Pulmonary abscess of viral-bacterial etiology in a neonate

Abstract

Abbreviations MRI Magnetic resonance imaging RSV Respiratory syncytial virusWe report the case of an infant with a polymicrobial pulmonary abscess visualized using magnetic resonance imaging. Respiratory syncytial virus, Escherichia coli, and Streptococcus pneumoniae were detected directly from abscess fluid, demonstrating the interaction between viruses and bacteria in the development of complicated pneumonia. Case reportA 14-day-old female infant was admitted to a local hospital because of dyspnoea and fever. She was born at term with a birth weight of 3,110 g and an Apgar score of 10. Two days before admission, she developed a cough and nasal discharge. Chest radiographs revealed interstitial infiltrates, and the concentration of serum C-reactive protein was high (on admission 141 mg/l, 2 days later 401 mg/l). Bronchiolitis was diagnosed but because of suspected sepsis, treatment was initiated with intravenous cefuroxime and supplemental oxygen. Blood, cerebrospinal fluid, and urine bacterial cultures were negative. She remained febrile despite expanded treatment with cloxacillin, gentamicin, and cefotaxime. After 7 days, she was referred to our hospital because of pulmonary infection unresponsive to treatment.On admission to our hospital, the girl was irritable and had low-grade fever. She had no dyspnoea, and her respiratory rate (50/min), breathing sounds, and arterial oxygen saturation (98% by pulse oximetry) were normal. Chest radiography showed a central parenchymal lung infiltrate and pleural fluid collection on the right side. Pleural drainage yielded only a minimal amount of fluid with growth of Escherichia coli. Nasopharyngeal aspirate and nasal swab samples were positive for respiratory syncytial virus (RSV) by PCR, and pneumococcal antigen was detected in the urine (Binax NOW; Binax, Scarborough, ME). The patient was treated with cefuroxime and erythromycin. Within the next week, the fever resolved and the C-reactive protein level decreased from 245 mg/l to 45 mg/l. Because of radiological persistence of a pleural shadow, a contrast medium-enhanced MRI of the chest was performed 9 days after referral to our hospital. The examination was performed without sedation while the infant was sleeping after feeding. The MRI showed an abscess in the right lower lobe, consolidation in the right middle and lower lobes, and pleural thickening with fluid on the right side (Fig. 1). The abscess wall and the pleura were loaded with contrast medium. A percutaneous needle puncture of the abscess yielded 7 ml pus that was positive for E. coli by culture, Streptococcus pneumoniae by antigen Eur J Pediatr (

Review of the clinical significance of respiratory virus infections in newborn infants

“…Bacterial involvement in a virus‐associated lower respiratory tract infection is possible. Furthermore, serious bacterial complications, such as a pulmonary abscess, have been reported to be associated with an RSV infection in a neonate . Respiratory virus infections are also often associated with bacterial complications such as acute otitis media and pneumonia that require antibiotic treatment.…”