Necrotizing Pseudomonas aeruginosa Community-Acquired Pneumonia: A Case Report and Review of the Literature

Abstract

Lung cavities are not typically associated with community-acquired pneumonia (CAP). CAP due to P. aeruginosa is rare and even less commonly causes necrotizing pneumonia. We report a case of P. aeruginosa CAP that progressed to necrotizing pneumonia and was eventually fatal. Procalcitonin (PCT) has been well investigated in guiding antibiotic therapy (especially CAP) in adults. In this case, PCT at presentation and sequentially was negative. We discuss this caveat and present hypotheses as to the sensitivity and specificity of PCT and C-reactive protein (CRP) in these patients. To better characterize P. aeruginosa CAP, we undertook a review of cases indexed in PubMed from 2001 to 2016 (n = 9). The data reveal that risk factors for P. aeruginosa CAP include smoking, alcohol use, obstructive lung disease, sinusitis, and hot tub use. The route of infection for P. aeruginosa CAP remains unknown. One of the most interesting findings on reviewing cases was that P. aeruginosa CAP involves the right upper lobe in the vast majority. We suggest that when physicians in the community see patients with distinctly upper lobe necrotizing or cavitary pneumonia, they should consider P. aeruginosa in their differential diagnosis. Further studies are needed to clarify route of infection, role of PCT and CRP, and optimal therapy including drug and duration.

Case Report of Disseminated Pseudomonas Infection with Superadded Burkholderia Infection - A Battle Lost!

“…It is a common pathogenic bacteria in hospital acquired pneumonia, and is usually seen in patients who have structural lung disease, or are immunocompromised [1] . However, it is rarely identified as a cause of pneumonia in previously healthy individuals, accounting for 0.4-6.9% of the reported cases of CAP requiring hospitalization [2] and 1.8-8.3% CAP requiring intensive care unit (ICU) admission [3] . Several studies [4,5] found that fatal P. aeruginosa pneumonia in healthy patients was associated with exposure to contaminated hot tubs.…”

Septic shock secondary to an acute necrotizing community-acquired pneumonia with bacteremia due to Pseudomonas aeruginosa

“…In the literature, we found 13 cases of necrotizing CAP due to P. aeruginosa associated with cavitation. Table 1 summarizes the 11 most recent cases [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]]. The main risk factors for necrotizing CAP due to P. aeruginosa are: lung structural abnormalities (including cystic fibrosis, emphysema, bronchial dilatation, chronic obstructive pulmonary disease), immunocompromised condition (including neoplasia, neutropenia, prolonged antibacterial therapy, immunosuppression), and exposure to contaminated liquids (including hot tub, spa, humidifier) [1,2].…”

“…Regarding antimicrobial management for CAP, the literature is summarized in Table 1 [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10]]. It is generally not appropriate to administer empiric anti-Pseudomonas therapy.…”

Marijuana “bong” pseudomonas lung infection: a detrimental recreational experience

“…Currently, there is a paucity of data regarding the emergence, incidence, progression, and outcome of pseudomonas lung infection. There is also no established explanation on the predilection of lung involvement, although the infection foci favours upper lobes of the lung postulated due to increased ventilation and perfusion ratio and less effective lymphatic drainage .…”