Complicated pneumonia in children

Benedictis, Fernando Maria de; Kerem, Eitan; Chang, Anne B.; Colin, Andrew A.; Zar, Heather J.; Bush, Andrew

doi:10.1016/s0140-6736(20)31550-6

Cited by 153 publications

(229 citation statements)

References 169 publications

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“…In fact, chest x‐ray has a low diagnostic yield for NP, and the use of computed tomography scan has been discouraged in children for its radiation impact. Lung ultrasound has recently been shown to have a good diagnostic potential in detecting the early changes of complicated pneumonia, 1 but this technique has seldom been employed in our centers for the evaluation of lung parenchyma. Therefore, diagnosis of NP may have been underestimated, particularly in cases with significant pleural involvement that could mask the parenchyma in first‐line image modalities.…”

Section: Discussionmentioning

confidence: 99%

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Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

Carloni¹,

Ricci

Rubino

et al. 2021

Pediatric Pulmonology

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Background Necrotizing pneumonia (NP) is a severe complication of community‐acquired pneumonia. The impact of 13‐valent pneumococcal conjugate vaccine (PCV13) on the epidemiology of NP in children has not been assessed. Patients and methods Medical records of children less than 18 years admitted with NP to two pediatric hospitals in Italy between 2005 and 2019 were reviewed. The following four periods were defined: 2005–2010 (pre‐PCV13), 2011–2013 (early post‐PCV13), 2014–2016 (intermediate post‐PCV13), and 2017–2019 (late post‐PCV13). Results Forty‐three children (median age, 44 months) were included. Most of them (93%) were previously healthy. No differences in age, sex, season of admission, comorbidity, clinical presentation, or hospital course were identified between pre‐PCV13 and post‐PCV13 periods. A significant decrease in the rate of NP‐associated hospitalizations was found between the early (1.5/1000 admissions/year) and the intermediate (0.35/1000 admissions/year) post‐PCV13 period (p = .001). An increased trend in admissions was found thereafter. Streptococcus pneumoniae was the most common agent detected in both periods (pre‐PCV13: 11/18, 61%; post‐PCV13: 13/25, 52%). Serotype 3 was the most common strain in both periods (pre‐PCV13: 3/11, 27%; post‐PCV13; 4/13, 31%). There were no changes in the etiology over time, but most patients with Streptococcus pyogenes or Staphylococcus aureus infection were admitted during the post‐PCV13 period. Conclusions The hospitalization rate for NP in children decreased a few years after the implementation of PCV13 immunization in Italy. However, an increased trend in admissions was found thereafter. S. pneumoniae was the most frequent causal agent in both pre‐ and post‐PCV13 periods. Pneumococcal serotypes were mainly represented by Strain 3.

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Section: Discussionmentioning

confidence: 99%

“…Necrotizing pneumonia (NP) is a severe complication of community‐acquired pneumonia 1 . It is characterized by destruction and cavitation of the lung parenchyma (“Emmentaler lung”), and is frequently associated with pleural involvement 2 .…”

Section: Introductionmentioning

confidence: 99%

Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

Carloni¹,

Ricci

Rubino

et al. 2021

Pediatric Pulmonology

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“…Although pneumonia is prevalent, complicated pneumonia such as empyema, lung abscess, and necrotizing pneumonia (NP) is uncommon in children. 1 The prevalence of complicated pneumococcal pneumonia decreased significantly after the introduction of the 13-valent pneumococcal vaccine in 2010. 1 NP in the pediatric population is a severe disease characterized by extensive destruction and liquefaction of the lung tissue resulting in loss of the pulmonary parenchymal architecture, cavitation of the lung, and pleural involvement.…”

Section: An Unusual Case Of Necrotizing Pneumonia Presenting With Acumentioning

confidence: 99%

“…1 The prevalence of complicated pneumococcal pneumonia decreased significantly after the introduction of the 13-valent pneumococcal vaccine in 2010. 1 NP in the pediatric population is a severe disease characterized by extensive destruction and liquefaction of the lung tissue resulting in loss of the pulmonary parenchymal architecture, cavitation of the lung, and pleural involvement. Renal complications of complicated pneumonia are rare and mostly reported as atypical hemolytic uremic syndrome (HUS).…”

Section: An Unusual Case Of Necrotizing Pneumonia Presenting With Acumentioning

confidence: 99%

“…NP is characterized by persistent high fevers and prolonged hospitalizations even with appropriate antibiotic treatment. 1 Most often, NP affects immunocompetent children with no underlying risk factors. 4 The pathophysiology of this complication is acute liquefactive necrosis of the lung parenchyma, which results in the development of pneumatoceles.…”

Section: An Unusual Case Of Necrotizing Pneumonia Presenting With Acumentioning

confidence: 99%

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An unusual case of necrotizing pneumonia presenting with acute kidney injury

Balkanci

Sas

Demirel

2020

Pediatric Pulmonology

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A high-calorie diet aggravates LPS-induced pneumonia by disturbing the gut microbiota and Th17/Treg balance

Liu

Bai

Xian

et al. 2022

Journal of Leukocyte Biology

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The intestinal flora plays an important role in the inflammatory response to the systemic or local infections in the host. A high-calorie diet has been shown to aggravate pneumonia and delay recovery, especially in children. However, the underlying mechanisms remain unclear. Our previous studies demonstrated that a high-calorie diet and LPS atomization synergistically promoted lung inflammation injury in juvenile rats. In this study, specific pathogen-free juvenile rats were placed in a routine environment, and subjected to a high-calorie diet or LPS atomization in isolation as well as combination. Our data revealed that LPS nebulization combined with a high-calorie diet resulted in significant changes in rats, such as slow weight gain, increased lung index, and aggravated lung inflammatory damage. Meanwhile, we found that the aggravation of LPS-induced pneumonia by a high-calorie diet disturbs the balance of Th17/Treg cells. Furthermore, high-throughput sequencing of intestinal contents revealed that a high-calorie diet changed the gut microbiome composition, decreased microbial diversity, and particularly reduced the abundance of the intestinal microbiota associated with the production of short-chain fatty acids (SCFAs) in rats. Consequently, the levels of SCFAs, especially acetate, propionate, and butyrate, were significantly decreased following the intervention of a high-calorie diet. More critically, the effects of a high-calorie diet were shown to be transmissible among pneumonia rats through cohousing microbiota transplantation. Taken together, we provide evidence to support that a high-calorie diet can potentially reset the gut microbiome and metabolites, disrupt Th17/Treg cell balance and immune homeostasis, and aggravate LPS-induced lung inflammatory damage, which may provide a new perspective on the pathogenesis of lung inflammation injury, and suggest a novel microbiota-targeting therapy for inflammatory lung diseases.

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Complicated pneumonia in children

Cited by 153 publications

References 169 publications

Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

Necrotizing pneumonia among Italian children in the pneumococcal conjugate vaccine era

An unusual case of necrotizing pneumonia presenting with acute kidney injury

A high-calorie diet aggravates LPS-induced pneumonia by disturbing the gut microbiota and Th17/Treg balance

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