Predictive value of lactate dehydrogenase for Mycoplasma pneumoniae necrotizing pneumonia in children based on decision curve analysis and dose-response analysis

Mycoplasma pneumoniae necrotizing pneumonia (MPNP) has a long and severe disease course, which seriously threatens to jeopardize patients' lives and health. Early prediction is essential for good recovery and prognosis. In the present study, we retrospect 128 children with MPNP and 118 children with Mycoplasma pneumoniae pneumonia combined with pulmonary consolidation to explore the predictive value of lactate dehydrogenase (LDH) in children with MPNP by propensity score matching method, multiple logistic regression analysis, dose-response analysis and decision curve analysis. The WBC count, PLT count and percentage of neutrophils were significantly higher in necrosis group than consolidation group. The serum CRP, PCT, ESR, D-D, FIB, ALT, LDH, IgG and IgM were significantly higher in necrosis group. Compared to consolidation group, necrosis group is more severe in chest pain and dyspnea. Multivariate logistic regression analysis showed that duration of LDH levels, high fever, D-dimer, and fibrinogen were independent predictive factors for the incidence of MPNP. Restricted cubic spline analysis showed that a non-linear dose-response relationship between the continuous changes of LDH level and the incidence of MPNP. Decision curve analysis revealed that LDH had an important clinical value in predicting MPNP. This study provides a potential serologic indicator for early diagnosis of MPNP.

[Rare cause of necrotizing pneumonia : A case report]

A 29-year-old Indian patient was admitted to the authors' pulmonary clinic with cough and fever. Community-acquired pneumonia was initially suspected. Various antibiotic therapies were administered, which did not lead to any clinical improvement. Despite detailed diagnostics, no pathogen was found. Computed tomography showed rapidly progressive pneumonia in the left upper lobe. Since the infection could not be managed conservatively, upper lobe resection was performed. Histologically, an amoebic abscess was found to be the cause of the infection. Since cerebral and hepatic abscesses were also found, hematogenous dissemination may be assumed.

Rapidly progressive necrotizing pneumonia: remember the Streptococcus anginosus group!

Acute necrotizing pneumonia in an immunocompetent host is uncommon and usually caused by Staphylococcus aureus infection. Streptococcus anginosus group (SAG) is a less recognized cause of rapidly destructive lung infection resulting in significant patient morbidity and mortality. Unlike many other bacterial infections, SAG can cross fascial planes and cause fulminant infections. Necrotizing pneumonia and lung abscesses due to SAG often fails conservative therapy with antimicrobials and requires definitive surgical intervention. Consideration of SAG as a potential etiology might help to institute definitive therapy earlier and prevent complications.

Severe necrotising pneumonia in a toddler: A rare presentation with dual bacterial aetiology

Necrotising pneumonia (NP) is a rare complication of bacterial pneumonia which is associated with severe morbidity and mortality. Pneumonia of polymicrobial aetiology predicts worse pathology with fulminating clinical course. Reports of necrotising pneumonia from multiple bacterial infections are scanty in published literature. We report a case of a toddler with NP in whom Klebsiella pneumonia and Staphylococcus aureus, two pathogens which are well documented in its aetiopathogenesis, were isolated concurrently from his sputum and blood. Severe pneumonia, which shows slow response to recommended antibiotics treatment, should raise the suspicion of NP and possibly one of the polymicrobial origins. Even in resource-constrained settings, prompt institution of antibiotics and supportive care can result in resolution of pulmonary lesions.

[CME: Cavitary Pulmonary Disease – Differential Diagnosis and Diagnostic Work-Up]

Zusammenfassung. Ein kavernierender oder kavitierender Lungenrundherd bzw. eine Lungenkaverne ist die Manifestation einer grossen Bandbreite von pathologischen Prozessen mit Befall der Lunge inklusive entzündlicher, infektiöser und maligner Ätiologien. Gleichzeitig kann das Vorhandensein einer Kaverne im klinischen Kontext helfen, die Differenzialdiagnosen und damit die weiteren Abklärungsschritte einzugrenzen. Wir werden im Folgenden einen Überblick über mögliche Diagnosen und die entsprechenden klinischen und radiologischen Zeichen kavernierender Lungenrundherde darlegen; ein besonderer Fokus wird dabei auf Vaskulitiden gelegt.

Necrotizing Pneumonia

Necrotizing pneumonia refers to the development of necrosis, liquefication, and cavitation of the lung parenchyma from an infectious pathogen. Nearly 4% of all community-acquired pneumonias are necrotizing, although studies retrospectively evaluating the incidence have found it to be increasing during the past 20 years. Common presenting symptoms include fever, tachypnea, and cough, and most of those afflicted also develop complications such as parapneumonic effusions, empyemas, or bronchopleural fistulae. When compared to age-matched controls with parapneumonic effusions or severe pneumonias without a necrotizing component, those with necrotizing pneumonia have been shown to have more elevated white blood cell counts and inflammatory markers that take longer to normalize, a longer duration of symptoms despite initiation of therapy, and a longer hospital stay. Despite the high incidence of complications during the acute phase of illness, the overall prognosis of necrotizing pneumonia has been shown to be promising, with nearly all children surviving the illness. [Pediatr Ann. 2017;46(2):e65-e68.].