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Necrotizing pneumonia

August 31, 2023

Necrotizing pneumonia (NP), also known as cavitary pneumonia or cavitatory necrosis, is a rare but severe complication of lung parenchymal infection.[1][2][3] In necrotizing pneumonia, there is a substantial liquefaction following death of the lung tissue, which may lead to gangrene formation in the lung.[4][5] In most cases patients with NP have fever, cough and bad breath, and those with more indolent infections have weight loss.[6] Often patients clinically present with acute respiratory failure.[6] The most common pathogens responsible for NP are Streptococcus pneumonia, Staphylococcus aureus, Klebsiella pneumoniae.[7] Diagnosis is usually done by chest imaging, e.g. chest X-ray, CT scan. Among these CT scan is the most sensitive test which shows loss of lung architecture and multiple small thin walled cavities.[3] Often cultures from bronchoalveolar lavage and blood may be done for identification of the causative organism(s).[8] It is primarily managed by supportive care along with appropriate antibiotics.[8] However, if patient develops severe complications like sepsis or fails to medical therapy, surgical resection is a reasonable option for saving life.[6][8]

History Edit

NP in adults was first described in the 1940s, whereas in children it was reported later in 1994.[3] Necrotizing pneumonia is an ancient disease which was once a leading cause of death in both adults and children.[9] Its clinical features were presumably first outlined by Hippocrates.[9] Later, in 1826, René Laennec described these features in a more detailed fashion in his seminal work De l’auscultation médiate ou Traité du Diagnostic des Maladies des Poumon et du Coeur (A treatise on the diseases of the chest, and on mediate auscultation).[9][10] Although availability of appropriate antibiotics had made NP a rare disease, over the last two decades it has emerged as a severe complication of childhood pneumonia.[1]

Causative organisms Edit

The most common pathogens responsible for NP are Streptococcus pneumonia, Staphylococcus aureus and Klebsiella pneumoniae.[7] Other pathogens which are less likely to cause NP are bacteria like Haemophilus influenzae, Streptococcus anginosus group, Pseudomonas aeruginosa, Mycoplasma pneumoniae, Acinetobacter baumannii, Streptococcus pyogenes, Stenotrophomonas maltophilia, anaerobes like Fusobacterium nucleatum and Bacteroides fragilis; fungi like Aspergillus sp. and Histoplasma capsulatum; viruses like Influenza and Adenovirus.[7][3][9]

Children Edit

Apart from Streptococcus pneumonia (also known as Pneumococcus pneumoniae), several other organisms have appeared to cause necrotizing pneumonia in children since 2002.[1] Most of the aforementioned organisms have been reported to be associated with childhood NP, except that, K. pneumoniae is not a common cause in children.[3] However, Pneumococci and S. aureus are frequently responsible for it.[3] Pneumococcal conjugate vaccine (PCV7) covering serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F was introduced in the USA in 2000.[11][12] Consequently, non-PCV7 serotypes like 3, 5, 7F 19A emerged as new threats. Of this, serotypes 3 and 19A were particularly associated with NP.[3] In 2010 PCV7 was replaced by a 13-valent pneumococcal conjugate vaccine (PCV13). PCV13 includes all PCV7 serotypes plus six additional serotypes (1, 3, 5, 6A, 7F & 19A).[12]Panton–Valentine leukocidin (PVL) producing S. aureus strains are oftentimes responsible for life-threatening necrotizing pneumonia in previously healthy children and young adults.[13] These PVL-producing strains are frequently methicillin resistant (MRSA).[3] In developing countries with high rates of HIV infection, Mycobacterium tuberculosis is the common cause of NP in children.[7]

Adults Edit

Adults are more commonly affected by community-acquired Staphylococcus aureus, S. pneumoniae and K. pneumoniae. Gram-negative organisms like K. pneumoniae and P. aeruginosa are usually associated with Pulmonary gangrene.[7]

Predisposing risk factors Edit

Adults Edit

Necrotizing pneumonia typically occurs in adult males who have coexisting health problems like diabetes mellitus, alcohol use disorder, and corticosteroid therapy.[2] Other risk factors may include smoking, gastrectomy, history of substance use disorder or HIV/AIDS.[7]

Children Edit

On the contrary, in most of the cases children of both sexes are affected equally.[3] Furthermore, it is unlikely that affected children have any underlying co-morbidities, but if any, asthma is the most common chronic disorder followed by recurrent otitis media.[3][1]

Relationship with viral infection Edit

Group A streptococcus such as S. pyogenes, often preceded by varicella infection, may cause severe invasive infections and complicated childhood pneumonia.[2] Influenza virus infection substantially increases the risk of developing necrotizing pneumonia in children mostly by PVL-producing S. aureus followed by S. pneumoniae.[7] In the United States it is observed that NP has increased following influenza owing to the emergence of MRSA strain USA300 infections.[14]

Additional imaging Edit

 


a) Initial plain chest radiograph showing a dense right upper zone airspace opacity and lingula airspace changes, consistent with multi-focal pneumonia. The following images were performed 24 h later. b) Plain chest radiograph with the patient intubated and ventilated revealing cavitation in the right mid to upper zones, pleural effusion and more general airspace changes bilaterally. c) Computed tomography (CT) scan, coronal view, demonstrating non-enhancing area (necrotic) thin-walled cavities within the right upper lobe and lingula. d) Lung ultrasonographic image displaying thin-walled cavities in the lingula region of the left lung. And this needs even more clarification.[note 1]

See also Edit

Notes Edit

  1. ^ Text was copied from this source, which is available under Attribution 4.0 International (CC BY 4.0)

References Edit

  1. ^ a b c d Sawicki, G. S.; Lu, F. L.; Valim, C.; Cleveland, R. H.; Colin, A. A. (2008-03-05). "Necrotising pneumonia is an increasingly detected complication of pneumonia in children". European Respiratory Journal. 31 (6): 1285–1291. doi:10.1183/09031936.00099807. ISSN 0903-1936. PMID 18216055.
  2. ^ a b c Tsai, Yueh-Feng; Ku, Yee-Huang (2012). "Necrotizing pneumonia". Current Opinion in Pulmonary Medicine. 18 (3): 246–252. doi:10.1097/MCP.0b013e3283521022. ISSN 1070-5287. PMID 22388585.
  3. ^ a b c d e f g h i j Masters, I. Brent; Isles, Alan F.; Grimwood, Keith (July 25, 2017). "Necrotizing pneumonia: an emerging problem in children?". Pneumonia. 9 (1): 11. doi:10.1186/s41479-017-0035-0. ISSN 2200-6133. PMC 5525269. PMID 28770121.
  4. ^ Scotta, Marcelo C.; Marostica, Paulo J.C.; Stein, Renato T. (2019). "Pneumonia in Children". Kendig's Disorders of the Respiratory Tract in Children. Elsevier. p. 435.e4. doi:10.1016/b978-0-323-44887-1.00025-0. ISBN 978-0-323-44887-1. S2CID 81700501.
  5. ^ Widysanto, Allen; Liem, Maranatha; Puspita, Karina Dian; Pradhana, Cindy Meidy Leony (2020). "Management of necrotizing pneumonia with bronchopleural fistula caused by multidrug‐resistant Acinetobacter baumannii". Respirology Case Reports. 8 (8): e00662. doi:10.1002/rcr2.662. PMC 7507560. PMID 32999723.
  6. ^ a b c Reimel, Beth Ann; Krishnadasen, Baiya; Cuschieri, Joseph; Klein, Matthew B; Gross, Joel; Karmy-Jones, Riyad (January 1, 2000). "Surgical management of acute necrotizing lung infections". Canadian Respiratory Journal. 13 (7): 369–373. doi:10.1155/2006/760390. PMC 2683290. PMID 17036090.
  7. ^ a b c d e f g Krutikov, Maria; Rahman, Ananna; Tiberi, Simon (2019). "Necrotizing pneumonia (aetiology, clinical features and management)". Current Opinion in Pulmonary Medicine. 25 (3): 225–232. doi:10.1097/mcp.0000000000000571. ISSN 1070-5287. PMID 30844921. S2CID 73507080.
  8. ^ a b c Chatha, Neela; Fortin, Dalilah; Bosma, Karen J (February 19, 2021). "Management of necrotizing pneumonia and pulmonary gangrene: A case series and review of the literature". Canadian Respiratory Journal. 21 (4): 239–245. doi:10.1155/2014/864159. PMC 4173892. PMID 24791253.
  9. ^ a b c d Spencer, David A.; Thomas, Matthew F. (September 1, 2014). "Necrotising pneumonia in children". Paediatric Respiratory Reviews. 15 (3): 240–245. doi:10.1016/j.prrv.2013.10.001. ISSN 1526-0542. PMID 24268096. Retrieved February 20, 2021.
  10. ^ "National Library of Medicine". Digital Collections. Retrieved February 21, 2021.
  11. ^ Benedictis, Fernando M de; Kerem, Eitan; Chang, Anne B; Colin, Andrew A; Zar, Heather J; Bush, Andrew (September 12, 2020). "Complicated pneumonia in children". The Lancet. 396 (10253): 786–798. doi:10.1016/S0140-6736(20)31550-6. ISSN 0140-6736. PMID 32919518. S2CID 221590241. Retrieved February 21, 2021.
  12. ^ a b Kaur, Ravinder; Casey, Janet R.; Pichichero, Michael E. (February 21, 2021). "Emerging Streptococcus pneumoniae Strains Colonizing the Nasopharynx in Children after 13-Valent (PCV13) Pneumococcal Conjugate Vaccination in Comparison to the 7-Valent (PCV7) Era, 2006-2015". The Pediatric Infectious Disease Journal. 35 (8): 901–6. doi:10.1097/INF.0000000000001206. PMC 4948952. PMID 27420806.
  13. ^ Gillet, Yves; Issartel, Bertrand; Vanhems, Philippe; Fournet, Jean-Christophe; Lina, Gerard; Bes, Michèle; Vandenesch, François; Piémont, Yves; Brousse, Nicole; Floret, Daniel; Etienne, Jerome (March 2, 2002). "Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients". The Lancet. 359 (9308): 753–759. doi:10.1016/S0140-6736(02)07877-7. ISSN 0140-6736. PMID 11888586. S2CID 20400336. Retrieved February 21, 2021.
  14. ^ Tenover FC, Goering RV (2009). "Methicillin-resistant Staphylococcus aureus strain USA300: origin and epidemiology". J Antimicrob Chemother. 64 (3): 441–6. doi:10.1093/jac/dkp241. PMID 19608582.

August 31, 2023
necrotizing, pneumonia, also, known, cavitary, pneumonia, cavitatory, necrosis, rare, severe, complication, lung, parenchymal, infection, necrotizing, pneumonia, there, substantial, liquefaction, following, death, lung, tissue, which, lead, gangrene, formation. Necrotizing pneumonia NP also known as cavitary pneumonia or cavitatory necrosis is a rare but severe complication of lung parenchymal infection 1 2 3 In necrotizing pneumonia there is a substantial liquefaction following death of the lung tissue which may lead to gangrene formation in the lung 4 5 In most cases patients with NP have fever cough and bad breath and those with more indolent infections have weight loss 6 Often patients clinically present with acute respiratory failure 6 The most common pathogens responsible for NP are Streptococcus pneumonia Staphylococcus aureus Klebsiella pneumoniae 7 Diagnosis is usually done by chest imaging e g chest X ray CT scan Among these CT scan is the most sensitive test which shows loss of lung architecture and multiple small thin walled cavities 3 Often cultures from bronchoalveolar lavage and blood may be done for identification of the causative organism s 8 It is primarily managed by supportive care along with appropriate antibiotics 8 However if patient develops severe complications like sepsis or fails to medical therapy surgical resection is a reasonable option for saving life 6 8 Necrotizing pneumoniaSpecialtyInfectious disease respirology Contents 1 History 2 Causative organisms 2 1 Children 2 2 Adults 3 Predisposing risk factors 3 1 Adults 3 2 Children 3 3 Relationship with viral infection 4 Additional imaging 5 See also 6 Notes 7 ReferencesHistory EditNP in adults was first described in the 1940s whereas in children it was reported later in 1994 3 Necrotizing pneumonia is an ancient disease which was once a leading cause of death in both adults and children 9 Its clinical features were presumably first outlined by Hippocrates 9 Later in 1826 Rene Laennec described these features in a more detailed fashion in his seminal work De l auscultation mediate ou Traite du Diagnostic des Maladies des Poumon et du Coeur A treatise on the diseases of the chest and on mediate auscultation 9 10 Although availability of appropriate antibiotics had made NP a rare disease over the last two decades it has emerged as a severe complication of childhood pneumonia 1 Causative organisms EditThe most common pathogens responsible for NP are Streptococcus pneumonia Staphylococcus aureus and Klebsiella pneumoniae 7 Other pathogens which are less likely to cause NP are bacteria like Haemophilus influenzae Streptococcus anginosus group Pseudomonas aeruginosa Mycoplasma pneumoniae Acinetobacter baumannii Streptococcus pyogenes Stenotrophomonas maltophilia anaerobes like Fusobacterium nucleatum and Bacteroides fragilis fungi like Aspergillus sp and Histoplasma capsulatum viruses like Influenza and Adenovirus 7 3 9 Children Edit Apart from Streptococcus pneumonia also known as Pneumococcus pneumoniae several other organisms have appeared to cause necrotizing pneumonia in children since 2002 1 Most of the aforementioned organisms have been reported to be associated with childhood NP except that K pneumoniae is not a common cause in children 3 However Pneumococci and S aureus are frequently responsible for it 3 Pneumococcal conjugate vaccine PCV7 covering serotypes 4 6B 9V 14 18C 19F and 23F was introduced in the USA in 2000 11 12 Consequently non PCV7 serotypes like 3 5 7F 19A emerged as new threats Of this serotypes 3 and 19A were particularly associated with NP 3 In 2010 PCV7 was replaced by a 13 valent pneumococcal conjugate vaccine PCV13 PCV13 includes all PCV7 serotypes plus six additional serotypes 1 3 5 6A 7F amp 19A 12 Panton Valentine leukocidin PVL producing S aureus strains are oftentimes responsible for life threatening necrotizing pneumonia in previously healthy children and young adults 13 These PVL producing strains are frequently methicillin resistant MRSA 3 In developing countries with high rates of HIV infection Mycobacterium tuberculosis is the common cause of NP in children 7 Adults Edit Adults are more commonly affected by community acquired Staphylococcus aureus S pneumoniae and K pneumoniae Gram negative organisms like K pneumoniae and P aeruginosa are usually associated with Pulmonary gangrene 7 Predisposing risk factors EditAdults Edit Necrotizing pneumonia typically occurs in adult males who have coexisting health problems like diabetes mellitus alcohol use disorder and corticosteroid therapy 2 Other risk factors may include smoking gastrectomy history of substance use disorder or HIV AIDS 7 Children Edit On the contrary in most of the cases children of both sexes are affected equally 3 Furthermore it is unlikely that affected children have any underlying co morbidities but if any asthma is the most common chronic disorder followed by recurrent otitis media 3 1 Relationship with viral infection Edit Group A streptococcus such as S pyogenes often preceded by varicella infection may cause severe invasive infections and complicated childhood pneumonia 2 Influenza virus infection substantially increases the risk of developing necrotizing pneumonia in children mostly by PVL producing S aureus followed by S pneumoniae 7 In the United States it is observed that NP has increased following influenza owing to the emergence of MRSA strain USA300 infections 14 Additional imaging Edit a Initial plain chest radiograph showing a dense right upper zone airspace opacity and lingula airspace changes consistent with multi focal pneumonia The following images were performed 24 h later b Plain chest radiograph with the patient intubated and ventilated revealing cavitation in the right mid to upper zones pleural effusion and more general airspace changes bilaterally c Computed tomography CT scan coronal view demonstrating non enhancing area necrotic thin walled cavities within the right upper lobe and lingula d Lung ultrasonographic image displaying thin walled cavities in the lingula region of the left lung And this needs even more clarification note 1 See also EditLung abscess PneumoniaNotes Edit Text was copied from this source which is available under Attribution 4 0 International CC BY 4 0 References Edit a b c d Sawicki G S Lu F L Valim C Cleveland R H Colin A A 2008 03 05 Necrotising pneumonia is an increasingly detected complication of pneumonia in children European Respiratory Journal 31 6 1285 1291 doi 10 1183 09031936 00099807 ISSN 0903 1936 PMID 18216055 a b c Tsai Yueh Feng Ku Yee Huang 2012 Necrotizing pneumonia Current Opinion in Pulmonary Medicine 18 3 246 252 doi 10 1097 MCP 0b013e3283521022 ISSN 1070 5287 PMID 22388585 a b c d e f g h i j Masters I Brent Isles Alan F Grimwood Keith July 25 2017 Necrotizing pneumonia an emerging problem in children Pneumonia 9 1 11 doi 10 1186 s41479 017 0035 0 ISSN 2200 6133 PMC 5525269 PMID 28770121 Scotta Marcelo C Marostica Paulo J C Stein Renato T 2019 Pneumonia in Children Kendig s Disorders of the Respiratory Tract in Children Elsevier p 435 e4 doi 10 1016 b978 0 323 44887 1 00025 0 ISBN 978 0 323 44887 1 S2CID 81700501 Widysanto Allen Liem Maranatha Puspita Karina Dian Pradhana Cindy Meidy Leony 2020 Management of necrotizing pneumonia with bronchopleural fistula caused by multidrug resistant Acinetobacter baumannii Respirology Case Reports 8 8 e00662 doi 10 1002 rcr2 662 PMC 7507560 PMID 32999723 a b c Reimel Beth Ann Krishnadasen Baiya Cuschieri Joseph Klein Matthew B Gross Joel Karmy Jones Riyad January 1 2000 Surgical management of acute necrotizing lung infections Canadian Respiratory Journal 13 7 369 373 doi 10 1155 2006 760390 PMC 2683290 PMID 17036090 a b c d e f g Krutikov Maria Rahman Ananna Tiberi Simon 2019 Necrotizing pneumonia aetiology clinical features and management Current Opinion in Pulmonary Medicine 25 3 225 232 doi 10 1097 mcp 0000000000000571 ISSN 1070 5287 PMID 30844921 S2CID 73507080 a b c Chatha Neela Fortin Dalilah Bosma Karen J February 19 2021 Management of necrotizing pneumonia and pulmonary gangrene A case series and review of the literature Canadian Respiratory Journal 21 4 239 245 doi 10 1155 2014 864159 PMC 4173892 PMID 24791253 a b c d Spencer David A Thomas Matthew F September 1 2014 Necrotising pneumonia in children Paediatric Respiratory Reviews 15 3 240 245 doi 10 1016 j prrv 2013 10 001 ISSN 1526 0542 PMID 24268096 Retrieved February 20 2021 National Library of Medicine Digital Collections Retrieved February 21 2021 Benedictis Fernando M de Kerem Eitan Chang Anne B Colin Andrew A Zar Heather J Bush Andrew September 12 2020 Complicated pneumonia in children The Lancet 396 10253 786 798 doi 10 1016 S0140 6736 20 31550 6 ISSN 0140 6736 PMID 32919518 S2CID 221590241 Retrieved February 21 2021 a b Kaur Ravinder Casey Janet R Pichichero Michael E February 21 2021 Emerging Streptococcus pneumoniae Strains Colonizing the Nasopharynx in Children after 13 Valent PCV13 Pneumococcal Conjugate Vaccination in Comparison to the 7 Valent PCV7 Era 2006 2015 The Pediatric Infectious Disease Journal 35 8 901 6 doi 10 1097 INF 0000000000001206 PMC 4948952 PMID 27420806 Gillet Yves Issartel Bertrand Vanhems Philippe Fournet Jean Christophe Lina Gerard Bes Michele Vandenesch Francois Piemont Yves Brousse Nicole Floret Daniel Etienne Jerome March 2 2002 Association between Staphylococcus aureus strains carrying gene for Panton Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients The Lancet 359 9308 753 759 doi 10 1016 S0140 6736 02 07877 7 ISSN 0140 6736 PMID 11888586 S2CID 20400336 Retrieved February 21 2021 Tenover FC Goering RV 2009 Methicillin resistant Staphylococcus aureus strain USA300 origin and epidemiology J Antimicrob Chemother 64 3 441 6 doi 10 1093 jac dkp241 PMID 19608582 Retrieved from https en wikipedia org w index php title Necrotizing pneumonia amp oldid 1153976994, wikipedia, wiki, book, books, library,

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