Pediatric Necrotizing Pneumonia

Ramgopal, Sriram; Ivan, Yaron; Medsinge, Anagha; Saladino, Richard A.

doi:10.1097/pec.0000000000000585

Cited by 28 publications

(9 citation statements)

References 13 publications

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“…Refractory symptoms, which occur despite appropriate therapy for pneumonia, are encountered commonly in the published cases of necrotizing pneumonia; in endemic regions. This might lead to a suspicion of pulmonary tuberculosis, as was the case of our current patient30,31.…”

Section: Discussionsupporting

confidence: 51%

A case of a 22-month-old boy with necrotizing pneumonia presenting with leukaemoid reaction misdiagnosed as leukaemia: A case report and review of the literature

Jumanne

2019

Mal. Med. J

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BackgroundNecrotizing pneumonia and hyperleukocytosis, to the extent of that seen in leukaemia, is a rarely reported presentation. The commonest trigger of such a presentation is an inflammatory process caused by an overwhelming infection which leads to bone marrow irritation. However, the misdiagnosis of this clinical entity as leukaemia should be avoided at all costs so as to avoid the anxiety associated with a diagnosis of cancer, both to the patients and their families.Case presentationHere, we report the case of a 22-month-old boy who was referred to our Pediatric Oncology Unit (POU). Owing to a high total leukocyte count (TLC) of 98,000 cells/µl, there was a strong suspicion of leukaemia. The boy had been reviewed at another hospital where he presented with fever and cough refractory to the commencement of tuberculosis medications as a result of chest radiography findings. Laboratory investigations performed on admission in the POU were negative for leukaemia and other myeloproliferative disorders. A chest computer tomography (CT) scan was performed to delineate opacification in the right middle lobe. This revealed multiple necrotic and emphysematous foci in line with a diagnosis of necrotizing pneumonia. Subsequently, the patient responded well to a course of piperacillin- tazobactam. The TLC normalized and the cough and fever resolved over a period of 2 weeks. ConclusionHere, we describe a particularly rare case of leukaemoid reaction with a massive leukocyte count. Such patients can be easily misdiagnosed as having leukaemia or other myeloproliferative disorders, especially in settings with limited diagnostic availability. Such misdiagnosis can cause undue stress on the patient and their families. Thus, it is important that patients presenting with these symptoms should undergo a thorough review of history, physical examination and a structured workup.

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Section: Discussionsupporting

confidence: 51%

A case of a 22-month-old boy with necrotizing pneumonia presenting with leukaemoid reaction misdiagnosed as leukaemia: A case report and review of the literature

Jumanne

2019

Mal. Med. J

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“…Necrotizing pneumonia (NP) is a rare but severe complication of pneumonia, occurring in 3.7% of all community acquired pneumonias (1). It is more likely to have pleural involvement, respiratory failure, and shock (2, 3).…”

mentioning

confidence: 99%

Characteristics and Outcomes of Children With Necrotizing Pneumonia

Ness-Cochinwala

Kobaitri

Totapally

2021

Pediatric Critical Care Medicine

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In this study, we describe the characteristics and outcomes of pediatric necrotizing pneumonia in the United States. DESIGN AND SETTING:A retrospective analysis of the Healthcare Cost and Utilization Project 2016 Kids Inpatient Database was performed. The Kids Inpatient Database is a large deidentified hospital discharge database of pediatric patients in the United States. PATIENTS:The database was filtered using International Classification of Diseases, 10th Edition code J85.0 to identify necrotizing pneumonia in children 28 days to 20 years old. INTERVENTIONS:Children with necrotizing pneumonia with and without bacterial isolation and with and without complex chronic conditions were compared. Sample weighting was employed to produce national estimates. MEASUREMENTS AND MAIN RESULTS:Of the 2,296,220 discharges, 746 patients had necrotizing pneumonia (prevalence: 3.2/10,000 discharges). In patients with necrotizing pneumonia, 46.6% required chest tubes, 6.1% underwent video-assisted thoracoscopic surgery, and 27.6% were mechanically ventilated. Pneumothorax was identified in 16.7% and pyothorax in 27.4%. The overall mortality rate was 4.1% (n = 31). Bacterial isolation was documented in 40.9%. The leading organisms identified in patients without a complex chronic condition were Streptococcus pneumoniae (12.6%) and Staphylococcus aureus (9.2%) and in patients with a complex chronic condition were S. aureus (13.4%) and Pseudomonas aeruginosa (12.8%). Patients with bacterial isolation were significantly more likely to develop pneumothorax (odds ratio, 2.6; CI, 1.6-4.2) or septic shock (odds ratio, 3.2; CI, 1.9-5.4) and require a chest tube (odds ratio, 2.5; CI, 1.7-3.5) or mechanical ventilation (odds ratio, 2.3; CI, 1.5-3.3) than patients without bacterial isolation.CONCLUSIONS: Bacterial etiology of necrotizing pneumonia in children varied with the presence or absence of a complex chronic condition. Bacterial isolation is associated with increased invasive procedures and complications. The mortality rate is higher in children with complex chronic conditions. This study provides national data on necrotizing pneumonia among hospitalized children.

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“…12 CONCLUSIÓN Las complicaciones supuradas de neumonía en la edad pediátrica son más frecuentes en lactantes, especialmente en la población con poca o ninguna cobertura de vacunas conjugadas para Haemophilus influenzae y Streptococcus Pneumoniae, resaltando poblaciones especiales como inmunosuprimidos o inmunodeficientes, y pacientes con neumonía nosocomial, particularmente aquellos que usan ventilación mecánica invasiva. 12 El empiema es la complicación supurada más común, provoca hospitalizaciones prolongadas, aunque en comparación con la población adulta, hay una tasa de mortalidad más baja. En la actualidad, esta patología se ha incrementado incluso en países desarrollados y en vías de desarrollo, como Perú.…”

Section: Discussionunclassified

Manejo de pioneumotorax en un paciente pediátrico en un hospital nacional de referencia

Monzón Flores

2022

Rev Peru Pediatr

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La neumonía complicada tiene una relevancia importante en los niños ingresados a hospitales referenciales a nivel nacional, con una presentación caracterizada por lesiones broncopulmonares y pleurales complejas. Cuando se extiende a las pleuras y se presenta un empiema, se modifica radicalmente el curso clínico y el comportamiento de la entidad, constituyéndose así en un reto para su manejo adecuado, ya que no hay un consenso en los criterios de clasificación lo que puede llevar a un retraso en la toma de decisiones y a una intervención oportuna. Las complicaciones más frecuentes incluyen: neumotórax, neumonía necrosante, empiema y fístula broncopleural. La neumonía necrosante se puede sospechar por radiología, pero por lo general se diagnóstica por tomografía computarizada. El uso de vacunas conjugadas contra S. Pneumoniae ha modificado su comportamiento con la aparición de serotipos relacionados con una mayor frecuencia de supuración. Es difícil calcular su real incidencia, pero varios estudios sugieren que ha ido incrementando su frecuencia. Su diagnóstico se ha hecho más fácil y frecuente con la disponibilidad de las técnicas imagenológicas. La neumonía necrosante habitualmente coexiste con el empiema, el cual también ha ido incrementando su incidencia en diferentes partes del mundo, incluyendo los países de América latina. Los abscesos pulmonares, aunque son complicaciones menos frecuentes en la neumonía adquirida en la comunidad en la edad pediátrica, también han aumentado su incidencia. En el tratamiento se incluye antibióticos intravenosos, colocación de tubo de drenaje torácico, fibrinolíticos intrapleurales, toracotomía mínimamente invasiva, cirugía toracoscópica asistida por video (VATS), y, rara vez, decorticación abierta.

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Pediatric Necrotizing Pneumonia

Cited by 28 publications

References 13 publications

A case of a 22-month-old boy with necrotizing pneumonia presenting with leukaemoid reaction misdiagnosed as leukaemia: A case report and review of the literature

A case of a 22-month-old boy with necrotizing pneumonia presenting with leukaemoid reaction misdiagnosed as leukaemia: A case report and review of the literature

Characteristics and Outcomes of Children With Necrotizing Pneumonia

Manejo de pioneumotorax en un paciente pediátrico en un hospital nacional de referencia

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