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.

Complicated pneumonia in children

“…It is characterised by necrosis and liquefaction of lung parenchyma, which is thought to be secondary to ischaemia caused by thrombosis of intrapulmonary vessels and can culminate in pulmonary gangrene [89] of single or multiple lobes [74,90]. Historically, the primary causative pathogen was thought to be S. aureus [91] but S. pneumoniae, particularly serotypes 1, 3 9V and 14 [88,89], is now the predominant cause, although M. pneumoniae [92], methicillin-resistant S. aureus and PVL strains of S. aureus [93] have also been implicated. Diagnosis is usually made on CT, as plain chest radiographs will not accurately demonstrate the typical disruption of normal parenchymal architecture where multiple airor fluid-filled cavities replace the normal lung tissue [90].…”

Molecular Epidemiology of Pediatric Pneumococcal Empyema from 2001 to 2007 in Utah

“…The prevalence of parapneumonic empyema (PPE), once a rare complication of pediatric pneumonia (17), has been increasing worldwide over the last decade (10,11,13,14,19,23,26,28,30,34,37,46). In Utah, rates of pediatric empyema were increasing prior to the introduction of the seven-valent pneumococcal conjugate vaccine (PCV-7) in 2000 (2,3).…”

Severe necrotizing pneumonia in a child with pandemic (H1N1) influenza

“…3 Necrotizing pneumococcal pneumonia is uncommon but has been described in previously healthy children. 5 Gangrenous lung changes may result from vascular and parenchymal compromise.…”