 citation statements)

References 37 publications

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“…The age range and demographic features of the present patients are similar to other published studies of children with complicated pneumonia [14][15][16]. Most children had developed symptoms of fever and cough for f1 week prior to their hospitalisation, indicating that the parenchymal damage in NP occurs rapidly.…”

Section: Discussionsupporting

confidence: 70%

Necrotising pneumonia is an increasingly detected complication of pneumonia in children

Sawicki¹,

Lu²,

Valim³

et al. 2008

European Respiratory Journal

173

171

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Necrotising pneumonia (NP) is a severe complication of community-acquired pneumonia characterised by liquefaction and cavitation of lung tissue. The present study describes the epidemiology, aetiology, management and outcomes of children hospitalised with NP over a 15-yr period. A retrospective observational study of NP cases was conducted from January 1990 to February 2005 analysing clinical presentation, laboratory data, hospital course and long-term follow-up. A total of 80 NP cases were identified, with the number of detected cases increasing from 12, in the period 1993-1996, to 40 in the period 2001-2004. In total, 69 (86%) cases had pleural effusion with a low pH (mean 7.08) and 38 (48%) patients had positive cultures, with Streptococcus pneumoniae as the predominant organism. Recently, other organisms, most notably methicillin-resistant Staphylococcus aureus, emerged. Patients had prolonged hospitalisations (median 12 days). A total of 69 patients required pleural interventions and those receiving chest drainage alone had similar outcomes to those managed surgically. All patients had full clinical resolution within 2 months of presentation. Necrotising pneumonia has increasingly been identified as a complication of paediatric pneumonia. Streptococcus pneumoniae remains the predominant organism, but since 2002, different bacteria have been isolated and the age range of cases has broadened. Despite the serious morbidity, massive parenchymal damage and prolonged hospitalisations, long-term outcome following necrotising pneumonia is excellent.

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Section: Discussionsupporting

confidence: 70%

Necrotising pneumonia is an increasingly detected complication of pneumonia in children

Sawicki¹,

Lu²,

Valim³

et al. 2008

European Respiratory Journal

173

171

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“…Other authors have reported the risk of complications in such cases, given that a timely diagnosis can prevent progression to pleural effusion in patients with CAP. (14,17,19,(27)(28)(29) A delay in the initiation of antibiotic therapy, an inappropriate choice of antibiotics, and the use of lower than recommended doses of antibiotics can have a negative impact on the clinical course of bacterial pneumonia. However, there is a concern about the incorrect indication of penicillins in viral processes; this is a commonplace practice in emergency rooms and can lead to increased bacterial resistance to the antibiotics that are widely used in pediatric patients.…”

Section: Resultsmentioning

confidence: 99%

Fatores associados às complicações em crianças pré-escolares com pneumonia adquirida na comunidade

et al. 2012

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Objective: To identify socioeconomic factors and clinical factors associated with the development of complications in preschool children hospitalized with community-acquired pneumonia (CAP). Methods: This was a prospective longitudinal study involving children (12-59 months of age) diagnosed with CAP and admitted to the pediatric wards of two hospitals in the metropolitan area of Campinas, Brazil. Children with cystic fibrosis, heart disease, pulmonary malformations, neurological disorders, or genetic diseases were excluded. The diagnosis of CAP was based on clinical and radiological findings. Data were collected from the medical records and with a semistructured questionnaire. The subjects were divided into two groups (complicated and uncomplicated CAP). Socioeconomic and clinical variables were compared, and multivariate logistic regression analysis was performed. Results: Of the 63 children included, 29 and 34, respectively, presented with uncomplicated and complicated CAP. No statistically significant differences were found between the groups regarding age at admission, gestational age, birth weight, gender, or socioeconomic variables. Significant differences were found between the groups regarding history of pneumonia (p = 0.03), previous antibiotic therapy (p = 0.004), time elapsed since the onset of CAP (p = 0.01), duration of fever prior to admission (p < 0.001), duration of antibiotic therapy (p < 0.001), and length of hospital stay (p < 0.001). In the multivariate analysis, only duration of fever prior to admission remained in the model (OR = 1.97; 95% CI: 1.36-2.84; p < 0.001). Conclusions: Biological variables, especially duration of fever prior to admission, appear to be associated with the development of complications in children with CAP.Keywords: Community-acquired infections; Pneumonia; Pleural Effusion. ResumoObjetivo: Identificar os fatores socioeconômicos e clínicos associados à evolução para complicações em crianças internadas com pneumonia adquirida na comunidade (PAC). Métodos: Estudo longitudinal prospectivo em crianças diagnosticadas com PAC (12-59 meses de idade) internadas em enfermarias gerais de pediatria de dois hospitais na região de Campinas (SP). Os critérios de exclusão foram ter fibrose cística, cardiopatia, malformação pulmonar, neuropatias e doenças genéticas. PAC foi diagnosticada por características clínicas e radiológicas. Os dados foram coletados dos prontuários médicos e por um questionário semiestruturado. Os sujeitos foram divididos em dois grupos (PAC complicada e não complicada). Foram comparadas variáveis socioeconômicas e clínicas, e foi realizada análise de regressão logística multivariada. Resultados: Das 63 crianças incluídas, 29 e 34, respectivamente, apresentaram PAC não complicada e PAC complicada. Não houve diferenças estatisticamente significantes entre os grupos quanto a idade na admissão, idade gestacional, peso ao nascer, gênero ou variáveis socioeconômicas. Houve diferenças significantes entre os grupos em relação a pneumonia anterior (p = 0,03)...

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“…El neumatocele es una complicación poco reportada de la neumonía 1 . Es una formación adquirida de contenido aéreo de paredes delgadas formadas por el parénquima pulmonar adyacente.…”

Section: Introductionunclassified

Neumonía complicada con neumatocele en un lactante, caso clínico

Chateau¹,

et al. 2008

Rev. chil. pediatr.

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Introduction: Pneumatocele is an uncommon complication of pneumonia, most often asymptomatic with spontaneous resolution. Case-report: Female infant with an history of right upper lobe pneumonia, an air filled structure was noted in the chest X-ray. Asymptomatic until admitted for a wheezing episode, where an increase in the size of the structure was evidenced. She had clinical and radiological follow-up as recommended in a recent study, observing that 5 months later the cystic image was completely resolved. Discussion: According to criteria from published studies, this case is a non complicated pneumatocele because it was asymptomatic, compromised less than 50% of the hemithorax and no atelectasia, bronchopleural fistula or signs of infection were observed. Non complicated pneumatoceles can be followed up, and complicated can be treated by image guided catheter drainage or surgical resection. In this case, we confirmed spontaneous resolution after clinical and radiological follow-up.

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Clinical characteristics and outcome of complicated pneumococcal pneumonia in a pediatric population

Cited by 61 publications

References 37 publications

Necrotising pneumonia is an increasingly detected complication of pneumonia in children

Necrotising pneumonia is an increasingly detected complication of pneumonia in children

Fatores associados às complicações em crianças pré-escolares com pneumonia adquirida na comunidade

Neumonía complicada con neumatocele en un lactante, caso clínico

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