Neumatocele en paciente pediátrico. ¿Cuándo debemos actuar? / Pneumatocele in a pediatric patient. When should we act?

El neumatocele es una lesión cavitada llena de aire de carácter adquirido que se encuentra en el interior del parénquima pulmonar. Aunque las causas pueden variar, el origen infeccioso bacteriano es lo más frecuente. Los cambios en los serotipos de neumococo y el aumento de las neumonías necrotizantes observado en las últimas décadas hacen de este tipo de lesiones algo cada vez más frecuente. Es importante conocer la evolución esperable, así como también saber qué paciente se beneficia de intervención para evitar secuelas a largo plazo y complicaciones graves. En este artículo se exponen las causas, epidemiología, orientación diagnóstica y una propuesta de manejo para el neumatocele.

A pneumatocele is an air-filled cavitary lesion of acquired nature located within the pulmonary parenchyma. Although causes can vary, bacterial infectious origin is the most common. Changes in pneumococcal serotypes and the increase in necrotizing pneumonia observed in recent decades have made these lesions increasingly frequent. It is important to know the expected evolution and to identify which patients would benefit from intervention to prevent long-term sequelae and severe complications. This article exposes the causes, epidemiology, diagnostic approach, and a management proposal for pneumatocele.

Necrotising pneumonia caused by Curvularia hawaiiensis (syn. Bipolaris hawaiiensis) and Mycobacterium tuberculosis coinfection in a patient with ascariasis: a case report and review.

INTRODUCTION: Curvularia hawaiiensis (formerly Bipolaris hawaiiensis) is a plant pathogen often isolated from soil and vegetative material. However, only a few cases of opportunistic invasive infections in humans have been described. CASE: A 16-year-old female patient without comorbidities was admitted to the emergency department because of fever and chest pain. We described the first coinfection of Curvularia hawaiiensis and Mycobacterium tuberculosis necrotising pneumonia. DISCUSSION: Multiple infections can alter immune responses. However, immunosuppression is the most critical risk factor for infection with species of the genus Curvularia. Therefore, it is crucial to carefully examine patients with tuberculosis, as they may rarely be coinfected with unusual fungi.

Aerossacolitis and pneumonia in an Indian peafowl caused by Lactobacillus agilis

Background: The peafowl is an ornamental bird that has the habit of eating directly from the earthy soil, which makes thisbird more susceptible to endoparasites. One important endoparasite is Eucoleus contortus, which leads to inflammatoryprocesses that alter the local microbiota, potentializing disease. By the other way, a member of the birds microbiota thereis the genus Lactobacillus, but when occurs some imbalance, these bacteria can overgrowth and even cause some infection.This report describes the pathological and microbiological findings of chronic necrotizing pneumonia and aerossacolitiscaused by Lactobacillus agilis in a peafowl, associated with parasitism by E. contortus.Case: A peafowl (Pavo cristatus), adult, male, who lived on a farm with contact with other species of animal, was submittedto post-mortem examination due to sudden death. This animal lived in an extensive system on the property and was the onlyone of its species. During the gross evaluation, the air sacs were filled with solid yellowish crumbly material. The samematerial was observed forming well-defined nodules that occupied > 50% of the lung parenchyma. Histological analysisshowed multiple parabronchi dilated and filled with caseous necrosis, characterized by abundant cellular debris and fibrindeposition. These areas were surrounded by the proliferation of fibrous connective tissue and inflammatory infiltrate ofmacrophages, giant cells, lymphocytes, and plasma cells. The air sacs parenchyma showed fibrin deposition and mixedinflammatory infiltrate. Multiple gram-positive bacilli were observed within the caseous foci in Gram-stained slides. Inthe crop and esophageal mucosa, cross-sections of filiform nematodes morphologically compatible with E. contortus wereassociated with chronic inflammatory infiltrate and epidermal hyperkeratosis. A lung section was submitted to GramBrown-Hopps and Ziehl-Neelsen...(AU)

Aerossacolitis and pneumonia in an Indian peafowl caused by Lactobacillus agilis

Background: The peafowl is an ornamental bird that has the habit of eating directly from the earthy soil, which makes thisbird more susceptible to endoparasites. One important endoparasite is Eucoleus contortus, which leads to inflammatoryprocesses that alter the local microbiota, potentializing disease. By the other way, a member of the bird’s microbiota thereis the genus Lactobacillus, but when occurs some imbalance, these bacteria can overgrowth and even cause some infection.This report describes the pathological and microbiological findings of chronic necrotizing pneumonia and aerossacolitiscaused by Lactobacillus agilis in a peafowl, associated with parasitism by E. contortus.Case: A peafowl (Pavo cristatus), adult, male, who lived on a farm with contact with other species of animal, was submittedto post-mortem examination due to sudden death. This animal lived in an extensive system on the property and was the onlyone of its species. During the gross evaluation, the air sacs were filled with solid yellowish crumbly material. The samematerial was observed forming well-defined nodules that occupied > 50% of the lung parenchyma. Histological analysisshowed multiple parabronchi dilated and filled with caseous necrosis, characterized by abundant cellular debris and fibrindeposition. These areas were surrounded by the proliferation of fibrous connective tissue and inflammatory infiltrate ofmacrophages, giant cells, lymphocytes, and plasma cells. The air sacs parenchyma showed fibrin deposition and mixedinflammatory infiltrate. Multiple gram-positive bacilli were observed within the caseous foci in Gram-stained slides. Inthe crop and esophageal mucosa, cross-sections of filiform nematodes morphologically compatible with E. contortus wereassociated with chronic inflammatory infiltrate and epidermal hyperkeratosis. A lung section was submitted to GramBrown-Hopps and Ziehl-Neelsen...

Neumonía necrotizante: experiencia en el Hospital Roberto del Río período 2014 a 2020 / Necrotizing pneumonia: experience at the Roberto del Río Hospital from 2014 to 2020

La neumonía necrotizante se refiere a la necrosis del parénquima pulmonar producto de una infección. Existe escasa literatura nacional sobre esta complicación. OBJETIVO: Caracterizar a los pacientes que cursaron con neumonía necrotizante en el Hospital Roberto del Río entre los años 2014 y 2020. MÉTODO: Revisión retrospectiva y descriptiva. RESULTADOS: 22 pacientes. Promedio de edad 4 años 7 meses, 68% masculino, esta complicación correspondió a 1,3% de todos los casos de neumonía hospitalizados en ese periodo. Un 95,5% presentó fiebre y un 59% dificultad respiratoria y tos. La duración promedio de la hospitalización fue de 31 días y del tratamiento antibiótico de 30,3 días. El 63% de los pacientes requirió cirugía. En el laboratorio destaca la leucocitosis y proteína C reactiva elevados con 71,4% > a 90 mg/L (promedio: 211 mg/L) y 52,3% leucocitosis > 15.000 (promedio: 18.127). La ecografía torácica fue la imagen más frecuentemente utilizada (95,5%). Agentes identificados Streptococcus pneumoniae (40%) y Staphylococcus aureus (40%). Un 63,6% ingresó a UCI, 35,7% requirió ventilación mecánica invasiva, 35,7% recibió drogas vasoactivas, 9% requirió de soporte ECMO (Oxigenación por Membrana Extracorpórea) y 1 paciente falleció (4,5%). DISCUSIÓN: en nuestro estudio encontramos una baja incidencia de esta patología, un alto índice de gravedad y una evolución favorable en la gran mayoría de los casos.

Necrotizing pneumonia refers to necrosis of lung parenchyma resulting from an infection. There is little national literature on this complication. OBJECTIVE: To characterize patients with necrotizing pneumonia at the Roberto del Río Children´s Hospital between 2014 to 2020. METHOD: Retrospective and descriptive review. RESULTS: A total of 22 patients, average age 4 years 7 months, male (68%). Average incidence 1.3% in 7 years; 95.5% had fever 59% had respiratory distress and cough. Average duration of hospitalization was 31 days and antibiotic treatment 30.3 days. A 63% of the patients had surgery. Leukocytosis and C-reactive protein (CRP) were elevated, 71.4% CRP > 90 mg /L (average: 211 mg /L) and 52.3% leukocytosis > 15.000 (average: 18.127). Chest ultrasound was used in 95.5%. Main agents identified were Streptococcus pneumoniae (40%) and Staphylococcus aureus (40%). A 63.6% of patients were admitted to ICU, 35.7% required invasive mechanical ventilation, 35.7% received vasoactive drugs, 9% required ECMO (Extracorporeal Membrane Oxygenation), and one patient died (4,5%). DISCUSSION: In our study we found a low incidence of this pathology, a high severity index an a favorable evolution in most cases.

Breakthrough Hormographiella aspergillata Infection in a Patient with Acute Myeloid Leukemia Receiving Posaconazole Prophylaxis: A Case Report and Review.

Breakthrough invasive infections occur in immunosuppressed patients while they are receiving antifungal agents for both prophylaxis and therapy. Under such conditions, unusual fungal infections emerge. Hormographiella aspergillata is considered an uncommon human pathogen and causes devastating infections. Here, we present a case report of necrotizing pneumonia caused by H. aspergillata as a breakthrough infection in a neutropenic patient and review all previous cases of H. aspergillata infection reported in the literature.

Surgical treatment of necrotizing pneumonia in children: a 10-year assessment. / Tratamento cirúrgico de pneumonia necrosante em crianças em um período de 10 anos.

OBJECTIVE: Necrotizing pneumonia (PNZ) is a severe and rare complication of a community-acquired pneumonia, affecting mainly children. We aimed to analyze medical records of children undergoing surgical treatment for PNZ and compare our results with those found in the medical literature. METHODS: Retrospective analysis of children's medical charts who underwent an operation for PNZ, between July 2006 and July 2016, in two hospitals in southern Santa Catarina, Brazil. RESULTS: A total of 26 children with a median age of 2.70 years and mostly females (61.5%) were included in the current study. The main symptoms were fever (88.5%) and cough (65.4%). There was an average use of 4.31 antibiotics per patient. The primary etiological agent was Staphylococcus aureus (23.1%), but cultures were negative in 69% of the patients. Decortication and debridement of necrotic areas were performed in 23 patients (88.5%). The mean postoperative pleural drainage was 8.12 days. The presence of bronchopleural fistula occurred in 50.0% in the preoperative period and 46.2% in the postoperative. The total length of hospital stay was, on average, 27.52 days and the postoperative length of stay was 12.60 days (mean). Postoperative complications occurred in 13 children and there was no mortality. CONCLUSION: The surgical approach is indicated to patients with no response to clinical treatment. Late surgical intervention is associated with progressive parenchyma infection and higher rates of complications. Surgery can lead to better clinical outcomes and earlier recovery.

OBJETIVO: A pneumonia necrosante (PNS) é uma grave e rara complicação da pneumonia adquirida na comunidade, acometendo principalmente crianças, sendo assim, objetivamos analisar prontuários de crianças submetidas ao tratamento cirúrgico de PNS e comparação dos resultados obtidos com os presentes na literatura médica. MÉTODOS: Análise retrospectiva dos prontuários de crianças submetidas ao tratamento cirúrgico por PNS entre julho de 2006 a julho de 2016 em dois hospitais do sul de Santa Catarina, Brasil. RESULTADOS: Do total de 26 crianças, com mediana de idade 2,70 anos, maioria mulheres (61,5%). Os principais sintomas foram febre (88,5%) e tosse (65,4%). Houve média de 4,31 antibióticos utilizados por paciente. O principal agente etiológico foi o Staphylococcus aureus (23,1%) mas as culturas foram negativas em 69% dos pacientes. Em 23 pacientes realizou-se decorticação e desbridamento das áreas necróticas (88,5%). A média de drenagem pleural pós-operatória foi 8,12 dias. Fístula broncopleural ocorreu em 50,0% no pré-operatório e 46,2% após a cirurgia. O tempo total de internação hospitalar foi, em média, de 27,52 dias e tempo pós-operatório com média de 12,60 dias. Complicações pós-operatórias ocorreram em 13 crianças e não houve mortalidade. CONCLUSÕES: Propõe-se abordagem cirúrgica nos pacientes sem resposta ao tratamento clínico, pois o atraso na intervenção cirúrgica associa-se a infecção progressiva no parênquima pulmonar e taxas maiores de complicações. A cirurgia pode conduzir a melhor evolução clínica e recuperação mais precoce.

Tratamento cirúrgico de pneumonia necrosante em crianças em um período de 10 anos / Surgical treatment of necrotizing pneumonia in children: a 10-year assessment

RESUMO Objetivo: A pneumonia necrosante (PNS) é uma grave e rara complicação da pneumonia adquirida na comunidade, acometendo principalmente crianças, sendo assim, objetivamos analisar prontuários de crianças submetidas ao tratamento cirúrgico de PNS e comparação dos resultados obtidos com os presentes na literatura médica. Métodos: Análise retrospectiva dos prontuários de crianças submetidas ao tratamento cirúrgico por PNS entre julho de 2006 a julho de 2016 em dois hospitais do sul de Santa Catarina, Brasil. Resultados: Do total de 26 crianças, com mediana de idade 2,70 anos, maioria mulheres (61,5%). Os principais sintomas foram febre (88,5%) e tosse (65,4%). Houve média de 4,31 antibióticos utilizados por paciente. O principal agente etiológico foi o Staphylococcus aureus (23,1%) mas as culturas foram negativas em 69% dos pacientes. Em 23 pacientes realizou-se decorticação e desbridamento das áreas necróticas (88,5%). A média de drenagem pleural pós-operatória foi 8,12 dias. Fístula broncopleural ocorreu em 50,0% no pré-operatório e 46,2% após a cirurgia. O tempo total de internação hospitalar foi, em média, de 27,52 dias e tempo pós-operatório com média de 12,60 dias. Complicações pós-operatórias ocorreram em 13 crianças e não houve mortalidade. Conclusões: Propõe-se abordagem cirúrgica nos pacientes sem resposta ao tratamento clínico, pois o atraso na intervenção cirúrgica associa-se a infecção progressiva no parênquima pulmonar e taxas maiores de complicações. A cirurgia pode conduzir a melhor evolução clínica e recuperação mais precoce.

ABSTRACT Objective: Necrotizing pneumonia (PNZ) is a severe and rare complication of a community-acquired pneumonia, affecting mainly children. We aimed to analyze medical records of children undergoing surgical treatment for PNZ and compare our results with those found in the medical literature. Methods: Retrospective analysis of children's medical charts who underwent an operation for PNZ, between July 2006 and July 2016, in two hospitals in southern Santa Catarina, Brazil. Results: A total of 26 children with a median age of 2.70 years and mostly females (61.5%) were included in the current study. The main symptoms were fever (88.5%) and cough (65.4%). There was an average use of 4.31 antibiotics per patient. The primary etiological agent was Staphylococcus aureus (23.1%), but cultures were negative in 69% of the patients. Decortication and debridement of necrotic areas were performed in 23 patients (88.5%). The mean postoperative pleural drainage was 8.12 days. The presence of bronchopleural fistula occurred in 50.0% in the preoperative period and 46.2% in the postoperative. The total length of hospital stay was, on average, 27.52 days and the postoperative length of stay was 12.60 days (mean). Postoperative complications occurred in 13 children and there was no mortality. Conclusion: The surgical approach is indicated to patients with no response to clinical treatment. Late surgical intervention is associated with progressive parenchyma infection and higher rates of complications. Surgery can lead to better clinical outcomes and earlier recovery.

Neumonía necrosante causada por el serotipo 3 del Streptococcus pneumoniae a pesar de la inmunización con la VCN13 / Necrotizing pneumonia caused by Streptococcus pneumoniae serotype 3 despite PCV13

El Streptococcus pneumoniae es la causa más frecuente de una neumonía complicada. La neumonía neumocócica necrosante (NNN) constituye una complicación rara y relacionada con el serotipo. Los serotipos 1, 3, 14, 15, 19A y 33 fueron los más frecuentemente informados en los niños con NNN antes de la inmunización. A pesar de la práctica extendida de la vacunación, el S. pneumoniae sigue siendo la causa de las enfermedades invasivas. Aquí se informa el caso de un niño que había recibido el esquema completo con la vacuna neumocócica conjugada de 13 serotipos (VCN13) diagnosticado con NNN del serotipo 3. La progresión de la enfermedad invasiva por S. pneumoniae debe considerarse a pesar de la inmunización completa.

Streptococcus pneumoniae is the most common cause of complicated pneumonia. Pneumococcal necrotizing pneumonia (PNP) is a rare and serotype related complication. Serotypes 1, 3, 14, 15, 19A and 33 were the most reported serotypes in children with PNP before immunization. Despite widespread vaccination, S. pneumoniae is still cause of invasive diseases. We reported a child, fully immunized with 13-valent conjugated pneumococcal vaccine (PCV13) who was diagnosed PNP due to serotype 3. Breakthrough invasive infection caused by S. pneumoniae must be considered in mind despite fully vaccination.

Necrotizing pneumonia caused by Streptococcus pneumoniae serotype 3 despite PCV13. / Neumonía necrosante causada por el serotipo 3 delStreptococcus pneumoniae a pesar de la inmunización con la VCN13.

Streptococcus pneumoniae is the most common cause of complicated pneumonia. Pneumococcal necrotizing pneumonia (PNP) is a rare and serotype related complication. Serotypes 1, 3, 14, 15, 19A and 33 were the most reported serotypes in children with PNP before immunization. Despite widespread vaccination, S. pneumoniae is still cause of invasive diseases. We reported a child, fully immunized with 13-valent conjugated pneumococcal vaccine (PCV13) who was diagnosed PNP due to serotype 3. Breakthrough invasive infection caused by S. pneumoniae must be considered in mind despite fully vaccination.

El Streptococcus pneumoniae es la causa más frecuente de una neumonía complicada. La neumonía neumocócica necrosante (NNN) constituye una complicación rara y relacionada con el serotipo. Los serotipos 1, 3, 14, 15, 19A y 33 fueron los más frecuentemente informados en los niños con NNN antes de la inmunización. A pesar de la práctica extendida de la vacunación, el S. pneumoniae sigue siendo la causa de las enfermedades invasivas. Aquí se informa el caso de un niño que había recibido el esquema completo con la vacuna neumocócica conjugada de 13 serotipos (VCN13) diagnosticado con NNN del serotipo 3. La progresión de la enfermedad invasiva por S. pneumoniae debe considerarse a pesar de la inmunización completa.

Toxoplasmose sistêmica em filhotes de gatos / Systemic toxoplasmosis in kittens

Background: Toxoplasmosis is a worldwide disease that affects virtually all species of warm-blooded animals. The felids,domestic and wild, are considered the definitive hosts of the protozoan. In Brazil, Toxoplasma gondii infection has beendiagnosed in horses, goats, primates, dogs and cats. In the backlands of Paraíba, the disease has been sporadically reportedaffecting dogs with canine distemper and swine, but cases of systemic toxoplasmosis in cats have not yet been described.The aim of the present study was to describe the main epidemiological, clinical and anatomopathological aspects of twocases of systemic toxoplasmosis in kittens.Cases: Two kittens were affected with three (cat 1) and six (cat 2) months old, females, and crossbreed. The kittens had notbeen vaccinated or dewormed, and were raised with other cats in a peridomiciliary regime in a rural area in the backlandsof Paraíba. Cat 1 was thin, apathetic, dehydrated, tachypneic and with pale mucous membranes. Cat 2, showed inappetence,apathy, jaundice, fever, dehydration, dyspnea and abdominal breathing pattern. At necropsy, non-collapsed, shiny, reddishlungs with multifocal whitish areas, punctuated or nodular, measuring from 0.1 to 0.3 cm in diameter, were found on thepleural surface and parenchyma. The livers were pale, with lobular pattern accentuation, and reddish depressed multifocalareas randomly distributed on the capsular surface. Histologically, multifocal to coalescent areas of necrosis, moderate (cat1) or marked (cat 2), associated with intralesional bradyzoites and tachyzoites and variable lymphoplasmacytic infiltratewere observed. In cat 2, numerous bradyzoites were visualized in the gray matter of the left cerebral hemisphere (temporaland parietal lobes), sometimes associated with a moderate lymphoplasmacytic inflammatory infiltrate. In the perivascularspaces of the...(AU)

Toxoplasmose sistêmica em filhotes de gatos / Systemic toxoplasmosis in kittens

Background: Toxoplasmosis is a worldwide disease that affects virtually all species of warm-blooded animals. The felids,domestic and wild, are considered the definitive hosts of the protozoan. In Brazil, Toxoplasma gondii infection has beendiagnosed in horses, goats, primates, dogs and cats. In the backlands of Paraíba, the disease has been sporadically reportedaffecting dogs with canine distemper and swine, but cases of systemic toxoplasmosis in cats have not yet been described.The aim of the present study was to describe the main epidemiological, clinical and anatomopathological aspects of twocases of systemic toxoplasmosis in kittens.Cases: Two kittens were affected with three (cat 1) and six (cat 2) months old, females, and crossbreed. The kittens had notbeen vaccinated or dewormed, and were raised with other cats in a peridomiciliary regime in a rural area in the backlandsof Paraíba. Cat 1 was thin, apathetic, dehydrated, tachypneic and with pale mucous membranes. Cat 2, showed inappetence,apathy, jaundice, fever, dehydration, dyspnea and abdominal breathing pattern. At necropsy, non-collapsed, shiny, reddishlungs with multifocal whitish areas, punctuated or nodular, measuring from 0.1 to 0.3 cm in diameter, were found on thepleural surface and parenchyma. The livers were pale, with lobular pattern accentuation, and reddish depressed multifocalareas randomly distributed on the capsular surface. Histologically, multifocal to coalescent areas of necrosis, moderate (cat1) or marked (cat 2), associated with intralesional bradyzoites and tachyzoites and variable lymphoplasmacytic infiltratewere observed. In cat 2, numerous bradyzoites were visualized in the gray matter of the left cerebral hemisphere (temporaland parietal lobes), sometimes associated with a moderate lymphoplasmacytic inflammatory infiltrate. In the perivascularspaces of the...

Neumonía necrotizante en paciente pediátrico / Necrotizing pneumonia in a pediatric patient

La neumonía es la causa de muerte de aproximadamente 4 millones de niños al año en todo el mundo, la gran mayoría en países en desarrollo. En el primer año de vida, la incidencia es de 15-20 casos/1.000 niños/año. De 1 a 5 años asciende a 30-40 casos y, de nuevo, desciende en los mayores de 5 años a 10-20 casos/1.000 niños/año. Es una infección aguda del tracto respiratorio inferior adquirida en la comunidad con una duración inferior o igual a 14 días, que produce tos y/o dificultad respiratoria y con evidencia radiológica de infiltrado pulmonar agudo. El Streptococcus pneumoniae es el principal agente bacteriano. Se presenta el caso de un preescolar masculino de 2 años de edad. Inicia su enfermedad actual con rinorrea hialina anterior, hipertermia no cuantificada, tos seca. Es evaluado por facultativo y realizan paraclínicos que reportan leucocitosis, neutrofília y trombocitosis reactiva, diagnostican infección respiratoria baja e indican tratamiento antimicrobiano vía oral, el cual cumple sin evidenciar mejoría. Posteriormente se asocia dificultad respiratoria, consulta a centro de salud donde ingresan e indican tratamiento médico durante 48 horas sin mejoría clínica, refieren al Hospital Universitario de Caracas en regulares condiciones generales. En TAC de tórax se evidencian imágenes sugestivas de neumonía necrotizante bilateral, se indica doble antibioticoterapia durante 11 días para dar cobertura a Streptococcus pneumoniae resistente y/o Staphylococcus Aureus meticilino resistente adquirido en la comunidad, productor de leucocidina Panton - Valentine. Con evolución clínica satisfactoria egresa, con antibioticoterapia vía oral por 21 días y control por Neumopediatría(AU)

Pneumonia is the cause of death of approximately 4 million children a year around the world, the vast majority in developing countries. In the first year of life, the incidence is 15-20 cases/1,000 children/year. From 1 to 5 years it reaches 30-40 cases and, again, it goes down in those older than 5 years to 10-20 cases/1,000 children/year. It is an acute infection of the lower respiratory tract acquired in the community with a duration of less than or equal to 14 days, which causes cough and / or respiratory distress and with radiological evidence of acute pulmonary infiltrate. Streptococcus pneumoniae is the main bacterial agent. The case of a 2-year-old male preschooler is presented. He begins his current illness with anterior hyaline rhinorrhea, hyperthermia not quantified, dry cough. It is evaluated by a physician and performs paraclinics that report leukocytosis, neutrophilia and reactive thrombocytosis, diagnose a lower respiratory infection and indicate antimicrobial treatment by oral route, which does not show improvement. Afterwards, respiratory distress is associated, consultation with the health center where they enter and indicate medical treatment during 48 hours without clinical improvement, refer to the University Hospital of Caracas in regular general conditions. Chest CT shows suggestive images of bilateral necrotizing pneumonia, double antibiotic therapy is indicated for 11 days to cover resistant Streptococcus pneumoniae and / or community-acquired methicillin-resistant Staphylococcus Aureus, producer of Panton - Valentine leukocidin. With satisfactory clinical evolution, he withdrew, with oral antibiotic therapy for 21 days and control by Pneumopediatrics(AU)

Chronic cavitary pneumonia by Rhodococcus equi in a highly prevalent tuberculosis country: a diagnosis challenge.

Rhodococcus equi is a facultative aerobic, intracellular, non-motile, non-spore-forming, Gram-positive, weakly acid-fast coccobacillus belonging to the group of nocardioform actinomycetes. R. equi infections are rare opportunistic illnesses in patients with Acquired Immunodeficiency Syndrome (AIDS), associated with a high mortality rate. The most common clinical presentation of R. equi infections is a chronic cavitary pneumonia. Due to its acid-fastness, R. equi can be mistaken for others acid-fast organisms, as Mycobacterium tuberculosis. In turn, R. equi is also a gram-positive pleomorphic bacteria and can be mistaken for diphtheroids or Micrococcus organisms, being accidentally disregarded as oral contaminants in sputum cultures. Therefore, in Brazil, a highly prevalent tuberculosis (TB) country, pulmonary infections caused by R. equi may mimic pulmonary TB and represent a diagnostic challenge. Here, we report on a case of chronic cavitary pneumonia by R. equi in a Human Immunodeficiency Virus (HIV)-infected patient, focusing on diagnostic aspects.

Lung necrosectomy in pediatric patients with necrotizing pneumonia.

INTRODUCTION: Necrotizing pneumonia is the consolidation of lung parenchyma with destruction and necrosis, forming solitary or multiloculated radiolucent foci. When antibiotic treatment fails and clinical course does not improve, patients might need lung tissue resection: segmentectomy, lobectomy or bilobectomy. We have performed a more conservative surgical approach in pediatric patients with necrotizing pneumonia, lung necrosectomy: resection of unviable necrotic tissue, to preserve more healthy and potentially recoverable lung parenchyma. The objective of this study is to present the results of our experience with lung necrosectomy. METHODS: Retrospective review of clinical charts of children with necrotizing pneumonia. The diagnosis was based on physical examination, laboratory data and contrast CT scan. Lung necrosectomy technique includes resection of necrotic tissue with careful debridement technique; air leaks were sutured and/or tissue imbrication. RESULTS: Twenty-four children were surgically treated for necrotizing pneumonia (18 girls and 6 boys). The mean age was 31.5 ± 13.5 months. All the patients presented productive cough, fever and dyspnea; chest X-rays showed consolidated areas with intraparenchymal cavities and hypoperfusion on the contrasted CT. Surgical treatment included: Lung necrosectomy 17 (70%); lobectomy 3 (12.5%); wedge resection 2 (8.3%); lobectomy + lung necrosectomy 1 (4.1%), and wedge resection + lung necrosectomy 1 (4.1%). The postoperative course was uneventful in 23 patients; mean postoperative hospital stay was 6.3. One patient died because of sepsis. CONCLUSIONS: Lung necrosectomy is a conservative, effective surgical treatment, which solves lung necrotizing infection avoiding resection of healthy lung parenchyma.

Group B streptococcal necrotizing pneumonia in a diabetic adult patient / Neumonía necrosante por estreptococo del grupo B en un paciente adulto diabético

The aim of this report is to describe a rare case of necrotizing pneumonia due to group B Streptococcus serotype III in a relatively young male adult (48 years old) suffering from diabetes. The organism was isolated from his pleural fluid and was only resistant to tetracycline. The patient first received ceftazidime (2 g/8 h i.v.) + clindamycin (300 mg/8 h) for 18 days and then he was discharged home and orally treated with amoxicillin clavulanic acid (1 g/12 h) for 23 days with an uneventful evolution. As in the cases of invasive infection by Streptococcus pyogenes, clindamycin could prevent streptococcal toxic shock syndrome.

El objetivo de esta presentación es describir un caso raro de neumonía necrosante debida a estreptococo del grupo B serotipo III en un diabético adulto de sexo masculino relativamente joven (48 años). El microorganismo fue aislado de líquido pleural y resultó ser resistente solo a tetraciclina. El paciente recibió ceftacidima (2 g/8 h iv) + clindamicina (300 mg/8 h) durante 18 días y luego fue dado de alta, bajo tratamiento oral con amoxicilina-ácido clavulánico (1 g/12 h). Este tratamiento se mantuvo durante 23 días, con buena evolución. Como en casos de infecciones invasivas por Streptococcus pyogenes, es posible que la clindamicina haya evitado la aparición del síndrome de shock tóxico estreptocócico.

Group B streptococcal necrotizing pneumonia in a diabetic adult patient.

The aim of this report is to describe a rare case of necrotizing pneumonia due to group B Streptococcus serotype III in a relatively young male adult (48 years old) suffering from diabetes. The organism was isolated from his pleural fluid and was only resistant to tetracycline. The patient first received ceftazidime (2g/8h i.v.)+clindamycin (300mg/8h) for 18 days and then he was discharged home and orally treated with amoxicillin clavulanic acid (1g/12h) for 23 days with an uneventful evolution. As in the cases of invasive infection by Streptococcus pyogenes, clindamycin could prevent streptococcal toxic shock syndrome.

Pediatric Necrotizing Pneumonia: A Case Report and Review of the Literature.

Necrotizing pneumonias occur infrequently in children but may be associated with significant morbidity. If not adequately treated, necrotizing pneumonia may lead to complications including bronchopleural fistula, empyema, respiratory failure, and septic shock. Staphylococcus aureus is the most commonly implicated agent, followed by Streptococcus pneumoniae. Antimicrobial treatment is the cornerstone of management, although surgical drainage may be required in some cases. We present the case of a 14-month-old child with fever and cough that persisted despite treatment with typical first-line oral antimicrobial therapy. An initial plain radiograph of the chest demonstrated lobar pneumonia. Ultimately, computed tomography of the chest revealed a cavitary lesion in the left upper lobe of the lung. We review the literature and describe the clinical presentation, diagnosis, microbiological etiology, and management of necrotizing pneumonia in children.

Neumonía adquirida en la comunidad por Staphylococcus aureus resistente a meticilina / Community-Acquired Pneumonia Due to Methicillin-Resistant Staphylococcus aureus

Los casos de infecciones causadas por Staphylococcus aureus resistente a meticilina han aumentado durante la última década. Dentro de ellas, la neumonía necrotizante (NN) adquirida en la comunidad se ha encontrado en pacientes jóvenes, sanos y sin factores de riesgo, lo que ha generado cuadros de evolución rápida y potencialmente mortales. En este artículo se discuten factores epidemiológicos, fisiopatológicos, de diagnóstico, tratamiento y pronóstico de la NN por Staphylococcus aureus resistente a meticilina adquirida en la comunidad.

The cases oí iníections caused by methicillirvresistant Stapkylococcus aureus have íncreased over the last decade, within them necrotizmg community'acquired pneumonía has been íound in healthy, young and with no risk factors patients, developing dínícal symptoms rapidly evolving and threatening. This artide discussed epidemiológica!, pathophysiological, diagnostic, treatment, and prognosis oí necrotizing pneumonía by Staphyiococcus aureus methicillin resistant communitV' acquired.