Necrotizing pneumonia: an emerging problem in children?

Abstract

Background: In children, necrotizing pneumonia (NP) is an uncommon, severe complication of pneumonia. It is characterized by destruction of the underlying lung parenchyma resulting in multiple small, thin-walled cavities and is often accompanied by empyema and bronchopleural fistulae.; Review: NP in children was first reported in children in 1994, and since then there has been a gradual increase in cases, which is partially explained by greater physician awareness and use of contrast computed tomography (CT) scans, and by temporal changes in circulating respiratory pathogens and antibiotic prescribing. The most common pathogens detected in children with NP are pneumococci and Staphylococcus aureus . The underlying disease mechanisms are poorly understood, but likely relate to multiple host susceptibility and bacterial virulence factors, with viral-bacterial interactions also possibly having a role. Most cases are in previously healthy young children who, despite adequate antibiotic therapy for bacterial pneumonia, remain febrile and unwell. Many also have evidence of pleural effusion, empyema, or pyopneumothorax, which has undergone drainage or surgical intervention without clinical improvement. The diagnosis is generally made by chest imaging, with CT scans being the most sensitive, showing loss of normal pulmonary architecture, decreased parenchymal enhancement and multiple thin-walled cavities. Blood culture and culture and molecular testing of pleural fluid provide a microbiologic diagnosis in as many as 50% of cases. Prolonged antibiotics, draining pleural fluid and gas that causes mass effects, and maintaining ventilation, circulation, nutrition, fluid, and electrolyte balance are critical components of therapy. Despite its serious nature, death is uncommon, with good clinical, radiographic and functional recovery achieved in the 5-6 months following diagnosis. Increased knowledge of NP's pathogenesis will assist more rapid diagnosis and improve treatment and, ultimately, prevention.; Conclusion: It is important to consider that our understanding of NP is limited to individual case reports or small case series, and treatment data from randomized-controlled trials are lacking. Furthermore, case series are retrospective and usually confined to single centers. Consequently, these studies may not be representative of patients in other locations, especially when allowing for temporal changes in pathogen behaviour and differences in immunization schedules and antibiotic prescribing practices.eCollection. Cited Medium: Print. NLM ISO Abbr: Pneumonia (Nathan). PubMed Central ID: PMC5525269. Linked References: Acta Paediatr. 2004 Sep;93(9):1172-7. (PMID: 15384879); Pediatr Int. 2012 Apr;54(2):293-7. (PMID: 22507158); Epidemiol Infect. 2016 Dec;144(16):3507-3519. (PMID: 27535335); Thorac Surg Clin. 2012 Aug;22(3):333-44. (PMID: 22789597); Pediatr Pulmonol. 2011 Jul;46(7):717-21. (PMID: 21626711); FEMS Microbiol Lett. 2015 May;362(10):. (PMID: 25877546); J Paediatr Child Health. 2009 Jul-Aug;45(7-8):431-6. (PMID: 19722296); Pediatr Pulmonol. 1999 Sep;28(3):217-21. (PMID: 10495339); Vaccine. 2014 May 1;32(21):2399-405. (PMID: 24637174); Pediatr Infect Dis J. 2010 Jul;29(7):607-12. (PMID: 20589980); Respiration. 2011;81(6):448-60. (PMID: 21051855); Arch Dis Child. 2010 Apr;95(4):305-6. (PMID: 20335240); Pediatr Crit Care Med. 2007 May;8(3):282-7. (PMID: 17417120); Emerg Radiol. 2016 Apr;23(2):201-2. (PMID: 26884402); Emerg Infect Dis. 2009 Oct;15(10):1696-8. (PMID: 19861083); J Trop Pediatr. 2009 Aug;55(4):257-61. (PMID: 19028727); Eur Radiol. 2002 Feb;12(2):391-6. (PMID: 11870440); J Clin Microbiol. 2010 Feb;48(2):520-5. (PMID: 20018815); Paediatr Int Child Health. 2016 Aug;36(3):235-9. (PMID: 25936434); Pediatr Pulmonol. 2010 Apr;45(4):387-94. (PMID: 20232474); CMAJ. 2011 Feb 8;183(2):215-9. (PMID: 21135076); Lancet Infect Dis. 2016 Aug;16(8):e139-52. (PMID: 27321363); Acta Cardiol Sin. 2016 Nov;32(6):751-754. (PMID: 27899865); Pediatr Neonatol. 2017 Aug;58(4):321-327. (PMID: 27989426); Pediatr Pulmonol. 2014 Mar;49(3):E90-5. (PMID: 24273123); Pediatr Infect Dis J. 2015 Mar;34(3):320-2. (PMID: 25191850); Eur J Pediatr. 2000 Sep;159(9):684-8. (PMID: 11014469); Clin Infect Dis. 2002 Feb 15;34(4):434-40. (PMID: 11797168); Pediatr Pulmonol. 2017 Feb;52(2):247-254. (PMID: 27392317); Vaccine. 2010 Jun 11;28(26):4249-59. (PMID: 20416266); Thorax. 2002 Apr;57(4):343-7. (PMID: 11923554); Thorax. 2011 Aug;66(8):663-8. (PMID: 21617169); Indian J Pediatr. 2008 Nov;75(11):1171-4. (PMID: 18810351); Clin Microbiol Rev. 2015 Jul;28(3):603-61. (PMID: 26016486); JAMA Pediatr. 2013 Feb;167(2):119-25. (PMID: 23229753); Thorax. 2011 Oct;66 Suppl 2:ii1-23. (PMID: 21903691); Lancet Respir Med. 2013 Sep;1(7):574-84. (PMID: 24461618); Clin Infect Dis. 2008 May 1;46(9):1346-52. (PMID: 18419434); Thorac Surg Clin. 2012 Aug;22(3):387-401. (PMID: 22789601); PLoS One. 2014 Feb 18;9(2):e89013. (PMID: 24558464); Pediatr Pulmonol. 2006 Aug;41(8):750-3. (PMID: 16779851); Adv Exp Med Biol. 2015;857:9-17. (PMID: 25468010); Chest. 2011 Feb;139(2):387-394. (PMID: 20724739); Pediatr Pulmonol. 2006 Jul;41(7):623-9. (PMID: 16703574); Paediatr Respir Rev. 2014 Sep;15(3):240-5; quiz 245. (PMID: 24268096); Eur Respir J. 2016 Dec;48(6):1764-1778. (PMID: 27811073); Cell Host Microbe. 2015 May 13;17(5):704-15. (PMID: 25865368); Vaccine. 2016 Jan 4;34(2):190-197. (PMID: 26100926); Acta Clin Croat. 2010 Sep;49(3):321-6. (PMID: 21462823); BMJ. 2006 Jun 3;332(7553):1333. (PMID: 16740569); Clin Infect Dis. 2008 Sep 1;47(5):729-30; author reply 730. (PMID: 18680398); PLoS One. 2015 Jun 18;10(6):e0130082. (PMID: 26086718); Clin Microbiol Infect. 2010 May;16(5):402-10. (PMID: 20132251); Am J Respir Crit Care Med. 2017 Jan 1;195(1):13-15. (PMID: 28035856); Clin Infect Dis. 2010 Mar 15;50(6):805-13. (PMID: 20166818); Clin Infect Dis. 2008 Jan 15;46(2):174-82. (PMID: 18171247); Hum Vaccin Immunother. 2013 Nov;9(11):2393-7. (PMID: 23863455); Pediatr Emerg Care. 2017 Feb;33(2):112-115. (PMID: 26785088); Clin Infect Dis. 2011 Oct;53(7):e25-76. (PMID: 21880587); Clin Microbiol Infect. 2013 Mar;19(3):E142-8. (PMID: 23237492); Pediatr Infect Dis J. 2011 Sep;30(9):740-4. (PMID: 21852763); Lancet. 2017 Dec 17;388(10063):3027-3035. (PMID: 27839855); Pediatr Infect Dis J. 2004 Jun;23(6):564-7. (PMID: 15194841); Pharmacotherapy. 2006 Dec;26(12):1758-70 (PMID: 17125437); Eur J Pediatr. 2012 Apr;171(4):711-7. (PMID: 22159957); Lancet Respir Med. 2014 May;2(5):387-94. (PMID: 24815804); Pediatr Infect Dis J. 2013 Oct;32(10):1146-9. (PMID: 23722529); Acta Paediatr. 2010 Jun;99(6):861-6. (PMID: 20178517); N Engl J Med. 2013 Jul 11;369(2):155-63. (PMID: 23841730); J Microbiol Methods. 2015 Jun;113:41-9. (PMID: 25819558); J Clin Imaging Sci. 2013 Dec 31;3:60. (PMID: 24605255); Curr Opin Pediatr. 2016 Dec;28(6):786-793. (PMID: 27755118); Eur Respir J. 2008 Jun;31(6):1285-91. (PMID: 18216055); Expert Rev Anti Infect Ther. 2013 Oct;11(10):1041-51. (PMID: 24073746); Vaccine. 2016 Jan 27;34(5):663-670. (PMID: 26706272); JAMA Pediatr. 2016 Sep 1;170(9):832-3. (PMID: 27380323); Respirology. 2004 Mar;9(1):109-14. (PMID: 14982611); J Pediatr Surg. 2012 Nov;47(11):2101-10. (PMID: 23164006); Lancet. 2002 Mar 2;359(9308):753-9. (PMID: 11888586); Clin Infect Dis. 2014 Apr;58(7):918-24. (PMID: 24532543); Clin Microbiol Infect. 2013 May;19(5):480-6. (PMID: 22591179); Pediatr Infect Dis J. 2015 May;34(5):499-505. (PMID: 25461475); Can Respir J. 2008 Apr;15(3):129-32. (PMID: 18437254); J Bras Pneumol. 2010 May-Jun;36(3):301-5. (PMID: 20625666); Curr Opin Pulm Med. 2012 May;18(3):246-52. (PMID: 22388585); Clin Infect Dis. 2007 Aug 1;45(3):315-21. (PMID: 17599308); Clin Infect Dis. 2016 Apr 1;62(7):817-823. (PMID: 26747825); Clin Microbiol Rev. 2008 Apr;21(2):305-33, table of contents. (PMID: 18400799); PLoS Pathog. 2010 Jan 08;6(1):e1000715. (PMID: 20072612); J Bras Pneumol. 2012 Sep-Oct;38(5):614-21. (PMID: 23147054); Pediatr Pulmonol. 2015 Jul;50(7):721-6. (PMID: 24692118); Lancet Infect Dis. 2013 Jan;13(1):43-54. (PMID: 23103172); Annu Rev Med. 2013;64:189-202. (PMID: 23327522); Int J Clin Pract. 2001 Dec;55(10):658-60. (PMID: 11777287); Int J Infect Dis. 2014 Sep;26:17-21. (PMID: 24980464); Pediatr Radiol. 1999 Feb;29(2):87-91. (PMID: 9933325); PLoS Pathog. 2013 Jan;9(1):e1003057. (PMID: 23326226); Can Respir J. 2014 Jul-Aug;21(4):239-45. (PMID: 24791253); J Infect Dis. 2016 Dec 1;214(11):1638-1646. (PMID: 27651418); Pneumonia (Nathan). 2016;8:. (PMID: 27635368); Curr Opin Infect Dis. 2016 Apr;29(2):187-96. (PMID: 26779776); Ann Intensive Care. 2011 Dec 22;1(1):52. (PMID: 22192614); Clin Infect Dis. 2016 Dec 1;63(suppl 4):S236-S243. (PMID: 27838678); Clin Microbiol Rev. 2017 Jan;30(1):277-319. (PMID: 27903593); Eur Respir J. 2014 Feb;43(2):331-3. (PMID: 24488989); AJR Am J Roentgenol. 1998 Jul;171(1):253-6. (PMID: 9648799); Eur Respir J. 2013 Dec;42(6):1595-603. (PMID: 23598951); Eur J Pediatr. 2009 Dec;168(12):1429-36. (PMID: 19238436); J Pediatr Surg. 2012 Jul;47(7):1358-62. (PMID: 22813797); Clin Respir J. 2018 Jan;12(1):253-261. (PMID: 27401931); Pneumonia (Nathan). 2016 Apr 12;8:1. (PMID: 28702281); Expert Rev Vaccines. 2016 Nov;15(11):1373-1392. (PMID: 27118628); J Pediatric Infect Dis Soc. 2012 Dec;1(4):314-28. (PMID: 26619424); Clin Microbiol Rev. 2016 Jul;29(3):449-86. (PMID: 27029594); Clin Infect Dis. 2011 Jan 1;52(1):99-114. (PMID: 21148528); Am J Respir Crit Care Med. 1994 Jan;149(1):242-4. (PMID: 8111589). Linking ISSN: 22006133. Subset: PubMed not MEDLINE; Date of Electronic Publication: 2017 Jul 25. Current Imprints: Publication: 2016->: London : BioMed Central; Original Imprints: Publication: [Nathan], Qld. : Griffith University ePress, [2012]- <br />