Clinical characteristics and pathogen profile of 133 cases of community-acquired necrotizing pneumonia in children
- Author:
LI Wanying
;
JIA Wanyu
;
FU Shuqin
- Publication Type:Journal Article
- Keywords:
Necrotizing pneumonia;
children;
Mycoplasma pneumoniae;
Streptococcus pneumoniae;
mixed infection
- From:
China Tropical Medicine
2024;24(9):1123-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the clinical data of pediatric community-acquired necrotizing pneumonia (NP) in 2023, summarizing its clinical characteristics and pathogen profile distribution. Methods The clinical data of hospitalized children with NP in 2023 at Henan Children's Hospital were retrospectively analyzed. Comparisons were made with those in the non-NP group to summarize the clinical symptoms, pathogenetic features, laboratory indices and imaging changes, treatment, and prognosis. Results Among the 133 NP cases, there were 64 males and 69 females, with a median age of 7 years. In the non-NP group, there were 61 cases, including 38 males and 23 females, with a median age of 6. The NP group showed significantly higher proportions of chest pain, dyspnea, poor mental response, refusal of food/dehydration signs, and extrapulmonary complications compared to the non-NP group (P<0.05). The hospitalization duration of NP children was 18 days, with a fever duration of 12 days. They had a peripheral blood leukocyte count of 11.44×109/L, C-reactive protein of 37.44 mg/L, procalcitonin of 0.207 ng/mL, blood sedimentation of 40 mm/h, D-dimer of 1.99 μg/mL, lactate dehydrogenase of 455 U/L, and serum ferritin of 233.8 μg/L, all significantly higher compared to the non-NP group (P<0.05). Enhanced chest CT in the NP group revealed necrotic foci on the (17.47±6.56) day of the disease, with some cases complicated by pleural effusion, pleural thickening, bronchial stenosis or dilatation, pulmonary atelectasis, pulmonary embolism, etc., accompanied by different degrees of impaired lung function. Bronchoscopy revealed mucosal congestion and edema, with some showing mucosal erosion and necrosis, phlegm thrombus obstruction, and rice soup-like secretions. Pathogens were detected in 129 (97.0%) children in the NP group, with the top five infectious agents being Mycoplasma pneumoniae, Streptococcus pneumoniae, adenovirus, rhinovirus, and influenza B virus. There were 76 cases (57.1%) of single pathogen infection, and 53 cases (39.8%) of mixed infection. The mixed infection group had higher peripheral blood leukocyte counts, poor mental response, refusal of food/dehydration signs, extrapulmonary complications, and application of gamma globulin compared to the non-mixed infection group (P<0.05). The prognosis was generally good after anti-infective and symptomatic supportive treatment, with some cases having residual respiratory sequelae. Conclusions Children with NP have a long course of disease, high inflammatory indexes, and are prone to intrapulmonary and extrapulmonary complications and lung function impairment. Chest CT enhancement scanning and bronchoscopy are helpful for early recognition of NP. The pathogen of NP infections in 2023 is dominated by drug-resistant Mycoplasma pneumoniae, with some children experiencing multi-pathogen mixed infections. The prognosis is generally good with aggressive treatment.
- Full text:202511111551372174018.Clinical characteristics and pathogen profile of 133 cases of community-acquired necrotizing pneumonia in children.pdf
