Severe Necrotizing Pneumonia Complicating Influenza A (H1N1): The Role of Immunologic Interaction

Guidi, Roberto; Osimani, Patrizia; Azzari, Chiara; Resti, Massimo; Benedictis, Fernando Maria de

doi:10.1177/039463201102400429

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…We speculated that many viruses cause seasonal respiratory infections peaking in the winter months and the preceding viral illness (especially influenza) might be an important risk factor for the potentially severe NP that could follow. 6,13 Additionally, severe or very severe pneumonia has been associated with bacterial and viral coinfection in some reports. [14][15][16] This copathogenesis is characterized by complex interactions between coinfecting pathogens and the host, which lead to the disruption of physical barriers, dysregulation of immune responses, and delays in the return to homeostasis.…”

Section: Discussionmentioning

confidence: 99%

“…However, severe lung necrosis is more commonly developed during winter. We speculated that many viruses cause seasonal respiratory infections peaking in the winter months and the preceding viral illness (especially influenza) might be an important risk factor for the potentially severe NP that could follow 6,13 . Additionally, severe or very severe pneumonia has been associated with bacterial and viral coinfection in some reports 14–16 .…”

Section: Discussionmentioning

confidence: 99%

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Early predictors of lung necrosis severity in children with community‐acquired necrotizing pneumonia

Zhang

Chen

et al. 2022

Pediatric Pulmonology

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Objective To analyze baseline clinical and laboratory characteristics and explore the possible predictors of lung necrosis severity in children with community‐acquired necrotizing pneumonia (NP). Methodology This retrospective observational study was performed in a tertiary referral center. A total of 104 patients aged <15 years with community‐acquired pneumonia and radiologically confirmed NP by computed tomography (CT) were included. Patients were classified into the mild, moderate, or massive necrosis groups. Results Among them, 29, 41, and 34 patients had mild, moderate, and massive necrosis, respectively. Moreover, 34.6% of the patients were admitted to pediatric intensive care unit. Massive necrosis was more likely to occur during winter (p < 0.05) and was associated with more severe clinical outcomes, such as longer duration of fever, longer hospitalization, increased mortality, and a higher risk of subsequent surgical intervention (p < 0.05). Multivariate analysis demonstrated that the following were independent risk factors for massive necrosis in this study: C‐reactive protein (CRP) (p = 0.036), serum albumin (p = 0.009), and immunoglobulin M (IgM) (p = 0.022). Receiver operating characteristic analysis showed that when the cut‐off value for CRP, serum albumin, and IgM were set at 122 mg/L, 30.8 g/L, and 95.7 mg/dl, respectively, they showed good diagnostic performance for differentiating patients with massive necrosis from all patients with NP. Conclusion NP is a potentially severe complication of pediatric community‐acquired pneumonia. Different severities of lung necrosis can lead to different clinical outcomes. CRP, serum albumin, and IgM levels are independent predictors of the degree of lung necrosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Early predictors of lung necrosis severity in children with community‐acquired necrotizing pneumonia

Zhang

Chen

et al. 2022

Pediatric Pulmonology

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“…Our study found no significant differences in age, sex, BMI, and underlying diseases among the groups; however, severe lung necrosis more commonly developed during winter. We speculated that viral infection was more likely to occur in winter and that preceding viral illness (especially influenza) might be an important risk factor for NP in childhood 10 .…”

Section: Discussionmentioning

confidence: 99%

Early predictors of lung necrosis severity in children with community-acquired necrotizing pneumonia

Zhang

Chen

et al. 2021

Preprint

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Objective: To analyze baseline clinical and laboratory characteristics and explore the possible predictors of lung necrosis severity in children with community-acquired necrotizing pneumonia (NP). Methodology: This retrospective observational study was performed in a tertiary referral center. A total of 104 patients aged <15 years with community-acquired pneumonia and radiologically confirmed NP were included. Patients were classified into the mild, moderate, or massive necrosis groups. Results: Among them, 29, 41, and 34 patients had mild, moderate, and massive necrosis, respectively. Moreover, 34.6% of the patients were admitted to the pediatric intensive care unit. Massive necrosis was more likely to occur during winter (p<0.05) and was associated with more severe clinical outcomes, such as longer duration of fever, longer hospitalization, increased mortality, and a higher risk of subsequent surgical intervention (p<0.05). Multivariate analysis demonstrated that the following were independent risk factors for massive necrosis: C-reactive protein (CRP) ≥ 122 mg/L (adjusted odds ratio [aOR], 8.780; 95% confidence interval [CI], 3.320–21.089; p=0.003), serum albumin ≤ 30.8 g/L (aOR, 11.608; 95% CI, 5.147–27.058; p=0.001), and immunoglobulin M (IgM) ≤ 95.7 mg/dL (aOR, 7.152; 95% CI, 2.240–17.692; p=0.021). Receiver operating characteristic analysis demonstrated that these variables showed good diagnostic performance for differentiating patients with massive necrosis from all patients with NP. Conclusion: NP is a potentially severe complication of pediatric community-acquired pneumonia. Different severities of lung necrosis can lead to different clinical outcomes. CRP, serum albumin, and IgM levels are independent predictors of the degree of lung necrosis.

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“…Among other causative agents, such bacteria as Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter lwoffii must also be considered in differential diagnostics [16]. In children with viral respiratory infections, in particular with recently emerged pandemic influenza A (H1N1), the interactive mechanisms between viruses and bacteria predispose to bacterial superinfections and development of necrotic pulmonary lesions [17]. In immunocompromised children, fungal infections with Candida, Aspergillus fumigatus, Cryptococcus neoformans as well as Scedosporium prolificans must be taken into account as causative agents of necrotic pneumonia [18].…”

Section: Discussionmentioning

confidence: 99%

Fatal Pulmonary Complications in an Immunodeficient Child with Chronic Active Epstein-Barr Virus Infection

Szczawińska-Popłonyk

Jończyk‐Potoczna

Ossowska

et al. 2014

Advances in Respiratory Medicine

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Primary Epstein-Barr virus infection in children typically presents as infectious mononucleosis and in immunocompetent individuals severe pneumonitis proves to be a rare complication. Chronic active Epstein-Barr virus infection (CAEBV) is associated with multiple life-threatening conditions, including interstitial lung disease with fibrosis and lymphoid and lymphohistiocytic infiltrations. We report on a pediatric patient in whom CAEBV resulted in severe pneumopathy with a fatal outcome.Pneumonol. Alergol. Pol. 2014; 82: 364-367

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Severe Necrotizing Pneumonia Complicating Influenza A (H1N1): The Role of Immunologic Interaction

Cited by 5 publications

References 24 publications

Early predictors of lung necrosis severity in children with community‐acquired necrotizing pneumonia

Early predictors of lung necrosis severity in children with community‐acquired necrotizing pneumonia

Early predictors of lung necrosis severity in children with community-acquired necrotizing pneumonia

Fatal Pulmonary Complications in an Immunodeficient Child with Chronic Active Epstein-Barr Virus Infection

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